Nephrology Nurses Research Articles

Self‐reported subjective sleep quality and fatigue in patients with peritoneal dialysis treatment at home

The aim of this study was to describe habitual sleep, daytime symptoms, sleep-disturbing factors, current sleep during 1 week and fatigue in patients with peritoneal dialysis treatment at home and also discover predictions for sleep quality outcome. The knowledge should increase possibilities for supportive nursing health care. Fifty-five patients answered two mailed questionnaires and filled in a sleep diary. Of these, 60% had moderate, persistent sleep problems combined with daytime symptoms. Nocturnal awakenings with difficulties falling asleep again and a sleep duration predicted as 57% of sleep quality. Nocturnal pruritus and 'difficulties finding a comfortable sleeping position' were significant sleep-disturbing factors. Sleep quality predictors means progress in knowledge about the complexity of the situation for peritoneal dialysis patients. Poor sleep, daytime symptoms, sleep-disturbing factors and chronic fatigue need to be enlightened, especially for the nephrology nurses who are in a unique position to give supportive nursing health care.

The acquisition and exercise of nephrology nursing expertise: a grounded theory study

This purpose of this study was to describe the process of expertise acquisition in nephrology nursing practice. It has been recognized for a number of decades that experts, compared with other practitioners in a number of professions and occupations, are the most knowledgeable and effective, in terms of both the quantity and quality of output. Studies relating to expertise have been undertaken in a range of nursing contexts and specialties; to date, however, none have been undertaken which focus on nephrology nursing. This study, using grounded theory methodology, took place in one renal unit in New South Wales, Australia and involved six non-expert and 11 expert nurses. Simultaneous data collection and analysis took place using participant observation, semi-structured interviews and review of nursing documentation. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Each stage was typified by four characteristics, which altered during the acquisitive process; these were knowledge, experience, skill and focus. This was the first study to explore nephrology nursing expertise and uncovered new aspects of expertise not documented in the literature and it also made explicit other areas, which had only been previously implied. Relevance to clinical practice. Of significance to nursing, the exercise of expertise is a function of the recognition of expertise by others and it includes the blurring of the normal boundaries of professional practice.

Uncovering the evidence of non‐expert nephrology nursing practice

Expertise in nursing has been widely studied although there have been no previous studies into what constitutes expertise in nephrology (renal) nursing. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, provides evidence of the characteristics and practices of non-expert nephrology nurses. Using the grounded theory method, the study took place in one renal unit in New South Wales, Australia, and involved six non-expert and 11 expert nurses. Sampling was purposive then theoretical. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semistructured interviews was undertaken. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Non-expert nurses showed superficial nephrology nursing knowledge and limited experience; they were acquiring basic nephrology nursing skills and possessed a narrow focus of practice.

DEVELOPMENT OF INDICATORS TO MEASURE

This paper describes a study to capture the key roles and activities of nephrology nurses across different countries in Europe. The concept of the study and the need to clarify the activities of the nephrology nurse arose as part of a larger study to develop the European Practice Database (EPD) (1). The Research Board (EDTNA/ERCA) needed to identify key questions that would detect significant differences in the role and responsibilities of nephrology nurses in different countries and monitor the evolution over time of nephrology nursing practice in Europe. It was therefore appropriate to devise a separate small study to generate evidence based questions for the EPD and confirm the reliability and usefulness of the information captured.

THE EUROPEAN POST-BASIC CORE CURRICULUM (PBCC) 2nd EDITION FOR NEPHROLOGY NURSING: PROGRESS UPDATE

It is ten years since the publication of the first edition of the Post-Basic Core Curriculum (PBCC) and following a review of this edition, by the Education Board of the EDTNA/ERCA, a second edition of the PBCC was published in 2004. This edition is currently available as a hard copy and on CD-ROM. The second edition includes changes to the structure and content of the curriculum, which reflects contemporary developments in Renal Care and Nephrology Nursing.

CURRENT PRACTICE IN RENAL ANAEMIA MANAGEMENT: TWO MULTINATIONAL SURVEYS

The European Best Practice Guidelines recommend that 85% of patients with standard causes of chronic renal failure should achieve a target haemoglobin concentration of > or = 11 g/dL. However, patient outcomes need to be improved as many patients respond suboptimally to treatment and fail to reach these targets. Two multinational surveys of nursing practice in the management of renal anaemia in northern (with comparative data from Australia) and southern Europe were conducted. The aim was to assess variations in the role and amount of responsibility delegated to nurses in renal units throughout Europe and Australia. Patient care could be optimised by developing formal training and educational programmes for nephrology nurses and this has already occurred in many units in the UK.

