Escape to Patient Safety Project: A Nursing Proposal.

ANNA's Administration SPN created this proposal as a clinical practice project to re-evaluate how training and education are provided to individuals working in the dialysis setting. This article describes an education initiative based on the escape room methodology to provide a fresh approach on dialysis curriculum.

Percepción de los estudiantes de enfermería sobre sus conocimientos acerca de la enfermería nefrológica / Nursing students' perception of their knowledge about nephrology nursing

INTRODUCCIÓN: La enfermedad renal crónica avanzada supone un gran problema sanitario para el que son primordiales los cuidados de enfermería y por tanto la formación de los futuros profesionales. OBJETIVO: evaluar la percepción de conocimientos y el grado de interés en enfermería nefrológica de los estudiantes de enfermería de la Universidad de Oviedo. MATERIAL MÉTODO: Estudio observacional descriptivo desarrollado entre enero-mayo de 2019, se incluyeron todos los alumnos matriculados del grado de enfermería que dieron su consentimiento por escrito. Se utilizó un cuestionario realizado por los investigadores, que incluyo variables sociodemográficas y 12 preguntas cerradas, formadas por dos tipos de respuesta: dicotómicas (si/no/no sabe) y tipo Likert (escala de 0 a 10). Se realizó un análisis descriptivo y se utilizaron las pruebas T de Student y ANOVA para buscar diferencias significativas. RESULTADOS: Obtuvimos 251 cuestionarios, con un índice de rechazo <1%. El 86% eran de mujeres entre 18-54 años. La media de conocimiento total para los cuatro cursos fue <5, habiendo encontrado diferencias estadísticamente significativas por edad (p < 0,003), pero no por sexo, curso o profesión. La importancia de la formación en nefrología fue percibida con 8,79±0,29 puntos de media y el interés por formarse en enfermería nefrología es de 3,82±0,61 puntos de media. CONCLUSIONES: La percepción de conocimientos de los alumnos en enfermería nefrológica es insuficiente a pesar de percibirlo como muy necesarios para su formación, además, en caso de que existiera, presentan escaso interés en realizar la especialidad

INTRODUCTION: Advanced chronic kidney disease is a major health problem in which nursing cares, and therefore the training of future professionals, are essential. OBJECTIVE: To evaluate the perception of knowledge and degree of interest in nephrology nursing of nursing students at the University of Oviedo. MATERIAL AND METHOD: Descriptive observational study carried out between January and May 2019, including all the students enrolled in the nursing degree who gave written consent. A self-prepared questionnaire was used, which included sociodemographic variables and 12 closed questions with categorical responses (yes / no / don't know) and Likert type (scale from 0 to 10). A descriptive analysis was performed and Student's t tests and ANOVA were used to search for significant differences. RESULTS: Two hundred and fifty-one questionnaires were obtained, with a rejection rate of less than 1%. 86% were women between 18-54 years old. The average of total knowledge for the four courses was less than 5, finding statistically significant differences by age (p <0.003), but not by sex, academic year or profession. The importance of nephrology training was perceived with a mean of 8,79±0,29 points, and interest in nephrology nursing training had a mean of 3,82±0,61 points. CONCLUSIONS: The students' perception of knowledge in nephrology nursing is insufficient despite perceiving it as very necessary for their training. Although, if the specialty existed, they show little interest in this training

[Improvement of the pre-examination phase of medical biology exams at the Henri Mondor University Hospitals: a pilot study]. / Une étude pilote pour l'amélioration de l'étape pré-analytique des examens de biologie médicale pris en charge au sein des hôpitaux universitaires Henri Mondor.

The medical and university department of biology pathology at Henri Mondor hospital in Créteil has been engaged in an NF EN ISO 15189 accreditation process since 2014. One of the elements of this process concerns the quality of handling of samples and their transportation to laboratories, including the implementation place requires fighting against pre-examination non-conformities, which are the source of many dysfunctions. The pre-examination group has implemented several actions in a targeted care service. Thanks to these, the rate of non-conformities has halved in 18 months. In parallel, a work project targeting student nurses on internship was born to follow up on the results of a statistical study carried out by the pre-examination group on non-conformities. The objective of the project was to include nursing students on internship in a full support course on good sampling practices and pre-analytical non-conformities. This was based on the realization of two knowledge quizzes (before and after training), theoretical training, and visits to several laboratories. This study lasted 10 months with the participation of 37 students. The results showed a marked improvement in knowledge of pre-analytics as well as total satisfaction of all students. Our approach has helped to better understand the needs of laboratories and demonstrates the usefulness of training students in good sampling practices in order to ensure better patient care as well as an improvement in their comfort and well-being.

Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD): A feasibility study.

BACKGROUND: There is substantial variation in peritonitis rates across peritoneal dialysis (PD) units globally. This may, in part, be related to the wide variability in the content and delivery of training for PD nurse trainers and patients. AIM: The aim of this study was to test the feasibility of implementing the Targeted Education ApproaCH to improve Peritoneal Dialysis Outcomes (TEACH-PD) curriculum in real clinical practice settings. METHODS: This study used mixed methods including questionnaires and semi-structured interviews (pretraining and post-training) with nurse trainers and patients to test the acceptability and usability of the PD training modules implemented in two PD units over 6 months. Quantitative data from the questionnaires were analysed descriptively. Interviews were analysed using thematic analysis. RESULTS: Ten PD trainers and 14 incident PD patients were included. Mean training duration to complete the modules were 10.9 h (range 6-17) and 24.9 h (range 15-35), for PD trainers and patients, respectively. None of the PD patients experienced PD-related complications at 30 days follow-up. Three (21%) patients were transferred to haemodialysis due to non-PD-related complications. Ten trainers and 14 PD patients participated in the interviews. Four themes were identified including use of adult learning principles (trainers), comprehension of online modules (trainers), time to complete the modules (trainers) and patient usability of the manuals (patient). CONCLUSION: This TEACH-PD study has demonstrated feasibility of implementation in a real clinical setting. The outcomes of this study have informed refinement of the TEACH-PD modules prior to rigorous evaluation of its efficacy and cost-effectiveness in a large-scale study.

An Intervention Design: Supporting Skills Development for Peritoneal Dialysis Trainers.

BACKGROUND: Peritoneal dialysis (PD) is a home-based therapy where nurses train patients in its use. There has been no published randomized controlled trial (RCT) evaluating any specific protocol for nurses delivering PD training. A standardized education package based upon the best available evidence and utilizing modern educational practices may lead to improved patient outcomes. The aim is to develop a standardized, evidence-based curriculum for PD trainers and patients aligned with guidelines from the International Society for Peritoneal Dialysis (ISPD), using best practice pedagogy. METHODS: A literature search and clinical audit were conducted to identify current practice patterns and best practice. Results were reviewed by a focus group of practitioners comprising PD nurses, nephrologists, consumers, a medical education expert, and an eLearning expert. From this, a training curriculum and modules were developed. RESULTS: A comprehensive PD training curriculum has been developed, which includes modules for training PD nurses (trainers) and patient training manuals. The package comprises 2 introductory modules and 2 clinical case modules. The curriculum is designed for both interactive digital media (trainers) and traditional paper-based teaching with practical demonstrations (patients). Assessment is also addressed. CONCLUSION: The need for the development of a comprehensive and standardized curriculum for PD nurse trainers and their patients was confirmed. This paper outlines the process of the development of this curriculum. Pilot testing of the modules was launched in late 2017 to examine feasibility, and planning has commenced for a RCT in 2019 to investigate the effect of the modules on clinical outcomes, and their wider application across Australia and New Zealand.

High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial.

BACKGROUND: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. METHODS: We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours). During the evaluation phase, management of CRRT sessions was randomized to either intervention or control nurses. Sessions were defined as UI if they were interrupted and the interruption was not prescribed in writing more than 3 hours before. RESULTS: Study nurses had experience with hemodialysis, but no experience with CRRT before training. Intervention nurses had higher scores than control nurses on the knowledge tests (grade, median [Q1-Q3], 14 [10.5-15] vs 11 [10-12]/20; P = .044). During a 13-month period, 106 sessions were randomized (n = 53/group) among 50 patients (mean age 70 ± 13 years, mean simplified acute physiology II score 69 [54-96]). Twenty-one sessions were not analyzed (4 were not performed and 17 patients died during sessions). Among the 42 intervention and 43 control sessions analyzed, 25 (59%) and 38 (88%) were labeled as UI (relative risk [95% CI], 0.67 [0.51-0.88]; P = .002). Intervention nurses required help significantly less frequently (0 [0-1] vs 3 [1-4] times/session; P < .0001). The 2 factors associated with UI in multilevel mixed-effects logistic regression were Sequential Organ Failure Assessment score (odds ratio [95% CI], 0.81 [0.65-99]; P = .047) and the intervention group (odds ratio, 0.19 [0.05-0.73]; P = .015). CONCLUSIONS: High-fidelity simulation nurse training reduced the rate of UI of CRRT sessions and the need for nurses to request assistance. This intervention may be particularly useful in the context of frequent nursing staff turnover.

