Nurses' professional views of medical care for dialysis patients in Japan: future directions for nursing care

Abstract

A questionnaire on nursing care for maintenance dialysis patients was mailed to 300 institutes and dialysis centers selected randomly from 2, 818 facilities registered with the Japanese Society for Dialysis Therapy. Questionnaire responses by nurses working at these facilities were analyzed, and in this report, their professional views on medical care for dialysis patients as well as future directions for nursing care are discussed.
Nurses responded that maintenance dialysis patients especially those treated in hemodialysis centers needed to become more self-reliant and must take greater initiative in managing their own medical problems. It is evident that nurses were critical about both medical care becoming a kind of commercial service and patients' attitudes toward maintenance dialysis.
In view of the increasing number of aged patients, respondants emphasized the need for these patients to receive medical care more coveniently as well as the effective application of public Long-Term Care Insurance System. Resondants also proposed the necessity of discussing the indications for initiating dialysis therapy for older aged patients.
With reference to medical economics and government policy in suppressing the rise in health care costs, some respondants pointed out the irrationality of patients not sharing the medical cost for maintenance dialysis treatment programs, and stressed the importance of appropriate sharing of the health care cost burden.
Regarding the future directions of nursing care, nurses responded that they should participate in the selection of treatment modalities and in education for self-care management. However, nurses are involved in so many activities in dialysis treatment that respondants reported a sense of crisis due to their heavy work load together with labor shortage. They responded that other medical staff should share the responsibilities based upon each professional activity and duty to provide efficient and safe medical care. To solve these problems and achieve higher quality nursing care, they also suggested a need for specialization of nurses involved in dialysis treatment programs.
Of note is that more than 90% of nurses working in dialysis treatment programs are female, but each gender has different responsibilities for social and familial matters. It is important for nurses to make every effort to enrich their humanity through experiences gained at each stage of their professional lives. As such, continuing education and technical training should be provided to achieve higher quality nursing care for dialysis patients.