plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Sat Mar 11, 2006 10:50 am Post subject: Less inspiring
--------------------------------------------------------------------------------
To back up what some of what the doctors above have to say there are the stats I've read:
*Limitations of Prevailing Treatment Methods Hemodialysis:
Outpatient hemodialysis has produced relatively poor clinical outcomes, high total treatment costs and low quality of life for dialysis patients. These clinical outcomes are reflected in the mortality rates of dialysis patients which, according to the USRDS, in 2000 were 24.0% in the United States as compared to 11.0% in France and 9.7% in Japan. Although mortality rates are influenced by many factors, including the relative risk of death determined by considering age, overall health and other variables, a study published in 1994 indicates that, even after adjusting for relative risk of death, the mortality rate in the United States was twice that of Japan. While the exact cause of this difference in mortality rates has not been established, the USRDS has determined that mortality in patients is highly correlated to the dose of dialysis delivered to patients. In general, the dose of dialysis depends on the performance of the artificial kidney, patient size and the duration of treatment.
*http://www.aksys.com/therapy/esrd.asp
*Annual mortality rates per 1,000 patient years at risk: hemodialysis patients
Year: 2001 2002 2003
23.96% 23.89% 23.78%
*page 525 of the 2005 ADR table H.12
**********************************************************
plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Sat Mar 11, 2006 10:58 am Post subject: posts
--------------------------------------------------------------------------------
And just to top it all off, I get to come here and read posts like the following:
?I have worked for both for-profit and non-profit. My experience has been that the non-profits staff better and appear to give their techs better training than the for-profits. In fact, the reason I left the last for-profit that I worked at was because of the RN to patient ratio. I felt that my license as an RN was in jeopardy when I was the lone RN with 16-22 patients. The techs worked at a 4:1 ratio and took turns dong the reuse on top of their patient load. Add in all the paperwork, care plans, meds, emergencies, anemia management, etc., all for 1 lone RN to do and it is no wonder that no one wants to work like a horse for next to nothing.
The PCT's do put on cath patients, but RN's must do dressing changes, the cath off packs and check all machine settings, baths, etc against the treatment RX.
The state I work in also requires that the pct's be state certified.
In my area, the for profit companies are having a very difficult time attracting and retaining adequate staff ( as in actual bodies) as word has gotten around about the working conditions. Those who do stay in dialysis usually go to a staffing agency and work through them for much higher wages and can pick and choose their own work schedule.
Dialysis is such a specialty that I doubt that any RN just off the street would even know much about it, what they learn all depends on the education they are given by the for-profit companies and from what I have seen, it is poor at best. As for the patients and their families, this is where education comes in, something the for-profits don't seem to want to pay for. Much easier to label someone as non-compliant than to educate them about their disease and treatment options.
I don't see the nursing shortage as creating an atmosphere of arrogance for RN's. Instead I see the
nursing shortage as finally giving RN's the ability to pick and choose where they want to work. They are no longer so desperate for jobs that they have to take what they can get. Some Administrations are treating RN's with more respect and thinking very hard as to what they can do to retain the RN's they have. Something the dialysis companies are not willing to do because they have such a big obligation to their stockholders. That obligation outweighs their obligation to the very patients who are the ones generating all the $$$$$ for the stockholders.
Yes it is frustrating. But until you and the staff make a stand, it will continue to be that way. These companies only understand when it hits them in the pocket book. And as long as you and the others are willing to put up with the current conditions, then as far as the administration is concerned and the money keeps rolling in, everything is just fine. It is after all your license.?
Still wonder why I have concerns if my daughter ever has to go back to dialysis?
**********************************************************
leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Sat Mar 11, 2006 12:11 pm Post subject: techs
--------------------------------------------------------------------------------
Plugger. the unit I am at the techs do cath dressing changes also. The techs have a 4:1 ratio and reuse has been eliminated
**********************************************************
plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Sun Mar 12, 2006 7:21 am Post subject:
--------------------------------------------------------------------------------
Hi Leadsag,
It's good to hear from you! It is also good to hear your unit eliminated reuse. I remember I had to ask that my daughter be taken off it after listening to the people here and reading the studies - another thing I'm grateful to the folks of DE for.
Anyway I posted the above as a reminder as to why this organization came into being in the first place. By itself it might be easy to label the people who have been part of this a bunch of malcontents; but add in the opinions of quite a few distinguished people in this field, the stats, and story after story and it gets hard to deny there are problems. I know Arlene has put up with quite a few personal attacks and ingratitude, but I for one can?t thank her enough. I also can?t forget the thanks I owe to such people as Founding RN, Marty, Jfwag, Dr. Bays, Brent Smith and family, Frank Brown, Victor, many countless posters, and of course you Leadsag. All have been an inspiration in fighting for what they believe in and hanging in there. Just thought it would be a good time to express what I think about all this and why.
