Assignment

64 Renal Society of Australasia Journal I Vol 15 I No. 2 I July 2019

Investigating the role of practice nurses in the early identification and management of

chronic kidney disease in the general practice setting: An integrative review Graeme L Turner, Sandra Grace, Christina Aggar and Rae Rafferty

Submitted 1 April 2019, Accepted 27 May 2019

Abstract Aim The aim of this study was to critically review research literature investigating the role of practice nurses in the early identification and management of chronic kidney disease (CKD) in the general practice setting.

Method An integrative review was performed to determine the extent to which the topic has been investigated. Quantitative and qualitative research papers were systematically located in peer-reviewed journals in electronic databases. Included papers were critically appraised using the relevant CASP appraisal tools.

Findings There is a paucity of research investigating the role of practice nurses in the early identification and management of CKD in primary health care. Three articles published between 2013 and 2017 were identified: two quantitative studies and one qualitative study. One study from The Netherlands quantified positive outcomes of practice nurse-centred management of CKD in general practice.

Conclusion Practice nurses may be effective in the early identification and management of CKD, including improving blood pressure control. Providing education to practice nurses appears to be a key factor in increasing practice nurses’ involvement in identification and management of CKD. Further research is warranted to see if the results are transferable to other jurisdictions.

Keywords Chronic kidney disease, practice nurse, general practice, primary health care.

For referencing Turner, G. L. et al. (2019). Investigating the role of practice nurses in the early identification and management of

chronic kidney disease in the general practice setting: An integrative review. RSAJ Journal, 15(2):64-70.

DOI https://doi.org/10.33235/rsaj.15.2.64-70

Graeme L Turner RN, GradCert (Clinical Nursing)(Edith Cowan), MNursing (Nurse Practitioner)(Newcastle) Northern NSW Local Health District, PO Box 419, Lismore, NSW 2480, Australia Southern Cross University School of Health and Human Sciences, Lismore, NSW 2480, Australia Email [email protected]

Sandra Grace DipEd(US), BA(US), GradCert(SportsChiro)(Melb), MSc(Macquarie), PhD(US), DC(SydCollege), DO(SydCollege) Southern Cross University School of Health and Human Sciences, Lismore, NSW 2480, Australia Email [email protected]

Christina Aggar BNurs(Hons)(Sydney), GradCertEdStud(HigherEd)(Sydney), PhD(Sydney) Southern Cross University School of Health and Human Sciences, Gold Coast, Qld, Australia Email [email protected]

Rae Rafferty MSc (SCU), MBA (CSU), BHSc (CSU), RN Northern NSW Local Health District, PO Box 419, Lismore, NSW 2480, Australia Email [email protected]

Correspondence to: Graeme Turner, PO Box 419, Lismore, NSW 2480, Australia Email [email protected]

Literature review

Renal Society of Australasia Journal I Vol 15 I No. 2 I July 2019 65

Summary statement What is known about this topic?

• There is a paucity of research investigating the role of

practice nurses in the early identification and management

of chronic kidney disease in the general practice setting.

What does this paper add?

• Literature suggests that practice nurses can play an

important role in the early identification and management

of chronic kidney disease when provided with appropriate

education and resources.

Introduction Diseases of the kidney and urinary tract are the ninth

leading cause of death in Australia (Australian Bureau of

Statistics, 2014). Dialysis treatment is the number one cause

of hospitalisation in NSW (NSW Dialysis Costing Studies,

2009). The early stages of chronic kidney disease (CKD)

are asymptomatic and if detected early and managed

appropriately, the otherwise inevitable progression of kidney

disease can be reduced and may even be reversible (Kidney

Disease: Improving Global Outcomes, 2013). Early detection

and appropriate management can slow or halt the progression

of the disease to the restrictive regime of dialysis and decrease

mortality. In Australia, one in 10 adults have indicators of

CKD such as reduced kidney function and/or albumin in

urine (Australian Bureau of Statistics, 2013). However, fewer

than 10% of people with CKD are aware that they have this

condition (Australian Bureau of Statistics, 2012).

