An investigation into the ways that nurses in dialysis sessions promote the uptake of home haemodialysis

Abstract

Previous research suggests for patients who are able and willing, it is cheaper and better health-wise to do their haemodialysis at home than for it to be done by nurses in a centre. Patients doing some of their own dialysis in centres (self management) could be a stepping stone to dialysing at home. The aim of this study was to investigate whether the way nurses care for, educate and train patients encourages self management and home haemodialysis.

Interviews were undertaken in three hospital and four satellite units across two hospital Trusts in the West Midlands. A total of 75 people were interviewed: 30 patients, 1 consultant, 6 nurse managers and 38 staff nurses.

The main findings were:

1) All nurses do a great job caring for their patients. Some enthusiastically encourage independence and home haemodialysis, but most do not. There is no education or training specifically for this.

2) Most nurses educate patients by giving dietary and lifestyle advice; for those training to dialyse at home, the focus is on mastering the complex technique. Initially this is probably good, but can lead to superficial, fragmented knowledge and doesn’t help patients take control. However, some staff want to develop patient independence to increase their confidence, feeling of usefulness and understanding of their illness. This rehabilitation role is stressful, goes against the caring culture, but is needed to encourage patients to look after themselves.

3) Decisions are made by the doctors and nurses, but shared decision making is needed to help patients look after themselves e.g. by interpreting monthly bloods or suggesting dialysis parameters before the nurse does.

4) Some patients are understandably frightened of dialysing on their own, so they should gradually learn to do this safely monitored by nurses before being asked whether they want to dialyse at home.

5) In several centres, patients expect to be passive: this needs to change. If all patients do what they can, then more will slowly become independent.