Nurses' knowledge to identify early acute kidney injury

Assessment of knowledge of acute kidney injury among non-nephrology healthcare workers in North-Kivu Province, Democratic Republic of the Congo

Background: Assessment of knowledge of acute kidney injury (AKI) among healthcare workers (HCWs) is necessary to identify areas of deficiency and key topics to focus on while organizing educational programs to improve AKI care. The objective of this study was to assess AKI knowledge and practice among health care providers in North Kivu province, the eastern Democratic Republic of the Congo. Material and methods: This was a cross-sectional study conducted in six public hospitals in North Kivu province using a self-administered questionnaire. Results: A total of 158 HCWs completed the survey, among them 66 (41.78%) were physicians. The mean age of respondents was 36.07 ± 10.16 years and the male gender was 56.33%. Only 12 (7.59%) of the respondents had a good knowledge of the definition and classification of AKI. The respondents’ mean scores were 6.76 out of a total of 18 about risk factors for AKI and 6.29 out of a total of 11 with regard to nephrotoxic drugs. Regarding practices, 28.48% of the respondents assess the risk of AKI in their patients in their daily practices; 31.65% report AKI in the patients’ medical history, and 33.54% call on a nephrologist specialist to get specialized advice. Conclusion: This study found considerable gaps in knowledge and practice regarding AKI among most of HCWs in North Kivu province.

Lesión renal aguda en el paciente pediátrico: revisión integrativa

Introducción: La lesión renal aguda se ha convertido en una complicación común en los niños hospitalizados, especialmente cuando están en una situación clínica crítica. Objetivo: Conocer y sintetizar la bibliografía científica más actualizada sobre la lesión renal aguda en la población pediátrica. Metodología: Estudio descriptivo de revisión integrativa. La búsqueda de artículos se ha realizado en las bases de datos Pubmed, Scopus y Google Scholar. La estrategia de búsqueda se estableció con los siguientes términos MeSH: ”acute kidney injury”, “children” y “pediatric”. La calidad metodológica se realizó mediante la escala STROBE. Resultados: Se incluyeron 35 artículos, 19 de diseño observacional retrospectivo, 12 observacionales prospectivos, 3 revisiones bibliográficas y 1 estudio cualitativo. No hay variables sociodemográficas destacables que impliquen mayor probabilidad de presentar lesión renal aguda. Tanto la etiología como los factores de riesgo son muy variables. La lesión renal aguda se asocia a mayor número de complicaciones y estancia hospitalaria. No hay evidencia de cuidados enfermeros en la lesión renal aguda en pacientes pediátricos. Conclusiones: Se observa una falta de homogeneidad en los criterios de definición, incidencia, etiología, factores de riesgo y de tratamiento en los pacientes pediátricos con lesión renal aguda, y escasez de artículos originales de investigación. La lesión renal aguda pediátrica se asocia a mayor mortalidad, morbilidad, mayor estancia hospitalaria y mayor duración de la ventilación mecánica. El papel de enfermería en el manejo del tratamiento conservador y de las terapias de reemplazo renal de este cuadro, es fundamental en la supervivencia de estos pacientes.

Predictive capacity of prognostic scores for kidney injury, dialysis, and death in intensive care units

OBJECTIVE

To assess the capacity of Charlson, SAPS 3 and SOFA scores to predict acute kidney injury, need for dialysis, and death in intensive care unit patients.

METHOD

Prospective cohort, with 432 individuals admitted to four intensive care units. Clinical characteristics at admission, severity profile, and intensity of care were analyzed using association and correlation tests. The scores sensitivity and specificity were assessed using the ROC curve.

RESULTS

The results show that patients with acute kidney injury were older (65[27] years vs. 60[25] years, p = 0.019) and mostly are from the emergency department (57.9% vs. 38.0 %, p < 0.001), when compared to those in the group without acute kidney injury. For dialysis prediction, the results of SAPS 3 and SOFA were AUC: 0.590; 95%CI: 0.507-0.674; p-value: 0.032 and AUC: 0.667; 95%CI: 0.591-0.743; p-value: 0.000, respectively. All scores performed well for death.

