Home dialysis expert offers training suggestions that support patients, families
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Based on more than 20 years of experience, a speaker at ASN Kidney Week discussed the role of the home dialysis training nurse, emphasizing the importance of tailoring training to best support individual patients and their families.
“Home dialysis nurses are avid supporters that develop close bonds with their patients and caregivers,” Lisa Koester, MSN, CS, CNN-NP, a renal nurse practitioner at Washington University School of Medicine in St. Louis, said in her virtual presentation. “We advocate for patients to do self-care. We are able to provide flexibility to adjust training for patients and their current partners based on their schedules and based on their needs, [thereby] individualizing training. We know and recognize that everyone has different learning styles and that we have to adapt to those learning styles to be successful with training for home care.”
She added that the home dialysis nurse serves as the primary interface between a patient and a program – working with an interdisciplinary team of physicians and social workers – to educate patients on how to safely conduct their own treatments.
Regarding home dialysis programs in recent years, Koester contended that many did not present a unified way of training these patients, with a survey from 2016 finding that none of the examined courses gave information on how to teach or assess adult learning. Being able to assess how a patient understands training is “crucial,” she said, to the success of any home dialysis program.
Following these findings, both the International Society of Peritoneal Dialysis and the International Society for Home Hemodialysis have created syllabi for training patients which incorporate a step-by-step curriculum on how to train patients.
According to Koester, the first necessary step in training is to provide patients with education on how to monitor and manage their kidney disease. This includes how to obtain blood samples for lab work, maintain appropriate diets and understand how the dialysis machine works.
“We [also] help the patient and their care partners cope with the barriers and the fears associated with home dialysis,” she said. “Dialysis is not easy. Most patients will tell you home dialysis is a part-time job.”
For this part of training, the nurse has conversations with patients about their specific hopes and needs, providing educational tools that align with individual learning styles.
“You have to assess patient factors that might impact their ability to learn,” Koester said. “You have to understand physical and psychosocial barriers, such as literacy, depression and memory impairments.”
Programs may need to be modified to meet each patient’s learning needs.
“When it comes to home dialysis training with the patient and family, we need to think out of the box to be successful,” Koestner concluded. “We want patients to stay at home and to be interactive at home, because dialysis doesn’t only affect that patient: it affects their families.
One of the blogs on Home Dialysis Central is called Life-Alyze, which I find it interesting because it is their life around dialysis. You want to dialyze to live. You don't want to live to dialyze and that's what home dialysis does for patients.”
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Koester L. Home dialysis training: Patient and family considerations. Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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