Opportunities to Improve Antibiotic Prescribing in Outpatient Hemodialysis Facilities: A Report From the American Society of Nephrology and Centers for Disease Control and Prevention Antibiotic Stewardship White Paper Writing Group.

Antibiotic use is necessary in the outpatient hemodialysis setting because patients receiving hemodialysis are at increased risk for infections and sepsis. However, inappropriate antibiotic use can lead to adverse drug events, including adverse drug reactions and infections with Clostridioides difficile and antibiotic-resistant bacteria. Optimizing antibiotic use can decrease adverse events and improve infection cure rates and patient outcomes. The American Society of Nephrology and the US Centers for Disease Control and Prevention created the Antibiotic Stewardship in Hemodialysis White Paper Writing Group, comprising experts in antibiotic stewardship, infectious diseases, nephrology, and public health, to highlight strategies that can improve antibiotic prescribing for patients receiving maintenance hemodialysis. Based on existing evidence and the unique patient and clinical setting characteristics, the following strategies for improving antibiotic use are reviewed: expanding infection and sepsis prevention activities, standardizing blood culture collection processes, treating methicillin-susceptible Staphylococcus aureus infections with ß-lactams, optimizing communication between nurses and prescribing providers, and improving data sharing across transitions of care. Collaboration among the Centers for Disease Control and Prevention; American Society of Nephrology; other professional societies such as infectious diseases, hospital medicine, and vascular surgery societies; and dialysis provider organizations can improve antibiotic use and the quality of care for patients receiving maintenance hemodialysis.

The Effect of Lavender Aromatherapy on Heart Rate, Blood Pressure, and Perceived Stress Among Cardiac Rehabilitation Patients: A Pilot Study.

The purpose of this study was to test the efficacy of lavender aromatherapy via inhalation as a stress management modality for patients in cardiac rehabilitation. This was a quasi-experimental design. Aromatherapy was provided via inhalation to participants before a cardiac rehabilitation session over 8 minutes using lavender essential oil. The same protocol was used in the nonaromatherapy session without the essential oil. Blood pressure and radial pulse were measured, and subjective data were also collected including assessment of stress level (1-10 scale) and affect using the Positive and Negative Affect Schedule (PANAS). Analyses were performed using SPSS Statistics version 20. Quantitative measures were analyzed using Mann-Whitney nonparametric equivalent to the t test. Inferential measures were analyzed using the χ2 or Fisher's exact test. In the outpatient cardiac rehabilitation program, 25 patients participated in this study. The average change in negative affect (PANAS-) between pre- and postaromatherapy compared with pre- and post--nonaromatherapy sessions was statistically significant. Results showed a reduction in blood pressure following both aromatherapy and nonaromatherapy sessions with no statistical significance between sessions. Heart rate decreased equally postaromatherapy and nonaromatherapy sessions. Aromatherapy may be a useful stress management tool for cardiac rehabilitation patients.

Innovation in COVID-19 Response: ANNA COVID-19 Surge Support Process and Map.

The COVID-19 pandemic began with uncertainty in how to care for patients and protect staff. The American Nephrology Nurses Association (ANNA) immediately recognized the need to provide its members and others in the nephrology community with as much information as possible. Resources were collected and disseminated in many forms (e.g., publications, webinars, virtual conference sessions). As COVID-19 surges began occurring across the country and staffing reached a crisis level, ANNA collaborated with other organizations to find potential solutions. One solution developed by ANNA was the ANNA COVID-19 Surge Support Process and Map - a process to connect the areas in high need with skilled and available staff. This article describes the ANNA COVID-19 Surge Support Process and Map, which has continued to help address COVID-19 staffing challenges.

Mental Health and Health-Related Quality of Life Among Nephrology Nurses: A Survey-Based Cross-Sectional Study.

Nephrology nurses face health and wellness challenges due to significant work-related stressors. This survey, conducted online between July 24 and August 17, 2020, assessed the psychological well-being of nephrology nurses in the United States during the COVID-19 pandemic (n = 393). Respondents reported feeling burned out from work (62%), symptoms of anxiety (47% with Generalized Anxiety Disorder-7 [GAD-7] scores ≥ 5), and major depressive episodes (16% with Patient Health Questionnaire-2 [PHQ-2] scores ≥ 3). Fifty-six percent (56%) of survey respondents reported caring for COVID-19 patients, and 62% were somewhat or very worried about COVID-19. Factors, including high workload, age, race, and the COVID-19 pandemic, may partially explain the high proportion of nephrology nurses who reported symptoms of burnout, anxiety, and depression.

Factors Related to International Travel for Transplantation Among U.S.-Listed Kidney Transplant Candidates.

Factors related to travel for transplantation were examined using data from the Scientific Registry for Transplant Recipients. Candidates who traveled abroad for a kidney transplant had higher odds of being male, Asian or Hispanic, college-educated, employed, privately insured, and a non-U.S. citizen/non-U.S. resident. Candidates with a body mass index greater than 30, a calculated panel reactive antibody (cPRA) greater than 80%, and a history of more than two years of hemodialysis or peritoneal dialysis had lower odds of traveling abroad for a kidney transplant. Geographically, candidates listed in the northeastern region of the United States (New York and Western Vermont) had the highest odds of traveling abroad for a kidney transplant. Findings of this study can be used to guide practice and education with transplant candidates, and to direct further investigation in this understudied but growing area of transplantation.

A Window into the World of Nephrology Nursing: Nephrology Nurses' Views of the Health and Safety of Their Work Environments, the Impact on Patient Care, and Opportunities for Improvement.

