Tania Barnes manages the Shared HD Care programme and is the Training Lead on the RCN-accredited Shared HD Care training course. A renal nurse of over 30 years, Tania has been hosted by Sheffield Teaching Hospitals NHS Foundation Trust and supported by Kidney Care UK.
I have always thought of myself as having an empathetic personality, caring deeply about the impact on the person who becomes a patient.
Prioritising their individual needs is the essence of true care for me and is what I have found most rewarding throughout my nursing career.
In my experience, being able to connect with someone by responding to what they consider to be important, has strengthened my relationships with people. This has resulted in more conducive partnerships where the ‘care’ is tailored to be ‘care’ and not a series of tasks.
Having said that, I realise that I still have a lot to learn about person-centred care and I can always improve on what I do which is why I enjoy the training days. There is always a different point of view, a new perspective or a way of describing something that resonates with me and deepens my own understanding.
As health care practitioners we are accustomed to being in control and it can leave us feeling vulnerable, exposed and unsure of our role when we let the patients take the lead.
I found the transition from being totally in control to facilitating conversations that enabled space for patients to participate more, was not easy but required a rethink of how I thought about my role, and how I could be more accepting of letting go and working with the patient and appreciating each other’s expertise.
My personal learning points:
- People are more capable than we think. I try not to make assumptions
- Choice equals empowerment whether you are a child or an adult – it gives us some control
- Every opinion is valid for that individual. I try to be curious not judgemental
- If I do less and support more, it is more successful than when I just take over
What do we mean when we say Shared Haemodialysis Care?
The term Shared Care was first described by a patient who said that we are sharing the tasks. This is different from the patient feeling they are responsible for doing everything!
This is where choice plays a big role because people have the choice to be involved in any aspect of their treatment that is meaningful to them. Given the choice they do not feel coerced but join if or when they feel it is right for them. They also have the choice to reduce what they do or stop for their own reasons. This means that it is entirely person centred and the reason that people are more comfortable with the concept as they are making decisions for themselves. Whatever they are involved in, however small their participation, they are doing Shared Care.
Why is it beneficial for patients?
- They say they enjoy taking part.
- They have more control.
- It boosts their self esteem and confidence.
- It can lead to more opportunities for learning and options such as Home Haemodialysis.
- It increases their health literacy.
- It provides a more uplifting and positive experience.
All of which can lead to better mental and physical health.
Shared Care doesn’t have to be all about completing tasks. It is playing an active part in a meaningful way that is important.
How can you make ‘involvement’ easy for you and your patients?
Some useful tips that don’t take any time:
- Ask patients to assist you with small tasks.
- Turn the dialysis machine towards your patients so that they see what you are doing.
- Talk through what you do.
These tips get people involved without them realising and promote questions.
Communication and language is key to engaging people in their own care
- Ask how they think it would benefit them to do Shared Care to understand their motivation.
- Start with what the patient is interested in and would motivate them.
- Listen to their ideas and be open to what they think will work for them.
Clever use of language to open and not close the door of possibility.
If a patient says they definitely can’t needle themselves…
"Are you needle shy?"
Many patients and staff use the term ‘needle phobic’ but phrased as shy may encourage people to think they could overcome this more easily.
"We can take it one step at a time. Which part would you feel comfortable with?"
"Why don’t you give it a try?"
Although keen, patients are often nervous of embarking on something they feel is beyond them.
"I will leave it with you to have a think about. You don’t have to do anything right now. Why not have a chat with one of the other patients?
What is challenging for Health Care Practitioners about Shared Care?
It is a different way of working to adapt to. Everyone will have their own priorities and not all health care practitioners will readily accept the change.
It can feel like another job on top of everything else and time is always quoted as an issue.
Shared Care can become an achievement target for staff. This is not helpful to patients unless they set the targets themselves.
My advice:
Work with what you have and be realistic about what you can personally achieve with your patients:
- Small steps will make a big difference to patients feeling involved and progressing. Involvement does not have to be physical tasks.
- Little and often means you can be more consistent and not feel over committed.
- Any achievement is a win: let the rest of the team know and celebrate with the patient together.
- Think more about improving the experience patients have when they attend dialysis. They are individuals and respond best when they are listened to.
- Look at ways to engage and motivate your colleagues to want to be more involved.
Join the Shared Care forums for new ideas, motivation and to check out the competition. LINK
If your team needs structure and a nudge forwards, enquire about the virtual training course.
Keep checking the website for new content to support you and your patients.