CONCLUSION

The prognostic scores showed good capacity to predict acute kidney injury, dialysis, and death. Charlson Comorbidity Index showed good predictive capacity for acute kidney injury and death; however, it did not perform well for the need for dialysis.

Pediatric Nurse and Pharmacist Knowledge of Acute Kidney Injury

OBJECTIVES

In this study, we assessed the knowledge and experience of pediatric pharmacists and nurses at a US tertiary-care pediatric center regarding the risk factors for, recognition of, and best practices for managing an acute kidney injury (AKI) in children.

METHODS

The authors developed a survey to assess the attitudes and knowledge of nurses and pharmacists regarding AKI in hospitalized children, which was reviewed by a small multidisciplinary group for content and length. The final 16-item survey consisted of demographic, self-assessment and attitude, and knowledge questions. All pediatric pharmacists and nurses at the study site received a voluntary online survey via e-mail. Data were analyzed by using descriptive statistics.

RESULTS

A survey was sent to 620 nurses and 50 pharmacists; 148 (25%) and 22 (44%), respectively, completed it. Most respondents were <35 years old and had ≤10 years of experience in both their professions and pediatrics. A total of 72% of pediatric nurses felt identification of AKI was within their scope of practice, and ∼60% felt confident in their ability to do so. More than 80% of pediatric pharmacists felt confident in their abilities to adjust medication doses in pediatric patients with AKI, but <60% felt confident in their ability to estimate the glomerular filtration rate in these patients. Nurses and pharmacists were able to correctly identify specific AKI criteria 60% to 70% and 70% to 90% of the time, respectively.

CONCLUSIONS

Although pediatric nurses and pharmacists have knowledge of AKI prevention and mitigation, gaps exist, and there is a desire for education in recognition of their key roles in the clinical team.

Acute Kidney Injury in Hospitalized Pediatric Patients: A Review of Research

INTRODUCTION

Pediatric patients who develop acute kidney injury (AKI) while hospitalized have longer hospital stays, increased morbidity and mortality, and are at an increased risk for developing chronic kidney disease. Early recognition of AKI is becoming a major clinical focus. There is little research focusing on nursing interventions that may affect a pediatric patient's risk for developing AKI. The purpose of this review is to summarize reported predictors of AKI to improve its early recognition and treatment among hospitalized pediatric patients.

METHODS

A review of research was conducted to further identify risk factors of AKI among noncritically ill hospitalized pediatric patients.

RESULTS

The current literature demonstrated inconsistent findings in early recognition of AKI among hospitalized pediatric patients.

DISCUSSION

Interventions for early recognition and treatment of AKI should consider other variables, such as previous history of AKI and fluid status as risk factors, warranting additional research.

KNOWLEDGE AND CARE PRACTICE OF NURSES OF INTENSIVE CARE UNITS REGARDING ACUTE KIDNEY INJURY

ABSTRACT Objective: to evaluate the knowledge and care practice of nurses in the care of patients with acute kidney injury in an intensive care unit. Method: cross-sectional study with 136 nurses from seven large public hospitals. Knowledge was measured by a questionnaire with 25 objective questions; and care practice, by a checklist with 15 questions. The instrument was created for this research and evaluated by judges regarding reliability, criterion and construct. Correlation tests, bivariate and multivariate analyses were used for data analysis. Results: the percentage of nurses' knowledge about acute kidney injury was 44.96%. The questions with the highest rates of correct answers dealt with nursing care. The percentage of execution of the practice was 47.54%. The most complete care was: applies protocol if the patient becomes hypotensive (89.7%); and checks skin condition, respiratory pattern and peripheral perfusion in complications (88.2%). Regarding professional data, it was observed that having a specialization in intensive care (p=0.034) and attending nephrology in specialization (p=0.030) were determining factors for greater knowledge, while specialization in intensive care (p=0.019) was a determining factor for practice. Conclusion: nurses obtained inadequate knowledge and care practice. It was observed that professionals with specialization in intensive care who attended a discipline or training in the area of nephrology showed better knowledge and care practices, when compared to those who did not. These data contribute to the construction of institutional policies that prioritize permanent education strategies in intensive care units.

