Palliative Care for Thai Older Adults with Chronic Kidney Disease: A Scoping Review.

Palliative care is an effective way to alleviate suffering and improve quality of life in older adults with end stage kidney disease (ESKD). The purpose of this scoping review was to identify gaps in available evidence about current and future needs for palliative care in community-residing older adults living in Thailand with advanced chronic kidney disease. Four essential elements (community, education, research, and nursing practice) were found related to older adults with ESKD, their families, and limited graduate palliative care education. Results support the need for graduate nursing education to meet the needs of a growing ESKD population in Thailand and other countries, including the United States.

Nephrology Nursing Scope and Standards of Practice: Take Pride in Practice.

The Nephrology Nursing Scope and Standards of Practice, 9th Edition, published by the American Nephrology Nurses Association, defines the scope of nephrology nursing and provides standards of practice, standards of professional performance, and competencies for registered nurses and graduate-level prepared registered nurses (e.g., advanced practice registered nurses, clinical nurse specialists) in an approach consistent with the American Nurses Association's Nursing Scope and Standards of Practice, published in 2021. Discussions addressing respect, equity, inclusion, and social justice have been included in the 9th edition. A new section related to altered/crisis standards has been added to assist nephrology nurses in developing strategies for implementing those standards. The section on how to use the standards has been updated with forms that organizations can download and individualize. This article provides an overview of the scope, standards, competencies, and strategies for implementing them in clinical practice.

Culture and Self-Care: Practices in Jamaican Adults with Diabetes Mellitus Residing in South Florida.

Jamaican adults with diabetes mellitus (DM) living in South Florida often believe taking conventional medications can cause harm. In an effort to limit adverse effects of these medicines, they frequently engage in folk care. However, this practice could actually increase risks of DM-associated complications, such as chronic kidney disease. Little is known about what folk care Jamaican adults are integrating into everyday health care. This focused ethnography explored and described how Jamaican adults with DM who live in South Florida use folk care for managing their DM. Knowing what folk care is part of everyday health practices among ethnical and racially diverse populations, such as Jamaican adults in this study, can help inform nephrology nursing practice and support future research.

Effects of End-of-Life Communication Knowledge, Attitudes, and Perceived Behavioral Control on End-of-Life Communication Behaviors Among Nephrology Nurse Practitioners.

The scope of end-of-life communication is not well known among nephrology advanced practice nurses (APNs). Guided by the Theory of Planned Behavior, the study aimed to examine the independent effects of knowledge, attitude, and perceived behavioral control on the engagement of APNs in end-of-life communication and the mediating and moderating effects of attitude and perceived behavioral control on the relationships between knowledge and end-of-life communication. A theoretically derived 17-item survey measuring the concepts was administered to a convenience sample of 127 APNs. Descriptive statistics, Pearson's correlation, and multiple linear regression were employed. Attitudes and perceived behavioral control on end-of-life communication mediated and moderated the relationship between knowledge of end-of-life communication and engagement in end-of-life communication among nephrology APNs.

Detecting dementia among older, ethnically diverse residents of rural subsidized housing.

Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ2(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.

Impact of Structural Racism on Kidney Health: A Scoping Review.

Structural racism remains a fundamental reason for persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic has highlighted that structural racism persists and negatively impacts the health of Black Americans. Despite significant evidence demonstrating the impact of structural racism on health, there is a lack of evidence explicitly focusing on kidney health. This scoping review was conducted to analyze the available evidence to identify the best strategies nephrology nurses can utilize to dismantle structural racism and improve kidney health in Black Americans. Results of this scoping review (n = 12) identified significant gaps in the literature regarding strategies to improve kidney health in Black Americans. There is a need for future research to understand the effect of structural racism on kidney health.

Testing the Effect of a Home Health Heart Failure Intervention on Hospital Readmissions, Heart Failure Knowledge, Self-Care, and Quality of Life.

For older adults, heart failure (HF) has the highest 30-day hospital readmission rate of any chronic illness. Despite research into strategies to reduce readmissions, no single program has emerged as sustainable. The purpose of the current study was to test a researcher-developed home health nurse HF intervention (CareNavRN™) on 30-day readmission rates, HF knowledge, self-care, and quality of life (QOL) among 40 older adults transitioning home. Home health nurses received specialized HF training and visited patients once per week at home for 4 weeks. The control group (n = 21) had six readmissions (29%) and the intervention group (n = 19) had three readmissions (16%); however, the results were underpowered and statistically nonsignificant. Pre-/post-surveys demonstrated significant improvement in HF knowledge (p = 0.043), self-care confidence (p = 0.003), and QOL (p < 0.001) in the intervention group. CareNavRN is a promising approach to improve outcomes during transition from hospital to home for patients without access to a comprehensive disease management program. [Journal of Gerontological Nursing, 46(2), 32-40.].

