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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. Key Words: Theory of Planned Behavior, end-of-life communication, advance care planning, end stage kidney disease, advanced practice nurse., The Institute of Medicine's (IOM, 2015) consensus report, Dying in America,, found that improving the quality and availability of medical and social services for patients and families could not only [...]

The End-Stage Renal Disease Treatment (ETC) Model, an aspect of the Advancing American Kidney Health Initiative implemented by the Centers for Medicare and Medicaid Services (CMS) in 2019, is designed to shift the predominant in-center hemodialysis dialysis model in the United States to a home dialysis model. This shift represents a monumental change in the treatment of end stage kidney failure and is occurring amid a strained nursing workforce. The CMS Conditions for Coverage for dialysis facilities mandate registered nurse responsibility for the conduct of patients' home dialysis training, and the current nursing shortage presents challenges because the need for nephrology nurses will increase to meet the growing demand for home dialysis during the ETC implementation period. As the ETC Model is implemented in randomly selected dialysis facilities across the United States, nephrology nurses must have leading roles as full partners with CMS and other stakeholders for the mutual determination of short- and long-term solutions for meeting the growing home dialysis training demands. Key Words: End-Stage Renal Disease Treatment Model, Advancing American Kidney Health Initiative, Centers for Medicare and Medicaid Services, Medicare Conditions for Coverage, end stage kidney failure, chronic kidney disease, patient care, home dialysis, hemodialysis, nursing shortage, patient safety, kidney replacement therapy., The amendment to the Social Security Act in 1972 created a Medicare entitlement for the treatment of kidney failure, including both dialysis and transplantation, and led to an expansion of [...]

Nephrology nurses face health and wellness challenges due to significant work-related stressors. This survey, conducted online between July 24 and August 17, 2020, assessed the psychological well-being of nephrology nurses in the United States during the COVID-19 pandemic (n = 393). Respondents reported feeling burned out from work (62%), symptoms of anxiety (47% with Generalized Anxiety Disorder-7 [GAD-7] scores [greater than or equal to] 5), and major depressive episodes (16% with Patient Health Questionnaire-2 [PHQ2] scores [greater than or equal to] 3). Fifty-six percent (56%) of survey respondents reported caring for COVID-19 patients, and 62% were somewhat or very worried about COVID-19. Factors, including high workload, age, race, and the COVID-19 pandemic, may partially explain the high proportion of nephrology nurses who reported symptoms of burnout, anxiety, and depression. Key Words: Nephrology nurses, mental health outcomes, health-related quality of life, mental health survey., Nephrology nurses provide complex technological care to large numbers of patients who have a substantial clinical burden (Li et al., 2018). This care can also involve providing long-term support to [...]

Patient safety is an important foundation of high-quality care. Yet little is known regarding the effects of nursing indicators on patient safety in dialysis units. The purpose of this study was to examine interrelationships among registered nurse (RN) staffing, workload, nursing care left undone, and patient safety outcomes in hemodialysis settings. The sample consisted of 104 staff nurses who worked in hemodialysis facilities and completed a mailed survey. Low RN staffing, high RN workloads, and RN nursing care left undone were significantly associated with unsafe patient shift change periods and low safety ratings. Care left undone was an indirect pathway through which low RN staffing and high workloads impacted safety. Patient safety in hemodialysis units can be enhanced by ensuring adequate RN staffing and reasonable RN workloads, as well as redesigning responsibilities so RNs can complete necessary care activities. Key Words: Hemodialysis, nurse staffing, nurse workload, missed care, patient safety., [CE] 1.4 contact hours Almost 500,000 persons with end stage renal disease (ESRD) in the United States receive hemodialysis as a renal replacement therapy, with 98% receiving their hemodialysis in [...]

Patients living with end stage renal disease (ESRD) who are undergoing hemodialysis experience frequent hospitalizations associated with complications of care and exacerbations of illness. Efforts to reduce hospitalizations have had limited success. The purpose of this study was to explore why hospitalizations occur from the perspectives of patients undergoing hemodialysis treatment, their caregivers, and health care providers. Semi-structured interviews and focus groups were conducted with 21 patients living with ESRD, 10 caregivers, and three focus groups with health care professionals. Findings are discussed under four main themes: Graft site/Catheter/Access issues, 'My resistance is low,' 'I could not breathe,' and 'The perfect storm.' Results highlight the complexity of care and vulnerability of patients with ESRD. Further interprofessional research is needed to improve transitional care and care delivery for patient populations receiving hemodialysis. Key Words: Hospitalization, kidney failure (chronic), dialysis, hemodialysis, end stage renal disease., End stage renal disease (ESRD) is a growing public health concern in the United States, with nearly 750,000 adults treated for renal failure annually (United States Renal Data System [USRDS], [...]

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. Key Words: Patient care, patient safety, quality improvement. legislation, policy., The current healthcare focus on patient safety and quality of care, coupled with healthcare fiscal pressures and consumer expectations, requires that all healthcare providers demonstrate the quality of care delivered. [...]