Management of ESRD

Paper Summary:

The prevalence of patients with End Stage Renal Disease (ESRD) has increased and efforts to control cost and meet managed care demands for lower reimbursements, have resulted in the increased use of unlicensed personnel in dialysis treatment centers. This paper compares the confidence and competence of licensed and unlicensed dialysis providers and identifies the differences between the two groups. The paper then focuses on ESRD literature investigating the prevalence and economics, the introduction of unlicensed personnel, the consequences of too few licensed personnel, future trends, differences found in personnel, and theoretical framework for this study. Finally, the paper discusses the methodology that was employed in the investigation between licensed and unlicensed personnel and divides the discussion into five sections - Research Design, Subjects and Sampling, Instrumentation, Procedure and Data Analysis.

From the Paper:

"Be this as it may, there is such a shortage of nephrology nurses that it may ultimately mean rethinking the way non-licensed personnel are used, and may in fact require expanded roles for them (Robbins, 1999). Vogel (1999) reports there is an increased use of permanent catheters (tunneled cuffed catheters) in chronic dialysis units. As it stands now, California law prohibits dialysis technicians from accessing permanent catheters (Business and Professions Code Section: 1247-1247.9). There is a critical shortage of nephrologists and the technician's training programs have not kept up with the rapid developments in hemodialysis technology, which may have led to related safety problems (Nissenson & Rettig, 1999; Rolston (1993)."

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