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International Nurses Day 2020: Case study of the week

10 March 2020


Thursday 12 March is World Kidney Day.

Kidney disease is a non-communicable disease which currently affects around 850 million people worldwide, and one in ten adults has chronic kidney disease. The 2020 campaign highlights the importance of preventive interventions to avert the onset and progression of kidney disease. This week’s IND case study showcases the work of a nurse practitioner in the USA, Guatemala and Thailand to improve medication adherence.

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Improving the health of adults with kidney disease through research and policy, United States and Guatemala

Contributor: Debra Hain

Chronic kidney disease (CKD) is a global health problem that has a high morbidity and mortality rate, particularly among adults over the age of 55. Disadvantaged populations may experience a higher risk due to lack of access to care.

About 10% of the population worldwide has CKD, but the incidence and prevalence varies across different regions of the world. Many countries, including the United States and Thailand, are faced with the challenge of how to provide the best quality care for people with CKD while reducing healthcare costs. Low resource countries, such as Guatemala, have similar CKD incidence but a much lower prevalence of untreated CKD.

The need for early identification for treatment, aimed at slowing the progression of CKD and improving health outcomes, led nephrology nurse practitioner Debra Hain to focus her research on this population.

Dr Hain began her career as a dialysis nurse, and while in this role she witnessed poor outcomes and realised the only way to improve nephrology nursing practice and the health of those she cared for, was to obtain an advanced degree.

After receiving her master’s degree in nursing as a Gerontological Nurse Practitioner, she began a new journey in nephrology rounding on patients receiving dialysis and providing education to those with advanced CKD.

Dr Hain knew that she could play an even more influential role in changing patient health outcomes, so she studied for her doctoral degree and later a post-master’s degree as an adult nurse practitioner.

Since receiving her PhD, Dr Hain has continued rounding on dialysis patients. Her practice has helped inform her research because it reveals the challenges faced in providing the best care at optimal cost.

In collaboration with other professionals, Dr Hain has conducted a qualitative study in Guatemala to gain insight into the understanding of risk for CKD in adults 55 and older who have diabetes, which is the number one reason for people to develop CKD.

The findings from this study supported a further study exploring the effect of a workshop for community health workers who are employed by a free medical clinic in the United States. The focus of the workshop, which was led by a nurse practitioner and a dietitian, was on the recruitment of Hispanic adults with diabetes to a CKD clinic. This project will also be replicated in Guatemala. In addition, Dr Hain also collaborates with nursing faculty at Thammasat University in Thailand, to implement a palliative care model for adults with advanced CKD.

Dr Hain’s work in the US has influenced the healthcare of adults with advanced CKD through research and policy initiatives. The findings from a research study examining the relationship between cognitive function and medication adherence in older adults with CKD receiving dialysis, supported a funded study of a nurse-led intervention with disadvantaged adults in Southeast Florida. This ethnically and racially diverse population has a high risk for cognitive impairment that makes it difficult for them to take their medications as prescribed, leading to poor health outcomes, including hospitalization and death.

Dr Hain is a nominated nursing member of National Quality Forum (NQF) Renal Standing Committee, representing a group of patients who often do not have a voice when policy is being decided.

The NQF is the driving force for improving quality in healthcare across the US and having nephrology nurses and nurse practitioners actively involved in healthcare policy is essential to improve the health of the growing CKD population.