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Preparing patients for dialysis

For any patient with chronic renal failure, deciding whether or not to undergo dialysis is a daunting and life-changing decision - and as far as pre-dialysis nurse specialist Nerys Brick is concerned, pretending otherwise to prospective patients is not an option. 'It is important that patients are aware of all the options and what their choices are. I don't wrap it up in a nice package, I tell it to them straight. Patients appreciate it when you are open and honest.'

For any patient with chronic renal failure, deciding whether or not to undergo dialysis is a daunting and life-changing decision - and as far as pre-dialysis nurse specialist Nerys Brick is concerned, pretending otherwise to prospective patients is not an option. 'It is important that patients are aware of all the options and what their choices are. I don't wrap it up in a nice package, I tell it to them straight. Patients appreciate it when you are open and honest.'

Having worked as a renal nurse since qualifying, including jobs in intensive care, Ms Brick took on the specially-created role of pre-dialysis nurse specialist at the Kent and Canterbury Hospital in 2003. 'Because it is a new role it has been a huge learning curve,' she admits.

'Previously, care was very fragmented with different people being responsible for different jobs: the registrar would be in charge of the theatre list, a nurse would run the education programme and there was little in the way of follow up. It made sense to employ one person to pull it all together - it is a much more patient-centred approach.'

The National Service Framework for Renal Services, published in January 2004, states that all patients with chronic renal failure should have access to all the information available to enable them to make informed decisions about their care. In line with this, Ms Brick sees patients who are approaching dialysis and runs education programmes, clinics and follow-ups.

'Education is my main role so I run monthly programmes consisting of three sessions: introduction, dialysis options [including conservative treatment] and looking at transplantation,' she explains. 'I also see patients at home because it is sometimes difficult for them to get to the hospital. The follow-up sessions are important because they help reinforce the information: the more informed a patient is the less daunting the process.'

The National Service Framework also states that patients should have a choice of clinically appropriate treatment options. Dialysis is not going to be suitable for everybody and, according to Ms Brick, the area of conservative management is growing. 'We currently have 30 to 35 patients on conservative treatment and because a lot of this is outside the clinical setting we have strong links with the community, such as GP surgeries and the local hospices.' Patients for whom dialysis is the appropriate option require permanent vascular or peritoneal access and it is Ms Brick's job to prepare patients for this and monitor them to ensure access is maintained. She is also responsible for their 'work-up' to dialysis, which includes blood work and observations.

As a pre-dialysis nurse practitioner, Ms Brick has to be able to work autonomously and as part of a team. A desire to teach and good interpersonal skills are a must as she has to communicate with patients of all ages in different stages of renal failure. As well as providing education, support and clinical services for her patients, she also liaises closely with a multidisciplinary team comprised of nurse consultants, counsellors and a dietician. 'It is important that the patients have access to things like social work and counselling services so that they can discuss any fears and anxieties, as well as what is clinically appropriate for them,' she says.

The rapidly expanding renal department also employs both full and part time anaemia nurses and a research nurse. And they are also looking to create a new role for a transplant coordinator. 'At present, our patients are transferred to Guy's Hospital in London for a transplant and then come back to us,' says Ms Brick. 'But we would like to be able to bring them back sooner so that they can be nearer their families as they recover.'

According to Ms Brick, there are lots of opportunities for new staff, especially in home therapies and continuous ambulatory peritoneal dialysis. 'We are also in the process of redeveloping the ward. There will be a new acute bay and we are also setting up a renal satellite unit in Dover.' Training opportunities are offered to nurses on the unit in that they can take a six month post-registration course in renal nursing in conjunction with Canterbury Christchurch University.

Undertaking a new role can often be daunting, but Ms Brick feels she has been well supported by her colleagues and given many opportunities to develop such as presenting data at international conferences. But it is still the knowledge that she has really made an impact on her patients' lives that she loves the most. 'When you are with a patient for what can be up to twelve months of preparation, you become part of their journey - somebody they can really rely on,' she explains.

'Dialysis can be very traumatic - it is a real rollercoaster of a ride. When patients are able to chat to you and have a laugh and a joke with you, you become more than just a nurse to them, you become their friend.'

How do I become a pre dialysis nurse specialist?

This could be for you if: you are passionate about educating patients and working closely with them, over a long time period, towards a specific clinical outcome

You need to be good at: working both autonomously and as part of a team, have excellent communication and interpersonal skills and be computer literate

You need to have: a registered nursing qualification and experience of renal nursing

You don't need to have: experience of actually doing dialysis as long as you understand the basic principles

Other similar jobs you could consider: anaemia nurse specialist or coordinator, transplant coordinator.

Where to find out more information: for more information about renal nursing you can visit 'nephrology at your fingertips' at www.nephronline.org where you can view the pre-dialysis forum seminar. Or you can visit the European Dialysis and Transplant Nurses association at www.edtna.org.

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