General population-based screening for CKD is not cost-

effective (Komenda et al., 2014). Mathew et al. (2010)

conducted a pilot study in Australia screening for CKD in

the community and workplace. While this pilot was effective

in identifying early CKD, it was an expensive procedure. In

another Australian study, Howard et al. (2006) looked at the

cost-effectiveness of early detection and intervention to prevent

the progression of CKD. They found that general practice-

based opportunistic screening of patients with risk factors for

CKD to be a likely cost-effective strategy for early detection

and management of CKD. This approach of screening high-

risk individuals was also supported in the systematic review

conducted by Komenda et al. (2014). General practice is

the logical setting for early detection of CKD. Eighty-five per

cent of Australians visit a general practitioner (GP) each year

(Razavian et al., 2011); 35% of consultations are associated

with chronic disease management (Australian Institute of

Health and Welfare, 2018). However, CKD remains significantly

under-diagnosed and under-treated in general practice. In the

AusHEART study, Razavian et al. (2011) found that only 18% of

patients with indicators for CKD had a CKD diagnosis recorded

in their medical record. Increased levels of protein in the urine

correlates directly with increased risk of progression of kidney

disease to kidney failure and increased cardiovascular risk

(Levey et al., 2011). Proteinuria screening was performed in

less than 60% of people with decreased estimated glomerular

filtration rate (eGFR) (Razavian et al., 2011). In Australia, one in

five patients commencing renal replacement therapy were late

referrals to nephrology services (Foote et al., 2014).

Peak national nephrology organisations such as Kidney Health

Australia (KHA) and the National Kidney Foundation in the

United States provide CKD education for health professionals,

including practice nurses (Kidney Health Australia, 2019;

National Kidney Foundation, 2019). KHA’s primary care

education program provides a variety of two-hour CKD

education modules, each presented by an expert speaker.

The program, which is accredited for continuing professional

development, reaches around 43,000 primary health care

professionals, including practice nurses each year (Kidney

Health Australia, 2019). However, it appears that evaluations

of KHA’s primary care education program have not been

published.

In Australia, the term ‘practice nurse’ is generally applied to

qualified nurses employed in the general practice setting (Jolly,

2007). This definition is used in this review. Practice nursing

is a growth area in the Australian general practice workforce.

Approximately 63% of general practices in Australia employ

at least one practice nurse (Agency for Clinical Innovation,

2015) and they have become an integral part of the general

practice team. Adult health checks, preparing chronic disease

management plans and chronic disease education and

management are all within the scope of practice nurses in

Australia (Australian Medicare Local Alliance, 2012). GPs report

increasing workloads that impact negatively on consultation

times and their capacity to deliver adequate care to complex

patients with chronic conditions (Agency for Clinical Innovation,

2015). They are often caught up in the business of diagnosis

and management of clients with acute symptoms, leaving

chronic disease management and follow-up to be managed by

practice nurses employed within the practice. Consequently,

practice nurses are ideally placed at the coal face in general

practice to assist GPs in the identification and management of

chronic conditions.

In order to determine the extent of the role of practice nurses,

specifically in the early identification and management of

CKD in the primary health setting, an integrative review of the

literature was conducted.

Method Design An integrative review is a comprehensive literature review

that includes both qualitative and quantitative methodologies

Investigating the role of practice nurses in the early identification and management of chronic kidney disease in the general practice setting: An integrative review

66 Renal Society of Australasia Journal I Vol 15 I No. 2 I July 2019

(Whittemore & Knafl, 2005). The integrative review method

involves identifying, selecting, appraising and synthesising

research in a structured and replicable format (Souza, Silva &

Carvalho, 2010).

Search strategy In March 2018, a systematic search was undertaken using five

electronic databases: Medline, Embase, CINAHL, Aushealth,

Nursing @ Ovid. The search consisted of seven steps using

MESH headings, relevant terms and abbreviations (Table 1).

