Related Experiment Video
Updated: Oct 18, 2025
07:13
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
4.6K
Exploring the Barriers Faced by Nephrology Nurses in Initiating Patients With Chronic Kidney Disease Into Advance
1PhD, RN, Assistant Professor, Department of Nursing, Tajen University, Pingtung, Taiwan, ROC.
The Journal of Nursing Research : JNR
|October 5, 2021
Summary
Nephrology nurses in Taiwan face significant barriers discussing advance care planning (ACP) with chronic kidney disease patients, including confidence and communication challenges. Addressing these barriers requires enhanced training and clear clinical guidelines to improve end-of-life care discussions.
Area of Science:
- Medical Sociology
- Nursing Research
- Bioethics
Background:
- Taiwan has the world's highest prevalence of end-stage renal disease.
- Advance directive signing rates in Taiwan are lower than in Western countries.
- Barriers to advance care planning (ACP) initiation are a significant concern.
Purpose of the Study:
- To explore the barriers nephrology nurses encounter when discussing ACP with patients with chronic kidney disease.
- To identify specific challenges faced by nurses in initiating advance care planning conversations.
Main Methods:
- A descriptive qualitative study design was employed.
- Data were collected from 34 nephrology nurses across northern, central, and southern Taiwan via eight focus groups.
- Qualitative content analysis was used to analyze the focus group transcripts.
Main Results:
- Five key themes emerged: nurses' lack of confidence, difficulty finding appropriate discussion opportunities, perceived personal inadequacy, interprofessional conflicts with doctors, and cultural/belief-based barriers.
- Nurses reported challenges in initiating ACP discussions due to systemic and personal factors.
- Cultural beliefs and differing perspectives within the healthcare team were significant obstacles.
Conclusions:
- Nurses require enhanced ACP knowledge, communication skills, and confidence to initiate discussions.
- Empowerment of nurses and development of clinical guidelines for initiating ACP are crucial.
- Improved collaboration and shared decision-making can facilitate advance directive completion and enhance end-of-life care quality.
Related Concept Videos
01:18Chronic Kidney Disease IV: Nursing Management
88
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
88
01:28Chronic Kidney Disease III: Interprofessional Care
129
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
129
01:16Kidney Transplant III: Nursing Management
103
Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
103
01:22Acute Kidney Injury VI: Nursing Management
115
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
115
01:21Planning Nursing Care I
5.1K
The planning phase of the nursing process helps nurses set priorities, outline patient-centered goals and expected outcomes, and tailor nursing interventions to align with the aligned care plan. Through the planning phase, the nurse applies critical thinking skills to align and develop interventions according to the patient's needs. It provides continuity of care allowing patients to receive the maximum benefit from treatment. It serves as a pilot plan for allocating individual staff to a...
5.1K
01:25Chronic Kidney Disease I: Introduction
185
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
185