In January 2018, the American Nephrology Nurses Association and Nephrology News and Issues conducted a national study, The Health and Safety of Nephrology Nurses and the Environments in Which They Work. This article presents initial qualitative results from that study - in the words of nephrology nurses. Based on responses of participants, themes and subthemes were identified: staffing, nursing practice (time to provide nursing care, nursing work hours, level of practice, nurses responsibility for the practice of others), work environment conditions (physical environments, psychological environments, civility/ incivility, environmental health, and work spaces), respect, recognition, interprofessional collaboration and support, and career and job satisfaction. Results of the study provide insight into what it is like to work on the frontlines of nephrology nursing.

The Health and Safety of Nephrology Nurses and the Environments in Which They Work: Important for Nurses, Patients, and Organizations.

Nurse health and safety and the environments in which nurses work impact nurses, patient safety and quality of care, and organizational outcomes. In January 2018, we conducted a comprehensive national assessment of the overall health and safety of nephrology nurses and their work environments as a follow-up study to the 2014 study on Patient Safety Culture in Nephrology Nurse Settings conducted by American Nephrology Nurses Association. This article presents initial broad findings of this national study. Results identified a number of opportunities for improvement in nephrology nurse work environments, especially in the areas of staffing, optimizing the knowledge and skills of registered nurses, and mental and physical health.

Fluid and Electrolyte Management Across the Age Continuum.

Optional function of body systems depends upon fluid and electrolyte balance; however, across the lifespan, disorders of fluid and electrolytes offset this, and the causative factors are varied. Nurses play a major role in the management of fluid and electrolyte balance. This article focuses on the role total body water content, plasma proteins, kidney function, and drug metabolism have on the age-related physiology impacting fluid and electrolyte balance, and on nursing implications.

Current State-of-Practice: Transportation for Patients with End Stage Renal Disease.

Patients receiving care for the management of end stage renal disease require transport to nephrology practice settings and treatment centers for hemodialysis and peritoneal dialysis. This type of transportation, defined as non-emergency medical transportation, has long presented a challenge for patients, families, and healthcare providers. This article explores the current and projected statistics and trends for chronic kidney disease,transportation challenges faced by patients and nephrology healthcare providers, and examples of successful transportation services and programs. Implications for practice with a focus placed on the importance of an interprofessional approach are described.

Patient Handoffs: What They Are and How They Contribute to Patient Safety.

Communication and patient handoffs during transitions in care have been increasingly investigated due to their relationships with patient safety, quality of care, and efficiency. Handoffs occur at two points in the delivery of nursing care: nurse transitions in care and patient transitions in care. This article explores the accepted definitions, best practices, and evidence related to patient handoffs and patient safety.

Patient Handoffs in Nephrology Nurse Practice Settings: A Safety Study.

Research investigating patient handoff processes has inundated the safety literature, but not in nephrology nurse practice settings. Effective patient handoffs are essential for maintaining patient safety by avoiding errors related to poor information exchange. This mixed methods research study investigated the process of patient handoff across nephrology practice settings and the implications for patient safety and nursing practice. Findings indicate there are too frequently issues with handoffs of patients with chronic kidney disease who must move between many different healthcare providers and healthcare settings. Nephrology nurses reported thar the use of multiple methods for handoff communications and practice sites having differing hours of operation present challenges to practitioners, which result in information too often "falling through the cracks."

Decreasing Infections in Nephrology Patient Populations: Back to Basics.

Infection is a leading cause of hospitalizations and deathfor nephrology patients, and a danger to the healthcare professionals who care for them. As primary caregivers, nurses are involved in the prevention, identification, and surveillance of infections and patient teaching associated with infection prevention. Results of a recent national survey revealed that there are many violations in adherence to proper infection control measures in nephrology practice settings, and the safety of this vulnerable patient population is being compromised. This article provides information on the results of the study and guidelines and best practices to decease infection rates, including the use of basic fundamentals of nursing practice, collaboration, and patient engagement.

Patient Safety and Patient Safety Culture in Nephrology Nurse Practice Settings: Issues, Solutions, and Best Practices.

In order to assure patient safety, it is necessary to create positive patient safety cultures. This article presents the initial qualitative results from a national study, "Patient Safety Culture in Nephrology Nurse Practice Settings." Based on the responses of participants, themes were identified for both issues and potential solutions and best practices. Issue themes included underreporting of events and near misses, poor staffing ratios, long work hours, communication lapses, and training, infection control, and compliance. Potential solutions and best practice themes included non-punitive and transparent event reporting, fall reduction strategies, improved medication administration practices, and scheduled safety huddles and safety meetings. The results of this landmark study can be used to start conversations and spark education programs to improve patient safety culture in nephrology nurse practice settings.

Patient Safety Culture in Nephrology Nurse Practice Settings: Results by Primary Work Unit, Organizational Work Setting, and Primary Role.

Patient safety culture is critical to the achievement of patient safety. In 2014, a landmark national study was conducted to investigate patient safety culture in nephrology nurse practice settings. In this secondary analysis of data from that study, we report the status of patient safety culture by primary work unit (chronic hemodialysis unit, acute hemodialysis unit, peritoneal dialysis unit) and organizational work setting (for-profit organization, not-for-profit organization), and compare the perceptions of direct care nurses and managers/administrators on components of patient safety culture.

Using Evidence-Based Practice to Move Beyond Doing Things the Way We Have Always Done Them.

Contemporary health care demands better care for individuals with kidney disease. In the quest for the Triple Aim of health care--improving the experience of care, improving the health of populations, and reducing per capita costs of health care--nephrology nurses can no longer afford to practice the way we have always done. Instead, it is critical to consider the best available evidence, personal expertise, and patient/family preference when engaging in clinical decision-making. This article provides the steps to develop an evidence-based project to address a clinical problem.