Evaluación del impacto de un programa de formación en Entrevista Motivacional a enfermería nefrológica / Assessing the impact of a training program in motivational interviewing to nephrology nursing

Introducción: Los profesionales de enfermería de cinco servicios de nefrología recibieron entrenamiento en Entrevista Motivacional mediante un taller de ocho horas centrado en como promover la adhesión al tratamiento en el paciente renal y su familia. El objetivo fue evaluar cambios en: competencia percibida en habilidades comunicativas especificas, respuesta empática espontanea e implantación de las habilidades in vivo medido a través de una rejilla observacional. Material y Método: Diseño pretest-postest sin grupo control. La muestra estaba formada por 46 profesionales del ámbito de la enfermería nefrológica. Resultados: Los resultados muestran cambios en la capacidad percibida de validar al paciente (p<0,031), así como en autorregulación emocional (p<0,014). La respuesta empática espontánea aumentó en los cuatro casos clínicos presentados, pero no llegó a alcanzar significancia estadística (p>0,05). La rejilla observacional, implementada durante el entrenamiento, informó acerca de indicadores de éxito tales como: reducir el tono paternalista, mostrar calma, generar confianza y escuchar de manera activa. Conclusiones: Los resultados son consistentes con otros estudios que evalúan el impacto de los programas de entrenamiento en habilidades de comunicación en nefrología

Introduction: Nursing professionals from five nephrology departments received training in Motivational Interviewing through an eight-hour workshop focused on how to promote adherence to treatment in renal patients and their families. The objective of the present study was to assess changes in: perceived competence in specific communication skills, spontaneous empathic response and readiness to apply in vivo communicative skills measured through an observation grid. Material and Method: Pretest-posttest design without control group. The sample consisted of 46 nephrology nurses. Results: The results show changes in the perceived competence to validate the patient (p<0.031), as well as emotional self-regulation (p<0.014). The empathic spontaneous response increased in the four clinical cases presented, but no statistical significance was reached (p>0.05). The observation grid, implemented during the training, reported on indicators of success such as: reducing the paternalistic tone, showing calm, generating trust and active listening. Conclusions: The results are consistent with other studies that evaluate the impact of communication training programs in nephrology

The effectiveness of alcohol-based gel for hand sanitising in infection control.

This article aims to evaluate the evidence relating to the effectiveness of alcohol-based gel for hand sanitising, or 'handrub', in infection control in healthcare settings with particular reference to renal nursing, as this has become pertinent due to the increasing reliance on evidence-based practice. There is a need to implement better infection control strategies and education, to reinforce knowledge among the public, health professionals and those at high risk of infection not only in renal nursing, but also in other areas of practice. Healthcare-associated infections (HCAIs) put patients' safety at risk, increase morbidity and mortality, extend the length of hospital admission and increase the cost to the NHS. There is evidence that the prevalence of HCAIs in England can be minimised through the use of different infection control measures. For example, alcohol-based handrub has been found to be associated with minimising the spread of gastrointestinal infections not only in hospital settings, but also in childcare centres. In addition, the UK national guidelines recommend regular handwashing (implementing the right technique) when hands are visibly dirty and hand disinfection with alcohol-based handrub when they are not visibly dirty. This should be before, in between and after different healthcare activities are performed.

Externalización del entrenamiento en Diálisis Peritoneal: riesgos sin beneficio / Externalization on Peritoneal Dialysis training: risks without benefits

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Análisis del impacto de los valores personales en la elección del Tratamiento Sustitutivo Renal / Analysis of the impact of personal values in the choice of Renal Replacement Therapy

