Renal services must get better at looking at the issues that “really matter to patients”, says the first nurse in the UK to be appointed as a professor of kidney care.
Professor Nicola Thomas was awarded the senior research and education role by London South Bank University, where she has worked in the School of Health and Social Care since March 2013.
She said she hoped her promotion to professor would be an inspiration to other renal nurses to explore opportunities to develop their careers and shape the future of kidney care.
“Because it is the first post of its kind with a nurse as a professor, it is saying to renal nurses generally, ‘look – you can make a difference in terms of the bigger picture’, not just working locally within your own trust,” she told Nursing Times.
“Obviously frontline nursing is critical, but you can have influence in a wider field – not just practice but education and research too,” she said.
“Making things better for people with kidney disease is the most important thing”
While she said the professorship was “the most exciting thing” for her and a personal achievement, she hoped the “main winners” would be people with kidney problems.
“Making things better for people with kidney disease is the most important thing and why I have stuck at it,” she said. “Kidney disease is a terrible condition and people’s lives can be devastated by it, and that is why a lot of my work has been around prevention.”
Professor Thomas, who is deputy vice president of the British Renal Society, said nurses had an absolutely vital role to play in work to stop kidney disease or prevent it escalating, as well as in supporting and caring for those with advanced kidney problems.
“It is about nurses working in primary care working with nurses who are specialists in secondary care,” she said. This included promoting the idea of “self-management” or “self-care” to those who can make a genuine difference to their own conditions and wellbeing, she said.
“When people are first referred to a kidney unit, we will talk to them about managing their condition from taking tablets through to having dialysis at home,” she said. “A lot of those who arrive have never thought they themselves could make a difference to their care.
“If we can get that idea into their heads early on, then that’s always with them. But for that to happen, we have got to have the practitioners – nurses and doctors – to help us do that.”
“We’re not so good at looking at things that matter to patients”
One area she is keen to explore is the kind of education, information and advice given to people at risk of developing kidney problems – such as those with diabetes – and what actually works.
“What is the best way to promote self-management to people with early kidney disease that changes behaviour?” she said. “At the moment we don’t know the answer to that.”
While renal services are adept at gathering, analysing and comparing data, she said it was also vital for nurses and others to focus on “what really matters to patients”.
“We’re very good at looking at the hard elements of it – the blood pressure, phosphate or potassium – but we’re not so good at looking at things that matter to patients,” she said.
“Often the most important thing for them is that they don’t have itchy skin or can sleep at night, go to work or go on holiday – we don’t concentrate on that enough,” said Professor Thomas.
She told Nursing Times that nurses were ideally-placed to research these “quality of life issues” and other ways to improve care.
“Healthcare professionals can assume lots of information all the time is a good thing”
She has just completed a project looking at how patients with kidney disease make decisions about key aspects of their treatment, such as whether or not to have dialysis and when to start.
Patients and carers were involved in shaping the project from start to finish, and trained as researchers to interview others in an example of “co-production”, a form of research advocated by Professor Thomas.
The findings contained some crucial messages for nurses and others about the type and timing of information they give to kidney patients, she said.
“Sometimes the information was too complex – people had too much and it was too difficult to understand,” she said. “We found people could put off having dialysis because it was such an awful decision to make.
“Sometimes the information came too early,” she said. “Healthcare professionals can assume lots of information all the time is a good thing, but it can be overwhelming.
“One message we’ll be sharing with nurses and other practitioners is to really think about how you provide that information,” she said. ”Is it too much? Is it too difficult? Is it at the wrong time?”
Professor Thomas is also in the process of applying for funding for a new research project on the experiences of people caring for others with kidney disease. The amount of research evidence in this area is currently “tiny”, she noted.
Like other nursing specialties, kidney care has been hit by nursing shortages and Ms Thomas also flagged up a lack of student placements on renal wards.
She added the renal community had not always been good at promoting the field as an exciting and interesting field of nursing.
Nurse appointed UK’s first professor of kidney care
“What we’re not so good at is explaining what a good specialty is it is,” she said. “Much of it is about long-term care with the chance to build those personal relationships with patients and their families, but there is also the acute side – it’s surgery and medicine and there is a lot of autonomy for nurses.
“There are nurse-led dialysis services and a lot of clinical nurse specialists in different areas of renal, so it is a great place to grow your career,” she said.
As well as her university role, Professor Thomas is an honorary consultant nurse at Barts Health NHS Trust, where she provides training and education to staff and patients at the East London Community Kidney Service.
The service “represents everything I believe in”, she said. “It is in the community, patients are at the centre of care and it is involving people in their care,” she explained.
As an academic, she said it was important to keep up to date with clinical practice and she praised her employers for giving her the freedom and flexibility to combine teaching, research and clinical work.
“If you are mixing with patients all the time, that will inform how you do your research and ensure you understand the challenges and what it is really like to have kidney problems,” she said.
Career: Professor Nicola Thomas
Professor Thomas first trained as a registered nurse at the London Hospital, Whitechapel in East London. She first started working in dialysis in 1982, and then had another ten years working in nephrology wards at the London Hospital, haemodialysis at St Bartholomew’s Hospital and peritoneal/home dialysis at Kings College Hospital. Later she became a lecturer practitioner at City University and completed an MA in Education. In 2004 moved to St Helier Hospital, Carshalton to be the lead nurse for renal research and during that time she completed a Doctorate in Professional Practice. In addition, she has been involved in three large scale quality improvement projects managed by Kidney Research UK and funded by the Health Foundation. In 2013 she moved to London South Bank University to continue her research and to collaborate with Barts Health NHS Trust to develop a renal nursing course. She has been President of the European Dialysis and Transplant Nurses Association/European Renal Care Association and is the Editor of the Journal of Renal Care. She is Deputy Vice President (Education) of the British Renal Society.