Estimated reading time: 6 minutes
An interview with Tania Barnes January 2020
What interests you about working in haemodialysis?
I like the responsibility of maintaining people’s well-being. I didn’t realise just how degenerative chronic kidney disease can be. Without dialysis people can die. There are lots of differences in patients and I like that you tailor the treatment to them. I am inquisitive and I like to know what I am doing and if a patient asks questions, I like to be able to give them the answers or feel confident to find out where I can get them from. I look online for courses to provide information or at UK Kidney information sites e.g., renal diets. I am not expected to do this but I find it beneficial and interesting
What don’t you like so much?
It can feel very routine and a bit the same, although there are never two days the same. The routine of treating the same patients three times a week is something very different from what I have been used to previously so I do miss the variety of new patients with different conditions.
What were your first impressions of Shared Care when you started?
A lot of patients were very negative when the audits took place with many of them stating they were not interested. They said they thought they would be doing our jobs! Staff felt that the patients were not bothered and had the attitude that it was much quicker and safer for staff to do it all. My thoughts were if we only have 15 minutes to put patients on, have we really got time to teach them and are they going to be able to perform the tasks in that time? I didn’t know anything else about it and I didn’t know how it could benefit patients. Although there was a shared care notice board, it was about a specific topic like taking temperature not what it means to do Shared Care.
What did you need to help you understand the concept of about Shared Care?
I would have liked to have seen a poster showing that Shared Care means a range of tasks that people can try and the benefits that it brings for patients.
How did you feel about attending the Shared Care course?
I was asked if I wanted to do the training in Sheffield but I didn’t want to go. I thought it would be sales techniques telling us how to do it. I thought I would hate it and it would be a nightmare. I imagined being told “You need to try!” but I couldn’t see how you could engage patients or make them enthusiastic when they were so negative. My manager had kept saying she knew if I went on the first day that I would enjoy it and asked if I would give it a go. She said if I didn’t like it after day 1, I didn’t need to go again. This helped persuade me but that negative feeling stayed with me up until the day I started. Having the option of a ‘get out’ made the decision to try it a bit easier. (I use this approach now with my patients).
So, how did you feel about the course after the first day?
It was much more relaxed than I thought it would be. Everyone was in the same boat and had similar difficulties. It was delivered in small steps in a clever way that wasn’t too much to take on. It was broken down into chunks to manage easily between study days. I was intrigued after day 1 to see if the methods described would actually have an effect. I had the course book with the homework in so I had a good reason to approach patients to ask them their thoughts on shared care because it was part of my course. I felt I was able to have a conversation with patients about their thoughts and feelings about shared care using this as a way in.
What changes did you notice in how you approached Shared Care?
I think I just opened my mind up to give it a go. When I spoke to patients about their thoughts on Shared Care it gave me an insight and a way in to engage them somehow. It prompted questions like “What if I get it wrong?” I was then able to give them an explanation. It was nice to reassure them by sharing that I wasn’t always as keen on shared care and I didn’t know what the benefits were but now I know you can learn as little or as much as you like and even just doing a little will help. I now always ask “Is there anything you want to do today or do you do your own blood pressure?” This gives them the opportunity to do something they might not have asked to do themselves. I find myself talking through everything I do so that I encourage them to question and learn. I ask “Do you want to have a go?” I think this approach has quickened patient progress. The fact that there is no pressure really makes a difference. They don’t feel that it’s completely their responsibility. This is where the ‘Give it a try, you don’t have to carry on if you don’t enjoy doing it’ phrase works.
What was it about the course training that helped you with a change of approach?
The ‘Smart’ plan I wrote on the study day which was to create a step by step flip over guide for patients to help prompt them with a task, was the part that really changed things for me and kept me invested. I felt I would be helping make the teaching process easier. As I was working on this plan, I had to make changes to it and I had to ask patients for their opinions and involve them because I needed to make a version that made it easiest for them. I realised that the way they see things is different to the way we see them. The final version includes pictures and simple instructions. This has been developed to create a guide to all the steps in a dialysis treatment from beginning to end to support patients. The tool has been used by other staff to take specific sections and translate them into other languages. This has resulted in a Chinese lady learning about and taking part in her treatment. This seemed to bring her out of her shell and she communicates more with us now. She has also grown in confidence and wants to learn the next steps in her treatment.
How do you feel now about Shared Care?
I feel more confident. It’s brought a new challenge to me and also broken the monotony. It makes me feel really positive and gives me a sense of achievement when I see patients grasping how to do a task and then achieving it. I get a sense of pride, particularly when it’s something they have felt they would not be able to do. It’s good to be able to empathise with patients, keep them positive so that they don’t get disheartened when training. Shared Care creates a really good atmosphere. It is really nice to see and hear the patients getting on. With the monotony of dialysis treatment, it is something different for them to do.
Doing Shared Care with my patients has been a very rewarding challenge that has had a benefit for both me and the patients in the unit. I can use the skills I have gained through my learning in other areas of life and care too. I have found that some of the skills, in particular my persuasion skills, how I approach patients and how to put a plan together have been most beneficial. It’s given me confidence and although it initially felt like quite a big challenge, I have proved it is achievable.