HRRC - Pre-Dialysis Education


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The role of patient education in preparing patients for end stage renal disease (ESRD) treatment is paramount. Patients with ESRD face an uncertain future with many life changes to contemplate. In addition, people with ESRD are expected to learn new information, skills and strategies for immediate self-care, and long term changes in lifestyle within short periods and often under highly stressful conditions (Cimprich, 1992, p. 39). Educational preparation is considered an essential process for facilitating patients' physical and psychosocial adaptation to end stage renal disease treatment. In addition, it is central to promoting independence with home dialysis, alleviating anxiety associated with impending treatment, and providing information for informed decision making.

Program Mission Statement

To provide a formalised integrated and planned pathway of educational initiatives focused on the learning needs of individuals approaching ESRD treatment.

Program Philosophy

The Hunter Renal Resource Centre's Patient Education Program philosophy is based on the belief that an individualised and flexible education program facilitates patients' smooth transition to dialytic treatment. It also provides a foundation for the development of behaviours required to maintain and improve health through the acquisition of knowledge, attitudes and skills which promote informed decision making regarding treatment options and independence with dialysis therapy. In this sense, the patient is viewed as an active rather than passive participant in their health care management. In addition, the educational process should be underpinned by values sensitive to the patients age, sexuality, gender, spiritual beliefs, cultural and economic background.

Program Aims

The aim of the program is to provide a planned educational pathway which enables patients to understand their disease process, available treatment options and resulting lifestyle changes. In addition, the program aims to facilitate optimal quality of life from the patient's perspective in order to reach their fullest potential in the rehabilitation process.

Program Broad Objectives

After completion of the Hunter Renal Resource Centre's Pre-Dialysis Education Pathway it is anticipated the patient will:

comprehend the treatment implications of end stage renal disease in relation to diet, fluids, medications and dialysis
be aware of the educational and clinical preparation for dialysis treatment
be committed to the principles of self care treatment
understand medical and nursing language associated with end stage renal disease
be aware of available support services
evaluate dialysis treatment options from their perspective
be less anxious and frightened about impending dialysis

Program Structure

Patients are formally accepted onto John Hunter Hospital's end-stage renal disease program (ESRDP) by a multidisciplinary health care team when their renal function declines to 15 mls/min. The pre dialysis education program is therefore initiated at a time when patients' ability to learn is optimal, and the need for dialysis is a reality and therefore, relevant to patients' immediate future.

The program is structured into three distinct modules: Assessment, Education and Treatment.

Patients progress through an educational pathway consisting of five educational stages as follows: End Stage Planning Clinic 1: Pre-Dialysis Seminar; Dialysis Tour; Access Education and Planning Clinic 2. Refer to Figure 1. The expected time frame is three to five months. After commencement of dialysis, patients progress to their respective dialysis training program which specifically prepares them for limited care, home haemodialysis and peritoneal dialysis.

Following is an overview of the innovative pre-end stage renal disease education program developed at the John Hunter Hospital Renal Unit.

Towards Independence - ESRD
Education Program

Dialysis Planning Clinic 1 ®

Formally linked into education program
Undertake educational profile and needs assessment
Identify potential problems for dialysis and rehabilitation
Identify and correct misconceptions about dialysis
Assess progress towards dialysis induction
Record and update information for dialysis database
Provide pre-dialysis education kit

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Nephrologist Referral to Acceptance Meeting - Kidney Function <15mls/min
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Pre-Dialysis Seminar ®

Provide comprehensive information encompassing kidney disease, its manifestations, treatment options and lifestyle changes
Provide forum for questions and issues of concern to be addressed

Dialysis Tour ®

Provide specific information regarding practicalities of treatment modalities
Assessment of patient's physical capabilities for dialysis modalities
Identify potential problems related to specific treatment preferences
Provide a realistic picture of peritoneal and haemodialysis

Access Education ®

Provide individualised one to one education regarding fistula creation, peritoneal catheter insertion and post-operative, and long term care

Planning Clinic 2 ®

Evaluation of education program
Formally state preferred mode of treatment
Provide small group sessions for discussion of patients progress concerns/problems related to preferred treatment choice
Follow-up on outstanding issues

Insertion of ¬
Peritoneal Catheter

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Admission to Ward

® In-Hospital Dialysis Commencement

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Home Dialysis Training

Home CAPD

Home Haemodialysis

Limited Care Dialysis

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INDEPENDENCE