Nephrology Nurses Research Articles

Nephrologists’ perspectives on the designs of mobile hemodialysis devices: A mixed methods approach

Early and iterative involvement of users in the designs of medical devices helps improve safety, enhance users' positive experiences, and reduce the risk of use error. Although notable technological progress has been made toward mobilizing hemodialysis devices, understanding users' perspectives is still in its infancy. To understand various perspectives of mobile hemodialysis device users, we aim to gather nephrologists’ perspectives on the early designs of two mobile hemodialysis devices: a wearable and a portable hemodialysis device, continuing our previous exploration to understand patients’, care partners’, and nephrology nurses’ perspectives. Using a mixed-methods approach of conducting questionnaires and semi-structured virtual interviews, we report the perspectives of 30 nephrologists on mobile hemodialysis treatments compared with current in-center and home hemodialysis treatments. We also report their perspectives on potential benefits and barriers to recommending such devices, and ideal features to be included in the device’s designs. The findings from this study help guide the design processes of mobile hemodialysis devices towards the goal of earning nephrologists’ acceptance and ultimately facilitating the recommendation and implementation of mobile hemodialysis devices for patients.

Perspectives of Chinese nephrology nurses on discussing sexual dysfunction with patients receiving haemodialysis: A qualitative study.

The study underscores the crucial yet often neglected issue of sexual dysfunction in haemodialysis patients. Despite nephrology nurses'close relationships with patients, there is a significant communication gap on this topic. In China, limited research highlights the need for further study. To describe the perspectives of Chinese nephrology nurses on discussing sexual dysfunction with patients receiving haemodialysis. A qualitative descriptive study. Ten Chinese nephrology nurses from a tertiary public hospital in Guizhou province, China. Semistructured interviews were conducted using an interview guide. Qualitative content analysis approach was utilised in analysis. There were five themes described: (1) lack of training in sexual education, as nephrology nurses described never being trained to manage patients' sexual health issues; (2) discomfort when discussing sexual topics, Chinese nephrology nurses found the topic of sexual dysfunction embarrassing and avoided discussing it; (3) sexual dysfunction viewed as a nonurgent topic, nephrology nurses prioritise physical health to aid patient survival; (4) belief in physicians as ultimate care advisors, nephrology nurses believed that doctors should handle discussions on sexually related topics; and (5) lack of a suitable environment for discussing sexual dysfunction, nephrology nurses viewed sex as a private matter, inappropriate for discussion in a public unit. The study identifies barriers to discussing sexual dysfunction in healthcare, including provider knowledge deficits, discomfort and lack of supportive environments. It recommends specialised training and conducive settings to improve communication in renal care. Future research should evaluate the effectiveness of these interventions.

Effect of Structured Nursing Intervention on Knowledge and Treatment Adherance Among Patients With End Stage Renal Disease in Kano Metropolis

<p><em><strong>Background</strong>: Chronic Renal Failure is a progressive irreversible deterioration in renal function in which the body’s power to maintain metabolic, fluid, and electrolyte balance fails, resulting in uremia which contributes to the patient's dependence upon hemodialysis for the maintenance of the internal milieu and to avoid uremia. Patients with end-stage renal disease (ESRD) are characterized by low levels of physical activity and a continuous decline in physical function. The main aim of the study was to assess the effect of structured nursing intervention on treatment adherence among patients with end-stage renal disease in Kano Metropolis. </em></p><p><strong><em>Methods</em></strong><em>: This study utilized a two-group pretest-post-test quasi-experimental design. Patients receiving dialysis care at Muhammadu Abdullahi Wase Teaching Hospital and Abubakar Imam Urology Hospital were purposively selected as experimental and control groups respectively. A total of 422 participants were estimated and selected for the study and equally shared among the two groups, i.e. 211 for the control and 211 for the experimental group. All statistical data were analyzed and described using simple frequencies, Chi-square, T-test and regressions. </em></p><p><strong><em>Results</em></strong><em>: Regarding treatment adherence, the pre-intervention mean score was 52.9 and 50.00, and the post-intervention score was 73.2 and 54.6 in the intervention and control groups, respectively. The effectiveness of the intervention was tested using unpaired t-test which was found to be significantly effective (p<0.005). </em></p><p><strong><em>Conclusion</em></strong><em>: Based on the findings of the study, the structured nursing intervention was effective in improving the level of knowledge regarding the disease and treatment adherence (p<0.005) among patients with end-stage renal disease in the Kano metropolis. It is therefore recommended that the nephrology nurses, hospital administrators, and the general public join hands to make the services accessible and affordable to these patients to maintain their normal life activities through good adherence to the treatment regimen.</em></p>

Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre

BackgroundTo analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours.MethodsWe retrospectively analysed patients’ chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015–2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have “immediate consequence”, inquiry was eligible for “processing next working day” or whether there was “no need for further action”. Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients’ acute hospitalization or need for nurses’ home visits were evaluated and quantified.ResultsIn total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00–9:00; median, 25-75th CI) and 6:30 p.m. (5:00–8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an “immediate consequence”. Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence.Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%.In 35 cases a nurse visit at patients’ home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively).ConclusionThe on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.

Nephrology Nurses: Essential Professionals in Sustainable Kidney Care.

The increasing frequency of extreme climate events underscores the need for urgent action on climate change. The health care system contributes 4.6% of greenhouse gas emissions (GHGs) in Canada; thus, it is a major contributor to the country's carbon footprint. Kidney care in particular can involve high amounts of waste (eg, plastic and consumable waste associated with dialysis, transportation, emissions, energy, and water consumption). Therefore, sustainability initiatives within the health care system, and especially in the context of kidney care, have great potential to make a positive impact on planetary health. Here, we outline ways in which nephrology nurses can expand our duty of care to the environment and incorporate sustainability into our work. A small advisory group of nephrology nurses in partnership with the Canadian Association of Nurses for the Environment (CANE) assessed ways that sustainable practices can be incorporated into nephrology nursing. Drawing on the Planetary Health Care model used by the Canadian Society of Nephrology: Sustainable Nephrology Action Planning (SNAP) committee, we assessed how the model could be adapted in the context of kidney care using 3 main actionable themes in their work: reducing the demand for health services, matching the supply of health services with demand, and reducing emissions from the supply of health services. We also reviewed and selected real-world examples of initiatives pursued by colleagues. Through this established framework, we provide recommendations and case examples for nephrology nurses to expand our duty of care to the environment. We describe nursing-led strategies used in Canada to improve environmental sustainability in kidney programs and consider their applicability to other renal programs. In 1 case example, we show how a simple nurse-led initiative at a single dialysis clinic can lower plastic waste and associated costs by $2042.59 per year. More broadly, we provide recommendations and actions for nephrology nurses to improve environmental sustainability in kidney care. Nurses in Canada have many responsibilities within limited timeframes, making it essential to choose sustainable practices that do not exacerbate burnout and high workloads. For sustainable practices to be successful, nurses must integrate them into their existing workflows.

Embracing Transformational Leadership in Nephrology Nursing

Embracing Transformational Leadership in Nephrology Nursing

The Status of Nephrology Nursing – Views from Nephrology Nurse Leaders

The Status of Nephrology Nursing – Views from Nephrology Nurse Leaders

The Current State of Kidney Supportive Care in Nephrology Nursing Practice: A Literature Review

The Current State of Kidney Supportive Care in Nephrology Nursing Practice: A Literature Review

Nursing practice patterns in advanced kidney care

The Association of Nephrology Nurses Advanced Kidney Care (AKC) Nurses Community of Practice provides a summary of a recent audit of advanced kidney care nursing services, roles and activity.

An Interview with Nancy Colobong Smith, President of the American Nephrology Nurses Association (2024-2025)

An Interview with Nancy Colobong Smith, President of the American Nephrology Nurses Association (2024-2025)

Acute Nephrology Nurse Managers and Medical Directors: The Roles and Relationships to Produce Quality in the Unit

Acute Nephrology Nurse Managers and Medical Directors: The Roles and Relationships to Produce Quality in the Unit

Nephrology nurses' perspectives working with patients experiencing needle-related distress.

