Icon - Teaching peritoneal dialysis (PD)

Teaching peritoneal dialysis (PD)

Teaching PD is a skill that is acquired over many years.

Ratios of nursing staff need to be adequate to allow one-on-one training where required, but in practice this is not always possible.

Commonly accepted ratios for PD are 1:25. It’s recognised that Indigenous and remote communities are factors that increase the need for lower patient ratios. 

The Queensland renal clinical network in 2010 determined a ratio of 1:10 for Home HD and 1:15 for PD as desirable and for review in 2011. It is acknowledged that the skills of a PD trainer are augmented over a period of years.

PD education involves both practical skills and theoretical understanding. Information sheets, check learning aids, risk assessment and trouble-shooting are some of the tools required. 

The PD equipment providers have some excellent tools for teaching their specific systems. You can find links to their teaching tools here.

Patient training components

  • Demonstration and practice
  • Visual pictures detailing how to perform the required practical skills
  • Written/multimedia information re all aspects
  • Theory to support rationale
  • A component to check learning and competence
  • Trouble-shooting
  • A revision component

Training curriculums and tools

  • A structured training curriculum to encompass all of the above
  • Industry-specific product training information and handouts
  • Training tools that are intellectually, culturally and language appropriate
  • Strategies to identify and support patients who are not literate

Documentation of progress is essential, as multiple trainers are involved and this provides back up to demonstrate achievement of a skill if issues occur later.

Training can be considered completed when competence is achieved.

Training location
To maximise the learning opportunities for the individual, when selecting a training location the following should be considered.

The training unit should have clinic rooms, demonstration equipment and support for the trainer.

For the frail, elderly and those with transport difficulties or social dependence, there may be occasions when home training is more effective.

The disadvantage of home training are the travelling involved for the trainer and some environments that are not ideal for training. Flexibility is the key.

Getting to know the individual
Any fear has the potential to be a barrier to achieving success at training. When fear of dialysis is apparent, early identification, acknowledgement and strategies to overcome the fear will minimise the negative impact. 

Social concerns, depression, denial and language barriers will all limit the effectiveness of training. The most effective home training nurses address these issues before training. Referral to a psychologist may help. 

Referral to an occupational therapist may also be of benefit, to determine if special training needs are required, whether psychological or physical.

Care partners or support persons
Support is essential but dependence on another person often has negative consequences. Support partner unavailability or burnout are risk factors. Loss of earnings can be significant. 

Care partners should be referred to social workers to ensure they gain all relevant financial support. Home dialysis patients often do not meet current Centrelink requirements, which means their carers may be ineligible for the carers’ pension.

Care partners can learn about trouble-shooting and how to provide support, but their most important role may be companionship. 

Further information about support and carers, which may be useful to share with your patients, is available here.

Pre-dialysis assessment tool
A pre-dialysis functional assessment tool is under development by the Hunter New South Wales Health Service. You can see the model here.

If you’d like the development team’s contact details, please email homedialysis@kidney.org.au

Documentation, procedures and protocols
Electronic documentation is gold standard. IT systems should be networked and secure, with the ability to link all members of the multidisciplinary team.

We are currently collating PD training tools and documentation from recommended sources. An example is the ‘Peritoneal Dialysis Protocol Manual’ produced by The Royal Children’s Hospital, Melbourne, which you can download here.

If you have any contributions or suggestions, please email them to homedialysis@kidney.org.au

Recommended weblinks
Procedures and protocols should meet the standards of relevant national guidelines, such as these:

References
References for this section of our website are all from ‘The Report on Home Dialysis’, which you can download here.

Further enquiries
If you have any queries about teaching PD, please phone us on freecall 1800 454 363 or email homedialysis@kidney.org.au.

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