Nephrology Nursing Journal最新文献

Evidence-based screening tools and guidelines for chronic kidney disease (CKD) are inconsistently utilized in primary care. A quality improvement (QI) project evaluated the impact of a CKD education workshop for interprofessional clinical staff and the implementation of the Screening for Occult Renal Disease (SCORED) risk assessment tool to improve identification of patients at risk for CKD in a primary care clinic. Results of the SCORED risk assessment indicated 92% of patient participants were at high risk for CKD. Overall, the SCORED risk assessment reinforced CKD risk factor knowledge among health care professionals.

Despite recommendations, cognitive screening in patients with end stage kidney disease (ESKD) rarely happens, leading to underestimates of cognitive impairment (CI) prevalence and missed opportunities for intervention. We aimed to describe CI prevalence and associated factors in 100 patients receiving in-center hemodialysis aged 50 years and older. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA). Descriptive analysis techniques characterized the sample and estimated mean scores. Non-parametric and parametric tests explored relationships among MoCA scores and other patient factors. Of the 100 patients, 32% had normal cognitive function, 56% mild CI, and 12% moderate CI. Age, income, and education level significantly corelated with cognitive function in our sample. Identifying clinical factors and appropriate follow up for abnormal screening are crucial next steps in managing cognitive impairment in patients with ESKD receiving in-center hemodialysis.

Kidney disease is associated with a high physical and psychological symptom burden. For patients whose condition is more compromised, receiving dialysis as a life-sustaining therapy may not improve longevity or quality of life. Palliative care for patients with kidney disease (also termed kidney supportive care [KSC]) is appropriate for this patient population. Nephrology nurses working in dialysis are well positioned to talk with patients about what patients perceive constitutes a meaningful life or death. A literature review was undertaken to find evidence about if and how nephrology nurses engage in KSC with patients receiving dialysis. Based on the 29 articles included in this review, the overarching finding was nephrology nurses working in dialysis are not routinely engaging in KSC. Reasons for this are varied and warrant further investigation.

Chronic kidney disease (CKD) affects more than 35 million people in the United States, many of whom are undiagnosed. Included in this number are individuals with many types of rare kidney diseases, affecting 20,000 to 200,000 individuals nationwide. There is a major need to educate these individuals on the disease and its progression, especially since many individuals are not aware they have the disease. Descriptive correlational research was conducted in a nationwide sample of adult individuals living with rare glomerular kidney disease. Patient activation and quality of life were the concepts studied across the five CKD stages. New findings included statistically significant differences between participants' self-reported mental health quality of life and CKD Stage 1, with CKD Stages 4 and 5 in the rare kidney disease population. Nurses are essential for educating and supporting patients with rare kidney disease to preserve kidney function and slow disease progression.

Tunneled central venous hemodialysis catheters have higher infection rates compared to other access devices. Recommendations for dressing changes of these catheters are to apply povidone iodine (PI) or a triple antibiotic ointment during catheter dressing changes. Growing evidence supports using chlorhexidine gluconate (CHG) dressings to prevent catheter-related bloodstream infections in patients with short-term central venous catheters. This quality improvement project studied whether dressing changes with PI ointment in tunneled dialysis catheters was equivalent to CHG-impregnated dressings in preventing vascular access infections (VAIs). Standardized education was required for all nurses and dialysis technicians working at four dialysis centers. VAIs were measured before and after the change. Results showed that CHG is equivalent to PI ointment in preventing VAI in tunneled dialysis catheters.

Implementing evidence-based practice in nursing is essential for connecting theoretical knowledge with practical patient care. The spirit of inquiry serves as the foundational step in the evidence-based practice process. Nephrology nurses are positioned to improve patient and system outcomes through an evidence-based practice process, highlighting its transformative impact on nursing practice and patient care. This article provides an overview of evidence-based practice and explores the essential elements for the development of a spirit of inquiry.

Patients requiring hemodialysis would benefit from evidence-based strategies that improve adherence to fluid restrictions while concurrently improving quality of life (QOL). This pilot study examined the effect of a four-week mindful drinking and eating intervention on interdialytic weight gain and QOL in patients on hemodialysis. Using paired t tests, no significant differences from pre- to post-test were found in interdialytic weight gain, a measure of fluid restriction adherence, or QOL in either the intervention (n = 18) or wait list control (n = 19) group. However, there was positive qualitative feedback from participants in exit interviews, and there were other indications of feasibility (low drop out, engagement in at-home practice according to weekly checklists). Lessons learned from this pilot study about conducting research regarding fluid restrictions for patients on hemodialysis are presented.