Patients with advanced chronic kidney disease (CKD) who are older, frail and have multiple comorbidities with poor functional status are increasing in numbers. Patients with advanced CKD with or without dialysis are suffering from high symptom burden and if untreated leads to a decreased quality of life (QoL). Integration of palliative care in CKD care had demonstrated to be effective in addressing the high symptom burden of the CKD population. Renal Supportive Care (RSC) is a nurse-led model of care which has been developed to address the palliative care needs of the CKD population.

A case of scurvy is identified in a dialysis patient. Treatment leads to an elevated reading, putting the patient at risk of oxalosis. 

Regional dialysis staff are became harder to secure, junior/graduate staff being used to increase staffing. An improved guide for new dialysis staff needed to give prospective staff the tools needed to be confident in working independently within a short period of time. 
 
There was inconsistency in training and willingness of senior nurses to train new staff, many were not confident to take on the responsibility. Resulting in inconsistent outcomes or staff not feeling confident or prepared to independently or missing important information. There was heavy reliance on one or two staff members to provide the majority of training, resulting in burn out. 
 
Working together, a new orientation workbook was developed built on previous pathways and recommendations from all staff and students. The workbook gave both senior staff and new staff/students clear pathway and standardised education to help instil confidence and the best outcomes for new staff and students. 

Background: Registered nurses (RNs) play a significant role in detecting patients at high risk of deteriorating in healthcare settings. Despite that, the inefficiency of RNs to escalate deteriorating patients seeking healthcare services in outpatient units by alerting the associate nurse unit manager (ANUM) or Medical Officer (DR), calls for the implementation of a patient safety initiative such as the afferent limb of a rapid response system (RRS). The literature asserts that as a patient safety initiative, created to warrant early recognition and care of deteriorating patients the afferent limb has universal interest.  This led to the following question: 

Þ   Question: Will implementing an afferent limb of a RRS in an outpatient healthcare setting improve nurses’ clinical performance, judgement and communication, to be able to recognise and care for deteriorating patients?

Adherence to fluid restriction remains a challenge for people with kidney failure undergoing haemodialysis (HD) and fluid overload is associated with increased mortality and morbidity. 

Delivering comprehensive renal nursing care to patients at the newly opened standalone heart hospital in Victoria is a key outcome along the patients’ journey. However, most of the nurses working in this cardiac hospital have limited experience in renal nursing. Therefore, upskilling registered nurses in the heart hospital with knowledge and skills required to provide optimal care to renal patients is important.

Like many chronic diseases, chronic kidney disease has lifestyle risk factors that through behavioural changes, may abate the disease progression and/or severity.  Patient education plays a significant role in guiding these changes.

This review explores the association of education as an intervention with slowing the progression of chronic kidney disease in the pre-dialysis population and improving renal patient outcomes.

Pregnancy in women with end-stage kidney disease (ESKD) undergoing haemodialysis presents unique management challenges that necessitate individualised treatment plans and close surveillance. This case study examines the successful completion of a 39-week pregnancy in a woman receiving haemodialysis treatment, highlighting the importance of tailored approaches and multidisciplinary care. 

Patient develops steal syndrome, following commencement of haemodialysis, leading to a secondary diagnosis of gangrene. Fistula was ligated to resolve the steal syndrome, but despite involvement from plastics surgeons, patient was sent home with thick black eschar surrounding nail bed to ring finger, with nil intervention to resolve the issue other than a nitrile cream. Patient visited GP numerous times, and was ‘fobbed off’ (as per patient) from plastics medicos at the tertiary centre where first examined.  Patient’s mental status declined over this period. Patient was waiting to transition to peritoneal dialysis but was concerned they would not be able to manage it, due to the ongoing pain and limited movability of fingers and hand. Nurse Y, with extensive wound care experience, suggested a wound care treatment plan to remove the eschar, for the finger to heal. Following 2 weeks of applying a debridement gel, the wound bed was cleared of necrotic debris and the healing process began. Since considerable improvement in the patient’s finger and hand, they have now been able to transition to PD, is pain free and with full movement of hand again. This demonstrates the impact of sound wound care principles being applied, as well as engaging the patient, to support the patient to achieve an effective outcome. Haemodialysis nursing does not just constitute cannulation, connecting and disconnecting from dialysis machines but involves engaging and supporting the patient throughout their treatment journey to support a quality of life that best meets their wishes.   

The Renal Social Worker (RSW) role is complex and specialised, and involved across the trajectory of kidney disease. RSW’s in diverse geographical areas face common clinical challenges, however there are no standardised models of care or RSW specific networks in Australia or New Zealand.

 

This led to the establishment of the inaugural Australian and New Zealand Renal Social Work Network (ANZRSWN) (the Network) in October 2022, providing: 

1.     Professional collaboration and peer support across Australia and New Zealand, by sharing knowledge and resources online, and

2.     A forum to explore the highest quality evidence based RSW practice

Background: Hemodialysis patients with multiple comorbidities have a higher risk of suffering a stroke, which can cause cognitive and functional decline. 

The Kidney Supportive Care (KSC) service has a person-centred approach to care for those living with advanced kidney disease. Patient satisfaction is an important and commonly used indicator for measuring quality in healthcare.