PALLIATIVE CARE NEEDS OF PATIENTS ON MAINTENANCE HEMODIALYSIS AT THIKA LEVEL 5 HOSPITAL, KIAMBU COUNTY, KENYA
Abstract
Globally, a huge gap exists between the required and the available renal palliative care services. The gap is particularly worse in low-and-medium income countries despite having the highest percentage of patients requiring palliative care. Maintenance hemodialysis patients contribute a sizable percentage of the global renal patient population in need of palliative care. Successful provision of adequate palliative care services requires a holistic understanding of the patients’ needs. The purpose of this study was to explore the palliative care needs of patients on maintenance hemodialysis at Thika Level 5 Hospital. A qualitative descriptive design was used to explore the palliative care needs of the patients at the institution. Purposive sampling was used to recruit participants. Data collection was conducted for a period of one month at the hospital’s renal unit. A total of twelve maintenance hemodialysis patients participated in the study. Audiotaped semi-structured interviews were used to conduct data collection. Thematic analysis was used to analyze the data. The study findings showed that maintenance hemodialysis patients have many palliative care needs. The needs regard to physical, psychological and social aspects. Distressing physical symptoms were identified as the primary physical needs where fatigue, skin changes and fluctuations in appetite were reported as the most prominent symptoms. Difficult thoughts related to uncertainty about the future, caregiver burden, inability to get more children, stress and worry as well negative self-image were reported as the psychological needs experienced by the patients. Interruption of social roles, abandonment by friends and financial burden on the family were revealed as the social needs of the patients. To deal with their illness and treatment related challenges, the patients primarily utilized spiritual coping where prayers were reported to be the most utilized coping method. Lack of knowledge on palliative care and fear of being judged were identified as patient related barriers to meeting palliative care needs of the patients. Understanding the palliative care needs of maintenance hemodialysis patients has important implications on practice and policy making. Findings could be used in developing renal palliative care services provision policies and protocols to use as a guide in the identification and provision of palliative care to maintenance hemodialysis patients. Also, nephrology nurses and other renal care team healthcare professionals could use the findings to develop strategies of addressing patient related barriers to meeting palliative care needs. For research, studies could be done to evaluate the influence and perspective of healthcare providers in the provision of palliative care to maintenance hemodialysis.
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