Renal Nurses Research Articles

Can a renal nurse assess fluid status using ultrasound on the inferior vena cava? A cross-sectional interrater study.

Ultrasound of the inferior vena cava (IVC-US) has been used to estimate intravascular volume status and fluid removal during a hemodialysis session. Usually, renal nurses rely on other, imprecise methods to determine ultrafiltration. To date, no study has examined whether renal nurses can reliably perform ultrasound for volume assessment and for potential prevention of intradialytic hypotension. This pilot study aimed to determine if a renal nurse could master the skill of performing and correctly interpreting Point of Care Ultrasound on patients receiving hemodialysis. After receiving theoretical training and performing 100 training scans, a renal nurse performed 60 ultrasound scans on 10 patients. These were categorized by the nurse into hypovolemic, euvolemic, or hypervolemic through measurement of the maximal diameter and degree of collapse of the IVC. Scans were subsequently assessed for adequacy and quality by two sonologists, who were blinded to each other's and the nurse's results. The interrater reliability of 60 scans was good, with intraclass correlation 0.79 (95% confidence interval (CI) =0.63-0.87) and with a good interrater agreement for the following estimation of intravascular volume (Cohen's weighted Kappa κw = 0.62), when comparing the nurse to an expert sonographer. A renal nurse can reliably perform ultrasound of the IVC in hemodialysis patients, obtaining high quality scans for volume assessment of hemodialysis patients. This novel approach could be more routinely applied by other renal nurses to obtain objective measures of patient volume status in the dialysis setting.

SUN-P148: Exploring Nutritional Support Practices in Renal Nurses in Hemodialysis Units Worldwide – Results of a Pilot Study

SUN-P148: Exploring Nutritional Support Practices in Renal Nurses in Hemodialysis Units Worldwide – Results of a Pilot Study

Carole Robinson—Renal Home Therapies Nurse of the Year

This year's British Journal of Nursing awards featured a brand new category for nurses specialising in kidney care. The title of Renal Home Therapies Nurse of the Year was given to dialysis specialist Carole Robinson. Here, she talks about what the award means to her and discusses the extensive work she undertook with prison nurses leading up to this achievement.

Renal telemedicine through video-as-a-service delivered to patients on home dialysis: A qualitative study on the renal care team members' experience.

The Lancashire Teaching Hospitals NHS Trust in the UK has been providing renal care through video-as-a-service (VAAS) to patients since 2013, with support from the North West NHS Shared Infrastructure Service, a collaborative team that supports information and communication technology use in the UK National Health Service. Renal telemedicine offered remotely to patients on home dialysis supports renal care through the provision of a live high-quality video link directly to unsupported patients undergoing haemodialysis at home. Home haemodialysis is known to provide benefits to patients, particularly in making them more independent. The use of a telemedicine video-link in Lancashire and South Cumbria, UK, further reduces patient dependence on the professional team. The purpose of this paper is to present the perspectives of the renal care team members using the renal telemedicine service to understand the perceived benefits and issues with the service. Ten semi-structured interviews with members of the renal care team (two renal specialists, one matron, two renal nurses, one business manager, one renal technical services manager, two IT technicians and one hardware maintenance technician) were conducted. Thematic analysis was undertaken to analyse the qualitative data. A range of incremental benefits to the renal team members were reported, including more efficient use of staff time, reduced travel, peace of mind and a strong sense of job satisfaction. Healthcare staff believed that remote renal care through video was useful, encouraged concordance and could nurture confidence in patients. Key technological issues and adjustments which would improve the renal telemedicine service were also identified. The impact of renal telemedicine was positive on the renal team members. The use of telemedicine has been demonstrated to make home dialysis delivery more efficient and safe. The learning from staff feedback could inform development of services elsewhere.

Psychology in kidney care: an inherent part of practice

Although the link between psychology and kidney care may not be entirely obvious to everyone at first, renal nurses and other members of the multidisciplinary team spend a large amount of time helping people shoulder the emotional burden of kidney disease. In the first article of a new series, Aysha Mendes explains how this link manifests, and why it is so important to those who provide care.

British Renal Society to develop first UK Renal Nurse Association

Vice Presidents of the British Renal Society are leading on the formation of a UK Renal Nurse Association. At present, a formal renal nurse association does not exist, meaning there is no single voice representing either registered or non-registered nurses working in the field of kidney care. Karen Jenkins and Paula Ormandy discuss the results of a recent nurse survey and focus group.

Social Risk Factors and Performance Under Medicare's Value-Based Purchasing Programs.

Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-based Purchasing Programs.1 US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. December 21, 2016. ### Policy Context Value-based purchasing (VBP), or pay-for-performance, comprises a growing portion of Medicare payment and the changes in physician payment enacted in the Medicare and Children's Health Insurance Program Reauthorization Act are likely to accelerate these trends even further.2 Simultaneously, there is growing consensus that social risk factors—such as income, race and ethnicity, and community environment—play a major role in health.3–5 Persistent and meaningful gaps exist in health and even in life expectancy based on these factors.6–9 These 2 issues intersect in VBP. If beneficiaries with social risk factors have worse health outcomes because of factors beyond providers’ control, providers could be unfairly disadvantaged under VBP. On the contrary, if beneficiaries with social risk factors have worse health outcomes because the providers serving them provide low-quality care, the financial incentives and accountability of VBP could be an important strategy for improving care and reducing disparities. In 2014, Congress passed the Improving Medicare Postacute Care Transformation Act (IMPACT),10 which required that the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the US Department of Health and Human Services complete an empirical report addressing the issue of social risk in Medicare’s current VBP programs to assist Congress in further decision making on this issue. The report covered here is the first component of the required work, which was submitted to Congress in December 2016. The ASPE report may have particular salience to cardiovascular clinicians, who practice every day in an environment significantly impacted by VBP. Many current quality measures in inpatient and outpatient VBP programs are cardiovascular in nature; patients …

Use of ultrasound by registered nurses—a systematic literature review

In Western Australia (WA), most stable patients undergoing haemodialysis receive treatment in a satellite setting where no doctors are on-site during treatment hours, so nurses must make critical decisions about fluid removal. Some patients regularly experience adverse events during dialysis (intradialytic), often due to excessive ultrafiltration goals, with intradialytic hypotension being particularly challenging. Ultrasound of the inferior vena cava has been previously demonstrated being a rapid and non-invasive method for volume assessment on haemodialysis patients, thus could hold valuable information for the treating nurse. This paper examines the existing literature in regards to the use of ultrasound measurements of the inferior vena cava in patients on haemodialysis for objective assessment of their intravascular volume status by renal nurses. A systematic literature review was performed within medical and nursing databases including CINAHL Plus with Full Text, SCOPUS, Web of Science and MEDLINE. Renal nurses are conscious of the significance of intradialytic hypotension and have only limited options for its prevention. Ultrasound of the inferior vena cava could add another objective dimension for intravascular volume assessment and prevention of intradialytic hypotension, but to date renal nurses have not been using this technique. Ultrasound of the inferior vena cava has the potential to assist in defining the ultrafiltration goal for that particular dialysis session, thus reducing the risk of intradialytic hypotension. Additionally, it has potential to change current renal nursing practice when added to clinical nursing assessment methods. Further studies are required to validate this assessment tool carried out by a renal nurse compared with a skilled ultrasonographer.

Research insights: views from the PIVOTAL coalface

The PIVOTAL trial—the largest renal clinical trial ever undertaken in the UK—has now reached its target of 2080 patients across 50 renal units nationwide. In this month's column, Angela Lumsdon shares the insights and opinions of three of the renal research nurses involved in the trial, including what it is like taking part in such an enormous project.

Clinical research nursing: a possible career pathway for renal nurses

Clinical research nursing is a fulfilling career opportunity for those seeking new challenges in the health-care sector. In this article, Christine Catley describes how this alternative career path can not only develops a nurse's own scientific knowledge, but can also drive engagement, as the role of research nurse is both highly rewarding and patient-centred.

Educational strategies and challenges in peritoneal dialysis: a qualitative study of renal nurses' experiences.

The aim of the study was to explore renal nurses' experiences, strategies and challenges with regard to the patient education process in peritoneal dialysis. Patient education in peritoneal dialysis is essential to developing a successful home-based peritoneal dialysis program. In this area research is scarce and there is a particular lack of focus on the perspective of the renal nurse. Qualitative design formed by thematic qualitative text analysis. Five group interviews (n=20) were used to explore the challenges peritoneal dialysis nurses face and the training strategies they use. The interviews were analyzed with thematic qualitative content analysis using deductive and inductive subcategory application. The findings revealed the education barriers perceived by nurses that patients may face. They also showed that using assessment tools is important in peritoneal dialysis patient education, as is developing strategies to promote patient self-management. There is a need for a deeper understanding of affective learning objectives, and existing teaching activities and materials should be revised to incorporate the patient's perspective. Patients usually begin having questions about peritoneal dialysis when they return home and are described as feeling overwhelmed. Adapting existing conditions is considered a major challenge for patients and nurses. The results provided useful insights into the best approaches to educating peritoneal dialysis patients and served to raise awareness of challenges experienced by renal nurses. Findings underline the need for nosogogy - an approach of teaching adults (andragogy) with a chronic disease. Flexibility and cooperation are competencies that renal nurses must possess. Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy.

