, 2005, p. 375).
With regard to the patient's quality of life and treatment the above study notes that; "We have observed that some older dialysis patients experience considerable difficulties with this treatment regime. Apart from physical discomfort, some patients have difficulty complying with treatment, or repeatedly express the wish to give up dialysis" (Tyrrell et al., 2005, p. 375). These and other problems emphasize the fact that the treatment regime can be arduous for elderly patients and, if not in administered and managed correctly by the nurse or caregiver, can radically decrease the quality of life of the patient and his or her family.
Another issue that is reiterated in the literature is the degree to which the elderly patient understands the treatment. This is an area where the philosophy of care and the holistic approach to nursing praxis comes into play; and where the nurse can help in the process of explanation and understanding. Related to this are the various psychological issues that can inhibit the treatment process. These may have a significant effect on the quality of life but as Tyrrell et al. note they "… are not routinely assessed in dialysis patients" ( Tyrrell et al., 2005, p. 375).
Therefore, the purpose of the above study was to evaluate levels of cognitive impairment, depressive mood and self-reported quality of life in older dialysis patients. A total of 51 outpatients receiving dialysis were assessed with, among others, a quality of life questionnaire (NHP). It was found that, "Sixty percent of the patients were depressed, and between 30 -- 47% had cognitive impairment. Almost half of the depressed patients were also cognitively impaired" (Tyrrell et al., 2005, p. 374). The study therefore suggests that "Regular assessments of depressive mood, cognitive ability and quality of life are recommended, given the prevalence of problems in these domains for older dialysis patients" (Tyrrell et al., 2005, p. 374). This study and others also note the relative paucity of research into the area of emotional well-being and its importance in the treatment of these patients. For example, "…Kimmel et al. (1998) also found that rates of hospitalization for dementia and organic disorders were "…much higher in patients with chronic renal failure, compared with those suffering other chronic diseases" (Tyrrell et al., 2005, p. 375).
In terms of the central focus of this paper, studies such as Renal dialysis abatement: lessons from a social study (2005) by Ashby et al. investigates"… the reasons why some people chose to abate & #8230; renal dialysis, together with the personal and social impact of this decision on the person concerned, and/or their families" (Ashby et al., 2005, p. 389). Significantly it was found that, "The desire not to burden others and the personal experience of a deteriorating quality of life were crucial elements in the decision to stop or decline dialysis" ( Ahsby et al., 2005, p. 389). Ashby et al. also note that cultural and language factors as well as communication play a role in ascertaining the quality of life of these patients.
Importantly, a number of studies stress that the quality of life should also be considered from an experiential and existential point-of-view. This has a bearing as well on the nursing management of these patients and is an aspect that has been relatively neglected in contemporary treatment. For example, Ashby at al.( 2005) state that some elderly patients withdraw from dialysis treatment as a result of difficultly in discussing their fears and doubts with medical staff and family. Some have deep religious convictions that they feel are not appropriate to share in a medical and nursing context. This means that a more inclusive and interpersonal methodology is necessary in many cases.
This also relates to the issue of faith and religious perceptions in the treatment process. Studies such as Faith by James Dette ( 2008) emphasize the importance of this dimension and its relationship to a more integrated and holistic approach. An article entitled Developing a renal supportive care team from the voices of patients, families, and palliative care staff ( 2008) explores the concept of a Renal Supportive Care Team, which is "… designed to elicit and provide for the needs of dialysis patients and their families throughout the trajectory of their illnesses"( Berzoff and Swantkowski, 2008, p.133). The results of this study provide insight into the more integrated and humanistic approach which is the central focus of this paper.
Respondents agreed that there needed to be greater education of both patients and families regarding all aspects of the disease process, open communication, on-going support...
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