Challenging behaviour in haemodialysis

Subject: Health Care
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Introduction

The burden of haemodialysis and chronic diseases on nursing, health-care services, and the multi-disciplinary team is a worldwide issue that is increasingly developing and need to be addressed as soon as possible. Challenging behavior is the conducts of an individual which offend and affects other people’s emotions. Some patients develop behaviors that affect their treatment process. There are many cases of Challenging behaviors in haemodialysis in various healthcare facilities. In most cases, some patients skip dialysis session, fail to turn up for clinic appointments, they are aggressive, fuzzy and also rude to the staff. Therefore, dealing with these kinds of patients is proving to be difficult for nurses. It is not clear what activates these behaviors, but some studies indicate that the challenging behaviors are caused by stress and fatigue of the dialysis session routines.

There are several nursing works of literature of non-compliance patients. Some studies argue that nurses’ interventions can address these challenging behaviors while others critique this approach (Winterbottom et al., 2007). How nurses handle difficult patients is a growing concern in the global world. It is the responsibility of nurses to understand that there are occasions when patients’ behavior may be difficult, inappropriate and emotive due to stress and health issues affecting them. Nurses are in the business of healing and caring, and they need to maintain an attentive and non-judgmental character for each patient.

Aims and objectives

The objective of this essay is to build and develop a critical nursing study to give a solution to nurses on how to deal with challenging behavior in haemodialysis.  Specific articles and works of literature are retrieved to support and demonstrate the concepts the essay is discussing. The paper will also discuss the role of nurses as health educators and health promotion agents. Finally, the essay will critically analyze nurses’ responsibility in ensuring patient’s best interests are protected and treatment is patient-centered.

Critical analysis and discussion

Nurses do not always have to like all their patients. Even though this statement sounds harsh, the caveat to it is that some patients have challenging behavior for the nurses to like them. However, according to healthcare and profession ethics, nurses have to deliver the best patient care possible, while maintaining professionalism and an appropriate level of compassion. Haemodialysis is a tedious process for both nurses and patients, but this is not enough reason for patients to be rude, skip sessions or fail CAPD. In the healthcare system, nurses play a fundamental role and that’s why some scholars refer them as the heart of hospitals (Brookhart 2010).

According to Kutner et al., (2002) research, one-third of patients in haemodialysis were non-compliant, and it affected their care and outcome. For several decades, nurses and dialysis units have had to deal with the rising number of aggressive and rude patients. This group of patients presents a range of behavior during the dialysis sessions, which harm their treatment processes and the nursing staff. According to Kutner et al., (2002) threat and physical abuse jeopardize the safety and health of both staff and the patient. Therefore, nurses and disciplinary health team should apply ethical principles to help manage and give the best care to the patients with challenging behavior in haemodialysis (Kammerer et al. 2007).

Nursing demands commitment and dedication as each patient’s behavior is different. Adequate care and compassionate entails objectivity (Hudson et al. 2016). Separating experience from emotions and restructuring is the first step in dealing with challenging behaviors in haemodialysis. Van Dulmen et al, (2007) argues that nurses should reform their perception of aggressive and rude patients and try to understand the challenges the individual is facing that are contributing to such challenging behaviors. Even though it’s hard to tolerate a patient who skips dialysis sessions, fails CAPD and is rude to staff; nurses cannot neglect them and stop taking care of them. According to van Dulmen et al., (2007), these kinds of patients require more care and psychological support to cure their emotional side because haemodialysis process drains away their strength.

According to Jablonski (2007), patients receiving dialysis always experience fatigue. Jablonski study showed that fatigue prevalence range between 60 percent and 97 percent. Therefore, the role of dialysis staff and the nurse is to encourage the patients on the importance of every session and clinical appointment. The role of a nurse it to ensure the patients gets the right care (Christensen & Smith 1995). Dialysis staff need to prepare well emotionally and avoid taking the patients’ challenging behaviors personally. As a healthcare promoting agent, nurses should keep in mind that some patients are dealing with circumstances which are unfortunate, and they are sometimes not to the best of their moods. Patients in haemodialysis are uncomfortable with their situation and nurses should not take it personal when they are aggressive or rude to them.

According to Needleman et al (2002), quality care is respecting, protecting the safety of a patient, giving the patient a choice, compassion and creating a safe environment. Dialysis staff and nurses and are expected to show empathy at a high level. It is the responsibility of caregivers to follow up on their patients and address any problem that may interfere with their treatment process and guide them to have a positive self-image and be confident (Chan 2012). However, in a healthcare setting, there are some professional boundaries that nurses should follow.

Patients acting aggressive or abusive may just be resistant, defensive or simply anxious about the situation around them (Davenport, 2009). Therefore, it is important for the dialysis nurse to take a step back and draw out the feelings of the patient and try to deliberate with them some of the possible solutions. Masters (2015) argues that poor communication skills and absence of physical function causes challenging behavior in haemodialysis. If a patient is not able to communicate his needs by conventional means, he will be aggressive and abusive to the staff. For that reason, nurses may apply communication strategies to help patients in haemodialysis to communicate their problems (Holloway & Wheeler 2013). If a nurse in any occasion notices that the patient is not taking his treatment process seriously, they should act and talk to the patient in a polite manner.

