Foundations in Renal Nursing

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About the course:

This course aims to prepare practitioners working in renal setting for their role within general nephrology and haemodialysis health care. They will have the opportunity to develop and critically evaluate specialist nephrology and haemodialysis skills and knowledge in order to deliver high quality and evidence based compassionate care. There will be emphasis on the wider context of care such as shared-decision making, social issues and the co-ordination of outside agencies.

At the end of the course you will be able to:

  • Develop and critically review their own skills and competence in the holistic care of the patient within a renal care setting
  • Enhance systematic assessment skills and professional experience in order to influence patient outcomes
  • Select and critically evaluate relevant research in order to promote evidence-based practice within the renal care setting including national and international guidelines
  • Synthesise knowledge and create responses to problems that expand / redefine existing practice in order to effect change within the practice setting
  • Critically appraise and compare protocols and the management of care for patients with renal diseases clients locally, nationally and internationally in order to achieve clinical effectiveness
  • Critically analyse the ethical, cultural, religious, spiritual and quality of life issues associated with renal disease, and debate how such issues are addressed in day-to-day practice
  • Explain the different treatment options available and patient involvement in shared decision making demonstrating use of educational tools and an understanding of the patient pathway
  • Critically evaluate and reflect on the professional role of the renal nurse within the inter-disciplinary settings and other members of the multi-disciplinary team to gain a more insightful perspective
  • Critically examine strategies used for the assessment, management and evaluation of care to patients with acute and chronic renal disease to enhance clinical practice
  • Critically discuss current resources in determining health care strategies for clients and their families / carers within the renal care setting
  • Demonstrate academic reflection and reflective practice and the ability to audit own practice and make recommendations to achieve clinical effectiveness

Teaching arrangements

This module incorporates a blended learning approach, with 50% taught session and 50% E-learning. The educational approach is student centred and you will experience a wide variety of teaching and learning strategies, including:

  • Lectures and discussions E-learning activities
  • Worksheets
  • Directed reading and study including online reading list
  • Case studies and discussion
  • Reflective practice
  • Personal and group tutorials practice placements

The Assessment Portfolio

The assessment is a portfolio made up of 3 entries aiming to assess your knowledge and development. Your portfolio should demonstrate your achievement of the learning outcomes of the course.

All three portfolio entries (The e-learning quizzes, essay and e-PAD) must be submitted in order to pass the course.

Syllabus

Introduction to the Course and e-learning, Portfolio & PAD

  • Demonstrate an awareness of the Course content & assessment Explain what is expected of them whilst on the course
  • Understands the nature of the portfolio assessment
  • Demonstrate an understanding of what is required for the portfolio
  • Understand what is expected of them regarding their clinical competence
  • Demonstrate understanding of how the competency document will improve clinical practice
  • Understand the assessment structure used within the course

Renal Guidelines, Tariffs & Commissioning

  • Critically evaluate the Renal Association clinical practice guidelines and NICE guidelines & how they influence practice
  • Critically analyse the UK standards with Kidney Disease Outcomes Quality Initiative (K/DOQI)
  • Have knowledge of the Renal Registry data and understand the relevance of this data
  • Demonstrate an understanding of renal tariffs and the implication they have on practice both nationally and locally
  • Demonstrate an understanding of the implications of specialised commissioning
  • Demonstrate an understanding of Quality, Innovation, Productivity and Prevention (QIPP) within the Renal setting

Chronic Kidney Disease & Complications

  • Understand the D/OQI classification and how they relate to practice
  • Analyse the psychological implications of the diagnosis of kidney disease Critically evaluate the multidisciplinary care of kidney disease protocols
  • Explore the interface between the primary and tertiary care of patients with CKD Understand the systemic complications associated with CKD
  • Explore the relationship of the heart, hypertension and kidney failure
  • Explain the pathophysiology of the heart and hypertension and the kidney Identify patients with Chronic Kidney Disease risk factors for developing
  • Hypertension & Cardiovascular Disease
  • Be able to discuss the pathophysiological mechanisms that contribute to increased cardiovascular morbidity and mortality
  • Critically evaluate the treatment options

 

Water Treatment

  • Evaluate the importance of water purification in Haemodialysis
  • Understand the complications of raw untreated water.