Reflections and Visions: 50 Years of Presidential Addresses

Reflections and Visions: 50 Years of Presidential Addresses

ESTABLISHING NEPHROLOGY NURSING SPECIALIZATION IN JAPAN: A MATTER OF URGENCY

This paper explores the current situation regarding the provision of renal services to patients with end-stage renal disease in Japan. The statistical data reveal that Japan is in a predicament regarding the current rate of incidence of end-stage renal disease in the population. The discussion highlights the fact that nephrology nursing practice is as yet not recognised as a speciality in its own right in Japan. Therefore Japanese nurses who work in the field of nephrology are still struggling to establish their own professional identity and to improve the professional level of their practice. This situation persists in Japan despite support from the literature, which confirms that appropriately qualified nephrology nurses are well equipped to provide specialised care. The recent decision by the Japanese Association of Nephrology Nurses is to establish the position of the specialised dialysis nurse, which does not cover the area of kidney transplantation and will start in 2004. It is expected that it will be an important challenge to improve professional skills and nephrology nursing status in Japan.

Renal nursing research, evidence-based practice and education — A European perspective

This paper describes the main challenges faced by professionals working in nephrology, dialysis and transplantation across Europe and evaluates how far the work of the European Dialysis and Transplant Nurses' Association/ European Renal Care Association (EDTNA/ERCA) supports its members by promoting the advancement of renal care through research and continuous professional development. Research studies include collaborative projects on vascular access, renal nutrition, pre-dialysis counselling, the treatment of water for dialysis, peritoneal dialysis catheter care, and the management of hepatitis C virus. The newly formed European Practice Database is also described. Educational projects include the development of a professional portfolio framework, European basic and post-basic curricula for nephrology nursing and the EDTNA/ERCA accreditation of post-basic nephrology nursing courses.

EDTNA/ERCA vascular access recommendations for nephrology nurses.

In 1989, SJ. Schwab stated that providing satisfactory vascular access for haemodialysis remains one of the most challenging problems confronting the nephrology team (1). Successful long-term haemodialysis in patients with end-stage renal failure depends to a large extent upon a trouble-free vascular access. Unfortunately, the creation as well as the use, maintenance and the treatment of vascular access complications nowadays still remain a serious clinical problem despite pharmacological and technical advances during the last decade (2). Even today, vascular access failure and complications form a major cause of morbidity leading to a high percentage (20 to 30 %) of hospitalization in the dialysis population (3). Moreover, we are confronted all over the world with a clinically complicated patient population, such as diabetics, patients with advanced atherosclerosis, cardiac and peripheral vascular diseases. Also the increased blood viscosity due to the systematic use of erythropoietin and the use of high blood flows in modern dialysis therapy necessitates a vascular access of excellent quality.

Nephrology nursing: blurring the boundaries: the reality of expert practice

Expertise in nursing has been widely studied; there have been no previous studies into what constitute expertise in nephrology (renal) nursing. This paper describes a 'real-world' characteristic of expert nephrology nursing practice. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept blurring the boundaries. The study utilized grounded theory methodology and symbolic interactionism. The study took place in one renal unit in New South Wales. Sampling was purposive then theoretical; the sample consisting of six non-expert and eleven expert nurses. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semi-structured interviews was undertaken. The study revealed that only expert nephrology nurses 'blurred the boundaries' of professional nursing practice. They did this by moving intermittently and purposefully, for the benefit of particular patients, into medical domains in the areas of prescribing, dispensing and ordering of pathology tests. Non-expert nurses did not cross these professional boundaries. Blurring the boundaries was a significant feature of expert nursing practice, and this study was the first to describe explicitly nursing boundaries as two distinct entities; that is, formal and informal. There are some nephrology nurses who have sufficient knowledge and experience to prescribe some medications and to order certain investigations.