At each step, articles were limited to English language and

to publication between 2007 and 2017. CINAHL search was

limited to “original research” as this filter was available in

CINAHL database search. Duplicates were removed. Citation

tracking and reference list inspections were undertaken to

search for further relevant papers. Quantitative and qualitative

research papers were systematically identified in peer-reviewed

journals. Two independent reviewers reviewed 38 abstracts

and 21 full text papers to identify suitable articles for inclusion

in the review.

also excluded. During the process of reviewing studies for

inclusion in the review, a number of studies involving short-term

interventions by specialist nephrology nurses visiting general

practices to assist with identification and management of

kidney disease were identified. These studies did not include

long-term follow-up, and sustainability of these interventions

may prove challenging. These studies did not meet review

criteria so were not included in this review.

Search outcome The systematic search strategy produced 38 citations; 5

were duplicates; 33 titles and abstracts were reviewed and

17 papers were excluded with reason. Five additional primary

research articles were identified from references in systematic

reviews, 3 were excluded with reason. The remaining 21 full

text papers were reviewed (Figure 1). Three studies were finally

included in the review.

Quality appraisal, abstraction and synthesis The Critical Appraisal Skills Programme (CASP) system of

appraisal was adopted to appraise the final three studies for

rigour, method, credibility and relevance (Critical Appraisal

Skills Programme, 2016). The CASP system of appraisal is a

well-utilised tool that can enhance the utility of evidence-based

research by health professionals through the identification of

quality research. The studies were critiqued for design, method,

aims, ethical considerations, sample population and size,

interventions and outcome measures (Table 2).

Results The three studies included in the review were published

between 2013 and 2018. One study was from The Netherlands

(Scherpbier-de Haan et al., 2013), one from Australia (Sinclair,

Day, Levett-Jones & Kable, 2017) and one from the United

States (Thompson-Martin, McCullough & Agawal, 2015).

Study design Methodological design varied between the three studies. The

study by Scherpbier-de Haan et al. (2013) was a quantitative,

cluster, randomised control trial comparing shared care

management between practice nurses and GPs with standard

care provided by a GP alone. The primary outcome measure

was a decrease in blood pressure (BP) in hypertensive patients

with CKD. Blood pressures were compared prior to the study

and at 12 months. Thompson-Martin et al. (2015) also used

quantitative methodology. Their study was quasi-experimental

using longitudinal knowledge surveys completed by practice

nurses. A pre-knowledge survey testing knowledge of Kidney

Disease Outcomes Quality Initiative (KDOQI) guidelines was

completed by participants before attending an educational

Investigating the role of practice nurses in the early identification and management of chronic kidney disease in the general practice setting: An integrative review

Table 1: Search strategy to identify papers for review

Step Search term 1. Keyword OR subject Heading ‘chronic kidney disease’

‘renal insufficiency, chronic’ (15920)

2. Keyword OR subject heading ‘nurse’ nurses, nurse prac- titioners, family nurse practitioners, nurse specialist, nurse clinicians, nurses, community health, nurses, public health (33848)

3. Keyword OR subject heading ‘General practice’ general practice, family practice (45088)

4. Keyword OR subject heading ‘primary care’ primary health care

5. Keyword OR subject heading ‘Community health services’

6. 3 or 4 or 5

7. 1 and 2 and 6 (38)

Inclusion and exclusion criteria Articles were included if they reported primary research

articles that focused on the role of practice nurses employed

in the general practice setting in the early identification and

management of CKD. Articles were excluded if they were not

published in the English language, were not primary research, if

the disease was not CKD, if the research was not in the general

practice setting and if the research did not report specifically

on the role of the nurse who was employed in the general

practice. Research where the patients had end-stage kidney

disease and were undertaking renal replacement therapy, or

had a renal transplant were also excluded. As the focus of

the review was to investigate the role of practice nurses in the

early identification and management of CKD in the general

practice setting, papers not differentiating practice nurses’ role

from that of the GP or other allied health professionals were

Renal Society of Australasia Journal I Vol 15 I No. 2 I July 2019 67

Investigating the role of practice nurses in the early identification and management of chronic kidney disease in the general practice setting: An integrative review