Management of Haemodialysis Access

  • Discuss ways of monitoring the function of access Analyse the effectiveness of fistula assessments
  • Critically discuss the advantages & disadvantages of different cannulation techniques
  • Discuss ways of monitoring the function of CVC’s Discuss ways of monitoring the function of CVC’s
  • Explore the rationale for the care of required for CVC

 

Advanced Kidney Care (Pre-dialysis Care)

  • Identify the multidisciplinary care provided for patient for patient with declining renal function
  • Discuss the important elements of patient education and how and why it should be individualised
  • Identify processes which enable shared decision making to occur

Anatomy & Physiology of Peritoneal Dialysis and its Access

  • Discuss the mechanisms and processes through which peritoneal dialysis works.
  • Explore the rationale for different access management procedures.
  • Discuss the care of the exit site.

Peritoneal Dialysis Prescriptions & Peritoneal Dialysis Trouble shooting

  • Critically evaluate the rationale for adjustments to the treatment plans
  • Discuss the different fluids available & when they should be considered
  • Identify the main complications of PD and how to manage them
  • Critically evaluate the management of the main complications of PD.

PET and Adequacy

  • Critically analyse the principles of adequacy measurements and the implications of the results.

 

Review blood results including Anaemia Management

  • Identify normal and abnormal blood values related to renal anaemia
  • Critically evaluate the clinical evidence for anaemia treatment protocols
  • Critically analyse and interpret laboratory data to enable the renal nurse make appropriate clinical decision during dialysis.
  • Apply appropriate knowledge of blood result and it’s impact on patients’ haemodynamic status during haemodialysis
  • Effectively make changes in haemodialysis prescription with less supervision
  • Relate laboratory data to patient’s clinical observation pre, intradialytic and post dialysis
  • Efficiently educate patients on outcome of blood results

Haemodialysis prescriptions

  • Explore the need for different haemodialysis prescriptions Discuss different haemodialysis filter membranes and sizes
  • Discuss and explore the rationale for different dialysate concentrations and flows and when they may be required
  • Identify high risk medications such as, IV anticoagulants, thrombolytics.

Assessment of the patient undergoing Haemodialysis

  • Discuss the physiological mechanisms of both oedema formation and dehydration. Critically evaluate how a fluid assessment is undertaken.
  • Analyse the importance of fluid management in a patient with renal failure.
  • Critically analyse the holistic assessment of patient prior to commencement of haemodialysis and appropriate adjustment to the treatment plan
  • Identify all the safety features on a Haemodialysis machine
  • Critically evaluate the importance & role of all technical aspects of the haemodialysis machine.

 

Management of the deteriorating patient with CKD

  • Evaluate the components of the decision-making process
  • Appraise the role of the nurse in the co-ordination of interprofessional teams to provide effective care for individual patients.

Routine Renal Investigations & Procedures

  • Identify and discuss common procedures undertaken during the diagnosis of acute kidney injury & chronic kidney disease.
  • Analyse the nursing management required for the identified renal investigations.
  • Discuss the potential complications of these investigations and how these maybe reduced.

Acute Kidney Injury (Assessment & Management)

  • Explore the common causes of AKI.
  • Critically analyse the diagnostic processes in AKI
  • Explore the nursing management of the AKI patient
  • Critically analyse the treatment options for AKI and their nursing management
  • Discuss continuous renal replacement therapies as a therapeutic option for patients with AKI

 

Haemodialysis Adequacy

  • Haemodialysis Adequacy
  • Discuss the principles of adequacy measurements and the changes that maybe required as a result.
  • Critically analyse the clinical effectiveness of different adequacy tools

Online Haemodialfiltration

  • Discuss the principles of this treatment option
  • Identify the advantages and disadvantages of this treatment over haemodialysis
  • Review of diffusion versus convection-based clearances: substitution infusion mode, technical issues, risks, benefits