Increasing African-American Living Kidney Donors

This article endeavors to suggest that there may be a better chance of attenuating the gap between the supply and demand of kidney organs for African-American patients, by increasing the number of living donors. Among the multiple issues focused on are the contrasting dynamics between cadaver and living kidney donations with this population. The dual importance of adequate information and providing it in a face-to-face approach with African-American family members is also discussed. The final focus is on the strategic position of nephrology nurses and social workers, in potentially helping to increase the number of African-American living kidney donors.

The European Basic Core Curriculum for Nephrology Nursing, the process of writing, publishing and disseminating.

In August 2002 the European Basic Core Curriculum (BCC) for Nephrology Nursing was published on the EDTNA/ERCA homepage. At the EDTNA/ERCA annual conference in The Hague in September 2002, it was presented to the delegates as an oral presentation and a poster presentation. Publicity flyers were translated into seven languages and distributed to delegates. This paper will describe the aims of the BCC, the process of writing and publishing, the use of the BCC in nursing schools and the measures that have already been taken in implementation and dissemination.

Validity Surveys: Selected NOC Physiologic Outcomes

PURPOSE To measure and provide evidence supporting the use of NOC as a nursing standardized language. METHODS Initially, the group used nursing resources and concept analyses to determine physiologic outcomes important to nursing care and demonstrate contributions of nurses to patient care. After refinement by the NOC team, outcome and indicators were approved and content validity surveys sent to members of the American Association of Nephrology Nurses. A modified Fehring's Diagnostic Content Validity Model was used to determine validity. Respondents used a 5-point Likert-type scale. Each indicator was rated and a weight assigned, and a mean for each indicator was determined. Results of the importance and contribution scores were interpreted using ≥.80 to indicate a “critical” indicator, and ≥.60 to indicate “important” indicators. FINDINGS There were 59 total responses with 45 valid cases. The nurses had worked an average of 21.4 years. Twenty-five of the nurses were involved in implementing standardized language, including care-planning systems. The majority, 95%, held master's degrees in nursing and 82.2% were certified. All results were analyzed for both contribution and importance using the established method to determine critical and important indicators in both categories. Hydration: 13 indicators analyzed. ▪ Contribution: No critical indicators; 11 were rated important (range: 60–77). ▪ Importance: 8 indicators rated critical. The 4 highest were shortness of breath not present (.90), blood pressure within normal limits (.89), peripheral edema not present (.88), and adventitious breath sounds not present (.88). Five were rated important (range: 69–78). Urinary Incontinence: 19 indicators analyzed. ▪ Contribution: No critical indicators; 9 were rated important (range: 61–74). ▪ Importance: 5 indicators were rated critical, the 3 highest being recognizes urge to void (.88), absence of urinary tract infection (.86), and absence of postvoid residual (.85) (range: 67–88). Dialysis Access Integrity: 15 indicators analyzed. ▪ Contribution: 3 were rated critical: drainage at site not present (.83), hematoma at site not present (.82), and bleeding at site not present (.81). There were 11 important indicators (range: 60–78). ▪ Importance: 7 were rated critical, the 3 highest being bruit (.97), thrill (.95), and drainage at site not present (.95). Seven were rated as important (range: 64–77). Systemic Toxin Clearance–Dialysis: 14 indicators analyzed. ▪ Contribution: No critical indicators and 12 important indicators (range: 60–78). ▪ Importance: 5 were rated critical, the top 3 being adheres to dialysis schedule (.95), urea reduction ratio (.95), and blood potassium within normal limits (.88). Nine were rated important (range: 63–77). DISCUSSION Based on these results, the indicators are representative of the outcomes. Analyses of the indicators supported an overall level of agreement. The highest averages were in two outcomes related to patients undergoing dialysis, which may be because the nurses cared for a specific target group. CONCLUSIONS The importance of indicators was rated more highly than the nursing contribution. Most of the indicators were judged quite or very important. The outcomes are nursing sensitive, and nursing is more influential than other disciplines for most of the outcomes.

