Journal of renal care最新文献

Objectives

To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to the Advanced Practice Nurse model.

Design

Descriptive, cross-sectional study.

Participants and Measurements

All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the ‘Advanced Practice Nurse Role Definition Instrument (IDREPA)’ were administered to assess the nurses' level of competence development.

Results

Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activity and 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty-seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of ‘expert care planning’ and ‘comprehensive care’. Three (11.1%) nurses met all criteria for advanced nursing practice.

Conclusion

The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses.

Implications for Clinical Practice

Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained.

Background

Despite albumin-creatinine ratio (urine) testing being recommended for detection of chronic kidney disease among adults with diabetes, testing rates are suboptimal.

Aim

We implemented and evaluated a quality improvement project in an inner-city diabetes population in London, UK to assess the feasibility and acceptability of implementing novel home-based urinalysis using smartphone technology.

Methods

After eligible patients were identified and consented, testing kits were sent to the patient's home. Test results and patient feedback were collected through the smartphone application. Focus group discussions were conducted to evaluate primary care staff perspectives on uptake and delivery of the service.

Results

In total 2370 patients agreed to take part. Of these, 1244 completed the test (61% of those eligible) and of these, 465 (37%) had clinically significant albuminuria. 98% of patients found the test easy or very easy to use. Staff in primary care found the service to be beneficial for patients, and reported ease of set up and minimal administrative processes. Concerns regarding barriers among patients with lower digital literacy and non-English speakers were raised although these concerns were not substantiated.

Conclusion

Home-based albumin-creatinine ratio urine testing may improve the testing rates of people with diabetes at higher risk of chronic kidney disease. This is important post-pandemic, as healthcare services are trying to return to pre-pandemic levels of care. The study also found that the use of smartphone technology in an underserved (deprived) community is feasible, despite reservations about levels of digital literacy and possible language barriers. Further evaluation of effectiveness and costs is required.

Background

Little is known about the usefulness of decision coaching for people with kidney failure facing decisions about end-of-life care.

Objectives

To investigate experiences of people with kidney failure who received decision coaching for end-of-life care decisions.

Design

We conducted a prospective case study bound by time (September to December 2021), location (one nephrology department), and guided by the Ottawa Decision Support Framework.

Participants

Adults with kidney failure facing end-of-life care decisions.

Measurements

A nurse trained in decision coaching screened for unmet decisional needs with the SURE test and provided decision coaching using the Ottawa Personal Decision Guide. Postcoaching, the participants were rescreened using the SURE test and interviewed to explore their experience with decision coaching. Change in SURE test findings was analysed descriptively and systematic text condensation was used for the analysis of interviews. Recorded decision coaching sessions underwent content analysis using the Decision Support Analysis Tool.

Results

Decision coaching was provided to four adults with kidney failure. Median pre-SURE test score was 2.5 (range 2–4) and posttest score was 3 (range 3–4), indicating a decrease in decisional needs. Participants described that decision coaching provided an overview of features of options to consider, identified remaining decisional needs for further discussion with relatives and health professionals and clarified next steps. Median Decision Support Analysis Tool score was 9 (range 8–9).

Conclusions

After decision coaching, results suggest that the participants experienced fewer decisional needs and seemed clearer about the next steps in the decision making process.

Background

Depression is prevalent across the spectrum of Chronic Kidney Disease and associated with poorer outcomes. There is limited evidence regarding the most effective interventions and care pathways for depression in Chronic Kidney Disease.

Objectives

To investigate how depression is identified and managed in adults with Chronic Kidney Disease.

Design

Scoping review.

Methods

Systematic search of eight databases with pre-defined inclusion criteria. Data relevant to the identification and/or management of depression in adults with Chronic Kidney Disease were extracted.

Results

Of 2147 articles identified, 860 were included. Depression was most identified using self-report screening tools (n = 716 studies, 85.3%), with versions of the Beck Depression Inventory (n = 283, 33.7%) being the most common. A total of 123 studies included data on the management of depression, with nonpharmacological interventions being more frequently studied (n = 55, 45%). Cognitive Behavioural Therapy (n = 15) was the most common nonpharmacological intervention, which was found to have a significant effect on depressive symptoms compared to controls (n = 10). However, how such approaches could be implemented as part of routine care was not clear. There was limited evidence for antidepressants use in people with Chronic Kidney Disease albeit in a limited number of studies.