A key skill of nephrology nursing is cannulation of patients receiving haemodialysis. Traumatic and unsuccessful cannulation experiences, particularly in the initial weeks of haemodialysis, may contribute to the onset of needle distress for patients. To identify the key knowledge, skills and attitudes of nephrology nurses working with haemodialysis patients and the competencies relevant to nephrology nursing working with patients with needle-related distress. A qualitative study involving semistructured interviews. Interviews were audio-recorded, transcribed and deductive, and inductive thematic analysis applied. Nephrology nurses (n = 17) were interviewed from a tertiary kidney service in South Australia. Nurses had varying roles and years of experience (range 1-30 years) working with dialysis patients within the service. Two overarching themes, (1) Flexibility in Practice and Care and (2) Responsibility of Nephrology Nursing, were identified as relevant across all knowledge, skills and attitudes of nephrology nurses working with patients with needle-related distress. Thirty-six knowledge, skills and attitudes were identified; 12 related to knowledge, 14 related to skills and 10 were identified as attitudes and were summarised under seven broad competencies. This study identifies potential knowledge, skills and attitudes and competencies required for nephrology nurses working with patients with needle-related distress. It highlights strategies that may prevent the onset and worsening of needle-related distress, as well as reduce it. It also brings to light that nurses desire additional education regarding strategies to improve the patient experience of cannulation and nurse confidence and skill in this area.

Views, attitudes, and reported practices of nephrology nurses regarding shared decision-making in end-of-life care.

End-stage renal disease (ESRD) is the final stage of chronic kidney disease. Yet dialysis is not suitable for all ESRD patients. Moreover, while shared decision-making (SDM) is the preferred model for making medical decisions, little is known about SDM between nephrology nurses and ESRD patients in Israel. Assessing the views, attitudes, practices, and ethical dilemmas of nephrology nurses in Israel regarding SDM with ESRD patients. Using the descriptive quantitative approach, questionnaires were completed by 444 nephrology nurses in Israel. In addition to conducting descriptive statistics, t-tests for independent samples, f-tests for analysis of variance, and both tests for independence were also performed. The research aims, expected advantages and risks have been explained to respondents before completing the questionnaire to secure informed consent. Anonymity and confidentiality were ensured throughout the study. The study was approved by the Research Ethics Committee at the University of Haifa (Approval # 411/21). About one-third (30%-36.5%) of nurses reported discussing quality of life issues with ESRD patients, asking about their advance directives/power of attorney, exploring cultural/religious beliefs in end-of-life care, and ask about their preferred place of death. Nurses who convey high levels of patient-centered care (68.9%, p<0.0001), have high end-of-life training (76.2%, p<0.0001), and report cooperating with interdisciplinary teams (63.8%, p = 0.0415), also reported higher SDM practices than others. Nurses who refer less patients to palliative care (70%, p<0.0001) reported higher involvement in SDM compared to other nurses. Nephrology nurses in Israel do not tend to implement the SDM model, despite its potential for improving quality of life for ESRD patients and their families and increasing conservative care options. Policy makers and educators in Israel should develop and implement training programs and support in the workplace, to enhance SDM between nephrology nurses and ESRD patients.

STOP—Safety, Taping, Observation, Pressure monitoring

In this piece, the Association of Nephrology Nurses (ANN) UK provides details on the STOP programme, which denote safety principles to reduce the risk of needle or catheter dislodgment during haemodialysis

