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Resumo A elevada carga da doença renal, disparidades globais no cuidado renal e desfechos ruins da insuficiência renal impõem uma sobrecarga crescente aos indivíduos afetados e suas famílias, cuidadores e a própria comunidade geral. Educação em saúde é o grau em que indivíduos e organizações têm, ou que igualmente permitem que indivíduos tenham, capacidade de encontrar, compreender e utilizar informações e serviços para tomar decisões e ações conscientes relacionadas à saúde para si e outros. Mais do que enxergar educação em saúde como um problema dos pacientes, a melhoria dessa educação depende principalmente da comunicação e educação efetiva dos profissionais em parceria com aqueles que apresentam doença renal. Para formuladores de políticas renais, educação em saúde é pré-requisito para que organizações migrem para uma cultura que coloque a pessoa no centro dos cuidados. A crescente capacidade e acesso à tecnologia oferecem novas oportunidades para melhorar educação e conscientização sobre doença renal para todas as partes interessadas. Avanços nas telecomunicações, incluindo redes sociais, podem ajudar a melhorar a educação de pessoas e provedores. O Dia Mundial do Rim declara 2022 como o ano da "Saúde dos Rins para Todos" promovendo trabalho em equipe global no avanço de estratégias para preencher a lacuna na educação e conhecimento em saúde renal. Organizações renais devem trabalhar para mudar a narrativa da educação em saúde como um problema de pacientes, para sendo responsabilidade dos profissionais e formuladores de políticas. Ao engajar-se e apoiar formulação de políticas centradas na saúde renal, planejamento de saúde comunitária e abordagens de educação em saúde para todos, comunidades renais esforçam-se para prevenir doenças renais e permitir viver bem com elas.

Background: The experience of loss and grief in patients' lives with life‐long treatment in haemodialysis, and in their families' lives is a major cause of mental health problems. In practice, nurses often describe a lack of time and limited knowledge of how to provide nursing care in situations of loss and grief, thus finding out from nurses' perspectives of what competencies they need to provide care would be useful for the development of nursing practice. Objectives: To develop knowledge in a nursing perspective of competencies to provide care for patients and their families, who experience grief linked to loss due to kidney failure, haemodialysis and/or death. Design: The study took a phenomenological‐hermeneutical approach. Semi‐structured interviews were conducted 12 nurses caring for patients receiving haemodialysis with no kidney transplantation option and family members. Ricoeur's interpretation theory involving naïve reading, structural analysis and critical interpretation and discussion was used for analysis. Results: Four themes emerged of nurse's experiences: (1) patient's loss and grief in everyday life, (2) dealing with supportive conversations when caring for patients, (3) families' losses are resulting in grief reactions and (4) importance of close relationships when caring for families. Conclusions: To nurses, patients on haemodialysis and their families have multiple loss and grief experiences. Nurses' working in kidney care need to develop competencies to support patients and families to cope with grief and loss. Further research is needed to develop these competencies and then to implement in education and practice. [ABSTRACT FROM AUTHOR]

Background: Living with chronic kidney disease is stressful as the disease and its treatments impact on everyday physical, psychological, and social activities. As this disease has a long trajectory, it is important to understand everyday life experiences of those at different points along this trajectory. Objectives: To explore the impact of chronic kidney disease and its treatment on everyday life. Design: Descriptive qualitative design Participants: Twenty‐five adults with chronic kidney disease across various grades were purposively recruited. Approach: Data were collected using semistructured interviews. Deductive content analysis informed by the revised Wilson and Cleary model was used to analyse data. Findings: There were four themes. Theme 1, experiencing deterioration of kidney function, reflected the physical and psychological problems experienced by participants. Theme 2, changes that happened to me and my family, explained the subsequent limitations in their physical, social and role functioning. Theme 3, responding to a new normal, identified adjustments needed in everyday life to cope with the disease and its treatments. The final theme, thinking ahead and making a decision, captured the future plans and decisions needed while living with chronic kidney disease. Conclusions: People with chronic kidney disease experience complex challenges such as greater symptom burden and functional limitations across the disease grades which impact on their everyday life. Nurses' recognition of these challenges is crucial for identifying and addressing unmet needs. Early individualised interventions, such as routine symptom assessment and management strategies that improve the wellbeing of people are needed. [ABSTRACT FROM AUTHOR]