Una de las actividades que se realizan en el proceso educativo con herramientas de ayuda a la toma de decisión (HATD) es ayudarles a explorar sus valores mediante las "tarjetas de valores". El objetivo del estudio fue, conocer los valores de las personas con Enfermedad Renal Crónica en la elección de modalidad de Tratamiento Sustitutivo Renal y analizar si existía relación entre los mensajes de las tarjetas y la modalidad de tratamiento. Estudio retrospectivo. Se incluyeron 281 pacientes que pasaron por el proceso de educación con HATD entre los años 2011-2016. Los datos se obtuvieron de los registros de enfermería de la historia clínica. Se estudiaron variables demográficas, tarjetas de valores y elección de tratamiento. La muestra fue de 281 pacientes. Las 3 tarjetas que obtuvieron un mayor porcentaje de elección fueron, Personal sanitario responsable del tratamiento (14,20%), Ser independiente (13,65%), Impacto para la familia (13,30%); según la modalidad de tratamiento elegida, HD: Impacto para la familia (15,94%), Personal sanitario responsable del tratamiento (15,58%), Ser independiente (13,04%). DP: Ser independiente (18,95%), Personal sanitario responsable del tratamiento (15,26%), Impacto para la familia (14,21%). Tratamiento médico conservador: Ser independiente (25,2%), Autonomía e Impacto para la familia (12,5%). Trasplante de donante vivo: Personal sanitario responsable tratamiento (30%), Ser independiente (30%), Autonomía (10%). Podemos concluir que la mayoría de los mensajes de las tarjetas, parecen estar en concordancia con la modalidad elegida. No hay valores propios de una modalidad de tratamiento sustitutivo renal sino personas con diferentes valores que marcan la toma de decisión (AU)

One of the activities carried out in the educational process with decision support tools (HATD) is to help patients explore their values through "value cards". The aim of the study was to know the personal values of Chronic Kidney Disease patients in the choice of Renal Replacement Treatment modality and to analyze if there was a relationship between the messages of the cards and the modality of treatment. Retrospective study. We included 281 patients who went through the education process with HATD between the years 2011-2016. Data were obtained from nursing records in the medical history. Demographic variables, stock cards and treatment choice were studied. The sample was 281 patients. The three cards that obtained a higher percentage of selection were: health personnel responsible for treatment (14.20%), independent (13.65%) and impact for the family (13.30%). According to the modality of treatment chosen, for hemodialysis patients were: impact for the family (15.94%), health personnel responsible for treatment (15.58%) and independent (13.04%); while for peritoneal dialysis patients, they were: independent (18.95%), health personnel responsible for treatment (15.26%) and impact for the family (14.21%). For those with conservative medical treatment, they were: independent (25.2%), autonomy and impact for the family (12.5%); and for those with live donor transplantation: health personnel responsible for treatment (30%), independent (30%) and autonomy (10%). We can conclude that most of the messages on the cards appear to be in accordance with the modality of treatment. There are no values of a modality of renal replacement therapy, but people with different values that influence in the decision making (AU)

Collaborative Approach to the Creation of an Arteriovenous Fistula on a US Navy Hospital Ship.

Early creation of arteriovenous fistulas (AVFs) decreases morbidity and mortality in patients with end-stage renal disease and is the standard of care in the United States. However, this procedure is frequently not accessible in low- and middle-income countries (LMICs). We present the first reported case of successful AVF creation as part of a humanitarian assistance mission. The patient was a 51-year-old male with diabetes, hypertension, and end-stage renal disease on hemodialysis via a temporary dialysis catheter. Preoperative assessment and patient selection were coordinated with the host nation (HN) nephrologist and dialysis team. The visiting surgical team provided education on AVF anatomy, complications, and cannulation techniques to the HN dialysis team. A left brachiocephalic AVF was created under regional anesthesia performed by the visiting surgeon and anesthesiologists. There were no postoperative complications, and the AVF was matured and accessed successfully by the HN dialysis team 7 weeks after creation. Performing AVFs as part of humanitarian assistance missions has the potential to significantly reduce morbidity and mortality in LMICs.

Components of A Successful Peritoneal Dialysis Program.

Although varying widely among different countries and geographic regions, the development of peritoneal dialysis invariably requires a well-established program. Key ingredients for the successful delivery of this therapy include adequate chronic kidney disease education, governmental or nongovernmental reimbursement, qualified physicians and nurses trained in the principles and practice of peritoneal dialysis, clinical management that incorporates an excellent and well-trained peritoneal dialysis team, a feasible and well-designed program for catheter insertion, a sound patient training and follow-up scheme, and continuous quality improvement. Some programs are enhanced by an active clinical research portfolio and other appropriate supportive systems. All of these factors are interlinked and inseparable from one another in ensuring a high-quality peritoneal dialysis program.

