The role of patients in the implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative.

Patients have a fundamental right to be involved in making decisions that affect their health care treatment and outcomes. Patients need to be knowledgeable about disease process and treatment options to exercise this right. The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Clinical Practice Guidelines on Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, Treatment of Anemia of Chronic Renal Failure, and Vascular Access, introduced in 1997, include new clinical recommendations that may impact patient treatment choices. Access to these guidelines presents a unique professional opportunity to empower patients through education related to NKF-DOQI. This article highlights the role of patients in implementing NKF-DOQI in light of studies conducted by two renal patient organizations, the National Kidney Foundation (NKF) and the American Association of Kidney Patients (AAKP). Results from the AAKP survey indicate that end-stage renal disease patients are willing to change behavior to feel better and live longer. Results from the NKF focus study show that dialysis patients need to receive information about NKF-DOQI and understand its direct impact on patient outcomes. In addition, results from both studies reveal that patients feel strongly about participating in health care decisions that impact on their treatment and outcomes.

Continuous renal replacement therapy. A national perspective AACN/NKF.

Health care providers rely on quality continuing education programs to increase their knowledge and to acquire new skills. Participation in programs such as CVVH: Implications for Clinical Practice-the Patient, the Circuit, the Team can potentially improve patient outcomes. While this study identifies critical care nurses as a receptive professional group for further CRRT training, it also indicates that additional education in this topic may benefit other members of the critical care team as well. Therefore, because the critical care nurse's role, while crucial to the clinical management of patients undergoing CRRT, does not include prescribing or initiating CRRT therapy, it is difficult to predict the impact of future workshops on the increased and sustained use of CRRT in critical care arenas. If you would like additional information on CVVH: Implications for Practice-the Patient, the Circuit, the Team, please contact the National Kidney Foundation at (800) 622-9010, or the American Association of Critical Care Nurses at (800) 899-2226.

Programs for families of organ and tissue donors.

Until recently, the families of patients who have given the gift of life have been the invisible group in the transplant circle. They donated the organs and tissues of their loved ones to unknown transplant recipients and then were to grieve alone. As transplantation has matured and become the treatment of choice for end stage organ failure and for other life-enhancing procedures, the importance of the donor and the donor family is being recognised and their needs and expectations identified.

Perspectives on communication issues among transplant and procurement professionals, transplant recipients, and donor families.

Communication among professionals, donor families, and transplant recipients is a controversial topic. Traditionally, transplant and procurement professionals have made the decision about the type and frequency of information that a donor family and transplant recipient receive regarding one another, and relationships that might develop as a result. Information obtained through questionnaires demonstrated inconsistency in addressing donor family and transplant recipient needs for initial and follow-up information and communication-not only between clinical transplant and procurement donation coordinators, but within organizations involved in the care and support of these people. This wide variance regarding communication among all disciplines demonstrated a need for standardization of practice guidelines. Guidelines are being developed through collaboration of the major organizations involved in the care of donor families and transplant recipients to standardize communication practices throughout the United States.

Making the critical difference: an innovative approach to educating nurses about organ and tissue donation.

Finding creative solutions to the critical shortage of available organs for transplantation continues to challenge those organizations and health care professionals who are intimately involved in donation procedures. This article describes Making the Critical Difference, an 8-hour continuing education program developed by the National Kidney Foundation and the American Association of Critical-Care Nurses. The program represents a model for identifying and addressing the barriers, attitudes, and needs of nurses as they participate in the donation process.

Donor family programs.

This article explores how the critical care nurse can support donor families. Some of the many programs currently available to assist families after the death of a loved one and after the donation of organs and tissues are described.