Patients receiving chronic hemodialysis frequently experience significant physical, psychological, and emotional stress that often contributes to patients' dysregulation, treatment resistance, and behaviors labeled as "difficult." Traditional responses to these situations can unintentionally escalate the distress the patient is experiencing and negatively affect the staff-patient relationship. This article explores patient behavior through the lens of emotional intelligence, trauma-informed care, and nervous system regulation. Examples from real-world clinical experiences are used to demonstrate how emotional intelligence can support effective de-escalation, strengthen patient-staff relationships, and improve patient experiences. The author has included two practical frameworks, ANCHORS and COMMUNITY, to assist nephrology nurses and dialysis staff in regulating their own nervous system while supporting patients during emotional overwhelm and nervous system overload. Emotional intelligence is presented as an essential clinical competency that promotes safety, trust, communication, and compassionate patient-centered care within the dialysis setting.

AThis randomized controlled trial evaluated the efficacy of an individualized, nurse-led, teach-back method of education intervention guided by the Roy Adaptation Model on treatment adherence and coping processes among adult patients on hemodialysis. Utilizing a parallel-group pretest-posttest design, 42 outpatients were randomized into intervention (n = 21) or control (n = 21) groups. Data were collected using validated adherence and coping scales. The intervention group received three face-to-face education sessions delivered via the teach-back method. After adjusting for baseline scores, the intervention group demonstrated statistically significant and higher posttest adherence and coping scores compared with the control group. Retrospective analysis confirmed a robust post-hoc power of 0.92. This theoretically guided framework supports multidimensional treatment adherence and coping mechanisms in patients on hemodialysis.

The End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) evaluates adherence behaviors of patients on maintenance hemodialysis (e.g., hemodialysis attendance, medication use, fluid restrictions, and diet restrictions). The ESRD-AQ, with 46 items, is considered lengthy by some clinicians with time constraints. Therefore, this study was conducted to develop and psychometrically evaluate a 9-item short form of the ESRD-AQ (ESRD-AQ-SF) for faster and more efficient administration. Content validity, construct validity, and test-retest reliability were assessed. Results demonstrated that the ESRD-AQ-SF is a valid and reliable tool for evaluating treatment adherence in patients undergoing maintenance hemodialysis.

Improving patient care in the dialysis setting begins with empowering nurses and interdisciplinary teams to lead quality improvement initiatives. As dialysis care becomes more complex and regulatory metrics intensify through the ESRD Quality Incentive Program, the need for continuous improvement is critical. The Plan-Do-Study-Act (PDSA) cycle offers a practical, iterative framework for driving meaningful change in dialysis settings. A discussion of each phase followed by a detailed example addresses the current educational gap and illustrates how this framework supports quality outcomes. By empowering dialysis staff, particularly nurses, as key agents of change, a culture of quality improvement and sustainability in the dialysis setting can be successfully achieved.

The Nephrology Nursing Certification Commission is updating the Certified Nephrology Nurse and Certified Dialysis Nurse certification programs in 2026 based on national practice-analysis findings. These changes include revised examination blueprints, standardized eligibility criteria, removal of the baccalaureate-degree requirement, and clearer differentiation between dialysis-focused and broader nephrology nursing practice. This article explains the rationale for the updates, summarizes key transition dates, interprets available education and practice-scope data, and provides practical guidance for nurses, educators, employers, and review-course developers. Under standing these changes can help nephrology nurses select the appropriate credential, prepare effectively, and align certification with contemporary specialty practice.

The term noncompliant remains common in clinical documentation, yet it can transmit bias, narrow clinical thinking, and obscure barriers influencing patient outcomes. This article describes the de-identified experience of a medically complex rural patient with diabetes, kidney-related specialty needs, alcohol use disorder, food insecurity, unstable housing, transportation barriers, and pending disability income who was repeatedly viewed through the lens of noncompliance. Longitudinal nephrology nursing documentation revealed a more complicated story: barriers to care rather than unwillingness to engage. Rather than withdrawing support, the nephrology team persisted with practical, nonjudgmental interventions focused on identifying barriers and coordinating resources. After disability income was approved, the patient obtained stable housing, re-engaged with care, and returned gas cards to the clinic to help other patients in need. This case illustrates how language can change trajectories and become a clinical intervention in nursing practice.

