On the unit where I dialyse a couple of patients seem to think that they can get away with dialysing twice a week, and Thursday is an optional day. Most of the other patients note this, but apart from grumbles to the nursing team, not much else is said. In fairness to the nursing team, they do explain that this is not sensible, to them on their next session, but call it ‘water off a ducks back’ or ‘in one ear and out of the other’, it seems to have no effect. In truth, some more serious education is required for people before they ever start dialysis, rather than just dragging the patient kicking and screaming into dialysis. Consider the one who recently joined the unit who is utterly convinced she will have a transplant and will not have a fistula, ‘over her dead body’! I wish her well and hope she does get a transplant, but her lack of knowledge shapes her opinions about dialysis, and that this is a means for her to stay alive, which she does not seem to understand.
Better education at the outset will help to shape the attitudes of patients about why they need to ‘do their time’ and coming off early, or missing sessions is not good for them. Also, better education at the outset will help the nursing teams, and also help with moving people through to some ownership of their treatment, maybe even self-care. So, at the point the doctors ‘diagnose’ the issue and ‘prescribe’ dialysis either there and then, or in a period of time in the future, a referral to training for the patient is required, and if suitable, home training, avoiding the patient ever getting on to the ward.
In the meantime, it seems optional Thursday will continue!
