Building Effective Communication at Heeley Dialysis Unit

By Cheryl Matthews, Senior Sister, Heeley Satellite Dialysis Unit, Northern General Hospital

Things are looking good at Sheffield Satellite Dialysis Unit.

In April 2013 Sheffield Satellite Unit was joined with Sheffield Kidney Institute, the main unit across at Northern General Hospital (NGH). As a new Senior Sister, my first impressions of the unit were that we had inherited a small team of very hard working, conscientious staff that obviously had the patient as their main priority.

The next couple of years were hard work for everyone. We had to learn a whole new way of working, learn all NGH policies/procedures and also adapt to working with a new manager. Me!!

One of the main aims at the unit was to increase our staffing numbers; correct staff for the correct job role, housekeeper to Clinical Social Worker. This then gave the staff more ‘time’. Time to spend with their patients, time to teach both each other but also the patients who were willing to learn.

As part of the staff development, myself and the lead nurse at Heeley have worked hard together to improve the lines of communication between not only staff but also staff and the patients. I regularly sit in on Doctor’s clinics at the unit where our consultant discusses relevant medical information with both the patients and their relatives. This gives me a good insight into the patient’s general medical background and any problems they are experiencing with their dialysis treatment. I then feed this information back to the staff at our daily handover session.  In the future this may be an opportunity to discuss the Your Health Survey results, the patients’ activation level and their symptom burden.  This would enable us and the doctors to address these results in our conversations and tailor our approach to each patient with them in mind.

A few months ago, I introduced a ‘getting to know you’ initiative with the staff. They had a challenge to learn some relevant information about their named patientsthat the rest of the staff possibly were not aware of. They then relayed this information to the team at handover.

This exercise was to not only learn more about the patients, but it was also to promote communication, between both patients and staff. In my experience as a dialysis nurse, it is all too easy to get caught up in the daily work pressures, for example starting the patients on treatment on time to avoid a knock on effect for later in the day, or completing your extra duties, so I felt that this was an important step in getting everyone talking together.

Our improved staffing numbers have made it possible for staff to attend the TP-CKD presentation last May, the communication workshop coming up in September, as well as the Shared Care course in Sheffield through the Share HD programme. They are learning new ways to work with the patients, get the best from them whilst engaging them in their care and treatment. The staff here are so engaged and we are learning something new every day.

We have also worked very hard with patients aiming for self- care, home Haemodialysis and also those just wanting to be a little bit more involved when they come for each dialysis session. When Rachel and Catherine visited the unit we were celebrating with one of our patients who was leaving us to start his training for Home Haemodialysis. This young man had been with us for a couple of years and when he first moved to the unit he would not engage with any part of his treatment. In fact, he would not make eye contact with staff and found it difficult to even speak to anyone most days. It became obvious that the harder we tried to engage with him the more he resisted. So we took a step back and left things as they were.

It wasn’t until we did some rescheduling of patient times that things changed for this patient. We moved the patients’ dialysis bed spaces around and without us realising it he was now sitting next to a young patient who he began to talk and chat with during treatment. They started little competitions with each other, this also included who could put a fistula needle in first! A couple of the staff latched onto this ‘competition’ and before either of them knew it, they were BOTH putting their own needles in. Result!!  The next stage for our young, disengaged patient was to self-dialyse at home. He has now achieved this and at his last clinic visit he was reported to be doing incredibly well.  It is clear this person, at the beginning of his treatment, had a very low activation level, and acknowledgement of this may have changed the way staff interacted with him at the early stage of his dialysis treatment.

Involving patients in their own care and health choices has now become part of our daily practice at the unit. We have collected Your health Surveys on almost all of our patients dialysing here at the unit as part of our regular audit, and we hope in the future these results can become a regular component of the conversations we have with patients.  A little prompting and encouragement can go a long way in building a patient’s confidence.

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