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End-of-Life Decisions
in the Dialysis Unit
Dialysis units need to prepare
for the possibility that patients die at the dialysis facility.
Many units don’t have adequate private space to keep
someone who has passed away. Building relationships with funeral
homes and encouraging them to respond quickly may help. The
dialysis unit should also incorporate do not resuscitate (DNR)
policies and procedures and train all staff on how to deal
with these situations.
The following forms, developed by the Kidney
End-of-Life Coalition, should be included in the policy and
procedure for DNR orders and disposition of the expired patient:
An important skill for staff
when discussing advance directives, cardiopulmonary resuscitation
(CPR) or DNR orders with patients is to avoid using professional
jargon. Words such as code, CPR, and vent
should be avoided; instead, use words such as heart stopped,
tried to start the heart, and breathing machine.
Staff should not be afraid to use the words died
and death; saying only that resuscitation was unsuccessful
or that the patient expired will often risk misunderstanding.
Other educational tools beneficial for staff:
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The National Kidney Foundation's Council
of Nephrology Social Workers has prepared a 1-page hospice
and dialysis care resource to help educate social
workers and others on Medicare coverage for hospice services
while receiving dialysis. *NEW*
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Network
5’s End-of-Life Module is an educational tool
that provides a complete in-service training session,
which defines palliative care and helps participants identify
end-of-life issues that might arise in the facility as
well as possible resources and support.
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Dying
Well (online course) is part of DIA Learning's Ethics
Education Series. This course contains high-quality video
documentary, text, and quiz components and is approved
by the National Association of Social Workers-Missouri
Chapter for 12 continuing education hours.
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