Objective 3 Cultural and spiritual considerations
Some ethical considerations must be addressed when dealing with the end-stage renal disease. The patient and family should be questioned regarding their beliefs using various questionnaires to get an understanding of what interventions are acceptable at this time. Some concerns to address are, but not limited to, “patient’s physical comforts, spiritual, and psychological well-being, and controls over goals of care,” as stated by Davidson, Murtagh, and Higginson (2008, p. 270). When finding about the perspectives of the patient and family, barriers of communication are less.
Once it has determined who is included in the support structure of the patient then it would be appropriate burden the illness has on the family. A myriad of different emotions may be expressed by the patient or family. Depression about impending mortality of the patient may elicit various forms of grief before and after death. Bereavement services may be necessary to aid in this transition Davidson et al. (2008, pp. 270-271).
Cultural considerations include, “societal, ethnic, and religious differences in end-of-life care preferences have been noted since the 1990s. For example, there is a consistent tendency toward a preference for more aggressive end-of-life interventions among African Americans,” as stated by Davidson et al. (2008, p273). Some patients choose not to lengthen their life, so it is important to consider this when dialysis becomes necessary. It is important to respect the autonomy of the patient and how they are basing their decisions Davidson et al. (2008, P.273).
There are some “cultures that do not value self-determination” mentioned by Davidson et al. (2008, p. 273), and may have a difficulty time grasping the fact of their mortality. CKD has a high pervasiveness in minority groups. Some topics to these groups about end-of-life may be unsettling to talk about openly. The perceptions of the patient’s and family’s ideas of end-of-life decisions about CKD will need to be included in the plan of care and consulted when a major intervention is pending. Jehovah’s Witnesses for example do not accept blood products for transfusions (Jehovah’s Witnesses, 2007). Some patients with anemia related to impaired production of erythropoietin which is a hormone released from the kidney that stimulates bone marrow production. (National Kidney) Epogen, Iron, and Vitamin B12 (Anemia, 2012), would be the treatment of choice treat anemia for Jehovah’s Witnesses with CKD and anemia. It is important to remember hemodialysis is acceptable, “no blood prime is used and there is no blood storage” (Jehovah’s Witnesses, 2007).
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