A family decision to discontinue dialysis treatment for a parent: an advanced practice nurse (APN) guided process.

Nephrology APNs play a major role in every aspect of caring for dialysis patients and often assume a leadership role with respect to patient and/or family concerns. It is always difficult to witness individuals and families struggle with making end-of-life decisions for a loved one. The middle-range theory of caregiver stress offers a way to utilize the RAM in the context of family caregiver experiences with a chronically ill relative. Additionally, there are a number of tools, such as the RPA/ASN guidelines, available for the APN working in nephrology. These guidelines provide a structured, systematic pathway for creating a plan of action. In the case of A.G., the intended outcomes were achieved largely due to the leadership role of the CNS in ensuring that there was a coordinated, dedicated, and comprehensive renal team approach. There were open lines of communication evident between all disciplines and the family throughout A.G.'s illness. His family received the full benefit of all available resources, and was able to make an informed decision with regard to the care of their father. Support was provided for the patient and his family at the end of life, culminating in a good death.