Table 2: Quality appraisal

Authors, date and location

Study design Primary aims/s Ethical

considerations

Sample population

and size

Comparative interventions

Outcome measures/ instruments

Main findings

Scherpbier- de Haan, Vervoot et al. , Netherlands, 2013

Cluster randomised control trial

Assess effect of a shared care model in managing patients with CKD who also have diabetes and hypertension

Not required as covered under data-sharing agreement from larger trial

Patients from 9 general practices in Netherlands. 90 intervention and 74 control patients

Structured care involving NP in general practice setting vs standard GP managed care

Achievement of BP targets 130/80 and lowering of BP in patients with diabetes mellitus or hypertension and an eGFR less than 70ml/min/1.73m2

Intervention group BP decreased by 8.1 (95% CI =4.8 to 11.3)/1.1 (95% CI =–1–3.2) compared to –0.2 (95% CI=- 3.8-3.3) / –0.5 (95% CI=–2.9–1.8) in control group. Use of lipid-lowering drugs, angiotensin system- inhibiting drugs and Vitamin D higher in intervention group

Sinclair, Day et al., Newcastle, Australia, 2017

Elicitation questionnaire to inform Theory of Planned Behaviour

To identify barriers and facilitators to CKD screening by practice nurses working in general practice in regional NSW, Australia

Yes 26 practice nurses working in general practice in regional NSW

N/A Elicitation questionnaire to inform Theory of Planned Behaviour. Two researchers independently conducted a direct content and frequency analysis of participant responses to questionnaire

Participants acknowledged that PNs were ideally placed to undertake CKD screening. Some participants recognised they had a knowledge deficit of best practice for CKD screening. No financial incentive for practice to perform CKD screening. Concern of harm to patient by causing stress due to additional health problem. Lack of knowledge to answer patient questions about CKD

Thompson- Martin, McCullough et al., Kansas, USA, 2015

Quasi- experimental, pre, post and 1 month follow-up

Change in knowledge of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Guidelines (NKF KDOQI guidelines) and knowledge retention of NKF KDOQI guidelines at 1 month

Yes 14 advanced practice nurses working in primary health care in urban mid-western USA

Pre and post education event surveys

Questionnaire to measure knowledge of NKF KDOQI guidelines pre, post and 1 month following APN educational meeting on NKF KDOQI guidelines

Increase of knowledge of CKD KDOQI guidelines following educational meeting; knowledge was retained 1 month later

meeting. One month after the meeting, they completed an

identical survey to test if the educational meeting had increased

practice nurses’ knowledge of KDOQI guidelines. Sinclair et

al. (2017) conducted a qualitative study, utilising an eight-item

elicitation questionnaire to investigate behavioural, normative

and control beliefs of practice nurses regarding screening for

CKD, informed by the Theory of Planned Behaviour.

Quality appraisal The study by Scherpbier-de Haan et al. (2013) was a high-

quality study. It was a well-powered, cluster, randomised

control trial and was able to provide statistical significance in its

primary endpoint, namely a decrease in BP.

The study by Thompson-Martin et al. (2015) used a quasi-

experimental design. While this was also a quantitative study,

it was of lower quality as randomisation was not used and

measurement was longitudinal. These factors make it difficult

to eliminate confounding factors that may influence results.

The authors used a small sample size, with 14 practice nurses

completing the study and convenience sampling, which further

68 Renal Society of Australasia Journal I Vol 15 I No. 2 I July 2019

Investigating the role of practice nurses in the early identification and management of chronic kidney disease in the general practice setting: An integrative review

limited generalisability of the results. A strength of the study

was that the authors utilised a validated assessment tool to

test the practice nurses’ knowledge and found an improvement

in the primary endpoint, that is an increase in practice nurses’

knowledge of KDOQI guidelines.

