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A comprehensive assessment tool and intervention typology for adult hemodialysis patients, based on the Roy Adaptation Model, is presented. The Roy model is reviewed, and examples from the assessment tool and intervention typology are presented. A case study illustrates application of the tool and typology to nephrology nursing. Comparison of the tool and typology with the ANNA Standards of Clinical Practice revealed that the Roy Adaptation Model includes additional important aspects of nephrology nursing practice., The purpose of this article is to describe a new approach for initial and ongoing nursing assessment and intervention for adult hemodialysis patients. The approach to assessment and intervention was [...]

Several factors may influence how patients with end-stage kidney disease decide whether to use four times daily self-directed dialysis or attend a clinic every other day for machine-based dialysis. Twenty-two patients requiring dialysis completed questionnaires regarding their decision-making process. Physical, mental, spiritual, cultural, and developmental reasons were given for their choices.

Objective: The purpose of this qualitative study was to elicit patients' perceptions of why, how, and by whom their dialysis treatment modality -- hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) -- was chosen. Design: The study design utilized a naturalistic method of inquiry employing a qualitative approach. The research was guided by the life-death decision in health care framework developed by Degner and Beaton and the Neuman Systems Model. Sample/Setting: Twenty-two informants were recruited from inpatient and outpatient renal dialysis units at a large urban tertiary care center on the east coast of the United States. Methods: Data were collected by individual, focused, semi-structured in-depth interviews. Results: A grounded theory, 'Patient's Choice of a Treatment Modality versus Selection of Patient's Treatment Modality' emerged from the data provided by the informants. The theory consisted of 11 themes that addressed the why, how, and by whom of decision-making: self decision; access-rationing decision; significant other decision; to live decision; physiologically dictated decision; expert decision; to-be-cared-for decision; independence verses dependence decision; no patient choice in making decision; patient preference/choice; and switching modalities due to patient preference/choice. Conclusion: The themes reflected two patterns of decision-making: the patient and/or significant other chose the treatment modality, and the treatment modality was selected because of clinical or practical circumstances., Since Congress enacted the United States Medicare End-Stage Renal Disease (ESRD) Program in 1973, there has been rapid growth in both the ESRD population and, subsequently, in program costs. This [...]