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.
The Nephrology Nursing Certification Commission isupdating the Certified Nephrology Nurse and CertifiedDialysis Nurse certification programs in 2026 based onnational practice-analysis findings. These changes includerevised examination blueprints, standardized eligibility cri-teria, removal of the baccalaureate-degree requirement,and clearer differentiation between dialysis-focused andbroader nephrology nursing practice. This article explainsthe rationale for the updates, summarizes key transitiondates, interprets available education and practice-scopedata, and provides practical guidance for nurses, educa-tors, employers, and review-course developers. Under -standing these changes can help nephrology nurses selectthe appropriate credential, prepare effectively, and aligncertification with contemporary specialty practice.
Initiating change in dialysis care can feel daunting, especially when past challenges and uncertainties linger. Recognizing the need for improvement is only the beginning. Imagine you have just reviewed the latest set of patient outcomes data for your dialysis facility and identify areas for improvement-the need to reduce central venous catheter (CVC) rates, decrease missed treatments, or address the attrition of home therapy patients returning to in-center care after unsuccessful attempts. The sheer scope of the problem can leave providers feeling paralyzed, unsure of where to start or how to move forward. Dialysis care team members, including nurses, patient care technicians, social workers, and dietitians, often experience this sense of contemplation, especially as they navigate the ever-changing health care landscape. The Plan-Do-Study-Act (PDSA) model offers a structured, yet adaptable, approach to quality improvement, transforming hesitation into actionable steps. This article explores how this powerful model can improve patient outcomes and create a culture of continuous learning and safety in dialysis settings.
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 9item 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.
Advocacy is an essential component of professional nursing practice, yet opportunities to experience advocacy across international health care systems are uncommon. This article describes a collaborative journey between leaders of the American Nephrology Nurses Association (ANNA) and the Canadian Association of Nephrology Nurses and Technologists (CANNT), beginning with a conversation at the 2025 CANNT Conference and concluding in participation at ANNA's 2026 Advocacy Forum in Washington, D.C. Through shared experiences, the authors explore similarities and differences in nurse advocacy within the United States and Canada, highlighting workforce challenges, kidney health priorities, legislative engagement, and the enduring influence of nurses' voices in shaping health care policy. Although advocacy pathways differ, the shared commitment to improving kidney care demonstrates that advocacy truly has no borders.