Blood borne viruses-Infection Prevention & Control

  • Review strategies to prevent bloodstream infections in patients on dialysis. Discuss patient perspectives on prevention of bloodstream infections
  • Relate the patients’ role in infection prevention
  • Discuss risk factors, clinical manifestations, medical management, and methods to prevent or reduce the transmission of common infections in haemodialysis patients
  • Discuss risk factors, clinical manifestations, medical management, and methods to prevent or reduce the transmission of Multi-Drug Resistant Organisms
  • Analyse the importance of good infection control procedures / practices within renal settings. Identify how different blood borne viruses are transmitted.

 

Common medications used for renal patients

  • Review Brief pharmacokinetics and dynamics
  • Discuss the action of medications affecting: heart, urinary system, lipid metabolism, GI, body fluid compartment, nervous system
  • Explore why certain medications require dose adjustment in patients with renal disease

Management of the deteriorating patient with CKD

  • Identify key features of acute deteriorating patient
  • Critically appraise the assessment process when a patient’s condition deteriorates
  • Examine the management strategies and nursing interventions for the deteriorating patient
  • ABCDEFG, Early warning scores & iSBAR
  • Seeking medical advice/referral
  • Critically evaluate advanced nursing skills when caring for the deteriorating patient
  • CPAP- indications and set-up
  • Haemofiltration- indications and set-up

Management of CKD associated falls

  • Identify the increasing the prevalence of falls among CKD patients
  • Know the intrinsic and extrinsic causative factors of falls
  • Design holistic falls assessment and implement individualised falls care plan
  • Know the key roles of different health care professionals in falls prevention and management
  • Discuss falls prevention strategies

 

Acute Haemodialysis/1st Dialysis

  • Discuss the principles of performing a holistic assessment in a relation to both 1st dialysis & dialysing an acutely ill patient
  • Critically evaluate acute dialysis prescriptions
  • Understand the differences between Acute & Chronic Haemodialysis
  • Demonstrate how to create an Acute Haemodialysis prescription / plan

Complications of Haemodialysis

  • Understand the precipitating factors for the development of haemodialysis complications
  • Ensure patent safety and to prevent further patient development of haemodialysis complications
  • Identify key features of acute deterioration associated with HD therapy
  • Critically examine the key factors associated with the assessment of an acutely ill patient
  • Utilise the ABCDEFG framework & Early warning scores
  • Critically appraise the assessment process when a patient’s condition deteriorates
  • Examine the management strategies and nursing interventions for the deteriorating patient
  • Seek medical advice/referral to medical personnel using iSBAR
  • Critically evaluate the role of the interdisciplinary team when caring for the deteriorating patient

Dialysis Induced Hypotension

  • Define the pathogenesis of dialysis induced hypotension
  • Identify haemodynamic changes during haemodialysis leading to hypotension using non-invasive devices
  • Classify patients in different risk categories, enabling specific therapy to be designed and implemented
  • Apply the most appropriate protective strategies for the hypotension prone patient on an individual basis
  • Analyse the care required for common intradialytic complications
  • Discuss the effectiveness of different interventions for dialysis induced hypotension.

 

Transplantation (Preparation & Surgery)

  • Understand the transplant operation procedure Explain the procedure to a patient
  • Understand current advances and innovative strategies in renal transplantation
  • Review of transplantation history
  • Explain transplantation as a treatment options to patients and provide them with evidence based information to enable patients make an informed choice
  • Understand current advances and innovative strategies in renal transplantation

Transplantation: Donor & Recipient work-up

  • The legal and ethical framework inherent with organ donation
  • Understand current advances and innovative strategies in renal transplantation
  • Be able to provide patients with evidence based information in relation to post organ donation/complications

Nursing Care of the Transplant Patient

  • Discuss the rationale for the nursing care of a patient post renal transplantation in both the immediate and longer term
  • Demonstrate ability to assess, plan, implement, utilise an evidence-based practice approach to evaluate care interventions in the care of the transplant patient and analyse the biological, psychological and sociological effects of transplantation on the patient
  • Discuss the importance of post-transplant observations and the significance of any changes
  • Discuss the management of the common complications post-transplantation