Improving Continuous kidney replacement therapy (CKRT) Outcomes in Neonates and Infants Through Interdis ciplinary Collaboration (ICONIIC) is a multicenter quality improvement and research registry. We aimed to identify programmatic structures and educational practices for neonatal and infant CKRT. A survey focusing on care delivery and models, units offering therapy, staff-to-patient ratios, and education protocols was distributed to institutions in ICONIIC using the Carpediem machine. Of the 13 responding sites, 11 used the Carpediem machine in Pediatric Intensive Care Units (ICUs), 9 in Neonatal ICUs, and 8 in Cardiac ICUs. A collaborative care model was most common (69.2%). While education practices varied, all sites required nurse-specific training, and all but one mandated provider oversight during CKRT initiation. Understanding these practices may inform best practices for neonatal and infant CKRT.

Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) play a vital role in dialysis, yet many face obstacles in advancing their professional careers. ANNA's Administration Specialty Practice Network utilized focus groups to explore the experiences and perceptions of LPNs regarding barriers to professional growth. Thematic analysis revealed four primary barriers: role undervaluation by registered nurses, limited access to educational opportunities, lack of individual and organizational support, and lack of networking opportunities. These findings underscore the need for targeted interventions and enhanced support systems to foster career development among LPNs.

The study investigated the decision-making process of patients with end stage kidney disease in choosing a dialysis modality. It used a mixed-methods approach to assess individual characteristics impacting decision-making in shared decision-making. Data collection involved an online survey. The study revealed that participation in shared decision-making was notably higher when patients had provider support. Those opting for peritoneal dialysis experienced lower decisional conflict compared to those opting for conservative care, hemodialysis, and transplants. Findings indicated that active participation in shared decision-making is associated with decreased decisional conflict. Moreover, higher decision self-efficacy correlated with decreased decisional conflict and contributed to predicting satisfaction with the decision. A strong rapport between patients and clinicians and patients engaging in shared decision-making with their health care provider could enhance satisfaction with the decision.

The transition from academic study to professional practice can be challenging for newly graduated nurses who have less than 12 months of experience. Newly graduated nephrology nurses need opportunities to build competence and confidence to provide quality and safe nephrology nursing care. A team of nursing educators and instructional designers integrated competency statements from the American Nephrology Nurses Association's Nephrology Nursing Scope and Standards of Practice (9th ed.) into a nurse residency program, which positively impacted competency obtainment, role confidence, and retention data for this population of nephrology nurses.

This study evaluates the Comprehensive Conservative Kidney Care Clinic (CCKC), the first known U.S. nurse practitioner-led program for patients with advanced chronic kidney disease (CKD) choosing non-dialytic management in an urban safety-net setting. Retrospective analysis of 32 patients (mean age 74.6 years) over four years demonstrated the model's feasibility. While 81.3% remained on conservative management (CM), significant racial disparities emerged: 29.6% of Black patients transitioned to dialysis compared to 0.0% of White or Asian patients (p = 0.03). Furthermore, 70.8% of patients on CM utilized hospice, whereas none who initiated dialysis did. Qualitative findings suggest clinician framing strongly influenced patient choice. Despite the small sample size, the CCKC model effectively provides person-centered care, emphasizing the need for strategies addressing social determinants to ensure equitable access.

Chronic kidney disease (CKD) is a chronic illness linked to major metabolic abnormalities, including high levels of potassium and phosphorus. These abnormalities can lead to serious complications, such as bone and cardiovascular diseases. There are established dietary guidelines for the treatment of CKD, yet many patients still struggle with their effectiveness and adherence. The 2020 Kidney Disease Outcomes Quality Initiative (KDOQI) nutrition in CKD update and other renal dietary guidelines provide evidence-based suggestions for controlling these risks through medical nutrition therapy, protein and energy intake, nutritional evaluation, and electrolytes; however, effective implementation is still limited by provider knowledge gaps. This quality improvement project used an organized staff education program on renal nutrition to close that gap. Results of this project indicate that nephrology staff preparedness to reinforce nutritional education for patients with CKD may be enhanced by a systematic renal nutrition education intervention.

Family caregivers of patients on hemodialysis (HD) experience significant burden that can impact their health and quality of life. Identifying effective strategies to reduce this burden is essential for improving outcomes for both patients and caregivers. This article highlights evidence-based strategies for addressing caregiver burden among family caregivers of patients receiving HD. A literature review was performed using EBSCOhost, ProQuest, and PubMed databases. Twenty-two related articles were identified, of which 12 met inclusion criteria. Five effective strategies were identified to reduce caregiver burden: the 5-A self-management model, stress management training, online peer mentoring programs, teach-back method based on the 'Timing it Right' framework, and peer support intervention. Nephrology nurses and health care professionals should work collaboratively to identify caregiver needs and offer appropriate tools to reduce burden.