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Driving a successful Shared Haemodialysis Care programme in a satellite unit.
Anitta works as a band 6 Sister at Hayes Dialysis Unit, one of the satellites of Imperial College Healthcare NHS Trust London. In September 2020, she was offered the opportunity to become a link nurse in Shared Haemodialysis Care (SHC), an initiative in which patients undergoing dialysis are encouraged to become more self-reliant. This role was particularly appealing to her, given her interest and skills in teaching and patient interaction.
Many of the unit patients were already carrying out some of the basic tasks such as weight, and blood pressure.
“I didn't realise that we were actually doing Shared Care initially as this was normal for our unit for patients to do some of their tasks”
Less than 10 patients however were undertaking more complex tasks, such as preparing their dialysis packs, machines and assisting with cannulation.
By accepting the link nurse role for SHC, there was an opportunity for Anitta to introduce an approach that could increase the number of patients willing to participate in their care.
Initially, she contacted other satellite units within the Trust with more established SHC programmes. Lead nurses were helpful in providing patient education leaflets and audit guidance. She and her colleague Cini visited St Charles's and Northwick Park and whilst working alongside the staff, they learned about some key initiatives that had been successful.
“It was beneficial working on the more experienced units. We learned how the staff managed SHC and the resources they used. We saw how staff identified suitable patients and asked them to arrive early to prepare their own equipment. They attach a tag to the folders to help identify participating patients and indicate the level of SHC skills. In the absence of the SHC link nurses on shifts, patients are encouraged to do what they were comfortable with when cared for by others.
Encouraging feedback was obtained from staff who had previously attended the Shared Haemodialysis Care course. This inspired us to want to learn more and apply for the training ourselves”.
Anitta and Cini attended the 'Virtual SHC course' in February 2021. Prior to their training date, Anitta established some baseline data using the audit tool on the SHC website. This helped her to know who was interested and understand what the patients thought about SHC.
“I found that many of the patients were unsure about SHC and one of the most common worries expressed was that they would be sent home to dialyse. Patients are scared of home haemodialysis in case something happens to them. They see some patients being trained to go home and they don't want that. These patients were followed up to reassure them that home dialysis was not the intention. I explained to them what SHC was and the benefits. I told them that it is not about going home. I explained that they are part of their own treatment plan and it would mean that they would spend time with us working together to learn how to do some of their dialysis in the unit. I said that they will be more independent and feel part of their treatment.
Initially I had a cohort of ten patients who expressed an interest in SHC. These patients wanted to do more than the basic tasks for themselves. They mainly wanted to prepare their dressing packs and a few wanted to learn how to set up and prime their machines. To facilitate effective learning, I requested an area for training. With support of the management, we identified four chairs together that could be used for training. After discussion with the other team members, it was agreed that the patients who wanted to participate in the programme could enter the designated area of the unit fifteen mins early. The training happened very quickly when patients started to learn in that area. Once they had trained in the skills they wanted to learn about, I handed them back over to their original teams and then received another four patients to train. The other patients started to see what the returning patients could do and also wanted to learn”.
Anitta requested one day a week to concentrate on SHC. Her successful style of training was supported by managers and her allocation was granted. She used this time to talk to patients about why they might want to learn new skills. She recognised the impact of patients talking to other patients and proactively used this subsequently as a method of engagement. By placing someone who was interested next to another person who was already engaged, the initiative expanded. Unfortunately, due to covid restrictions, the casual conversations that would normally occur between patients before and after dialysis were significantly reduced.
“Patients were not allowed to be in close proximity. Nevertheless, they could talk to each other once sitting down in their dialysis chairs and that encouraged the confidence of SHC novices to grow by being able to watch established patients carrying out tasks confidently around them.”
After completing the course and gaining traction with some new ideas, Anitta recognised that she should focus on encouraging and teaching other staff on the unit so that they could support the SHC programme.
“I prepared a PowerPoint presentation for the staff which was delivered face to face and I was able to explain what my future plans were. The staff were interested and enthusiastic. They expressed similar initial assumptions to those of the patients, i.e., that the initiative was intended to teach patients to become independent and thus be suitable for home dialysis.
Once everyone understood that 'teamwork' between staff and patients was focus, the staff were happy for patients to come in early and understood how they could help them instead of resisting the change.
Now staff see the benefits of the training and how the patients have become really interested and enjoy the learning. This has helped the staff as a lot of patients are more independent now.”
Anitta and her colleagues designed some time saving resources such as photographs showing the dressing pack and the prepared machine. These are placed in the patient's folder and used to support patients new to SHC.
“We are sometimes short staffed and don't have time to teach, so to help patients keep going and to jog their memories they can use the photograph as prompts.”
Anitta's intention to hold a social coffee morning event for patients to share their experiences with others was not feasible due to Covid restrictions. Having already talked about it beforehand with participating patients, she didn't want to let them down:
“The patients really wanted to share their experience and to help others so I persuaded my manager to buy an iPad to allow them to record their individual stories. The patients were extremely enthusiastic about my idea. We also installed the training videos on the iPad, from the SHC website so that anyone could learn from watching. Some patients have changed how they feel about their dialysis treatment and are now really positive. This positivity has rubbed off on the staff too”
The Hayes unit Renal consultant, Dr.Eleanor Sandhu is very supportive of SHC and has taken on an active role in promoting the programme by directing patients to the newly established resources and to the SHC website for information.
“When new patients come to our clinic, Dr.Sandhu explains what SHC is and records any expression of interest in the medical notes. She also talks about my role so that new patients know about me when they start. When the consultant speaks positively of the programme, I think patients listen attentively. The consultant also reassures the patient and family that if patients agree to participate in the programme, they can enter the unit early to learn as part of the treatment. I am also privileged to have an extremely supportive manager Ms.Cherry Manilay and nursing team who go to great lengths to ensure the success of SHC. I would like to express my deepest gratitude to my nursing team for standing strong with me and supporting this all the way.”
Two years into focussing on the SHC program, the number of patients carrying out more complex tasks has increased. There are now 36 more patients doing their observations, 12 more preparing their machines and 31 more preparing their packs.
Anitta has spoken several times on the SHC course and been a speaker on staff network forums. A story written about one of her late patients is published on the website and illustrates the difference that SHC made to him and his family. Many of her ideas have been adopted by other SHC champions from around the UK.
“I see that SHC empowers the patient to take control of the management of their dialysis. This gives a boost to their self-esteem as it provides the feeling of being in control of their situation.
I really enjoy sharing ideas with other staff. The SHC course helped me to move forwards and focus on what I needed to make the difference. Being part of the SHC network gives me an opportunity to engage with staff from other centres who have now taken my learning experiences and implemented them successfully. I feel great sharing my experience because I have seen how it improves the quality of life for patients and I know that sharing even a small change idea can make a big difference that will then benefit patients beyond my unit. I enjoy encouraging others!.”
Anitta won an award from her hospital trust for 'Making a difference' and was promoted to a Band 6 post demonstrating a recognition of the skills and leadership she has shown whilst implementing SHC.
Key points that have helped Anitta establish the successful programme in her unit
- Demonstrating enthusiasm and leadership within her link role for SHC
- Learning from other more established units
- Identifying a designated area for teaching
- Allocating time to initiate the programme
- Integrating and utilising the empowered patients to influence their peers
- Promoting SHC with patient stories, videos, patient friendly resources
- Training staff about SHC and establishing communication methods to promote teamwork
- A 'can do' attitude to work around barriers such as covid and short staffing
- Engaging with medical staff to support the messages and promotion of SHC
Watch the following YouTube link to see Anitta and her introduction tour of her unit and SHC: