Iron-Deficiency Anemia in CKD: A Narrative Review for the Kidney Care Team.

Anemia is a common complication of chronic kidney disease (CKD) and is associated with increased mortality and reduced health-related quality of life. Anemia is characterized by a decrease in hemoglobin, the iron-rich protein that the body uses for oxygen transport. Iron is required to produce hemoglobin, and disruptions in the iron homeostasis can lead to iron-deficiency anemia. Management of anemia in individuals with CKD is typically performed by a team of physicians, nurse practitioners, physician assistants, or registered nurses. Throughout the care continuum, the management can be enhanced by multidisciplinary care, and individuals with CKD can benefit from the involvement of other specialties, with dietitians/nutritionists playing an important role. However, a key area of unmet clinical need is how to assess and address iron-deficiency anemia. This review aims to provide an overview of iron-deficiency anemia in CKD and how this may be diagnosed and managed by the entire kidney care team, such as describing the mechanisms underlying iron homeostasis, the complications of iron-deficiency anemia, and the current challenges associated with its diagnosis and treatment in CKD. Opportunities for each multidisciplinary team member to add value to the care of individuals with CKD and iron-deficiency anemia are also described.

Geriatric Nephrology.

Older adults receiving critical care have a high risk for acute kidney injury (AKI) for many reasons. It is important that critical care nurses know and have the skills to address the risk factors, conduct a comprehensive geriatric assessment, and implement evidence-based interventions. This article provides a review of this information.

Ethical Challenges When Caring for African American Older Adults Requesting to Withdraw From Dialysis.

The number of African American adults 65 years and older with end-stage kidney disease receiving maintenance hemodialysis is increasing. The high symptom burden (ie, pain, fatigue, depression) can make it challenging for many to continue dialysis, which can lead to request to withdraw from dialysis. This can present ethical challenges when someone has diminished decision-making capacity and no advance directives or family to assist with this complex decision. This article will provide a brief overview of ethical issues to consider when responding to an older adult's request to withdraw from a life-sustaining treatment such as dialysis. Suggestions for research to address the gaps in knowledge will be presented.

All Things Bed Bugs: A Primer for Nephrology Nurses.

Bed bug infestation is on the rise, affecting individuals across all demographics and geographics worldwide. Of concern is nursing's lack of knowledge about bed bug transmission, prevention, elimination, and the management of bed bug bites. This article explores the evidence about the lifecycle of the bed bug, its typical presentation, and ways to prevent and eliminate bed bug infestation. Ways that the nephrology nurse can assist in eradication and policy development are discussed, and resources are provided for further information.

Nephrology Nurse Perceptions Toward Advance Care Planning: Validation of a Measure.

Advance care planning is critical for persons with chronic kidney disease because they face a shortened lifespan. There is a paucity of reliable and valid measures exploring nephrology nurse perceptions toward advance care planning. This article reports the results of testing the factor structure, reliability, and validity of a newly developed measure of nephrology nurse perceptions toward advance care planning as well as information on nephrology nurses'perceptions on advance care planning. Measuring nephrology nurse perceptions toward advance care planning may facilitate planning of interventions to assist nurses to become more active in the process.

Exploring Advance Care Planning from the Nephrology Nurse Perspective: A Literature Review.

Advance care planning is a process that engages healthcare providers and patients to articulate wishes of patients as their illness progresses. Persons with chronic kidney disease require earlier and more frequent advance care planning conversations because they are faced with increased co-morbidities and a shortened lifespan. This literature review explores the phenomenon of advance care planning and the potential factors affecting nephrology nurse engagement in these discussions.

Development and Initial Validation of the NephRN Perceptions Toward Advance Care Planning Instrument.

The purpose of this study was to develop and pilot test an instrument to measure the perceptions of nephrology nurses toward advance care planning, the NephRN Perceptions Toward Advance Care Planning instrument. Four components of advance care planning were identified: knowledge, attitudes, comfort, and support. The four-component solution explained 63.88% of variance. Cronbach's alpha was 0.92, and subscale reliability ranged between 0.86 and 0.94. This instrument shows promise as a reliable and valid measure of nephrology nurse perceptions toward advance care planning for persons with chronic kidney disease.

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.

Does Hemodialysis Dialysate Potassium Composition Matter?.

