Practical Tips for Home Dialysis Training Nurses

This blog post was made by Gale Schulke, RN, CDN on July 14th, 2016.
Practical Tips for Home Dialysis Training Nurses

How we educate patients about the techniques of dialysis can make the difference between having a patient who is independent and one who is needy. We always have a few patients who require a lot of handholding initially, but we can educate them out of that by using a few techniques.

The first thing we, as nurses, need to focus on is how we teach. Not everyone learns the same way:

  • We have visual learners, who need to watch you a few times before they are ready to try things themselves.
  • We have audio learners who need to hear the instructions more than once before they are ready to try something on their own.
  • Then, we have the tactile learners. If they cannot get their hands on the equipment early on in the process, you will lose them. They are the “watch one, do one, teach one” kind of people.

None of these methods are better than another, and many people are a combination of two or more. If we fail to watch and listen to the patient to find out what type they fall under, we will not be successful.

Once you have established your adult learner type, there are a few more things you need to take into consideration:

  1. Can your patient hear clearly? It is a fact that most people over the age of 50 start to lose the sharpness of their hearing. The older they get, the less likey they are to be hearing every word that you say. Face them, without a mask on, the first time you go through a procedure. You need to speak clearly. Use words they can understand, in a language they understand. Don’t talk to them while you are washing your hands—unless you can face them as you are doing it. The water running and the fact that you are talking to the wall will prevent them from hearing all the instructions.

  2. Ensure understanding. Don’t assume that just because your patients are nodding their heads up and down that they really understood you. Have them give you a verbal answer and a return demonstration. Even the most educated person is going to have some degree of impairment, initially.

  3. Assess their vision. Your patient may need reading glasses to see the tip of their catheter. Or, they may need to take off their glasses to see the tip of the catheter. If they have diabetes, do they have retinopathy? Do they have cataracts?

  4. How is their dexterity? Uremia itself reduces the touchiness in the fingertips...

Most important of all is this: Teach the WHY. Are you merely teaching the procedure and have forgotten the importance of knowing WHY? Everything we do, everything we learn has a WHY component to it. When you wash your hands, WHY are you doing it? To get as many germs off of them as possible. We cannot completely sterilize hands, but we can get close by washing them for the prescribed period of time. WHY do you connect the catheter to the tubing? To establish a pathway from the catheter to the other components of the dialysis, while maintaining sterile technique to prevent contamination of the catheter. When you give patients the reasons why, you are empowering them. They no longer have to take it on faith that you are giving them the correct information. They are more likely to do the procedure the correct way and continue to do so if they are aware of the consequences of not doing so.

Have you asked your patients what they hope to gain by doing home dialysis? What is their goal:

  • Do they want to go back to work?
  • Do they want to take trips?
  • Do they want to gamble in Vegas?

What is your patient’s life plan for being on a home modality? Perhaps the only goal is to NOT have to go to the clinic 3 days a week. Maybe it is a family’s goal to keep grandma or grandpa at home in a safe environment because of Alzheimers. It is our job as providers to find out our patient’s goals so we can gear their training and their goals to accomplish them. This knowledge affects your training. Are you going to make a patient do CAPD for a month if they have to work from 6am to 6pm? How would they do that? Would you put someone on CCPD if they work nights and only average 6 hours of sleep before they have to get up and pick up the kids from school? Will you put someone on a Baby K if their goal is to travel?

This all looks like common sense, but how often do we do things because we have always done it this way? I have been told that “all the doctors want their patients on CAPD for at least a month.” My question was WHY? As long as we remind patients how to do manual exchanges every few months, that is ridiculous in most cases. Instead, I called the doctors for CCPD orders—and got them. The doctors didn’t know why all of their patients had to do CAPD for a month, either!

As we change our practice to include the needs of the patients we are there to help, we will all find that our patients will learn faster and better. They will be more confident, and they will know that someone genuinely cares about them and what THEY want.

Comments

  • Gail Dewald

    Aug 10, 7:43 AM

    Thanks Gale for this well written blog. I will be sharing it with the clinics I visit. Keep the practical messaging coming!

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  • David Rosebloom

    Jul 23, 2:20 PM

    Excellent blog and truly patient-centered. Thank you!

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  • John Agar

    Jul 14, 6:51 PM

    Spot on, Gayle.

    An excellent blog! ... and some much-needed but simple teaching, training and understanding wisdom.

    I would add another reminder about an assumption we all make about a factor that is often hidden and/or very well disguised ... = literacy and numeracy.

    We assume all our patients read and/or write, and 'get' numbers and numeracy concepts like we, the trainers, do but, sadly, even in our first world countries, this is not always so. By adulthood, those in our society whose reading, writing, and arithmetic skills are poor develop some impressive street smarts that disguise their deficit ... yet words and numbers are merely squiggles on a blank page to them.

    My point? ... don't assume every patient can read or write.

    This comes back, I agree, to styles of learning - visual, auditory, touch - but teach by pictures, too. Simple pictures, sketches, stick figures, line drawings, actual photos ... all reinforce and remind.

    But, this minor addition aside, I loved your blog.

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    • Gale Schulke

      Jul 15, 6:07 PM

      Thank you for your comments. You are absolutely right. People are embarrassed that they cannot read or write, so it stays hidden unless you accidentally discover it. Also, someone who speaks English as a second language may not read it AND may not be able to read their native tongue.

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