In contrast to the two quantitative studies described above,

Sinclair et al. (2017) used a qualitative study design to elicit

practice nurses’ beliefs about barriers and facilitators to

opportunistic screening for CKD in general practice. Twenty-

one practice nurses were recruited via convenience sampling.

The CASP qualitative checklist was used to assess the study

and it was deemed to be of rigorous design with credible

results. Qualitative results are context-dependent and generally

not intended to be generalised, although the findings may be of

use in other similar contexts.

The extent and effectiveness of practice nurses’ role in

the early identification and management of CKD in the

primary health care setting

This integrative review identified that there is a paucity of

literature regarding the role of practice nurses in the early

identification and management of CKD. Scherpbier-de Haan

et al. (2013) found that shared care between practice nurses

and GPs led to improvement in BP control in people with CKD

compared to management by GPs alone. Thompson-Martin

et al. (2015) were successful in improving practice nurses’

knowledge of the KDOQI guidelines using an education

session. Sinclair et al. (2017) found that practice nurses

believed they had a role to play in the early identification of

CKD, but were challenged by knowledge, time and financial

barriers. The three studies reviewed, although undertaken in

different health jurisdictions, all support the notion that practice

38 citations identified through Boolean database searches

38 citation titles and abstracts reviewed 22 Papers excluded with reason:

• Duplicate (n=5) • Not chronic kidney disease (n=5) • Research protocol (n=4) • Not general practice setting (n=4) • Not practice nurse specific (n=4)

16 full text papers reviewed

Additional 5 full text papers identified in systematic reviews appraised.

Total 21 full text papers reviewed.

2 Systematic Reviews • Primary articles from systematic reviews

obtained(n=8) • Duplicates excluded (n=3) • Full text papers reviewed (n=5)

3 full text papers included in integrative review

18 Papers excluded with reason: • Not general practice setting (n=7) • Multidisciplanary care, not nursing

specific (n=5) • Advanced practice nurse external from

general practice team, not practice nurse (n=4)

• Not chronic kidney disease (2)

Figure 1: Search flow chart

Renal Society of Australasia Journal I Vol 15 I No. 2 I July 2019 69

nurses can play a role in the early detection and management

of CKD.

Discussion The aim of this study was to critically appraise the research

literature to determine the extent to which the practice nurses’

role in the early identification and management of CKD in the

primary health care setting has been investigated. The review

highlighted that there has been little work completed in this area and only three studies were identified for inclusion in the integrative review.

All three studies included in the review discussed shortcomings in the early identification and management of CKD in the GP setting and suggested that practice nurses could play a role in improving early identification and management of CKD in the general practice setting. The Scherpbier-de Haan et al. (2013) study was the only study that attempted to measure effectiveness of a shared care model with the practice nurse (nurse practitioner) playing a central role in management of CKD compared to standard GP care of CKD. The remaining two studies focused on facilitators and barriers to practice nurses’ involvement in identification and management of CKD. Thompson-Martin et al. (2015) suggested practice nurses' CKD knowledge deficit was a barrier that could be addressed through education. Sinclair et al. (2017) took a qualitative look at barriers and facilitators to practice nurses providing opportunistic screening for CKD. Facilitators identified included beliefs that practice nurses were ideally positioned to identify CKD and that early identification of CKD benefits patients. Barriers included practice nurse knowledge deficit, nursing time constraints and lack of financial reimbursement to practices for CKD screening activities.