Disseminating Scholarly Work through Nursing Presentations.

This article in the "Exploring the Evidence: Focusing on the Fundamentals" series provides nephrology nurses with basic principles related to the dissemination of knowledge in a professional conference setting. This article provides steps to follow in the preparation and submission of an abstract, as well as the subsequent development of a poster or podium presentation.

Administration of Etelcalcetide for the Treatment of Secondary Hyperparathyroidism in Patients with CKD-MBD on Hemodialysis: A Nephrology Nursing Perspective.

The number, volume, and timing of oral medications prescribed to treat secondary hyperparathyroidism can add to the burden of disease management for both the patient and the nurse. Administering intravenous (IV) medication when possible has the potential of reducing the burden of medication management. Data on the use of IV calcimimetic etelcalcetide has shown improvement in blood calcium, phosphorus, and parathyroid hormone levels. IV administration of etelcalcetide at the end of each hemodialysis session may reduce the pill burden for patients and has the potential to help improve disease management within an environment that supports person-centered care.

Identification of Potential Mediators Between Depression and Fluid Adherence in Older Adults Undergoing Hemodialysis Treatment.

Controlled fluid intake is an important aspect of living with end stage renal disease (ESRD), and is complicated by depression, the most common mental health issue affecting individuals with ESRD. Factors that mitigate the deleterious effects of depression are underexplored. This study sought to identify potential mediators between depression and fluid adherence in 107 individuals with ESRD aged 50 years and older by comparing four logistic regression models. Age was associated with an increase in fluid adherence (adjusted odds ratio [AOR]=1.08, 95% confidence interval [CI]=1.02-1.14), whereas depression was associated with a decrease in fluid adherence (AOR=0.82, 95% CI=0.67-0.99), but when self-efficacy was entered into the model, the association between depression and fluid adherence weakened. Findings suggest that self-efficacy and age are important factors in fluid adherence, and self-efficacy can potentially mediate the negative effects of depression in older adults with ESRD.

Ferric citrate controls serum phosphorus in dialysis patients: retrospective data
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Ferric citrate is an approved phosphate binder for use in patients with chronic kidney disease on dialysis. Clinical trials demonstrated that ferric citrate controlled serum phosphorus levels and increased iron stores. The aim of this retrospective chart review was to evaluate real-world bone mineral and anemia parameter data from patients treated with ferric citrate. 92 adult dialysis patients taking ferric citrate (average starting dose of 6 tablets/day) for at least 6 months were included. Bone mineral, anemia, and iron biomarker levels were extracted from patient medical records before and during the first 6 months of ferric citrate treatment; 21 (23%) patients were phosphate binder naïve, and 71 (77%) patients had been on other phosphate binders. Before starting ferric citrate, 22% of patients had serum phosphorus ≤ 5.5 mg/dL, increasing to 65% of patients at 6 months of treatment (month 6). Mean (standard error of the mean (SEM)) baseline serum phosphorus was 6.55 ± 0.17 mg/dL decreasing to 5.40 ± 0.17 mg/dL at month 6. Mean (SEM) baseline hemoglobin, ferritin, and transferrin saturation were 10.6 ± 0.2 g/dL, 734 ± 65 ng/mL, and 27.1 ± 1.6%, respectively, and 11.1 ± 0.2 g/dL, 947 ± 66 ng/mL, and 37 ± 1.9%, respectively, at month 6. The serum phosphorus and anemia biomarker levels observed in this retrospective chart review were similar to those seen in clinical trials.
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Nephrology Nursing Scope and Standards of Practice: Integration into Clinical Practice.

The eighth edition of the Nephrology Nursing Scope and Standards of Practice, published by the American Nephrology Nurses Association (Gomez, 2017), defines the scope of nephrology nursing practice, and provides standards of practice and professional performance in an approach similar to the American Nurses Association (ANA) 2016 standards. ANNA's eighth edition of the Nephrology Nursing Scope and Standards of Practice incorporates competencies for graduate level-prepared nurses in addition to the registered nurse (RN) and advanced practice registered nurse (APRN). The section on how to use the standards in practice has been updated with user-friendly forms. This article provides an overview of the scope of practice, standards, competencies, and situations that require intervention by the nephrology nurse.

