Calling Dialysis Nurses: Be a Hero—Home Dialysis Needs YOU!

This blog post was made by Dori Schatell, MS, Executive Director, Medical Education Institute on July 29th, 2015.
Calling Dialysis Nurses: Be a Hero—Home Dialysis Needs YOU!

To me, some of the very best and most inspiring Americans in home dialysis—the ones who are passionate about empowering their patients to live as fully as they can, who train people patiently and do home visits, who answer questions at all hours, who care—are nephrology nurses. My heroes are advocates and problem-solvers. They find ways to say YES, not no. Their approach changes over time as they learn more (and become even more person-centered). They give people hope.

An intriguing pair of Canadian studies has identified nursing beliefs, attitudes, and behaviors as key factors in whether people will be offered home treatments—PD and/or home HD—and will succeed at them if they decide to try. Tennankore et al1 assessed nurses’ attitudes and perceptions toward dialysis modality choice, possible barriers, and options education, hypothesizing that nurses who had expertise in home therapies would be more favorable to it, and those who did not would be more opposed. Multiple contributors fine-tuned a survey that was emailed to nurses and offered as a web link, and 129 ultimately responded, of whom 89 completed all or part. Significantly more home dialysis than in-center dialysis nurses responded (84% vs. 28%).

One question the nurse respondents were asked was “What modality would you choose for yourself if you needed dialysis?” Eighty percent of home dialysis nurses preferred a home modality (not 100%?), while only 48% of in-center nurses preferred in-center. Not surprisingly, most (79%) PD nurses would prefer to do PD, and most home HD nurses (86%) would prefer to do home HD. People are clearly comfortable with what they know—and less so with what they don’t.

In-center nurses felt that patient factors like poor socioeconomic status, multiple chronic illnesses, no post high school education, being older than 70, not speaking English as a primary language, working or attending school, and not having a care partner were barriers to home treatment. Home nurses did not. Everyone agreed that patients could use more options education—and that nurses could benefit from continuing education about dialysis options.

In a follow-up study, the group did an intervention to see if attitudes of in-center nurses toward home dialysis could be changed with education.2 The happy answer was, YES! (Both of these articles are free PDF downloads, by the way, from PubMed. See the references for links.) After repeating the initial survey, 89 in-center HD nurses from a different hospital took a 3-hour continuing education session during one of five offered times. The session included:

  • Context of chronic kidney disease in the region
  • Home dialysis targets (NOTE: There are targets for home dialysis in Canada!)
  • Discussion about the perceived benefits of home therapies
  • Discussion about perceived and actual barriers and how to overcome them
  • Types of home therapies offered
  • Patient suitability criteria
  • Training schedules
  • Cost comparisons between options
  • Educational resources for staff
  • A 20-minute video showing interviews with people doing PD, home HD, and in-center self-care HD and the nursing staff

When the survey was repeated after the education session, significant changes had occurred in these nurses’ attitudes and beliefs about PD and home HD. They were significantly more open to considering patients as home candidates whom they didn’t prior—such as those with low socioeconomic status, multiple comorbidities, little space at home or no care partner (NOTE: The U.S. is unusual in its requirement that every home HD patient have a care partner. Other countries tend to require that people be able to do their treatments unassisted), poor vision or motor strength, etc. Their perceptions of the idea distribution of modalities changed as well.

We need more home dialysis hero nurses in the U.S. to offer more people with kidney failure the best possible chance to live as fully as they can. If YOU feel that you need more education about home therapies—or know other nurses who do—the non-profit Medical Education Institute (MEI) has a great deal for you!

Create an online account on MEI’s Continuing Education website. You can get five CE credits for our Help, I Need Dialysis! book, in which you can learn details about every type of dialysis and its impact on patients’ lifestyle and survival, for $50—and we’ll mail you the book for free (a $14.99 value + shipping and handling). Be a hero!


  1. Tennankore KK, Hingwala J, Watson D, Bargman JM, Chan CT. Attitudes and perceptions of nephrology nurses towards dialysis modality selection: a survey study. BMC Nephrol. 2013 Sep 10;14:192. doi: 10.1186/1471-2369-14-192. http://www.ncbi.nlm.nih.gov/pubmed/24020978
  2. Phillips M, Wile C, Bartol C, Stockman C, Dhir M, Soroka SD, Hingwala J, Bargman JM, Chan CT, Tennankore KK. An education initiative modifies opinions of hemodialysis nurses towards home dialysis. Can J Kidney Health Dis. 2015 Apr 28;2:16. doi: 10.1186/s40697-015-0051-z. http://www.ncbi.nlm.nih.gov/pubmed/25922688

Comments

  • L Spencer

    Aug 13, 7:10 PM

    Can you advocate without repercussions? Can you attempt to educate without reprisal? Can the patient exhibit wear and tear on the body without accusations of personal neglect? When the answers to these questions are yes, more patients will become advocates .

    .until then patients continue to have their very existence on this earth at the hands of clinicians working to make their life easier. . to use your words.

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    • Dori

      Aug 13, 11:22 PM

      That's a very vulnerable and scary place to be--which is exactly why it's so vital that professionals help and step up to advocate on behalf of patients. Expecting people who feel lousy, don't know what's going on or what to expect, and are afraid to advocate for themselves is asking a lot.

      What sort of reprisal do you see for folks who try to educate, if you don't mind me asking? Years ago (1989) when I first started to work in this field, we routinely used to hear staff in clinics say, "We don't want to educate our patients--then they'll ask us questions." It was an uphill battle to make education a right, and it still doesn't happen as often or as usefully as it could. Do you still see that sort of resistance? I do occasionally (and believe a LOT of the "patient-centered care" language I hear is lip service, and what people really mean is "compliance," but I am getting more cynical...).

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  • Lea spencer

    Aug 13, 3:07 PM

    I absolutely agree with this article and wish more nurses understood how valuable home dialysis can be to patients. especially those patients facing social and economic disparity. it's unfortunate how many nurses eliminate home dialysis as an option because they're not willing to learn more about it and most importantly to learn more about their patients. They should attempt to learn as much as they can about all the types of dialysis so that many more patients can be helped and especially those facing socio economic disparities, those with language barriers, those with transportation issues those families trying to support their loved one doing the time that their life is changed.

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    • Dori

      Aug 13, 4:23 PM

      Thank you, Lea. When I do talks for nursing and social worker groups, one of the points I try to make is that we are ALL patients--perhaps not kidney patients, but there is not one of us who doesn't encounter the medical system in a patient role. So, we need to think about what WE would want if we were the ones faced with these choices. We already know that most clinicians would choose a home treatment for themselves or their loved ones. We need to be advocates for people with kidney disease and help them get the treatment that will make their lives work best--not our lives easiest.

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