I have been placed into the community renal clinic at St. Joseph’s Health Centre, Toronto. The centre provides its services with a help of a renal management clinic, 15 hemodialysis stations and offers peritoneal dialysis care. St. Joseph’s is also a teaching hospital, which commits to foster a healthy community by working with it in a close partnership. Its underlying goal is to serve, engage and raise the awareness about the disease so that the health of patients, their families and communities as a whole can be enhanced (St. Joseph’s, 2011).
The community renal clinic makes a focus on a strategy, which can lead to an excellent patient and family care in nephrology. In order to meet the overwhelming demand for hemodialysis in Greater Toronto Area, the Ministry of Health and Long-term Care has approved the centre as an executor of a regional Dialysis Program (St. Joseph’s, 2011).
The community renal clinic of St. Joseph’s Health Centre serves those patients who are having kidney failure on an outpatient basis. The clinic offers a splendid team of nurses, pharmacists, social workers, nephrologists and dieticians who have a daily responsibility to visit those patients who are at the onset of chronic kidney failure (St. Joseph’s, 2011). The goal is to stabilize their disease and prevent the need for kidney replacement (dialysis or kidney transplantation) within the help of the proper in-time health treatment. The team achieves the goal while working with the patients and their families by consulting and helping to carry out the decisions.
The centre provides treatment to those patients who have Peritoneal Dialysis and offers consultations to the patients with chronic kidney disease and their families regarding managing the renal disease.
The renal therapy centre, which provides chronic kidney failure treatment on inpatient and outpatient basis, is currently executing the Provincial Peritoneal Dialysis Joint branches Initiatives of the Ministry of Health and Long-term care (St. Joseph’s, 2011). The objective of this project is to encourage nephrologists to educate their patients and families regarding the benefits of home peritoneal dialysis. One of the benefits of this method of dialysis treatment is that it offers convenient regular access to professional medical treatment at home and promotes more natural way of removing toxins from the bloodstream compared to in-centre hemodialysis programs (St. Joseph’s, 2011). The Provincial peritoneal Dialysis Joint Branches Initiatives also focus on ensuring the best practice of professional treatment provided by the hospitals, patient education and follow up care (St. Joseph’s, 2011).
Currently St. Joseph’s Renal Management Clinic serves over 450 patients living in the West End of Toronto. According to the polls, the total attendance of the clinic reached up to 3600 visits in 2012 (St. Joseph’s, 2011). Jacqui Cooper, the Patient Care Manager for Renal Therapy of St. Joseph’s says that they have found increase in the rate of those patients with kidney disease living in the areas where they provide services. Cooper claims that the centre “is designed to bring dialysis care to patients in the community, closer to home, and to de-institutionalize treatment” (St. Joseph’s, 2011).
The home peritoneal Dialysis clinic has moved from the hospital to the community renal clinic in 2004. In the past, in order to receive treatment patients had to be placed into the hospital for an overnight stay. This has now changed as patients can go through disease diagnostics at home. The Ministry of Health and Long-term Care has obliged health care institutions to increase the use of this form of dialysis to 30% of dialysed patients by 2010. Today St. Joseph’s is above the national average with 27% of total dialysed patients who carry out the treatment at home (St. Joseph’s, 2011).
St. Joseph’s Health Centre is working in partnership with St. Michael’s Hospital in Toronto. Therefore, it refers those patients who are suitable for kidney transplants to St. Michael’s. The future goals of renal therapy program include setting a partnership with Toronto Rehabilitation Institute in order to open six hemodialysis care stations (St. Joseph’s, 2011).
The majority of the patients of this renal clinic are adults who have a progressive kidney failure. Patients who come to the clinic have different disease backgrounds, which explain why their kidneys started deteriorating. The hypertension and diabetes are the two main causes.