Conhecimento dos enfermeiros da atenção primária à saúde sobre fatores de risco para Lesão Renal Aguda

RESUMO Objetivo Descrever o conhecimento dos enfermeiros sobre a identificação, medidas de prevenção e de autocuidado direcionadas à lesão renal aguda (LRA) em hipertensos e/ou diabéticos na atenção primária à saúde (APS). Método Estudo transversal e quantitativo. Amostra constituída de 57 enfermeiros atuantes na APS. Adotou-se questionário semiestruturado para coleta de dados. Realizou-se análise descritiva e inferencial. Considerou-se significativo resultado com p≤0,05. Resultados O perfil dos enfermeiros era jovem (idade 42± 9 anos) e tempo de exercício profissional de 9±6 anos. O conhecimento sobre aspectos gerais relacionados a LRA mostrou-se abaixo da média (48±19 pontos), embora, uma maioria, tenha descrito o conceito corretamente 41 (71,9%). Os fatores de risco relacionados à LRA foram majoritariamente: exposição às drogas 56 (98,2%) e diabetes mellitus 49 (86%). O tempo de atuação na APS aliado ao conhecimento insuficiente sobre alteração do valor da creatinina sérica implicou na decisão sobre a necessidade de encaminhamento ao nefrologista (p=0,004). Conclusões e implicações para a prática O conhecimento dos enfermeiros mostrou-se insuficiente para reconhecimento dos fatores de risco, prevenção e autocuidado da doença renal. Evidencia-se, portanto, a necessidade de capacitação dos enfermeiros da APS para otimizar a identificação precoce da LRA, evitando progressão e cronificação dessa doença.

Comprehensiveness of care-permanence in nephrology: nurses' conceptions

OBJECTIVE

To discuss how care-permanence comprehensiveness is for patients undergoing treatment in nephrology.

METHOD

A qualitative, exploratory and descriptive study anchored in Sociopoetics, conducted in the first semester of 2018, in Rio de Janeiro, Brazil, with nurses from nephrology services. The data were produced after applying the creative technique with drawings and collages and taking recorded statements about the signifieds and signfiers of care-permanence. The analysis was performed based on the principles of Sociopoetics from the philosophical conceptions of the research groups.

RESULTS

Fifteen (15) nurses with experience in nephrology services participated in this study. Four conceptual axes were shared referring to: comprehensive care; complex care; continuous care; and inclusive care, which considers the patient's family, team, society and their context, in addition to the patient themselves.

CONCLUSION

A philosophical reflection on care of the human being implies considering the physical, emotional, and individual dimensions, but also its micro and macromolecular revolutions of existence as a social being. The nature of knowledge from the ludic production enabled reflection and awareness for all the time and at all times about the comprehensiveness of care by nurses in nephrology.

Impact of Daily Electronic Laboratory Alerting on Early Detection and Clinical Documentation of Acute Kidney Injury in Hospital Settings

Acute kidney injury, especially early-stage disease, is a common hospital comorbidity requiring timely recognition and treatment. We investigated the effect of daily laboratory alerting of patients at risk for acute kidney injury as measured by documented International Classification of Diseases diagnoses. A quasi-experimental study was conducted at 8 New York hospitals between January 1, 2014, and June 30, 2017. Education of clinical documentation improvement specialists, physicians, and nurses was conducted from July 1, 2014, to December 31, 2014, prior to initiating daily hospital-wide laboratory acute kidney injury alerting on January 1, 2015. Incidence based on documented International Classification of Diseases diagnosis of acute kidney injury and acute tubular necrosis during the intervention periods (3 periods of 6 months each: January 1 to June 30 of 2015, 2016, and 2017) were compared to one preintervention period (January 1, 2014, to June 30, 2014). The sample consisted of 269 607 adult hospital discharges, among which there were 39 071 episodes based on laboratory estimates and 27 660 episodes of documented International Classification of Diseases diagnoses of acute kidney injury or acute tubular necrosis. Documented incidence improved significantly from the 2014 preintervention period (5.70%; 95% confidence interval: 5.52%-5.88%) to intervention periods in 2015 (9.89%; 95% confidence interval, 9.66%-10.12%; risk ratio = 1.73, P < .001), 2016 (12.76%; 95% confidence interval, 12.51%-13.01%; risk ratio = 2.24, P < .001), and 2017 (12.49%; 95% confidence interval, 12.24%-12.74%; risk ratio = 2.19, P < .001). A multifactorial intervention comprising daily laboratory alerting and education of physicians, nurses, and clinical documentation improvement specialists led to increased recognition and clinical documentation of acute kidney injury.