Nursing issues related to patient selection, vascular access, and education in quotidian hemodialysis

Background: Increased interest in quotidian hemodialysis (HD) programs requires that nephrology nurses have a larger role in transitioning patients to more frequent HD. Nursing issues include the selection, training, and education of patients before they begin more frequent HD therapy. Methods: The London Daily/Nocturnal Hemodialysis Study directly compared data from patients undergoing either short daily HD (n = 11) or long nocturnal HD (n = 12) with those undergoing conventional thrice-weekly HD (n = 22). Patient training, education, safety, and vascular access data were collected. Results: The patient training period varied from 10 to 25 days, with an average length of 16.64 days. Patients used 1 of 3 types of vascular access: native arteriovenous (AV) fistulae, grafts, or central catheters. No statistically significant differences in access flow rates between the study and control groups were noted or when comparing different types of access. A significant decrease in catheter infection rate was seen when patients switched to daily HD therapy. Patient cannulation surveys showed that patients with AV fistulae or grafts showed improvements with ease and comfort as the study progressed, and patients widely preferred the buttonhole technique to the rotating-needle method for cannulation. Conclusion: With growing interest in the development of quotidian HD programs, HD nursing personnel face the exciting challenge of improving on existing training programs and treatment modalities.

A study on the projected workforce of nephrology clinical nurse specialist (CNS) in Korea

The purpose of this study was to study the projected workforce of nephrology CNS in Korea. Need models, ratio methods and expert opinion were used for projecting needs for the nephrology CNS. In 2001, there are 28,046 ESRD(end stage of renal disease)patients, 304 renal replacement centers and 1695 nephrology nurses in Korea. the hemodialysis patients per hemodialysis nurse was 12. The number of nephrology CNS required to meet the demand for caring of ESRD patients in 2002, 2005 and 2020 was estimated at 616, 837 and 3105, respectively. 47 ESRD patients per nephrology CNS was revealed as a workforce standard before 2005. After 2005, It was 31 ESRD patients per nephrology CNS. This study founded the need to project future increments and development in supply of qualified nephrology CNS.

European Basic (Pre‐registration) Core Curriculum in Nephrology Nursing

European Basic (Pre‐registration) Core Curriculum in Nephrology Nursing

Scientific production of nursing about insertion of intravenous catheter arteriovenous fistulae: implications for nurse of substitutive renal therapy

The present study tells a bibliographical revision about the nursing intervention of intravenous catheter insertion at arteriovenous fistulae(AVF), with the objective of knowing the literature regarding the subject. It was used in that study the exploratory research, with bibliographical risings through manual and computerized search, from 1979 to 2001. The nursing prescriptions related to the insert of intravenous catheter in AVF include the preoperative orientations, the technique of insert of the intravenous catheter and the selfcare orientations. At the end of the bibliographical rising, it was noticed that, in spite of the insert of intravenous catheter in AVF to be so important and routine in practice of the nephrology nursing, the production scientific nursing Brazilian is scarce regarding that prescription, unlike the foreign scientific production.

A decade review: methods to improve adherence to the treatment among haemodialysis patients.

Haemodialysis patients are asked to adhere to a very difficult treatment regimen consisting of fluid and diet restrictions, many daily medications, and usually 3 or 4 hour haemodialysis sessions three times each week. Many haemodialysis patients fail to adhere to their prescribed treatment and although this regimen is difficult, it is necessary for patients to adhere for optimal health and well-being. It is important for nephrology nurses to know what interventions help patients overcome the barriers that keep them from adhering to prescribed treatment The purpose of this paper is to review the literature to examine the research that has been published on methods to improve adherence among haemodialysis patients. Behavioural approaches, education, and primary nursing are interventions that have been researched More research has been reported on the demographics of noncompliant haemodialysis patients than on effective methods that help patients improve adherence to the treatment regimen. Demographic characteristics do not consistently predict compliance for individual patients. Each patient is unique. Research supports the idea that the nephrology nurse should spend time with the patient on a regular basis in order to understand the factors that hinder the individual patient from adhering to the treatment regimen. The nurse who knows the patient well is empowered to develop individualised interventions aimed at reducing barriers that interfere with the patient's ability to adhere to treatment.

Pre‐registration Nephrology Nursing

EDTNA-ERCA JournalVolume 27, Issue 1 p. 55-56 Pre-registration Nephrology Nursing Maria Saraiva, Maria Saraiva Education Board MemberSearch for more papers by this author Maria Saraiva, Maria Saraiva Education Board MemberSearch for more papers by this author First published: 30 July 2012 https://doi.org/10.1111/j.1755-6686.2001.tb00138.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume27, Issue1January‐March 2001Pages 55-56 RelatedInformation