Miss Giovanna Legge1
1Rockhampton Hospital, Queensland Health, Rockhampton, Australia
Biography:
I am a Clinical Nurse, with six years of experience across haemodialysis, peritoneal dialysis, home training, and outreach dialysis. My qualifications include a Bachelor of Nursing, Postgraduate Certificate, Graduate Diploma Graduate and a Masters of Clinical Nursing (Renal Specialisation).
Throughout my career, I have developed a strong understanding of dialysis processes, patient needs, and operational requirements of a renal service. I have undertaken acting Nurse Unit Manager responsibilities, which provided insight into the leadership, planning, and resource considerations involved in service development. These experiences have equipped me to identify practice gaps, evaluate evidence-based alternatives, and design feasible practice change initiatives.
Abstract:
Background: Patients with end-stage kidney disease receiving dialysis face high symptom burden and mortality, yet advance care planning (ACP) and end-of-life (EOL) care are often delayed or under-utilised. Renal nurses are uniquely positioned to embed patient-centred approaches into dialysis care; however, they also face ethical tensions and moral distress when treatment decisions conflict with patient values.
Aim: This discussion paper explores the role of renal nurses in delivering patient-centred EOL care, with a focus on ACP, ethical challenges, and strategies to improve practice.
Discussion: Key ethical dilemmas in dialysis include withdrawal of treatment, perceived futility, and family conflict. Nurses’ long-term therapeutic relationships enable advocacy and compassionate communication, yet many report limited training and organisational support. Evidence demonstrates that nurse-led ACP and Kidney Supportive Care (KSC) frameworks improve goal-concordant care, reduce decisional conflict, and support workforce wellbeing.
Conclusion: By embracing nurse-led ACP and integrating supportive care into routine practice, renal nurses can act as leaders in ensuring dignity, autonomy, and cultural safety at the end of life. Policy, education, and organisational investment are needed to empower nurses as ethical advocates and to promote sustainable, patient-centred dialysis care.
Keywords: End-of-life care; advance care planning; dialysis; renal nursing; patient-centred care