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.

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.

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.

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.

Clinical Management of Hyperkalemia.

Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K+) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting. There is a need to improve effective management of hyperkalemia, including classification and K+ monitoring, when to reinitiate previously discontinued renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and when to use oral K+-binding agents. Monitoring serum K+ should be individualized; however, increased frequency of monitoring should be considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia and for those receiving RAASi therapy. Recent clinical studies suggest that the newer K+ binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Enhancing the knowledge of primary care physicians and internists with respect to the safety profiles of these newer K+ binders may increase confidence in managing patients with hyperkalemia. Lastly, the availability of newer K+-binding agents requires further study to establish whether stringent dietary K+ restrictions are needed in patients receiving K+-binder therapy. Individualized monitoring of serum K+ among patients with an increased risk of hyperkalemia and the use of newer K+-binding agents may allow for optimization of RAASi therapy and more effective management of hyperkalemia.

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.].

Story-Sharing Intervention to Improve Depression and Well-Being in Older Adults Transitioning to Long-Term Care.

Older adults frequently experience depression and reduced well-being when transitioning to long-term care (LTC) that can lead to increased risk for mortality. In the current randomized controlled trial, older adults (N = 93) who were transitioning to LTC facilities in Southeast Florida were enlisted. It was hypothesized that when transitioning to LTC (a) story sharing (i.e., sharing stories in groups) could lead to reduced depression and improved well-being, and (b) baseline sociodemographic characteristics could predict depression and well-being. Baseline results revealed that participants were not depressed and had moderate well-being, and postintervention results indicated that there were no significant improvements in depression (p = 0.35) and well-being (p = 0.41). Some baseline sociodemographic characteristics predicted depression (p = 0.04) and well-being (p = 0.03). Future research should incorporate moderate depression as an inclusion criterion and more weeks of story-sharing sessions. Targets: Adults age 65 and older transitioning to LTC. Intervention Description: Two to three participants met as a group to share five stories over 3 weeks. Mechanisms of Action: Story sharing will improve well-being. Outcomes: Participant level of well-being will improve, and sociodemographic characteristics and factors related to the move will predict risk for depression and reduced well-being. [Res Gerontol Nurs. 2019; 12(2):81-90.].

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.

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.

Ferric citrate controls serum phosphorus in dialysis patients: retrospective data
.

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.
.

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.

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.

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.

The CMS Annual Wellness Visit: bridging the gap.

In 2011, Medicare beneficiaries became eligible for an Annual Wellness Visit, which includes a health risk assessment and a customized wellness or personal prevention plan. This article discusses strategies for performing the exam in a primary care setting.