Should renal nurses be aware of water quality?

Although traditionally considered the domain of the renal technologist, many units do not have technicians or may only have part-time access to one. In these cases, it often falls to nursing staff to ensure that patients are dialysed safely. However, water quality is an area in which some nurses do not feel confident. This paper is aimed at providing information about the importance of appropriate water treatment, water testing and monitoring and the implications to the patient if the water is not checked appropriately in accordance with the guidelines

Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary

Introduction: First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. Main recommendations: These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2 , and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. Changes in management as result of the guidelines: Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.David J Tunnicliffe, Samantha Bateman, Melissa Arnold-Chamney, Karen M Dwyer, Martin Howell, Azaria Gebadi, Shilpa Jesudason, Janet Kelly, Kelly Lambert, Sandawan William Majoni, Dora Oliva, Kelli J Owen, Odette Pearson, Elizabeth Rix, Ieyesha Roberts, Kimberly Taylor, Gary A Wittert, Katherine Widders, Adela Yip, Jonathan Craig, Richard K Phoo

Antimicrobial stewardship programs and renal units in 2019 and beyond

Editorial.Approximately 30% of antimicrobial doses administered in hemodialysis units are considered unnecessary (D’Agata et al 2018). Therefore implementing an antimicrobial stewardship program (AMS program) in our renal units could optimize antimicrobial therapy and at the same time improve patient safety and patient quality of care. AMS programs can be seen as a key tool in facilitating the appropriate use of antimicrobials and help address the problem of antimicrobial resistance and other unintended consequences, such as antimicrobial toxicity and adverse drug reactions (Morency-Potvin, Schwartz & Weinstein, 2017).Melissa Arnold-Chamne

Challenges facing the renal nursing workforce

Editorial.There has been extensive research investigating stress in the nursing workforce, known as a ‘caring’ occupation, to assess the impact of the emotional labour of caring. Most of the recent evidence cites increasing nursing workloads contributing to the phenomenon of nursing stress, and this is widely predicted to continue to increase. The current shortage in the renal nursing workforce has largely been considered a ‘subset of overall supply’; however, with hundreds of registered nurse (RN) vacancies in renal globally, as well as increases in population level end stage kidney disease (ESKD), the renal specialty is under additional pressure (Wolfe, 2014).Kathy Hill and Melissa Arnold-Chamne

Patients and the public: knowledge, sources of information and perceptions about healthcare-associated infection

Statutory bodies provide information about healthcare-associated infection (HCAI) in the UK. Information is also available on National Health Service trust websites. Opinion polls demonstrate that fear of developing HCAI, especially meticillin-resistant Staphylococcus aureus, is the single greatest concern of people contemplating healthcare. We undertook a literature review to determine lay knowledge of HCAI, sources of information and perceptions of the risks. Twenty-two studies met the inclusion criteria. Of these, nine explored knowledge and perceptions as the primary research aim. The remainder consisted of a heterogeneous assortment of works comparing the knowledge and perceptions of different groups, their experiences of being infected or colonised and/or isolated. In all accounts, lay people expressed anxiety about the risks and consequences of HCAI. The most frequently reported source was the media, which has been blamed for sensationalist and inaccurate accounts. Lay people do not appear to access credible sources of information, or, if they do access them, are unable to understand their messages. Organisations that provide patient-focused information about HCAI are generic in scope, so that obtaining specific information may take time and effort to locate. Research is necessary to explore the acceptability, comprehensibility and accessibility of lay sources of information about HCAI and to find ways of readjusting risk perceptions to realistic levels in order to provide sensible levels of reassurance to those about to undergo healthcare

Once we knew it, we couldn’t unknow it

Nari Sinclair, Jared Kartinyeri, Melissa Arnold-Chamne