July Meeting Announcements

October 7-10, 2023, Academy of Nutrition and Dietetics, Food and Nutrition Conference and Expo (FNCE) 2023, Colorado Convention Center, Denver, CO. www.eatright.org/FNCE or call 800-877-1600 ext. 4862. October 14-16, 2023, American Nephrology Nurses Association (ANNA) Fall Meeting, Hilton Chicago, Chicago, IL. www.annanurse.org/events/2023-nephrology-nursing-practice-management-leadership-conference or call 888-600-2662. November 2-5, 2023, American Society of Nephrology (ASN) Kidney Week 2023, Pennsylvania Convention Center, Philadelphia, PA. www.asn-online.org/education or call 866-849-8868. April 13-16, 2024, International Society of Nephrology (ISN) World Congress of Nephrology 2024, Buenos Aires, Argentina. Visit www.theisn.org/wcn. April 14-17, 2024, American Nephrology Nurses Association (ANNA) 2024 Natl Symp Caribe Royale All Suite Hotel Convention Cent Orlando, FL. www.ananurse.org/events/2024-national-symposium or call 888-600-2662 May 14-18, 2024, National Kidney Foundation (NKF) Spring Clinical Meeting, Long Beach, CA. Visit www.kidney.org. or call 800-622-9010. May 23-26, 2024, 61st European Renal Association-European Dialysis and Transplantation Association (ERA-EDTA) Congress, Stockholmsmassan, Stockholm, Sweden, [email protected]. August 28-31, 2024, International Society on Renal Nutrition and Metabolism, 21st Congress of the International Society of Renal Nutrition and Metabolism, Hyderabad, India. www.icrnm2024.com. September 26-29, 2024, International Society for Peritoneal Dialysis, 40th Anniversary Congress, Dubai, UAE. www.ispd.org/dubai2024.

An International Survey of Peritoneal Dialysis Exercise Practices and Perceptions

Low activity levels and poor physical function are associated with technique failure and mortality in people receiving peritoneal dialysis (PD). Adequate levels of physical function are required to maintain independence for people choosing this predominantly home-based therapy. The objective of this study was to identify the exercise-related perceptions and practices of PD clinicians globally. We conducted a cross-sectional survey of PD clinicians from English-, Thai-, Spanish-, and Portuguese-speaking PD-prevalent countries exploring clinicians' perceptions and practices of swimming, activity following PD catheter insertion, lifting, and falls prevention. This study was convened by the International Society of Peritoneal Dialysis and Global Renal Exercise Network between July and December2021. Of 100 of the highest PD-prevalent countries, 85 responded and were represented in the findings. A total of 1125 PD clinicians (448 nephrologists, 558 nephrology nurses, 59 dietitians, and 56 others) responded from 61% high-income, 32% upper middle-income and 7% lower middle-income countries. The majority (n= 1054, 94%) agreed that structured exercise programs would be beneficial for people receiving PD. Most respondents believed people on PD could perform more exercise (n= 907, 81%) and that abdominal strengthening exercises could be safely performed (n= 661, 59%). Compared to clinicians in high-income countries, clinicians from lower middle-income status (odds ratio [OR], 5.57; 1.64 to 18.9) are more likely to promote participation in physical activity. Clinicians know the importance of physical activity in people receiving PD. Exercise counseling and structured exercise plans could be included in the standard care of people receiving PD to maintain independence.

Enhancing practice in kidney care: a renal nursing course

This report introduces the launch of an online course, Enhancing practice in kidney care, a renal nursing course developed by the Association of Nephrology Nurses (ANN) UK

Compliance to Haemodialysis Regimen among End-stage Renal Disease Patients: A Case Study of three Selected Hospitals in Kwara State, Nigeria

Aims: The study investigated the determinants of compliance and outcomes of haemodialysis regimens among patients with end-stage renal disease (ESRD) in Ilorin, Kwara State. Background: Chronic kidney disease (CKD), also known as chronic kidney failure, is the persistent decline in glomerular filtration rate (GFR) for more than three months and it often progresses to (ESRD) with permanent loss of kidney function and increased mortality. Objective: The study investigated the determinants of compliance and outcomes of haemodialysis regimens among patients with ESRD in Ilorin, Kwara State. Methods: Total population and purposive sampling techniques were used to guide the recruitment of 80 participants. The research design was descriptive and cross-sectional research designs using quantitative strategy. Socio-demographic data and compliance level for haemodialysis regimen were determined using standardized questionnaire while biophysical measurements and laboratory investigations were used to determine treatment outcomes. Descriptive and inferential statistics were used for data analysis. Results: Findings from the study revealed that 66.3% of the participants were 41 years and above, 45% had up to tertiary education while 76.3% of the participants relied on family members for treatment funding. Regarding treatment compliance, 58.8% and 47.5% had moderate compliance to fluid and diet, respectively. Barriers to compliance were transportation logistics (50%), haemodialysis side effects with machine malfunction (52.2%), changes in lifestyle (50%) and cost (41.3%). Conclusion: Exorbitant nature of haemodialysis treatment militated against good outcomes. Thus, nephrology nurses and other healthcare professionals should intensify efforts to promote treatment adherence among patients with ESRD. Government and other policymakers could assist in subsidizing the cost of haemodialysis therapy to aid compliance and improve treatment outcomes. Thereby, promoting patients’ quality of life with a reduction in mortality rate.

