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Nephrology Nursing News Briefs
Final Decisions: Nurses Key Role in End-of-Life Planning
When it comes to advance care planning and end-of-life (EOL) issues, difficult emotions can easily overwhelm patients and families. This makes it crucial for nurses and health care workers to provide guidance and prevent important decisions from falling through the cracks.
In the November-December 2008 issue of Nephrology Nursing Journal, Christine Ceccarelli and coauthors examine why 65% of dialysis patients do not have advance care plans in place and explore nurses role in ensuring optimum EOL planning.
Ceccarelli goes to the heart of the matter by exploring nurses barriers to broaching this important topic. She cites several studies that reveal nurses fear patient/family reactions to the topic, lack confidence in starting EOL conversations, feel uncertain their supervisors will support their efforts, and are unsure how to handle patients religious and cultural beliefs. Many nurses also voiced concerns about ethical and legal boundaries in EOL discussions.
To overcome these hurdles, the authors recommend careful collaboration by the health care team.
Nurses cannot initiate advance care planning with patients in a vacuum, Ceccarelli writes. Support for these discussions requires commitment, planning, and leadership by all caregivers.
Proper planning and appropriate referrals will be achieved after all parties (including patients and families) have been educated and effective communication has occurred, according to the authors.
To help support and educate nurses, the American Nephrology Nurses Association (ANNA) participates in EOL workgroups with other nephrology organizations across the country. ANNA has also developed two educational modules on End-of-Life Decision-Making and the Role of the Nephrology Nurse, which are available on ANNAs Web site, www.annanurse.org, in the Resources section.
(Advance Care Planning for Patients with Chronic Kidney Disease Why Arent Nurses More Involved?; Christine M. Ceccarelli, MSN, RN, MBA, CNN; Debra Castner, MSN, RN, APNC-BC, CNN; Mary S. Haras, MS, MBA, APN, NP-C, CNN; Nephrology Nursing Journal; November-December 2008; www.annanurse.org/journal)
New Hope for Patients with HIV Who Need Organ Transplants
Thanks to better medications and care, patients with HIV are living longer, healthier lives. The flip side is that many of these patients are developing end stage liver and kidney disease.
Despite many challenges, advances in medications and promising research have begun to nudge open doors that were previously closed to this patient population, according to an article by Laurie Carlson in the November-December 2008 issue of Nephrology Nursing Journal. In the past, for example, patients who were HIV positive were not considered possible transplant recipients as physicians felt the immunosuppressive medications used to prevent rejection would further compromise their already taxed systems and increase their risk for infection and death. Also, organs are always in great demand and go to patients who are expected to have a better outcome of survival.
Following strides in care and improved HIV drugs, the National Institutes of Health in 2000 launched a study to evaluate transplants in HIV-infected individuals.
The preliminary results are encouraging enough to dispute the conventional wisdom that individuals infected with HIV should never be considered as potential transplant recipients, Carlson writes. As more transplant centers begin transplanting HIV-infected individuals following a standard protocol, more data will become available to address the many questions that await clarification.
Protocols include strategies that improve outcomes such as pre-transplant screenings for vaccinations, infectious diseases, and tuberculosis. Post-transplant, medication management and prevention of opportunistic infections are also carefully monitored.
(Clinical Management of the HIV-Positive Kidney Transplant Recipient; Laurie Carlson, MSN, RN; Nephrology Nursing Journal; November-December 2008; www.annanurse.org/journal)
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Nephrology Nursing Journal is a refereed clinical and scientific resource that provides current information on a wide variety of subjects to facilitate the practice of professional nephrology nursing. Its purpose is to disseminate information on the latest advances in research, practice, and education to nephrology nurses to positively influence the quality of care they provide. For more information, visit www.annanurse.org/journal.