Koester Lisa
Washington University School of Medicine, Renal Division, St. Louis, MO, USA.
Nephrol Nurs J. 2013 Jan-Feb;40(1):43-8; quiz 49.
The number of patients requiring renal replacement therapy continues to grow. When patients are told they need a life-sustaining treatment, it is a profound experience that impacts all aspects of their lives and the lives of their families. In the United States, the stark reality is the majority of patients are treated with in-center hemodialysis, and only a very small percentage with a home dialysis therapy, such as peritoneal dialysis or home hemodialysis. Why is this? Do patients not factor in preference, independence, or quality and maintenance of a normal life? Or is it that as a renal community, nephrology nurses do not expose patients to the knowledge they need and promote involvement in this decision-making? Is patient autonomy being fostered? This article explores the reasons for the tiny percentage of patients on home dialysis and suggests strategies to address the education needed, the dynamics of why patients decide on a therapy, patient selection characteristics, and myths of who is and is not a candidate.
需要肾脏替代治疗的患者数量持续增长。当患者被告知他们需要维持生命的治疗时，这是一种深刻的经历，会影响他们生活的方方面面以及其家人的生活。在美国，严峻的现实是大多数患者接受中心血液透析治疗，只有极少数患者采用家庭透析疗法，如腹膜透析或家庭血液透析。原因何在？是患者没有考虑偏好、独立性或正常生活的质量与维持吗？还是作为肾脏领域，肾病护理人员没有向患者传授他们所需的知识，也没有促进患者参与这一决策过程？患者的自主权是否得到了培养？本文探讨了接受家庭透析的患者比例极小的原因，并提出了应对所需教育、患者选择某种治疗方法的原因动态、患者选择特征以及关于谁适合或不适合成为家庭透析患者的误区等问题的策略。