Dyskalemia is known to cause cardiac arrhythmias and cardiac arrest. In persons undergoing hemodialysis, potassium dialysate composition has been identified as a contributingfactor in addition to co-morbidities, medications, dietary potassium intake, and stage of kidney disease. Current evidence recommends a thorough evaluation of all factors affecting potassium balance, and lower potassium concentration should be used cautiously in patients who are likely to develop cardiac arrhythmias. Nephrology nurses play a key role inpatient assessment and edu- cation related to potassium balance.

Exploring the evidence for end-of-life care in patients with chronic kidney disease.

Much of the evidence supporting a focus on end-of-life care for persons with kidney disease is in the form of expert opinion and professional practice guidelines based on multi-disciplinary input and an exploration of the known illness trajectory for renal disease. Limited intervention studies or randomized control trials related to palliative or hospice care for patients in the U.S. with ESRD remain, providing rich opportunities for nephrology researchers. Nephrology nurses should remain vigilant and open to opportunities to participate in research related to improving end-of-life care for persons with ESRD and should be at the forefront of designing evidence-based practice projects for end-of-life care options for this population.

Age-appropriate health promotion education: roots firmly established in baccalaureate nursing pediatric rotation.

The Essentials of Baccalaureate Education for Professional Nursing Practice [American Association of Colleges of Nursing. (2008, October 8). Retrieved September 11, 2009, from http://www.aacn.nche.edu/Education/pdf/BaccEssentials08.pdf] addresses the importance of health promotion at the individual level across the lifespan to effect optimal population health. This qualitative study explores senior baccalaureate nursing students' perceptions (n = 85) of the teaching and learning experience related to health promotion during their pediatric clinical rotation. Four distinct learning factors of student, client, learning process, and subject matter emerged. Knowledge was enhanced, and students identified that the format of presentation influenced the quality of participant learning. Students' perception of the importance of patient and family teaching evolved over the course of the semester and highlights the importance of providing students with the tools necessary to be effective teachers and change agents to promote healthy behaviors across the lifespan. Fink's Taxonomy of Significant Learning can be applied to facilitate integrated course design for a pediatric baccalaureate nursing curriculum.

Planning for a good death: a neglected but essential part of ESRD care.

Planning a "good death" is a neglected, but essential, part of the care of patients with end stage renal disease and their families. Many of these patients do not have advance directives and few utilize palliative care. Guidelines from medical and specialty nursing organizations regarding end-of-life (EOL) issues and palliative care have been developed, but they are not consistently used by the nephrology community. Nephrology nurses are frequently positioned to begin EOL discussions with patients and families, and advanced practice nurses are in a unique position to coordinate and facilitate a patient's transition from chronic to terminal illness and to increase the likelihood that the patient and family experience a "good death". This article reviews the need for practice improvement in EOL care and a review of the current literature.

Advance care planning for patients with chronic kidney disease--why aren't nurses more involved?

Few patients with chronic kidney disease complete advance care planning and require the assistance and encouragement of their caregivers to address advance care planning needs. However, most nephrology nurses are reluctant to initiate these discussions and believe that patients will find these discussions upsetting. This article explores the fears that nephrology nurses have in addressing ACP with their patients, how this reality relates to general nursing research on the topic, and possible approaches to assist nephrology nurses in gaining confidence and expertise in this area.

End of life issues and advance care planning in the elderly patient.

Mr. J. achieved the desired outcome that was the best for him and his family. It remains to be seen how his trial of dialysis will fare. To date he is doing well and has not been readmitted to the hospital. The shift in his opinion regarding what would be the best decision for him has been significant, an evolutionary process, and followed a predictable course. When presented early, in a non-emotional situation, perhaps greater numbers of patients will have advance directives signed and in place when the decision to start or withdraw from dialysis are imminent. Recognizing that advance care planning is one facet of end-of-life planning will remind the nurse to look at all of the components in designing a patient plan of care. Further, knowing that this is an evolutionary process and should be revisited frequently will enable the nurse to incorporate the understanding that palliative care/hospice should be offered with dialysis, instead of taking an either/or approach. The unique issues facing the older adult also need to be evaluated and discussed with the patient/family. An acknowledgement of co-morbid conditions, mental status, and ambulatory status will help guide the nurse in estimating the best possible outcome and success of initiation of treatment. Nephrology nurses need a constant reminder that patients can change their minds at any point. As the dialysis population and number of patients with CKD continue to grow, the nephrology nurse practitioner and nephrology community are obligated to revisit and evaluate the success of their personal implementation of the guidelines that have been so rigorously formulated.