However, I would like share my experience about one unique patient whose kidney function did not deteriorate due to hypertension or diabetes. The condition was called hypotonic bladder. When I was reviewing the history of medical treatment of this patient, the materials I studied regarding renal and urinary disease, became clear and understandable to me. Surprisingly, this patient was born with only one kidney and did not know about that until he reached his adulthood and started to suffer from hypotonic bladder that started damaging his kidney.
The challenge faced by the patients living with chronic kidney disease is managing diabetes. From what I concluded looking precisely into each patient history, most of the people have their kidney function declining more and more after each visit. Nevertheless, hypertensive patients with kidney disease are in better conditions here. Their high blood pressure can be successfully managed with medications. Diabetes makes the kidney function decline faster as patients tend to eat food that should be abandoned from the diet of diabetic patients.
The most vulnerable population for progressive kidney failure are elderly who are hypertensive or diabetic. If you take it in general, elderly living alone with no family support can manage their health conditions quite poorly, especially those with diabetes. They are not able to prepare food, cannot do groceries regularly and buy selective foods that are recommended by the dietician. As a result, the poorly managed diabetes slowly damages the kidney and slows down the glomerular filtration rate. Senior Care Canada (2007) claims that, “it is clear that in the nearest future type 2 diabetes will impose an increasing health burden on older Canadians. In order to provide prevention and control of the situation it will be required to combine the efforts of seniors themselves, their families, health care providers, and health care institutions.”
The main concern of the clinic is to manage the patient’s hypertension and diabetes in such way, that the kidney disease can be successfully stabilized. As a student nurse, placed in Community Health Nursing, my responsibility is to follow all the standards of practice for Community Health Nurses. For instance, we promote health by using personal approach that helps the individual and the family. We give information sessions to the vulnerable population on how the kidney disease can affect their health overall and how they should manage their health (Canadian Community Health Nursing, 2011).
Disease prevention and health protection are the major important standards followed by the staff of the clinic. It is essential to select the most effective measures for the levels of prevention such as, educating patients during their first stages of disease about how to prevent it from progressing. As a secondary prevention measure, the disease is controlled with medications and a balanced nutrition. The last step that can be taken is the help that nurses provide to the patients making decision regarding the hemodialysis, peritoneal dialysis, transplantation, etc.
The effective health maintenance is the main goal of the clinic, as they want their patients to maintain their kidney failure properly and live quality of life by managing the conditions and symptoms that are leading to chronic kidney failure. Professional relationships are very important for the team at the renal clinic as all the staff, including nephrologists, nurses, pharmacists, social workers and dieticians have a common goal of the effective health maintenance of the patients and collaboration in order to overcome health inequities. Nurses of the community renal clinic also build individual knowledge by collaborating with the patients to increase awareness about their health status. Nurses encourage positive lifestyle choices to be made by the patients. Nurses support active life position and evaluate the change of the state of health of the individuals and their families. Medical access and the equality of the treatment are provided by offering resources and services equally throughout the population. Nurses make sure that they provide culturally sensitive care to patients as they are coming from diverse backgrounds. Finally, it is essential for every nurse to demonstrate responsibility and accountability in the medical practice (Canadian Community Health Nursing, 2011).
One of the challenges I faced while going through the practical studies in the clinic was that I felt slightly shy while communicating with the patients regarding managing their kidney disease by controlling hypertension and diabetes. That is the main goal of our clinic, but I usually feel shy while communicating. However, I am working on pursuing the skills required by the standard of Prevention and Health Protection. Therefore, as was indicated on my learning plan I will be developing my skills to achieve this goal.
References:
St. Joseph’s Health Centre. (2011). Renal therapy centre. Retrieved May 27, 2013, from http://www.stjoe.on.ca/programs/medicine/renal_therapy.php
Senior Care Canada. (2007). Diabetes in Canada. Retrieved May 27, 2013, from http://seniorcarecanada.com/articles/2003/q3/diabetes/
Canadian Community Health Nursing. (2011). Professional Practice Model & Standards of Practice. Public Health Agency of Canada.
