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A concept analysis of renal supportive care: the changing world of nephrology

Authors

  • Helen Noble,

    1. Helen Noble BSc RN DMS Doctoral Student Care for Older Adults Research Team, St Bartholomew School of Nursing & Midwifery, City University, London, UK
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  • Daniel Kelly,

    1. Daniel Kelly PhD RN Reader in Cancer & Palliative Care School of Health & Social Sciences, Middlesex University, London, UK
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  • Karen Rawlings-Anderson,

    1. Karen Rawlings-Anderson MSc RN DipN Ed Senior Lecturer/MSc Nursing Programme Director Department of Adult Nursing, St Bartholomew School of Nursing and Midwifery, City University, London, UK
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  • Julienne Meyer

    1. Julienne Meyer BSc MSc PhD RN RNT Professor of Nursing: Care for Older People St Bartholomew School of Nursing and Midwifery, Institute of Health Science, City University, London, UK
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H. Noble: e-mail: H.R.Noble@city.ac.uk

Abstract

Title. A concept analysis of renal supportive care: the changing world of nephrology

Aim.  This paper is a report of a concept analysis of renal supportive care.

Background.  Approximately 1·5 million people worldwide are kept alive by renal dialysis. As services are required to support patients who decide not to start or to withdraw from dialysis, the term renal supportive care is emerging. Being similar to the terms palliative care, end-of-life care, terminal care and conservative management, there is a need for conceptual clarity.

Method.  Rodgers’ evolutionary method was used as the organizing framework for this concept analysis. Data were collected from a review of CINAHL, Medline, PsycINFO, British Nursing Index, International Bibliography of the Social Sciences and ASSIA (1806–2006) using, ‘renal’ and ‘supportive care’ as keywords. All articles with an abstract were considered. The World Wide Web was also searched in English utilizing the phrase ‘renal supportive care’.

Results.  Five attributes of renal supportive care were identified: available from diagnosis to death with an emphasis on honesty regarding prognosis and impact of disease; interdisciplinary approach to care; restorative care; family and carer support and effective, lucid communication to ensure informed choice and clear lines of decision-making.

Conclusion.  Renal supportive care is a dynamic and emerging concept relevant, but not limited to, the end phase of life. It suggests a central philosophy underpinning renal service development that allows patients, carers and the multidisciplinary team time to work together to realize complex goals. It has relevance for the renal community and is likely to be integrated increasingly into everyday nephrology practice.

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