The Peer Support for Dialysis Staff Engage in End-of-Life Care: Action Research in the Dialysis Facility

Abstract

Objective: The objective of the present study is to clarify outcomes expected to be gained from sharing the experience of end-of-life care provision with a peer group of dialysis staff.

Method: Action research qualitative approach was employed, targeting on staff working in dialysis facilities that agreed on entire participation throughout the research.

Results: The following 5 phases are identified: [1] Dialysis staff realize that they do not have opportunity to express their feelings or thoughts over end-of-life care. [2] Difficulties in preparing advance directives make dialysis staff realize the importance of everyday involvement with patients. [3] Dialysis staff pour out and share emotion regarding care for dialysis patients facing nearing death. [4] End-of-life care for dialysis patients practiced jointly among clinical engineer and nurse. This change, the first endeavor at the facility, developed into a concerted effort of end-of-life care practice with the entire dialysis staff supporting each other. [5] Dialysis staff seek to continue their own forum for discussing end-of-life care for dialysis patients.

Discussion: This study offered new insight that end-of-life care is an extension of everyday care. The meetings that served as a secure opportunity for the dialysis staff allowed them to reveal and share their honest emotion. Furthermore, this change is considered representing a transformation from a task-oriented organization that operates based on doctors’ instructions to a more autonomous organization of cooperative practice with consultation with doctors. These findings provide practical suggestions toward a new team approach for end-of-life care.