Content area
Full text
Focus on Issues from ANNA's Special Interest Groups
Nephrology nursing has come a long way. Before 1963, the year home dialysis began, the role of the nephrology nurse consisted mainly of comfort measures for patients; later, this role expanded to include patient education. Patient education was a new concept for nurses and did not appear in textbooks until 1968. For several years, patient education consisted of training the person to go home and manage a complex treatment regimen (Hoffart, 1989). Historically, education has been one of the primary interventions nephrology nurses have implemented when providing care to people with chronic kidney disease (CKD). Education mainly focused on increasing knowledge of people undergoing some form of renal replacement therapy (RRT) (Hibbert, Toupin, & Baker, 20 06). It was believed that by providing necessary information, people would adhere to the prescribed treatment regimen and gain self-confidence in managing the disease. Ultimately, this would lead to a better quality of life, improved health, and improved functional status (Devins & Binik, 1996; Korniewicz & O'Brien, 1994). Although, education is an essential part of care, this alone has not proven to be effective in changing behavior. People make choices that they perceive fit within their lifestyle. Over the past decade, an evolution in patient education has occurred.
In 20 02, the National Kidney Foundation (NKF) published the Kidney Disease Outcomes Quality Initiative (K/DOQI) CKD clinical practice guidelines (see Table 1), which provided a much needed definition and staging of this chronic disease (NKF, 20 02). In 20 06, CKD was further identified as a public health problem requiring further action (Schoolwerth et al, 20 06). Both actions have led to a paradigm shift in education. No longer are nephrology nurses only focusing on a population undergoing RRT, but instead, are viewing education as something that should occur before an individual requires RRT. Hence, the term CKD education is now used.
CKD education encompasses more than dialogue regarding treatment options. Currently, there is focus on health promotion and shared decision making regarding strategies to slow the progression of CKD. For the first time since 1972, when the Centers for Medicare and Medicaid Services (CMS) committed to provide coverage for people with ESRD, CMS has established a new education benefit for...