Background: Nurse‐sensitive indicators (NSI) assess the quality of nursing care provided to patients. These indicators assess the structures (supportive measures), processes (nursing actions) and outcomes of care. The McIntyre Audit Tool (MAT) was developed to measure haemodialysis NSIs. Objectives: The objective of this study is to evaluate the feasibility and utility of the MAT in measuring haemodialysis NSIs in clinical practice. Design: Multisite nonrandomized feasibility study. Participants: A convenience sample of nurses (n = 30) were recruited from two haemodialysis units in Australia. Measurements: Participants completed the MAT once daily for 1 week, to measure the extent the clinical indicators were being met. Feasibility data including utility and acceptability of the tool was collected once from each participant. Data were analysed descriptively. Results: Participants completed a total of 97 audits. Results revealed the majority of structural (75%) and process indicators (73%) were being achieved although some variation between sites was observed. Results for the outcome indicators showed more variation (5.9%–94.1). Feasibility results found most nurses (79%) took <5 min to complete the MAT and found the tool easy to use (91.7%). Most participants (83.3%) reported audits could be completed during a shift and auditing was easily implemented (79.2%). Conclusion: Use of the MAT in clinical practice is a feasible and acceptable way of auditing the quality of haemodialysis nursing practice. The tool could be used to establish minimum standards and improve the quality of nursing care in haemodialysis units, also enabling benchmarking between services. [ABSTRACT FROM AUTHOR]

Background: Education is an essential component in optimising chronic disease self‐management. Teach‐back is a robust approach in patient education, which is suitable for varying health literacy although its effectiveness in chronic kidney disease patient education is unknown. Objective: To evaluate the impact of teach‐back method in health education for improving self‐management and adherence to treatment regimens in chronic kidney disease. Design: Systematic review. Participants: Adults with any chronic kidney disease grade or treatment modality. Measurements: A comprehensive search was undertaken in MEDLINE, CINHAL, EMBASE, Cochrane library, PsychINFO, Web of Science, ERIC, JBI library and WHO International Clinical Trial Registry to identify published studies from September 2013 to December 2022. The methodological quality of studies was assessed using Joanna Briggs Institute guidelines. Results: Six studies involving 520 participants were retrieved for this review. A meta‐analysis could not be conducted due to substantial heterogeneity between studies. Nevertheless, there was some evidence that teach‐back could improve self‐management, self‐efficacy and knowledge. There was limited evidence on improvement in psychological outcomes or health‐related quality of life. Conclusion: Teach‐back seems to improve both objective and patient‐reported outcomes, although further studies are needed. Using teach‐back can improve both understanding of health information and the development of skills. Kidney care teams could use teach‐back for all patients as it takes account of varying patient health literacy abilities. Teach‐back assists with communicating important health information to improve patients' knowledge, confidence and skills in self‐managing this disease and its treatment. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) affects more than 10% of the Australian adult population. It is a progressive disease that involves multiple physiological systems and is associated with several comorbid conditions, making it particularly burdensome on patients and the healthcare system. Alternative models of healthcare delivery are required to slow the progression to kidney failure. Aim: To describe the characteristics, patient profiles, and health outcomes of patients with CKD attending a nephrology nurse practitioner-led clinic. Design: Longitudinal health-service exploratory design. Methods: Following ethics approval, data were extracted from a chronic kidney disease registry for all consenting patients who attended a nephrology nurse practitioner-led clinic. Data were analysed descriptively. Results: Over the study period, 253 patients (122 male and 131 female) attended the clinic. The mean age was 70.27 ± 10.48 years, and at baseline most had either chronic kidney disease grade 3A (32.8%) or 3B (41.5%). For the majority of those who remained in the clinic, kidney function remained stable or slightly improved. A large proportion were within recommended target ranges for systolic (85.6%) and diastolic (98%) blood pressure although many had high BMI (mean 31.99 ± 6.47) and HbA1c (57.1%). Conclusion: The nephrology nurse practitioner-led clinic demonstrated effectiveness in addressing CKD targets for patients and provides an opportunity to transform traditional primary and specialist healthcare delivery. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners (NP) have an expanded scope of practice beyond that of a registered nurse. In kidney care, nephrology NP can manage patients at various points along the chronic kidney disease (CKD) trajectory. Objectives: To profile the characteristics, service patterns, and domains of practice of nephrology NP in Australia. Design: A cross‐sectional online secure survey. Participants: Nephrology NP (NP students) who were members of the Renal Society of Australasia and working in Australia (n = 73). Measurements: Data collected were demographic and practice characteristics, and domains of practice (using the modified Strong Model of Advanced Practice). The survey also sought qualitative perspectives of the enablers and barriers to sustainability nurse practitioner healthcare delivery services. Results: Nephrology NP (n = 45) primarily worked in adult services, managing those receiving haemodialysis, peritoneal dialysis, or patients with earlier grades of CKD. Providing direct comprehensive care was the dominant domain of advanced practice although administrative activities took up considerable time each week. Support from nurse leaders and medical colleagues was identified as key enablers for sustainability of these services whereas succession planning, and workload were the main barriers. Conclusions: This study found a highly qualified, experienced but older nephrology nurse practitioner workforce who provide an additional model of health service delivery which can meet the growing CKD burden. Internationally, this level of nurse provides an opportunity for a career pathway to maintain nurses in direct clinical roles and to expand the nephrology nursing workforce. [ABSTRACT FROM AUTHOR]

