The American Association of Critical-Care Nurses (AACN) recently endorsed the clinical practice guideline, "Shared Decision Making in the Appropriate Initiation of and Withdrawal from Dialysis," developed by Renal Physicians Association (RPA), Rockville, Md.
The guideline, originally published in 2000, incorporates new evidence from medical literature about withholding or withdrawing dialysis in adult patients with acute renal failure (ARF) or end-stage renal disease (ESRD). It provides clinicians, patients and families with current evidence about the benefits and burdens of dialysis for patients with diverse conditions that includes the following recommendations:
•Establish shared decision-making relationships between patients and providers
•Inform patients about their diagnosis, prognosis and treatment options
•Facilitate advance care planning, making a decision to forgo dialysis in certain well-defined situations
•Resolve conflicts about treatment plans
•Provide effective palliative care
AACN Clinical Practice Manager Robi Hellman, RN, MSN, CNS, notes the relevance of the revised guideline to critical care nurses and other healthcare providers who care for ARF or ESRD patients saying, "Understanding the complexities of initiating and withdrawing dialysis treatment in critically ill patients is central to ethical and compassionate care." She adds, "Nurses, who care for these critically ill patients, rely on evidence-based guidelines to advise their practice."
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