Surveillance nursing diagnoses, ongoing assessment and outcomes on in-patients who suffered a cardiorespiratory arrest

Objective The purposes of this study were to examine the frequency of surveillance-oriented nursing diagnoses and interventions documented in the electronic care plans of patients who experienced a cardiac arrest during hospitalization, and to observe whether differences exist in terms of patients' profiles, surveillance measurements and outcomes. Method A descriptive, observational, retrospective, cross-sectional design, randomly including data from electronic documentation of patients who experienced a cardiac arrest during hospitalization in any of the 107 adult wards of eight acute care facilities. Descriptive statistics were used for data analysis. Two-tailed p-values are reported. Results Almost 60% of the analyzed patients' e-charts had surveillance nursing diagnoses charted in the electronic care plans. Significant differences were found for patients who had these diagnoses documented and those who had not in terms of frequency of vital signs measurements and final outcomes. Conclusion Surveillance nursing diagnoses may play a significant role in preventing acute deterioration of adult in-patients in the acute care setting.

Diagnósticos, resultados e intervenções de enfermagem em pacientes com lesão renal aguda

Resumo Objetivo: Identificar prevalência de diagnósticos (DE), resultados (RE) e intervenções de enfermagem (IE) em pacientes com lesão renal aguda (LRA) internados em unidade de terapia intensiva (UTI). Correlacionar DE, RE e IE identificados. Métodos: Estudo transversal, conduzido em Unidades de Terapia Intensiva de um hospital público de grande porte da cidade de São Paulo. Foram incluídos, numa amostra intencional, 98 pacientes com LRA em tratamento hemodialítico internados em UTI, maiores de 18 anos. Foi utilizado software SPSS v21.0 para estimação da prevalência, fixando a estimativa no intervalo de confiança (IC) de 95% e erro amostral de 0,05. A coleta de dados foi realizada por meio da consulta de enfermagem, composta de entrevista estruturada, anamnese e exame físico dos pacientes, utilizando instrumento elaborado pelos pesquisadores. A coleta de dados foi realizada no período de março a julho de 2016, e o instrumento de coleta de dados foi preenchido pela pesquisadora principal. A consulta de enfermagem teve duração de aproximadamente 30 minutos. Do total da amostra, 10% foi selecionada aleatoriamente e checada, com o propósito de avaliar a qualidade dos dados e valores atípicos. Foi também realizado teste piloto em dois pacientes, previamente, para verificar se as informações contidas no instrumento atingiriam os objetivos da pesquisa. Resultados: Participaram 98 pacientes, predominantemente com idade ≥60 anos (33%), sexo masculino (60%) e classificados com lesão pré-renal (54%). DE prevalentes (100%): risco de infecção, risco de perfusão gastrointestinal ineficaz, risco de perfusão renal ineficaz, risco de desequilíbrio eletrolítico, volume de líquidos excessivos e risco de volume de líquidos desequilibrados. RE prevalentes (100%): gravidade da infecção, acesso para hemodiálise, perfusão tissular: órgãos abdominais, equilíbrio hídrico, mobilidade, remoção de toxinas e função renal. IE prevalentes (100%): promoção contra infecção, controle de infecção, manutenção de acesso para diálise, controle hidroeletrolítico, controle de eliminação urinária, controle ácido-básico, controle de eletrólitos, controle de hipervolemia, controle hídrico, monitorização hídrica, fisioterapia respiratória, monitorização respiratória e posicionamento. Correlações foram significativas (p< 0,001) entre DE e IE e entre IE e RE. Conclusão: Os principais DE, RE e IE foram relacionados à perda da função renal, origem das alterações na perfusão renal, volemia, distúrbios hidroletroliticos e risco para infecção. O número de DE atribuídos mostrou-se relacionado ao número de IE, assim como, das IE aos RE.