Nursing resources for earlier and better end-of-life care

The UK is renowned for its provision of high-quality end-of-life care. In the latest article in a series on palliative care, Aysha Mendes stresses the importance of renal nurses making use of the resources available to them, as these can help educate and encourage confidence.

What is being done in the world's top-ranking palliative care nation?

With an extensive integration of palliative care into the NHS and comprehensive national policies in place, the UK is consistently recognised as one of the best countries in the world with regards to end-of-life care. Aysha Mendes explains how renal nurses play an important part.

How are families taught to look after their children on peritoneal dialysis?

For patients to be started on peritoneal dialysis (PD), they need to be trained on how to perform dialysis at home. Understanding how to carry out dialysis is difficult for adults, but perhaps even more challenging for parents of children. This study was performed to examine the PD teaching programs for parents of children with end-stage renal disease (ESRD) and to explore the issues related to educating parents of children with ESRD. A survey method was used to carry out the research through the distribution of self-completed questionnaires to pediatric dialysis units (ten units) in Saudi Arabia in both governmental and non-governmental hospitals. The questionnaire content was identified using information gained from other research performed in the field of home PD training. The questionnaire was piloted with experienced renal nurses. Questionnaires were distributed to 87 specialized nurses within the ten PD units. Descriptive statistical analysis SPSS (19.00) was used to analyze the data. Statistical tests were used to distinguish the relationship and the significant effects between variables. The response rate was 72% (n=63). Peritonitis rates varied in each hospital, and ranged from zero to three episodes per patient-year (median 1.17 episodes per patient-year). There was a significant association between home visits and peritonitis rates (P<0.01). This study has provided an initial overview of pediatric PD training programs in Saudi Arabia and has provided valuable data in this regard.

Working towards independence.

Specialist nurse Diane Walker believes self-care dialysis units in hospitals signal a new era for renal nursing, writes Catherine Sadler

Spirituality in Renal Supportive Care: A Thematic Review.

Chronic kidney disease is marked by a reduced life expectancy and a high symptom burden. For those who reach end-stage renal disease, the prognosis is poor, and this combined with the growing prevalence of the disease necessitates supportive and palliative care programmes that will address people’s psychosocial, cultural and spiritual needs. While there is variation between countries, research reveals that many renal specialist nurses and doctors are reluctant to address spirituality, initiate end-of-life conversations or implement conservative treatment plans early. Yet, other studies indicate that the provision of palliative care services, which includes the spiritual dimension, can reduce symptom burden, assist patients in making advanced directives/plans and improve health-related quality of life. This review brings together the current literature related to renal supportive care and spirituality under the following sections and themes. The introduction and background sections situate spirituality in both healthcare generally and chronic kidney disease. Gaps in the provision of chronic kidney disease spiritual care are then considered, followed by a discussion of the palliative care model related to chronic kidney disease and spirituality. Chronic kidney disease spiritual needs and care approaches are discussed with reference to advanced care planning, hope, grief and relationships. A particular focus on quality of life is developed, with spirituality named as a key dimension. Finally, further challenges, such as culture, training and limitations, are explicated.

More listening, less talking: difficult decisions in withdrawing dialysis

For those with advanced chronic kidney disease, the questions and options surrounding withdrawal from dialysis are complicated and multifaceted. When approaching such a difficult decision, renal nurses may be best placed in providing much needed support to patients.

PAlliative Care in chronic Kidney diSease: the PACKS study--quality of life, decision making, costs and impact on carers in people managed without dialysis.

BackgroundThe number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK.MethodsIn this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to ‘opt-in’ with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists.DiscussionThe study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

Fifth priority of care: acknowledging patients' preferences

The Liverpool Care Pathway has been recently phased out in favour of new priorities of care. In her regular column, Aysha Mendes delves into the rapidly evolving world of end-of-life care and explores what it all means for renal nurses who are caring for patients with end-stage renal disease.

Understanding peritoneal dialysis: an intrinsic part of safe patient care

For many patients with established kidney disease, peritoneal dialysis is an important therapy option, one which can be undertaken in either the outpatient or hospital setting. In this informative article, Peter Ellis considers the basic biological processes that make peritoneal dialysis work and emphasises the importance for renal nurses to understand this.