NN&I - August 2010

Empowerment 38 Nephrology News & Issues August 2010Subscribe to our free eNewsletter at www.nephronline.comfelt sympathetic ear. This also repre-sents a prime opportunity to encourage patient empowerment. Remember that anger typically arises from the patient's feeling that they are losing control of their life. Limiting lifestyle benefits Disallowing simple conveniences of daily life during a patient's time on dialysis can be very disturbing for patients and diminish their feeling of self-control. One example is the policy that cell phones are not allowed dur -ing treatment. One would suspect that it could be annoying and distracting to health care professionals and other patients when cell phones are ringing during treatments. From another view, dialysis facilities should offer a dialysis experience that encourages patients to stay empowered. The patient on the cell phone could be attempting to con -duct business, deal with family mat -ters, or otherwise stay actively involved in his or her life. To ensure that cell phone calls are not inconveniencing their neighbors (or the staff), a compro-mised approach requiring that patients keep their cell phones on vibrate and limit their calls to brief conversations could be considered. Care with cannulation Patients have a choice of where they dialyze and are often particular about who cares for them. A patient may come in and request that a particular dialysis technician/nurse stick them. Understandably, the dialysis facility may have a protocol that sees this kind of request as being impractical from a staffing perspective. But dialysis facili- ties should also strive to understand the patient's perspective. Patients real -ize that the vascular access is their lifeline, and many have had unpleasant and potentially life-threatening experi -ences when problems arose related to their access. Empowered patients are therefore protective of their access. While a dialysis facility's policy not to give in to patient requests for a specific staff member for cannulation may be understandable, requests for a particular staff member should not be routinely dismissed. Such a response may diminish patient confidence in the dialysis staff, while hindering empow -erment and patient adherence. As an alternative to requesting a familiar technician, the facility could also offer to teach patients to self-cannulate to help them overcome their fears. Time (what time?) on dialysis Understandably, it's hard to accom -modate a patient's scheduling request. But instead of responding with an apologetic negative response, the dialy-sis facility can provide other alterna-tives. Examples could include educat -ing patients about home treatments or providing a bulletin board where notices can be posted to see if another patient would be willing to switch their schedule. Such an approach could be especially important to accommodate patients who are still able to work. 'It's cold in here.' Patients need to be made aware up front that they will often feel cold dur -ing dialysis. Most dialysis facilities no longer provide blankets, but staff mem-bers can encourage patients to bring their own blankets, warm socks, or scarves. Be consistent on patient information It is important that all members of the health care professional team deliv -er the same information. For instance, a patient may hear from their dietitian that it is okay to eat high potassium foods in moderation, while their doctor may tell them to avoid all potassium foods. Meanwhile, the technician may tell the patient what foods are high in potassium in a way that conflicts with information from other team mem -bers. Dialysis facilities need to devel-op policies and procedures that pro-vide cohesive educational information with consistent messages from all staff members. By acknowledging the importance of patient feedback, dialysis facilities can help empower patients by provid -ing them with a sense of their own importance. In contrast, I suspect that if the patient perceives that their treat -ment has gone poorly several times in a row, they'll have a higher likelihood of not showing up for dialysis. This is the ultimate disengagement. Patient engagement may be a bit more time consuming, but the rewards are unparalleled. There are five simple steps to remember that will help you to engage your patients: Listen, smile, respond, thoughtfully, encourage, and provide hope. Learn by example, and people who have kidney disease can learn to be engaged when they see fel-low patients who are actively involved in their own care. And engagement is even more likely if patients see and know that their health care team is encouraging and fostering patient involvement and empowerment. Don't miss next month Coverage of the 2010 U.S. Transplant Games from Madison, Wisc. For more information on the Games, visit www.kidney.org/news/tgames2010 Empowerment_NNI-0810_8.indd 38 7/15/10 5:50:48 PM