Two themes emerged that were common to all three papers reviewed. The first theme to emerge from the studies was that it is perceived that practice nurses can indeed play a role in early identification and management of CKD. Results from the Scherpbier-de Haan et al. (2013) study support this hypothesis. They achieved their primary endpoint of improvement in BP control in people with CKD, with statistical significance using a shared care model, with the practice nurse playing a central role in management of CKD. In the Dutch general practice setting, nurse practitioners (referred to as advanced practice nurses in the paper) were employed in the general practice setting. These nurse practitioners were masters- prepared advanced practice nurses (Dutch Professional Nurse Practitioner Organisation V&VN VS, 2015). In Australia, the vast majority of practice nurses are baccalaureate-prepared registered nurses or diploma-trained enrolled nurses. Practice nursing is not as well recognised in Australia, as an independent nursing specialty, as it is in some other countries (Halcomb, Salamonson, Davidson, Kaur & Young, 2014). Further research is required to determine if the Dutch results are transferable to the Australian general practice setting with

its bachelor- and diploma-qualified practice nurses. The fact that Sinclair et al. (2017) found that practice nurses themselves believe that they are ideally placed to play a role in the early detection of CKD in the Australian setting, suggests that the findings from the Scherpbier-de Haan et al. (2013) study may be transferable to the Australian setting. Thompson-Martin et al. (2015) hypothesised that increasing practice nurse knowledge of KDOQI guidelines would increase appropriate referral of people with CKD to specialist nephrologists — a clear indicator of the role that practice nurses can play in the early detection and management of CKD.

The second theme was practice nurses’ knowledge about CKD. Both the Scherpbier-de Haan et al. (2013) and Thompson-Martin et al. (2015) studies involved increasing practice nurses’ CKD knowledge to facilitate their involvement in management of CKD. In the Scherpbier-de Haan et al. (2013) study, specialist nephrology staff provided education sessions to practice nurses at the start of the study, thereby attempting to increase practice nurses’ CKD knowledge. The study established a connection between the practice nurses and a specialist nephrology nurse, allowing the practice nurse to consult with the nephrology nurse, as required. Thompson- Martin et al. (2015) increased practice nurses’ knowledge of KDOQI guidelines through successful provision of an education session to practice nurses. Practice nurses surveyed by Sinclair et al. (2017) perceived a lack of CKD knowledge as a barrier to their role in the early identification of CKD. Education opportunities similar to those described by Scherpbier-de Haan et al. (2013) and Thompson-Martin et al. (2015) could go some way to addressing Sinclair et al. (2017) practice nurses’ knowledge deficit barrier.

Other barriers to practice nurses’ involvement in the early identification of CKD highlighted by Sinclair et al. (2017) included nursing time constraints and lack of financial reimbursement to practices for CKD screening activities. The Australian Primary Health Care Nurses Association (2017) states that health promotion, illness prevention and chronic disease management are skills that can be undertaken by practice nurses. They go on to state that primary health care nurses can facilitate increased access to health care. The practice nurse workforce in Australia is increasing (Australian Medicare Local Alliance, 2012). In fact, in general practices employing nurses, practice nurse to GP ratio increased from 0.49PN/1.0GP in 2007 to 0.56PN/1.0GP in 2012. Consequently, the available practice nurse resource is increasing in general practice in Australia. This should go some way to addressing time constraint issues. In Australia, the Practice Nurse Incentive Program (PNIP) has been

introduced to assist general practices to fund practice nurse

positions. There are also a number of Medicare items that

apply to particular skill sets or services undertaken by practice

nurses (Agency for Clinical Innovation, 2015). This means that

government subsidies apply to those items. Iles et al. (2014)

Investigating the role of practice nurses in the early identification and management of chronic kidney disease in the general practice setting: An integrative review

70 Renal Society of Australasia Journal I Vol 15 I No. 2 I July 2019

found that practice nurse-led care for chronic diseases was

economically viable for general practices in Australia. The

financial barrier to practice nurse involvement in identification of

CKD recognised by Sinclair et al. (2017) may be addressed by

providing education to general practice managerial and clinical

staff on financial reimbursement available through PNIP and

Medicare item numbers in Australia.

