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What is self-care in-center dialysis?

Today in the United States, an estimated 37 million people suffer from Chronic Kidney Disease (CKD) or End Stage Renal Disease (ESRD). Many of them are required to supplement their bodies’ natural filtering capabilities through kidney dialysis.

If you are one of these people, your first visit to the dialysis center can be overwhelming. You’ve heard stories about dialysis — that it’s uncomfortable, unpleasant, and extremely time-consuming. Many people speak poorly of their experience, but luckily, this clinic is different, you are walking into an empowered self-care in-center dialysis unit.

“Thank you for coming,” they say. “We know this is scary, but we’re going to do everything we can to give you Control, Dignity, and Hope in a partnership way to improve your health and quality of life. We’re going to spend the time to explain everything to you at your speed and find a plan that works best for you. You’re going to be involved in your own care.”

A Day of Self-Care In-Center Dialysis

The idea of dialysis was overwhelming at first, but now after a few weeks, you feel like a pro. The clinic staff have been coaching you the entire time. Most dialysis patients are required to sit for four hours at a time, three times a week, which is more than enough time to learn something new — and restore purpose and meaning to your life.

“You have been warmly welcomed into a unique culture that encourages education, collaboration, and control.”

If you still need help, you’re never afraid to ask. You’ve become quite close to the staff and other patients, and everyone is always eager to lend a helping hand. It’s obvious that everyone here is working towards a common goal, to recognize your abilities and respect your humanity. You have been warmly welcomed into a unique culture that encourages education, collaboration, and control.

Once you have invested the time and energy necessary to take full Control of your own care, your day in the self-care in-center dialysis clinic looks something like this…

1. Take and Record Vitals

When you first arrive at the self-care in-center dialysis clinic, you take your vitals. You measure and record your weight, blood pressure, and temperature. You know to look out for any abnormalities, and you can keep an eye on weight gain between treatments.

2. Receive and Inspect Supplies

Then, there’s no waiting around for the next available technician. You check to make sure your disposable supplies are correct. The dialysis machine looked scary to begin with, but clinic staff have now walked you through the process many times. You know exactly what you need, and you’re able to identify if anything is missing or out of place.

3. Assemble and Test Machine

Next, you assemble and test your dialysis machine and set up your chair. Everyone sets up their own space a little differently, and you are encouraged to make yourself at home. When you’re sitting for many hours at a time, physical and emotional comfort are a very important part of converting depression and helplessness to joy, optimism, and hope.

4. Prepare Arm

Next, you’ll wash your arm to make sure it’s clean. You know it’s extremely important to avoid infection. Because everyone is in Control of their own care here, this clinic has exceptionally low infection and hospitalization rates — and the data clearly shows that patients live longer when they are in control of their own care.

5. Cannulation

Cannulation was, by far, the most intimidating part of self-dialysis, but after a methodical desensitization program, you are now an expert. You began practicing with a simple pen, then a dull needle. For a while, your nurse would get the needle started for you, but now you can do the whole thing start to finish. It’s your own body, after all, and you know exactly where you need to place your needle every time.

6. Understand and Monitor Machine Readouts

During your treatment, your machine is turned to face you. You can monitor your own numbers, including time left, blood flow rate, arterial pressures, Phoenix meter conductivity, and more. You know which numbers could indicate a problem, and since you’re in Control, you can find the perfect balance between speed and comfort.

7. Dialysis Cleanup

After your treatment is complete, you know how to properly remove your needle, bandage your arm, and clean up your space.

8. Session Debrief

Before you leave (typically while you’re still undergoing treatment), your medical team will set aside a moment to personally review your treatment with you. Together, you’ll look at numbers and symptoms. You’ll track your progress and figure out how to help the next session go even more smoothly.

You will often talk about your options for the future (transplant, home therapy, etc.), and you get the feeling that dialysis isn’t the final destination, but merely a step along the way to whole-body health.

Patient Empowerment is for Everyone

It’s important to realize that the situation above is an example of a patient capable of full self-care dialysis. We teach four basic levels of empowerment as part of our program and encourage staff members to work with patients to come up with a plan that works for them. There is always room for patients to take control on some level, and often, it makes all the difference.

There is a common misconception that self-care dialysis should be a privilege reserved only for a select few well-behaved, advanced users. This couldn’t be farther from the truth! Within an empowered culture, even “non-compliant” patients are given the tools to take control of their own situation, and we’ve seen many of them rise to the occasion to become true champions of self-care.

“Within an empowered culture, even “non-compliant” patients are given the tools to take control of their own situation, and we’ve seen many of them rise to the occasion to become true champions of self-care.”

“One lady had a stroke and really wanted to be empowered, but there wasn’t much she could do,” shared Taunja Arvela, a nurse who worked with dialysis patients in an empowered clinic. “She was smart though, and she knew her dry weight and how much needed to come off… she could do that and a few other things, and that was enough. She felt so empowered and was so proud to do that.”

The Social Benefits of Empowered Self-Care Dialysis

As you can imagine, empowered self-care dialysis has unprecedented social and emotional benefits. When they are given control over their own health, patients are happier, attentive, and motivated. There is a community feeling when both patients and staff members are all looking out for one another and cheering each other on.

In a self-care in-center dialysis environment, we see staff’s role change from technicians to coaches. When the burden of everyday dialysis tasks are spread out among the patients, staff actually get more time to slow down and provide a higher level of care in a positive environment.

Systematic Benefits

The social/emotional benefits of self-dialysis translate into quantitative improvements for healthcare providers and payers too. Empowered patients experience fewer complications and lower mortality rates, both of which translate to reduced costs.

Empowered staff also experience less burnout and turnover, resulting in higher staff retention and efficiency — again translating to reduced costs for payers.

Together, we can revolutionize kidney care

According to Don Berwick, president emeritus of the Institute for Healthcare Improvement (IHI), “Some is not a number; soon is not a time.” Change is scary, and it’s tempting to limit bold plans like self-care dialysis to “some” people, perhaps sometime “soon.” The time to act is NOW, and empowered healthcare is for the benefit of ALL patients and staff.

If you’d like to learn more about instituting an empowered kidney care model at your clinic, don’t hesitate to reach out to us today.

Dr. Richard Gibney

Dr. Richard Gibney has been in the kidney care industry for over four decades. Like many nephrologists (kidney specialists) he simply didn’t know that there were alternatives to the status quo. In 2006, a partnership with the Institute for Healthcare Improvement (IHI) inspired him to innovate. Years later, his eyes were opened by a visit about an acclaimed dialysis program in Jonkoping, Sweden. Over a four year period, Dr. Gibney led the successful transformation of 11 dialysis units in central Texas to an empowered model, serving over 500 patients with exceptional results. Staff and patients were extremely satisfied, and mortality and hospitalizations were cut in half. Today, Dr. Gibney and his specialized team of doctors, nurses, and technicians help others achieve the same empowered results.