A dialysis nurse is an expert in treating patients with acute and chronic kidney diseases. For this kind of treatment, additional training is required since nursing patients with a kidney disease is different from nursing patients in a hospital ward like most of us know. Being a dialysis nurse includes the support and monitor of a patient as well as to medicate and educate the patients. This kind of nursing field, like every other kind of specialty, will make a difference in the wellbeing of a patient and extend their lifespan.

In this article we will interview the second of three dialysis nurses working in Africa. Our goal is to find out what it is like to be a dialysis nurse and which challenges they have to deal with.

 

Nurse, please introduce yourself

My name is Noula Draper, I am a Clinical Technologist, specializing in Nephrology (the study of the kidney).  I am a Renal Dialysis Unit Manager in Pretoria, South Africa.  I have been working in renal dialysis since 2009, where I started as a student Clinical Technologist, then a Diploma Clinical Technologist and later became a Graduate Clinical Technologist.

Why did you choose a job in this field? Why are you interested in this particular job?

I have always had a love for patient care and going into a medical field was inevitable.  I heard about the course Clinical Technology from family, and this interested me, as in basic training you are exposed to 7 specializations before settling on one.  The study of the kidney was fascinating to me, that such a small organ had so many functions.  Also being able to be part of a multi-disciplinary team who assists patients with lifesaving therapy due to renal failure was a calling for me, and a second chance on life for them.

 

Are there any desirable personality traits that a dialysis nurse should have?

Compassion, understanding and patience.  Receiving life altering news about a disease diagnosis that will have a patient make several lifestyle changes, can be very hard to process.

Describe to me the position of a dialysis nurse.

A renal technologist/nurse will firstly be responsible for educating a patient on their diagnosis of renal failure.  What this means for their lifestyle, their families, and ultimately what type of renal replacement therapy they will have to choose that would fit their lifestyle.  The options are Hemodialysis, Peritoneal Dialysis and/or Transplantation.

In a Hemodialysis unit, a patient will attend treatment usually 3 times per week for 4 hours per session.  In the unit, the clinical staff tends to patient care in the sense of diet, medication and blood results education, connecting and disconnecting patients from therapy, handling any medical emergency situations that might occur, whilst working with a multi-disciplinary team on the patients overall health and wellness.

With Peritoneal Dialysis, patients are trained to do their own dialysis treatment from home in the form of putting a glucose based fluid in their abdomen, surrounded by the peritoneum.  Clinical staff assists here again with education of diet, medication and blood results.  Ordering of the dialysis fluid to be delivered monthly to the patients’ house, home visits and tube changes also form part of what the clinical staff’s responsibilities.

Transplantation is when the patient will get a kidney transplant from either a live donor or a cadaver.  If the renal failure is diagnosed in the early stages, then a patient can start his transplant work-up even before needing the 2 abovementioned therapies.  Here again, the patient works with a large team of medical specialists, including the renal technologist/nurse, to do an array of medical tests, to make sure they are stable enough to receive a kidney transplant.  If a live donor is donating the patient a kidney, they also undergo extensive testing, to make sure they have no underlying illnesses that can prevent them from donating.

 

As a team leader, how would you lead your team?

You need to be a strong and knowledgeable leader, as this is a specialized field.  But being a leader, means being with all your other staff in working with patients on every level, to educate both the patient and your other team members.  Being able to also step up and communicate on a higher level with the various Doctors these patients have, but also being able to get down to a patients level and explain complex concepts to them.

 

How flexible is your schedule?

The schedule more or less is planned around what renal replacement therapy the patient is on.  In a Hemodialysis unit, the patients have set days and times they are to attend treatment in the unit.  With Peritoneal Dialysis, patients have their set times daily to do their treatments at home.  The renal technologist/nurse will have set appointment dates for home visits, training, stock delivery and tube changes with these patients.  In transplantation, it will depend if the kidney is from a live donor or a cadaver.  With a live donor, the patient and donor will have a set date for donation and transplantation.  However, if the patient is on the transplant list for a cadaver kidney, they can receive that call at any time of day or night, and patients and clinical staff needs to be flexible for that situation.

 

What is most challenging about dialysis patient care?

Personally, it is the loss of a patient that has come a long way with their renal team.  It does not ever get easier to lose a patient that you have cared for, for many years.  We build a relationship with them and their families over years of treatment, unlike where a patient that will just be in and out of hospital for various reasons.

 

Working with patients for a long time, you build up a relationship. How close do you get to the patients?

We get very close with them, because helping them to deal with the grief of their loss of renal function, is an issue that sometimes involves the whole family.  Of course the level of professionalism and trust is of utmost importance as well.  As patients, they need to be able to confide in their renal technologist/nurse about anything, even psychological issues, that the proper care can be given to them holistically.

 

How do you deal with difficult patients?

Grief is a very difficult emotion for any person to deal with, and this is exactly what a newly diagnosed patient is going through, the grief of losing health.
The 5 steps of grief are known as denial, anger, bargaining, depression and then acceptance.  A difficult patient is usually stuck going between anger and depression, until they can completely come to terms with their diagnosis.  As the renal technologist/nurse, you need to understand that they are still just coming to terms with the lifestyle change that has been forced upon them.
Being firm, but still compassionate with them during the ‘difficult’ phase, will not only make them come to terms quicker with the diagnosis, but also elevate their level of trust in you as their renal technologist/nurse.  A difficult patient, is usually a scared patient.  Spending extra time with them in the early stages, educating them or even just listening will bear fruits in the end.

How are you handling the dialysis treatment during the corona crisis?

All dialysis units have strict policies and procedures in place in general with regards to hand hygiene, cleanliness with the patients and sterile patient dialysis access care.  During the COVID-19 pandemic, units are more vigilant, as all other health care institutions.  No visitors are allowed in units, and all staff, patients and delivery personal do a risk assessment every single day to check for any signs and symptoms.  No one is to enter the unit if they start experiencing symptoms at home, and are to contact the COVID-19 hotline for further instructions.  We have no COVID-19 positive staff or patients currently in the unit, but contingency plans are in place to continue with efficient patient care if the situation would arise.
This is an unknown area for many of us, but with strict policies in place in each unit, the risk is at a minimum.  Renal failure patients are known to be immune-compromised, so all of them have been educated to take extra care of their own health, not go out of the house unnecessarily and  to make sure they keep healthy during this time.

 

Thank you, Noula Draper, for your time to do this interview with us. All the best of luck to you and your colleagues in making a difference in your patients’ life.

Keywords: Dialysis Nurse, Clinical Technologist, Dialysis Patient Care, Corona Crisis