Pain Management & Immunosuppressive Therapy

  • Discuss the action of immunosuppressive drugs
  • Discuss the action of commonly used antihypertensives
  • Explore why certain medications require dose adjustment in patients with renal disease

 

ABO incompatibility

  • Identify the types of ABO incompatibility and pathophysiology
  • Identify the incidence and causes of rejection
  • Undertake an accurate assessment of the patient with rejection
  • Review the psychological impact of rejection

Psychological Implications of kidney disease

  • Explore the signs and symptoms of psychological distress
  • Identify different psychological presentations patients may display
  • Explore different coping strategies patients utilize
  • Explore different strategies that healthcare professional can use to help patients to cope with being on dialysis
  • Analyse the potential reasons for psychological problems patients may present with. Have knowledge of possible services available to assist patients.

Nutrition Needs for Patients with Renal Diseases

  • Identify the key nutrients considered in the nutritional treatment of renal failure and their main food sources in the diet
  • List the health consequences of abnormal levels of these nutrients in the blood
  • Identify the incidence and causes of malnutrition in patients with chronic kidney disease
  • Select the appropriate nutritional tools available at ward level to undertake an accurate nutritional assessment of a patient with chronic renal failure
  • Identify the four methods of nutritional support used in malnourished patients with chronic renal failure.

 

Symptom management and End of Life Care

  • Discuss the importance of symptom management as a treatment option.
  • Analyse the nursing care this group of patients require.

Management of Diabetes in Patients with CKD

  • Critically evaluate the relationship between diabetes and the kidney
  • Briefly review the pathophysiology of diabetic foot ulcer
  • Critically analyse the nursing care required by the non-HD patient with diabetes
  • Review, design and implement individualised holistic care plans for diabetic HD patients including foot care

Mineral Bone Disease

  • Identify the physiological processes that occur within the bones of patients with chronic kidney disease.
  • Analyse the degenerative effects and complications of abnormal calcium, phosphate and PTH
  • Briefly describe mineral bone disease & types
  • Critically analyse the principles of the management of the mineral bone disease.
  • Understand treatment of calcium & phosphate imbalances
  • Describe the management of patients with mineral bone disease
  • Discuss products available
  • Advantages and disadvantages of each different product
  • Discuss treatment strategy

 

Shared / Self-Care / Home HD

  • Background & Research
  • Review of patient education theories
  • Self-Care/management Shared Haemodialysis Care - Steps to Independence

Sustaining change

  • To understand the importance and interplay of effective leadership in the process of change management.
  • To develop an overview of the principles of change management in order to form a basis for further learning & personal development.
  • To begin to understand the various types of leadership and management, the difference, and their suitability for certain organisational roles.

Patient education / Patient story

  • To understand the importance and interplay of body and mind \
  • To develop an overview of the principles of bio-psycho social assessment
  • Critically analyse the principles of therapeutic relationship
  • Critically analyse attachment as a framework for understanding behaviour
  • Critically analyse the implications of body mind interplay and promoting recovery for team

Register your interest:

Please fill out the form below to register for the course. We will be in touch with further information.

About the author:

Roseline Agyekum

Roseline Agyekum

FHEA MSc PG Cert HCP BSc CCN RN | Lecturer Practitioner | King's College Hospital NHS Foundation Trust

Roseline's educational research area is long term conditions with special interest in chronic kidney disease awareness especially among people of African and Afro-Caribbean Ancestry. Her publications have focused on vascular access longevity. Vascular access is the Achilles heel of haemodialysis as a renal replacement therapy.

Her role at King's College Hospital fosters the embedding of research into clinical care through Practice Development. She is involved in a number of Quality Improvement projects to deliver harm-free evidence based care to patients. She is intentional about developing an empowered, motivated, and sustainable renal workforce.

Course design:

Florin Ivan

Florin Ivan

Project Manager, Learning Hub | King's Health Partners
Cost: £500.00
Quantity: 

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