The treatment/medical consent procedure has generally been performed by doctors. Despite the recognised importance of the consent process, formal initial consent for maintenance dialysis was poorly performed at in our service and rarely performed thereafter. As a large renal unit with a commitment to excellence in patient care, we felt this was out of keeping with our remit and sought to change the process to ensure we delivered useful information to allow our patients to have a meaningful discussion around consent issues. We trained senior nurses to perform the re-consent process, and took the opportunity to reassess patients’ decision-making competence, discuss advance care planning, blood consent and personal data privacy issues. We demonstrated a large improvement in the number of patients having a valid dialysis consent form, and realised the potential of this procedure to improve the care we give to our patient group. We recommend the benefits of nurse-led consent for dialysis to other services.
In Australasia diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease (ESKD), accounting for 47% and 38% of incident patients in New Zealand and Australia respectively. People with DKD also have worse outcomes on dialysis and lower rates of kidney transplantation. To assist in healthcare improvement, we conducted a qualitative study with patients with DKD to better understand their experiences of their diabetes care.
In this study, ten participants with DKD were purposively selected and interviewed face to face.Four main themes were identified from the participants’ transcripts; the value of education, relationships with healthcare providers, coping with diagnosis and the importance of whānau/family.
The study results revealed a standardised approach to diabetes care is required to ensure equity of care for all patients regardless of the service they receive care from. Implementing more specialist nursing models of care in general practice may provide better consistency and continuity for patients as well as enhance collaboration between primary and secondary providers.
There is little doubt that patient education around options for treatment of chronic kidney disease (CKD) improves patient outcomes. However, different education models are seldomly evaluated head-to-head. This study evaluated self-assessed knowledge, treatment choices and decision-making for patients receiving CKD education delivered in a traditional group lecture setting compared with one-on-one individual sessions. Thirty-nine participants were allocated to either group or individual education and completed surveys before and after each session, as well as receiving a follow-up phone call 2 weeks after the education.
The primary outcome was self-assessed level of understanding of kidney replacement therapy (KRT) modalities. Secondary outcomes were the utilisation of written resources and an assessment of the factors that influenced participants’ selection on their choice of modality. Thirty participants completed all three surveys. Participants in the individual education had enhanced comprehension across all modalities of KRT, particularly peritoneal dialysis (PD) and transplantation. Utilisation of educational resources was similar between the two groups. In both groups, lifestyle considerations were the most important factor when deciding on a KRT modality.
An individual, one-to-one style of interactive education was associated with a trend towards better knowledge and understanding, especially the modalities of PD and transplantation and, as such, is another option for delivering enhanced CKD education. Further research is required to assess which factors might advocate for one education format over another in order to optimise patient satisfaction with their education experience.
Proper nutrition can delay disease progression and manage complications of non-dialysis dependent chronic kidney disease (NDD-CKD). Little research has investigated knowledge of a renal diet in patients with NDD-CKD stages 3–5. The objective of this paper was to describe knowledge of diet restrictions for sodium, potassium and phosphorus and food sources of these nutrients in patients with NDD-CKD stages 3–5. Patients (n=266) with NDD-CKD and glomerular filtration rate (GFR) less than 45mL/min were recruited from an urban nephrology clinic in the United States. Knowledge of diet restriction and food sources of sodium, potassium and phosphorus were assessed via a questionnaire. Diet restriction knowledge was reported as percent of patients aware of the diet restriction. Food nutrient knowledge was reported as the percentage of foods correctly identified as high in that nutrient. Most patients were aware of the need to limit sodium (96%) and food sources of sodium (77%). Fewer were aware of the need to limit potassium (81% of those with hyperkalaemia) and phosphorus (40%). Knowledge of food sources of potassium (42%) and phosphorus (17%) were poor. Patients with hyperkalaemia were more aware of the potassium diet restriction (p<0.05) than those without. Sodium food knowledge was higher in patients with greater education or living in higher income neighbourhoods (p<0.05). Higher food knowledge scores for all nutrients were found for patients who reported following a diet restriction (p<0.05). Patients with NDD-CKD stages 3–5 are aware of the need to restrict sodium for kidney heath and understand food sources of sodium. However, knowledge of potassium and phosphorus is suboptimal.