Rylance et al (2015), perspective of roles and responsivities of nurses is that they are the primary caregivers. The caregiver offers interventions to meet psychosocial, physical, environmental and spiritual needs of a patient using critical reasoning skills and nursing process. Nurses are empathetic and skilled in dealing with any behavior of a patient. Therefore, their active roles are health promotion, illness prevention, and maintenance. Patients with challenging behaviors also need people to educate them and promote their health (McCarley 2009). Thus, patients who are difficult to deal with should not be neglected but nurses should find a proper way to deal with such situations.

According to Maddux & Gosselin (2003), nurses are coordinators and leaders and thus their roles in a healthcare facility are unique. The behavior of a patient is controlled and monitored by the multidisciplinary team to improve the treatment outcome. Haemodialysis is a process that needs strict follow-up because some patients are difficult to manage. The vital part of a caregiver is to carry out a psychosocial and physical assessment, educate, support and center on care coordination. Nurses’ role is to assist patients and coordinate their diagnostic tests and direct them to the right health professionals. According to Maddux and Gosselin (2003), for a patient with challenging behavior in haemodialysis, a coordinator is an essential resource because the nurse can monitor them in case they miss an appointment or skip a dialysis session. Nurses as coordinators are accountable for maintaining patient’s clinical competence

Kutner et al. (2002) argue that dialysis patients can display different kinds of behaviors such as missing an appointment, aggressiveness and being abusive which may interrupt operations flow in a haemodialysis. A nurse should remember some patients feel that the attention given to them is not enough and their concerns are not being addressed adequately. According to Maddux and Gosselin (2003), it is not an individual’s choice to be sick but nurses choose this profession hence they should perform in accordance with healthcare ethics.

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According to Suhonen et al., (2008), the role of a caregiver in a haemodialysis demands more than only giving safe care, but also providing support, reassurance and information to the patient. This is a commitment that also nurses should stand by irrespective of patient’s impulsive behaviors. Suhonen et al., (2008) says that, nurses should pay attention to aggressive patients and if need be inform their risk manager and nursing supervisors about the challenging characters. Sometimes, when a patient makes it hard for nurses to work comfortably, it is logical for the nurse to take a step and change the patient. Therefore, let another nurse take care of that patient (Walton & Molzahan 2002).

Critical reflection

            Judgmental is not a character that nurses should possess even though some patients are difficult to like. But they have legal and ethical obligation to provide and rise beyond their emotions and give the best care which may prove to be difficult when managing a patient with challenging behave specially in haemodialysis. Nurses need stress-free and safe solutions to cope with unruly behaviors of patients (Moorhead 2013. The best methodical approach to be followed by nurses is not to be offended. This is a conscious decision will eliminate the barriers affecting the patient’s dialysis process.

Nurses should understand that some situations can be managed and not resolved. Unruly patients are sometimes a challenge and not a difficult situation and should be accepted the way they are. A caregiver should look for the underlying cause and not judge the patient. Dialysis is a process that requires support and motivation. Nurses need to look at why the patient is overly aggressive, critical and abuse (Jeffreys 2015). They have an obligation to address the situation in a professional way. To take care of unruly patients, nurses are supposed to learn on how to prioritize. It is important to view the needs of a patient objectively. Nurses should never abandon a patient because they feel pressured and not respected.

Stressful situations can be prevented when a nurse is more observant. It is important to be attentive to intensifying social situations that may soon cause patients distress. Paying attention, a caregiver may be able to diffuse an awkward situation. Nurses are supposed to stay calm.  It is easy for nurses to become irritated, annoyed and angry when dealing with an unruly patient but maintaining calmness is always a good solution to control aggressive patients (Hamric et al. 2013). It is easier to tolerate the behaviors of an unruly patient and be compassionate when the nurse understands the patient.

A nurse should never accept abuse.  There should always be a boundary between a nurse and abusive patients (Piko 2006). In case the abusive behavior is intolerable they should inform their immediate supervise. Additionally, nurses should recognize that patient care requires collaboration and understanding at every level. However, it is important for nurses to keep in mind that all patients regardless of their behaviors also deserve the best care (Piko 2006).

The role of a nurse is patient advocacy. The importance of this role is to boost and respect patient’s autonomy. Advocacy in nursing includes patient protection, safe self-determination and a nurse-patient relationship that is therapeutic (Zaccagnini & White 2015). A nurse as a patient advocate is responsible for representing and empowering the patient. Aggressive and disobedient patients that skip appointment and do not turn-up for dialysis need an advocate that can empower and represent their demands.  Nurses are supposed to act as if the interests of patients are their own.