Influencia de la consulta de enfermedad renal crónica avanzada en la elección de modalidad de terapia renal sustitutiva / Influence of the consultation of advanced chronic kidney disease in the choice of renal replacement therapy modality

Introducción: La enfermedad renal crónica constituye un problema de salud pública por su elevada incidencia y prevalencia, importante morbimortalidad y coste asistencial. Un aspecto fundamental para el paciente es la elección de modalidad de terapia sustitutiva renal. En este sentido, la consulta de enfermedad renal crónica avanzada o prediálisis, puede jugar un papel fundamental. Objetivo: Conocer producción científica sobre la influencia de la consulta de enfermedad renal crónica avanzada en la elección de modalidad de diálisis por parte del paciente. Metodología: Revisión bibliográfica para la que se realizaron búsquedas en las bases de datos de PubMed, Scielo, Science Direct, Proquest y Google Académico. Se analizaron los artículos que trataban la consulta prediálisis, variables que influyeran en la elección de modalidad de diálisis y satisfacción del paciente. Resultados: Se han revisado 25 artículos publicados en los años 2002-2014, de diseño observacional descriptivo y de cohortes. Se ha encontrado relación en la elección de las técnicas domiciliarias con la existencia de un programa de educación prediálisis, la información que ofrece enfermería, la entrada programada en diálisis, menor edad, menor comorbilidad y factores socioeconómicos o estructurales. Conclusion: Los factores que favorecen la elección de las técnicas de diálisis domiciliarias son la existencia de consulta de enfermedad renal crónica avanzada y la referencia oportuna del paciente a dicha consulta, ser joven, menor comorbilidad y la necesidad de contención de costes. Esta elección se ve perjudicada por factores estructurales. Las terapias domiciliarias producen mayor satisfacción en los pacientes (AU)

Introduction: Chronic kidney disease is a public health problem due to its high incidence and prevalence, important morbidity and mortality, and cost of care. A fundamental aspect for the patient is the choice of modality of renal replacement therapy. In this sense, the consultation of advanced chronic renal disease or predialysis, can play a fundamental role. Objective: To know scientific production on the influence of the consultation of advanced chronic renal disease in the choice of renal replacement therapy modality from the patient perspective. Methodology: Bibliographic review for which the databases of PubMed, Scielo, Science Direct, Proquest and Google Scholar were searched. We analyzed those articles that addressed the pre-dialysis consultation, variables that influenced the choice of dialysis modality and patient satisfaction. Results: We have reviewed 25 articles published in the years 2002-2014, both descriptive observational and cohort design. We have found a relationship in the choice of domiciliary techniques with the existence of a predialysis education program, the information offered by nursing, the programmed entrance into dialysis, younger age, lower comorbidity and socioeconomic or structural factors. Conclusion: The factors facilitating the choice of home dialysis techniques are the existence of advanced chronic kidney disease consultation and the patient’s timely reference to such consultation, being young, reduced comorbidity and the need for cost containment. This choice is hampered by structural factors. Home therapies produce greater patient satisfaction (AU)

Education, certification, and professional membership can help with career goals.

For the professional nephrology nurse, the interplay of certification, education, and professional association membership go hand-in-hand. The association provides the foundation, networking, and educational opportunities; certification validates skills and expertise; and education challenges and inspires the nurse to keep moving forward.

Nephrology Nursing and Education.

Professional nephrology nurses are responsible for their ongoing education and competency in their area of practice. ANNA has an additional opportunity for education for nephrology nurses at the 47th National Symposium to be held May 1-4, 2016, in Louisville, Kentucky. The Janel Parker Memorial Opening Session keynote speaker for the meeting will be Suzanne Miyamoto, PhD, RN, Senior Director of Government Affairs and Health Policy with the American Association of Colleges of Nursing. Her topic will be "Are We Practicing to the Fullest Extent? Licensure, Certification, and Education?" This session will help address educational competence in nephrology nursing.

Relationship Between Age and Pre-End Stage Renal Disease Care in Elderly Patients Treated with Maintenance Hemodialysis.

Receipt of pre-end stage renal disease (ESRD) clinical care can improve outcomes for patients treated with maintenance hemodialysis (HD). This study addressed age-related variations in receipt of a composite of recommended care to include nephrologist and dietician care, and use of an arteriovenous fistula at first outpatient maintenance HD. Less than 2% of patients treated with maintenance HD received all three forms of pre-ESRD care, and 63.3% received none of the three elements of care. The mean number of pre-ESRD care elements received by the oldest group (80 years and older) did not differ from the youngest group (less than 55 years), but was less than the 55 to 66 and 67 to 79 years groups; adjusted ratios of 0.93 (0.92 to 0.94; p < 0.001) and 0.94 (0.92 to 0.95; p < 0.001), respectively. A major effort is needed to ensure comprehensive pre-ESRD care for all patients with advanced chronic kidney disease (CKD), especially for the youngest and oldest patient groups, who were less likely to receive recommended pre-ESRD care.