May Meeting Announcements

May 7-10, 2023, American Nephrology Nurses Association 2023 National Symposium, Renaissance Palm Springs & Palm Springs Convention Center, Palm Springs, California. www.annanurse.org/events/2023-national-symposium or call 888-600-2662. June 3-7, 2023, American Transplant Congress 2023, San Diego Convention Center, San Diego, California. www.atcmeeting.org/# or call 703-414-7870. June 15-18, 2023, 60th European Renal Association-European Dialysis and Transplantation Association Congress, Milano Convention Center, Milan, Italy. [email protected]. October 7-10, 2023, Academy of Nutrition and Dietetics, Food and Nutrition Conference and Expo 2023, Colorado Convention Center, Denver, Colorado. www.eatright.org/FNCE or call 800-877-1600 ext. 4862. October 14-16, 2023, American Nephrology Nurses Association Fall Meeting, Hilton Chicago, Chicago, Illinois. www.annanurse.org/events/2023-nephrology-nursing-practice-management-leadership-conference or call 888-600-2662. November 2-5, 2023, American Society of Nephrology Kidney Week 2023, Pennsylvania Convention Center, Philadelphia, Pennsylvania. www.asn-online.org/education or call 866-849-8868. May 14-18, 2024, National Kidney Foundation Spring Clinical Meeting, Long Beach, California. Visit www.kidney.org. or call 800-622-9010. August 28-31, 2024, International Society on Renal Nutrition and Metabolism, 21st Congress of the International Society of Renal Nutrition and Metabolism, Hyderabad, India. www.icrnm2024.com. September 26-29, 2024, International Society for Peritoneal Dialysis, 40th Anniversary Congress, Dubai, the United Arab Emirates. www.ispd.org/dubai2024.

Importance of physical exercise prescription in patients with chronic kidney disease: results of the survey of the Grupo Español Multidisciplinar de Ejercicio Físico en el Enfermo Renal [Spanish Multidisciplinary Group of Physical Exercise in Kidney Patients] (GEMEFER)

IntroductionDespite the benefits of physical exercise (PE) for patients with chronic kidney disease (CKD), the number of Nephrology services that have PE programs is limited. ObjectivesTo describe the degree of knowledge of PE benefits in patients with CKD among professionals, as well as the level of implementation and characteristics of PE programs in Nephrology services in Spain. MethodsA questionnaire on the degree of knowledge and prescription of PE in patients with CKD was designed and sent to members of the Spanish Nephrology and Nephrology Nursing Societies, as well as to physiotherapists and professionals in the Sciences of Physical Activity and Sport (PASS). Results264 professionals participated. 98.8% agreed on the importance of prescribing PE, but only 20.5% carry out an assessment of functional capacity and 19.3% have a PE program for patients with CKD in their centre. The most frequent programs are performed for haemodialysis patients and strength and aerobic resistance exercises are combined. A physiotherapist or a PASS usually participates in its prescription. The main barriers were the absence of human and/or physical resources and the lack of training. ConclusionsHealthcare workers know the benefits of PE in patients with CKD. However, the implementation of these programs in Spain is low, motivated by the lack of resources and training of professionals. We must establish strategies to guarantee an adequate functional capacity within the care of our patients.