Background: Nurse sensitive indicators measure the quality of nursing care. Although there are some haemodialysis nurse sensitive indicators, there are currently no validated audit tools available to measure the indicators. Objectives: To test the validity of the McIntyre Audit Tool. Design: This study used a descriptive observation design conducted over two phases to assess face and content validity. Participants: An expert panel of haemodialysis nurses (n = 13). Methods: Face validity (phase 1) involved 13 nurses in two focus groups who reviewed the audit tool with qualitative data generated analysed to identify common themes. Phase 2 used a modified version of the audit tool to test for content validity for each item and then scale level content validity was calculated by combining all item scores. Measurements: Ten nurses rated 26 indicators in the audit tool using a 4‐point Likert scale to assess each item for clarity, relevance, appropriateness, and ambiguity. Results: All 26‐haemodialysis nurse sensitive indicators achieved item content validity indices ranging from 0.825 to 1.00 with a scale content validity index average of 0.910. However, based on feedback from phase 2, 6 outcome indicators were removed from the audit tool to reduce staff burden and assist with ease of use. The final audit tool had an excellent average scale content validity index of 0.924. Conclusions: The McIntyre Audit Tool to measure 20 haemodialysis nurse sensitive indicators has been validated. It now requires feasibility and reliability testing before auditing the quality of haemodialysis nursing care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To test whether the revised Wilson and Cleary model could identify which factors contribute to health‐related quality of life in chronic kidney disease. Background: Chronic kidney disease affects a person's health‐related quality of life detrimentally although nursing practice informed by theory is only beginning to emerge. Design: A cross‐sectional study reported using the STROBE guidelines. Methods: About 886 participants with chronic kidney disease (varying grades) completed validated measures of symptoms (renal version of the Integrated Palliative care Outcome Scale), and general health perceptions and health‐related quality of life (European Quality of Life five‐dimension three‐level). Socio‐demographic and renal characteristics were also collected. Data were analysed using descriptive statistics and structural equation modelling. Results: Biological function (decreased kidney function and haemoglobin and greater number of comorbidities), directly contributed to increased symptom burden. Symptoms demonstrated strong negative relationships with both general health perceptions and health‐related quality of life. General health perceptions had a direct positive relationship with health‐related quality of life. As age increased, health‐related quality of life decreased. The only environmental characteristic of significance was the distance between home and hospital although it was not directly associated with health‐related quality of life. Overall, the model explained approximately half of the deterioration in health‐related quality of life. Conclusions: The model demonstrated how various factors influence alteration of health‐related quality of life in people with chronic kidney disease. Early identification of these factors could assist nurses to introduce effective management strategies into patient care plans proactively. Relevance to clinical practice: Comprehensive symptom assessment needs to occur not only in kidney failure but in earlier chronic kidney disease grades to enable timely interventions targeted at improving people's wellbeing. Patient or public contribution: Validated interviewer administered questionnaires were completed by participants with chronic kidney disease in this study. [ABSTRACT FROM AUTHOR]