A nurse is an educator. In healthcare settings, nurses are expected to provide all the information patients need about their illness. They teach patients about the rehabilitation and treatment needs (Bally 2007). This role can benefit nurses when dealing with patients who have irrational behaviors.  Patients in haemodialysis can take dialysis session seriously when educated about its importance. Aggressive behaviors are developed by patients when they do not understand how to embrace changes in their lives especially those necessitated by diseases. Therefore, the role of nurses is to help patients to deal with such situations.

A nurse is a collaborator. In the nursing profession, collaboration influences patient’s outcome. Nurses and multidisciplinary teams need collaboration practices to manage patients’ situations (Furlong & Smith 2005). To deal with unruly patients’ collaboration is essential. Nurses need to improve on their authority and assume accountability to achieve the collaboration role in practice areas. Various health professionals offer a different solution to solve challenging behaviors of patients, and nurses are supposed to appreciate their effort (Yoder-Wise 2014). Nurses and patients are expected to work together in a passionate and enthusiastically manner to achieve the best outcome. Through collaboration, patients will never skip an appointment or not turn-up for dialysis sessions because the nurse is always in following their conduct.

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A Nurse is a practitioner. This role entails management, assessment of patients using skills and knowledge of nursing. However, the role is grounded in the values, practices and theories of nursing profession (Furlong & Smith 2005). Expectations and standards of nursing are put in place to protect the needs of all patients. Nurses should practice accountability, competence, and ethics all the time they are dealing with patients. Competence and ethics help the nurses’ deal well with challenging behaviors of patients. These skills are very crucial in ensuring that the best care is given and the patient’s outcome is improved.

It is a moral obligation to the multidisciplinary team, and nurses to help the disruptive and challenging patient. The wellbeing and rights of a patient should be protected. Most dialysis patients require treatment to control their health (Massoudi et al. 2011). Thus, skipping dialysis sessions can jeopardize their lives. Therefore, dealing with challenging behavior in haemodialysis requires utmost empathy. If a patient does not turn up for an appointment, encourage him or her to plan well in the future to avoid such occurrences.  Also, let him or her understand that these kinds of behaviors are unacceptable and may affect the treatment outcome.

To deal with aggressive patients, nurses need to develop a communication strategy that helps them refrain from judgmental attitude.  A nurse should softly and remain neutral when dealing with aggressive patients (Massoudi et al. 2011). In this position, nurses should avoid being authoritative and may look for a way to save the situation. Also, it is important for the nurse to show patients that he or she understands the situation and his or her objective is to see them overcome the pain and get the best outcome from treatment. This knowledge is applied in an ethical manner so that the rights of the patient are protected (Bally 2007). Quality assurance is another important and typical responsivity of nurses which ensure that the caregivers recognize their healthcare accountabilities. When nurses are providing care to patients, they need to consider the four moral principles of ethical theory; beneficence, autonomy, non-maleficence and justice. Patients’ choices should be respected (Naylor & Kurtzman 2010). However, it is the responsibility of a nurse to reason with patients so that they make the right decisions based on their health status.  For patients in haemodialysis deciding to skip dialysis is a bad decision. Therefore, nurses should educate them and make them understand the consequences of their actions.

Health professional ethics require nurses to treat all patients equally and justly (Needleman & Hassmiller 2009). No patient should be discriminated or isolated because of their unruly behavior. Nursing professionalism is about understanding the feelings of a patient and helping them attain quality care and the best outcome (Needleman & Hassmiller 2009). Dialysis staff and nurses are supposed to be reflective practitioners who can analyze, understand, observe and implement quick, straightforward and long-term prevention strategy.

Explaining to the family the service routine and encouraging them always to ensure this routine is followed accordingly can control the challenging behaviors of a patient. Also, educating the family about the consequences both negative and positive that may result from the patient’s non-compliance to appointments, will make it a duty for the family to follow up on the patient. However, it is essential for nurses to understand the element of confidentiality (Stringer et al. 2008). Confidentiality is a requirement for every nurse to follow. Privacy and legislations concerns are professionalism ethics of nursing. Therefore, nurses are expected to keep patients’ information private within the realms of the patient.  A nurse is the most relevant staff in a patient’s life because he or she spends most of the time taking care patient’s needs (Stringer et al. 2008). All information about the patient is in the hands of a nurse. Therefore, they deserve respect and motivation to deal with stressful situations (Needleman et al., 2001). Nursing profession requires dedication and a lot of sacrifices to able to deal with challenging behaviors, especially in haemodialysis.

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Conclusion

In recent years, nurses have improved their roles to several practice spheres.  It seems that the progression is continuing to advance to accommodate all patients in different situations. Hospitals have achieved quality patient care through coordination between nurses and multidisciplinary team. Challenging behavior in haemodialysis has raised the standards of nurses in healthcare facilities. Because it has equipped them with tools needed to deal with patients with irrational behaviors. The role of a nurse is to ensure patients gets the best outcome and be well represented. In conclusion, the nurses’ responsibilities demand enthusiasm and sacrifice to deal with aggressive, fuzzy and abusive patients.

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