Conclusions

Depression is commonly identified using validated screening tools albeit differences exist in reporting practices. Evidence regarding the management of depression is mixed and requires better-quality trials of both pharmacological and nonpharmacological approaches. Understanding which clinical care pathways are used and their evidence, may help facilitate the development of kidney care specific guidelines for the identification and management of depression.

Background

Patients usually feel pain when a needle is inserted into the fistula. This acute pain can be relieved by acupressure, which is a nonpharmacological application method.

Objective

This study was designed to explore the effect of acupressure application to the Hegu point on the severity of acute pain caused by fistula needle insertion in patients with antecubital arteriovenous fistula.

Design

It is a randomised control study.

Participants

The study was conducted with 32 intervention and 32 control patients, recruited from a dialysis centre of a foundation university in Turkey between October 2021 and January 2022.

Measurements

Acupressure was applied 3 min before needle placement in the fistula area of the patients in the experimental group.

Result

While there was no decrease in the severity of acute pain during fistula needle insertion in the patients in the control group, there was a significant decrease in the mean acute pain severity scores experienced by the patients in the experimental group, whose Hegu point acupressure was applied.

Conclusion

The results of this study support the effectiveness of Hegu point acupressure as an effective and low-cost way to reduce the acute pain of needle insertion put on dialysis patients with a fistula. In addition, the results provide a practical reference for acute pain management for dialysis nurses.

Background

Nursing, between healthcare professions, is the most at risk of violence and aggression. Most healthcare organizations rely on training as the primary strategy for the prevention of violence. Very little is known about the key factors for prevention against nurses: staff education, training and risk assessment.

Objectives

The aim is to verify if the number of observed episodes of violence and aggression in renal units are associated with structural and prevention managerial strategies.

Design

An observational, cross-sectional study.

Participants

They were part of a convention sample of participants in the European Dialysis and Transplant Nurses Association/European Renal Care Association Conference of 2019, who understood the English Language and had a smartphone or tablet.

Measurements

The tool used was a questionnaire developed by Zampieron in 2010, with closed questions, focused on violence and aggression's prevention and management.

Conclusions

In conclusion our study found that organizational and managerial strategies to address violence and aggression are highly correlated with observed violence in unit. Nurses are encouraged to become proactive by participating in prevention committees and policies, attending prevention training offered by unit, and reporting all incidents including those witnessed.

Background

Peritonitis is a common cause of hospitalisation and death among patients undergoing peritoneal dialysis. Periodic retraining is recommended to prevent peritonitis, especially in older adults.

Objectives

We evaluated the effectiveness of a retraining programme for reducing peritonitis and exit site infection rates in older adults on peritoneal dialysis. The cost–benefit ratio was also calculated.

Design

A two-arm prospective randomised controlled trial.

Participants

One hundred and thirty patients aged 55 years or older were recruited. Participants were randomly assigned to the intervention or control group. While both groups received usual care, the intervention group received a retraining programme (a knowledge and practical assessment and a one-on-one retraining session) 90 days after starting home-based continuous ambulatory peritoneal dialysis therapy.

Measurements

The outcomes included peritonitis rate, exit site infection rate and direct medical costs at 180, 270, and 360 days after starting home-based continuous ambulatory peritoneal dialysis therapy.

Results

No significant differences were found in the baseline characteristics between groups. The peritonitis rates were 0.11 episodes per patient-year in the intervention group versus 0.13 in the control group. The incidence of exit site infection was 20.0% in the intervention group and 12.3% in the control group. The cost–benefit ratio of retraining was 1:9.6. None of the results were statistically significant.

Conclusions

The absence of statistical significance may be partly explained by the premature termination of the study. Large-scale multi-centre trials are warranted to examine the effectiveness of retraining. The timing and long-term effects of retraining also need to be examined.