**********************************************************
Guest
Guest
Posted: Mon Mar 13, 2006 1:39 pm Post subject: Updates
--------------------------------------------------------------------------------
It's been a while since the board has been going as good as it used too. Plugger, I agree with you things are still a miss in the dialysis field. You can hardly look anywhere anymore and not know that U.S. patients are underdialyzed and yet the home programs are slow growing. Or even offering more in-center dialysis is slow in coming around. But the good news is, after 6 years of waiting our home dialysis center is going to start a program. The other good news is our hemo hemo dialysis center has grown very well and therefore are willing to try the new machines such as NxStage.
This seems to be catching on very fast with patients. Very little work to do with it; requires no water, and you can travel with it. I hope and pray your daughter never has to go back to dialysis but if she does I hope their will be a versatile home hemo program she can get into. I will always support cleaning up the centers but I also think patients should really start looking and contemplating home hemo. I still think it's a sin you can only get into home hemo if your unit "feels" like offering it.
Marty
**********************************************************
plugger
Joined: 11 Jan 2003
Posts: 226
Posted: Tue Mar 14, 2006 5:46 am Post subject:
--------------------------------------------------------------------------------
Marty,
It is great to get some good news for a change! You have been a bright spot in all of this.
Take care,
plugger
**********************************************************
rdh_vr@yahoo.com
Guest
Posted: Fri May 19, 2006 7:00 am Post subject: Re: Dr. Carl Kjellstrand/AKF
--------------------------------------------------------------------------------
[quote:930e3ecb9c="Jfwagg"]I am so happy that the American Kidney Fund is to bestow its highest honor on Dr. Carl Kjellstrand. I will never forget when I read one of his ?statements? (on this board) so early on in
my dialysis career. Below is what was read and to me at least it was very profound.
That?s not to mention what the AKF did for my spouse and me at one of the lowest points in our lives. The AKF is a great resource.
Below is something that I find very influential and moving when "debating" home dialysis at the time. He made a difference.
Dr. Carl Kjellstrand
DIALYSIS IN THE USA
In recent medical studies, it has come to light that people receiving
dialysis treatment for kidney failure in Europe experience, on average,
better health with fewer complications and longer life expectancy than do
their American counterparts. There are a number of possible reasons for this
discrepancy, such as differences in patient populations and in treatment
procedures, but the most significant seems to be the difference in the
respective goals of treatment.
In Europe, the goal of dialysis is rehabilitation. Patients are expected
to do well and to return to normal lives, and their doctors are not satisfied
until they do. In the United States, however, the goal often seems to be
merely to keep patients alive, without any serious ongoing attention to
rehabilitation or quality of life. Might this great difference in intentions
and expectations be the deciding factor in the difference in outcomes?
Bernie Seigel, M.D., Deepak Chopra, M.D., and others, have written about
the influence that expectations of doctors and medical staff have on patient
outcomes. Their thesis is that since patients tend to conform with their
doctor's expectations, performing up to, or down to, those expectations, it
is a doctor's solemn responsibility to convey as positive and hopeful an
outlook as possible to assure the most beneficial outcome. A recent study in
Clinical Psychology Review on the 'placebo syndrome' clearly shows that
belief in a particular outcome can be as strong a determinant as any
medication. Indeed, is it really any surprise that low expectations lead to
less than optimal outcomes?
Dialysis in the USA has become by default a kind of limbo, and the
experience of patients, while fraught with difficulty, is rarely allowed full
expression or resolution. Instead, patients are expected to be 'nice' while
being treated as little more than items on an assembly line. The prevailing
attitude of doctors and staff at many clinics is that of denial: that the
situation is so bad that it must not be dealt with. The corporate owners,
usually far removed from the clinics, tend to make treatment decisions based
on short-term profitability, often to the short-term and long-term detriment
of their customers well-being. Although patients become inured to the idea
of having to dialyze, and would be more than happy to get on with worthwhile
lives, they are held back by a system that regards them as permanent invalids
with one foot in the grave.
It seems that aversion to the idea of dialysis is the stumbling block
preventing further investigation of solutions to dialysis-related problems.
The common perception is that dialysis is an awful burden which it is
impossible to do anything about. Great pains are taken to impose this view
on the patients, with regular negative reinforcement: in combination with
the treatment, it is an effective form of brainwashing. This defeatism
inevitably colors treatment decisions, and leads to a poorer quality of life
for all concerned.
I don't think that kind of mentality is appropriate in any medical
situation. There may be no cure per se for kidney failure, nor is there a
cure for blindness, amputation, paralysis, or brain damage. However, the
general trend in all these other cases is to overcome the disability and
return the person to a full and worthwhile life, regardless of the obstacles.
What makes dialysis so different? Is it the machine? Is it the blood?
What is it? I think it is a self-fulfilling prophecy.
The time is overdue to re-examine our priorities and re-establish the
dialysis program on a solid basis of the optimization of the quality of life
of each individual dialysis patient. When that becomes the standard of care,
we will also see the optimization of outcomes: patient satisfaction,
rehabilitation, and longer, healthier, more productive lives. That is what
the system was intended to produce, and that is what we are paying for.
Let's do what it takes to make it so.
April 15, 1994