Emphasizing the Value of Nephrology Nursing Through Nursing-Sensitive Indicators: A Call for Action.

Nursing is the largest healthcare profession in the United States (U.S.). As principal frontline caregivers in the U.S. healthcare system, nurses have tremendous influence over a patient's healthcare experience. A growing body of evidence states that the nursing workforce has a direct impact on healthcare quality. A standardized approach to measuring nursing's contribution to patient care and safety using nursing-sensitive quality indicators assists in examining the extent to which nurses and nursing affect the quality and safety of health care. This article focuses on nursing-sensitive quality indicators and discusses healthcare quality indicators and nursing-sensitive indicators used in the U.S. A summary of the work of the American Nephrology Nurses' Association Task Force on Nephrology Nursing-Sensitive Quality Indicators (NNSQI) and an NNSQI exemplar are provided.

What Are Ethical Issues When Honoring an Older Adult's Decision to Withdraw from Dialysis?

Over the next decade, nephrology nurses will witness a continual growth of older adults undergoing hemodialysis. At some point after initiating dialysis, some people will request withdrawal from dialysis, which can present ethical challenges for nurses as they engage in shared decision-making with the patient, family, and other healthcare professionals. This article presents an older adult's story from initiation of dialysis to withdrawal from dialysis and discusses an approach to address ethical issues related to withdrawal from dialysis.

The perfect storm: older adults and acute kidney injury.

Older adults have a high risk for acute kidney injury (AKI), often necessitating critical care admission. The majority of older adults live with 1 or more chronic conditions requiring multiple medications, and when faced with acute illness increased vulnerability can lead to poor health outcomes. When combined with circumstances that exacerbate chronic conditions, clinicians may witness the perfect storm. Some factors that contribute to AKI risk include the aging kidney, sepsis, polypharmacy, and nephrotoxic medications and contrast media. This paper discusses specific risks and approaches to care for older adults with AKI who are in critical care.

IV Iron: To Give or to Hold in the Presence of Infection in Adults Undergoing Hemodialysis.

Intravenous (IV) iron is often given to treat iron deficiency anemia in adults undergoing hemodialysis. Evidence supports an association between IV iron and infection exits, which often create a clinical dilemma: whether to give or to hold in the presence of infection. This article presents the best available evidence regarding the risk of IV iron and infection along with nephrology nursing practice implications.

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.

Changing Nephrology Nurses' Beliefs about the Value of Evidence-Based Practice and Their Ability to Implement in Clinical Practice.

A rapidly evolving healthcare environment demands sound research evidence to inform clinical practice and improve patient outcomes. Over the past several decades, nurses have generated new knowledge by conducting research studies, but it takes time for this evidence to be implemented in practice. As nurses strive to be leaders and active participants in healthcare redesign, it is essential that they possess the requisite knowledge and skills to engage in evidence-based practice (EBP). Professional nursing organizations can make substantial contributions to the move healthcare quality forward by providing EBP workshops similar to those conducted by the American Nephrology Nurses'Association.

Remaining in the nursing home versus transfer to acute care: resident, family, and staff preferences.

Resident and family insistence on transfer is a major factor in the occurrence of potentially avoidable transfers from nursing homes (NHs) to acute care. The purpose of this study was to explore resident, family, and staff preferences regarding transfer to acute care. A sample of 271 NH residents, family members, staff, and medical providers were interviewed. Seventy-seven percent of residents reported that they had not given any thought to the question of whether they would want to be transferred to acute care. Family members wanted more information than residents, but more residents (39%) thought they should be fully involved in the transfer decision than their family members (12%) or staff (12%). Staff preferred keeping residents in the NH. Families were divided between transferring residents and having them remain in the NH. More residents indicated that their desire to transfer would depend on the severity of their condition and their prognosis. Ethnic group differences were noted. Results suggest that discussion of this issue should occur soon after admission and that differences in perspectives may be expected from those involved.

Barriers to NP Practice that Impact Healthcare Redesign.

As healthcare reform evolves, nurse practitioners (NP) will play key roles in improving health outcomes of diverse populations. According to the Institute of Medicine (IOM) 2011 report, The Future of Nursing: Leading Change Advancing Health, nurses should be change advocates by caring for populations within complex healthcare systems. The IOM reports asserts, "advanced practice registered nurses (APRNs) should be able to practice to the fullest extent of their education and training" (IOM, 2011, s8). However, existing barriers in the healthcare arena limit APRN practice. This article will discuss some of these barriers and provide suggestions for possible ways to decrease the barriers.