Conclusion Research investigating the role of practice nurses in the early

identification and management of CKD in the general practice

setting is scant. The three studies included in the review all

suggest that there is a role for practice nurses in the early

identification and management of CKD, including effectiveness

of the role in improving BP control. Providing education

to practice nurses in early identification and management

of CKD appears to be a key factor in increasing practice

nurses’ involvement in the identification and management

of CKD. These education programs could include clinical

education for practice nurses as well as education regarding

financial reimbursement for chronic disease identification and

management for their general practices. Further research

is warranted to evaluate the role that practice nurses could

have in the early identification of CKD in the Australian general

practice setting, subsequently reducing the burden of disease

to both patients and their communities.

References Agency for Clinical Innovation. (2015). Understanding and working with general practice. Chatswood, NSW: Agency for Clinical Innovation. Available at: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/292561/ Understanding_and_working_with_general_practice.pdf

Australian Bureau of Statistics. (2012). Australian health survey: First Results 2011–12. Report No.:4364.0.55.001. Available at: http://www.ausstats.abs.gov.au/Ausstats/subscriber. nsf/0/1680ECA402368CCFCA257AC90015AA4E/$File/4364.0.55.001.pdf

Australian Bureau of Statistics. (2013). Australian Health Survey: Biomedical Results for Chronic Diseases, 2011–12. Canberra: ABS. Available at: http://www.ausstats.abs.gov.au/Ausstats/subscriber. nsf/0/01ECE269AAE6E736CA257C0700114DBA/$File/AHS%20-%20 Biomedical%20Results%20for%20Chronic%20Diseases.pdf

Australian Bureau of Statistics. (2014). Causes of Death, 2012. Canberra: ABS. Available at: http://www.abs.gov.au/AUSSTATS/[email protected]/ Lookup/3303.0Main+Features12012?OpenDocument

Australian Institute of Health and Welfare. (2018). Australia’s Health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW. Available at: https:// www.aihw.gov.au/getmedia/6bc8a4f7-c251-4ac4-9c05-140a473efd7b/aihw- aus-221-chapter-3-3.pdf.aspx

Australian Medicare Local Alliance. (2012). General practice nurse national survey report. Available at: https://www.apna.asn.au/files/DAM/3%20Knowledge%20 Hub/2012GeneralPracticeNurseNationalSurveyReport.pdf\

Australian Primary Healthcare Nurses Association. (2017). Improving patient outcomes. Primary health care nurses working to breadth of their scope of practice. Position statement. Available at: https://www.apna.asn.au/files/ APNAPositionStatementScopeofPracticeSep2017.pdf

Critical Appraisal Skills Programme. (2016). Making sense of evidence. Oxford, UK: Critical Appraisal Skills Programme. Available at: http://www.casp-uk.net/

Dutch Professional Nurse Practitioner Organisation V&VN VS. (2015). The Nurse Practitioner in the Netherlands. Retrieved 19 December 2017, from https:// venvnvs.nl/wp-content/uploads/sites/164/2015/08/2015-10-30-Factsheet- Nurse-Practitioner-Netherlands-2015.pdf

Foote, C., Clayton, P. A., Johnson, D. W., Jardine, M., Snelling, P., Cass, A. (2014). Impact of Estimated GFR Reporting On Late Referral Rates and Practice

Patterns for End-Stage Kidney Disease Patients: A Multilevel Logistic Regression Analysis Using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). American Journal of Kidney Diseases, 64(3), 359–366.

Halcomb, E. J., Salamonson, Y., Davidson, P. M., Kaur, R., Young, S. A. M. (2014). The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on. BMC Family Practice, 15, 52.

Howard, K., Salkeld, G., White, S., Chadban, S., Craig, J., McDonald, S., Perkovic, V., Cass, A. (2006). Cost-effectiveness of early detection and intervention to prevent progression of chronic kidney disease in Australia. Kidney Health Australia Sydney NSW 2006 Available at: https://kidney.org.au/cms_ uploads/docs/stage-2-costing-study-executive-summary.pdf

Iles, R. A., Eley, D. S., Hegney, D. G., Patterson, E., Young, J., Del Mar, C., Synott, R., Scuffham, P. A. (2014). Revenue effects of practice nurse-led care for chronic diseases Australian Health Review, 38, 363–369. Available at: http:// dx.doi.org/10.1071/AH13171

Jolly, R. (2007). Practice Nursing in Australia. Canberra: Parliament of Australia. Available at: https://www.aph.gov.au/About_Parliament/Parliamentary_ Departments/Parliamentary_Library/pubs/rp/RP0708/08rp10

Kidney Disease: Improving Global Outcomes (KDIGO). (2013). CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int, Suppl 3, 1–150.

Kidney Health Australia. (2019). Primary care education. Retrieved 25 February 2019 from: https://kidney.org.au/health-professionals/detect/education

Komenda, P., Ferguson, T. W., Macdonald, K., Rigatto, C., Koolage, C., Sood, M. M., Tangri, N. (2014). Cost-effectiveness of Primary Screening for CKD: A Systematic Review. American Journal of Kidney Disease, 63(5), 789–797.

Levey, A. S., de Jong, P. E., Coresh, J., El Nahas, M., Astor, B. C., Matsushita, K., Gansevoort, R. T., Kasiske, B. L., Eckardt, K. U. (2011). The definition, classification and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney International, 80(9), 17–28.

Mathew, T. H., Corso, O., Ludlow, M., Boyle, A., Cass, A., Chadban, S. J., Joyner, B., Shephard, M., Underwood, T. (2010). Screening for chronic kidney disease in Australia: a pilot study in the community and workplace. Kidney International, 77(Suppl 116), S9–S16: doi:10.1038/ki.2009.538

National Kidney Foundation. (2019). Professional Education Resource Centre. Retrieved 25 February 2019 from: https://education.kidney.org/course-catalog- list

NSW Dialysis Costing Study. (2009). Volume 1: Main Report New South Wales. Sydney: Department of Health. Available at: https://ahsri.uow.edu.au/content/ groups/public/@web/@chsd/documents/doc/uow082154.pdf

Razavian, M., Heeley, E. L., Perkovic, V., Zoungas, S., Weekes, A., Patel, A. A., Anderson, C. S., Chalmers, J. P., Cass, A. (2011). Cardiovascular Risk Management in Chronic Kidney Disease in General Practice (The Ausheart Study). Nephrology Dialysis Transplantation, 27(4), 1396–1402.

Scherpbier-de Haan, N. D., Vervoot, G. M. M., van Weel, C., Braspenning, J. M., Wetzels, J. F. M., de Grauw, W. J. C. (2013). Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial. British Journal of General Practice, DOI: 10.3399/bjgp13X675386

Sinclair, P. M., Day, J., Levett-Jones, T., Kable, A. (2017). Barriers and facilitators to opportunistic chronic kidney disease screening by general practice nurses. Nephrology, 22, 776–782.

Souza, M. T., Silva, M. D., Carvalho, R. D. (2010). Integrative review: what is it? How to do it? Einstein (Sao Paulo, Brazil), 8(1), 102–6. doi:10.1590/S1679- 45082010RW1134

Thompson-Martin, Y., McCullough, P. A., Agrawal, V. (2015). Impact of an educational program for advanced practice nurses on knowledge of Kidney Disease Outcomes Quality Initiative Guidelines. Nephrology Nursing Journal, 42(5), 455–460, 496.

Whittemore, R., Knafl, K. (2005). The integrative review: updated methodology. Journal of Advanced Nursing 52(5), 546–53. doi: 10.1111/j.1365- 2648.2005.03621.x

Conflicts of interest The authors declare no conflicts of interest.

Acknowledgements This work is supported by a research grant from NSW Agency

for Clinical Innovation.

Investigating the role of practice nurses in the early identification and management of chronic kidney disease in the general practice setting: An integrative review

Copyright of Renal Society of Australasia Journal is the property of Cambridge Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.