Enhancing Nursing and Allied Staff Peritoneal Dialysis Education in a Chronic Kidney Disease Program

The option of peritoneal dialysis for management of advanced chronic kidney disease (CKD) is best introduced while the patient is being followed up in the CKD clinic. Educational approaches to patients with CKD include classes, instruction one-on-one by a nurse educator or other allied health care professional, and information provided by the physician. A team approach is often used in peritoneal dialysis education as part of a well-run CKD program. Therefore, all members of the team should be fully informed and up to date about peritoneal dialysis. The CKD team may include medical assistants, physician assistants, nurse practitioners, dieticians, nurses, and renal fellows as well as nephrologists. Education about peritoneal dialysis should be provided to these important team members.

Educating allied health care professionals about peritoneal dialysis, a modality with which many are unfamiliar, ensures that all speak with informed voices and avoid giving incorrect information about peritoneal dialysis. It is rather common for those with little knowledge about peritoneal dialysis to tell patients that the procedure is associated with a high risk of infection, thus discouraging patients from home peritoneal dialysis. Patients may also have obtained information about renal replacement therapy from the Internet (1). Although some websites have factually, clearly presented information, others are inaccurate and may be self-serving. It is quite possible that allied health care professionals have likewise been exposed to incorrect information about peritoneal dialysis, and this may unfortunately reinforce a patient’s wrong perceptions. Therefore, a structured approach to educating staff members of the CKD clinic about peritoneal dialysis seems desirable.

CKD patients with GFR levels of 20 mL/min or lower who are aware that dialysis will be likely needed in their future often have major depression (25 percent) or subthreshold depression (20 percent) according to structured psychiatric interviews (2). The team approach for these patients provides support and correct information in a longitudinal fashion. Many CKD clinics do not have the services of a social worker, so other allied health care professionals must provide such support and psychological insight. Sequential measures of depression, loneliness, and isolation might be useful in this setting. Some patients use avoidance, which results in faster progression of CKD (3). Patients facing dialysis who have greater psychological stress levels related to CKD as measured by the Chronic Kidney Disease Stress Inventory are more likely to start dialysis with in-center hemodialysis than with peritoneal dialysis (4). It seems probable that support by a well-educated CKD team will diminish stress in this setting.

Table 1 shows resources for teaching health care professionals about peritoneal dialysis. Most of the information would be suitable for physician assistants, nurse practitioners, nurses, and social workers who work in the CKD clinic. The best approach to training these allied health care professionals is not known, but it might include attendance at one of the meetings listed, regular reading of the journal Peritoneal Dialysis International, and a review of the free slide set put together by expert members of the International Society for Peritoneal Dialysis North American Chapter (ISPD NAC) available at the ISPD website (http://ispd.org/NAC/education/pd-curriculum). A peritoneal dialysis expert in the program could present the slide sets to the health care professionals working in the CKD program.

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To summarize, little is known about the level of knowledge regarding peritoneal dialysis among allied health care professionals who work in CKD clinics. It appears probable that knowledge of peritoneal dialysis is variable and often lacking. A well informed approach to educating the allied health care professionals in the CKD clinic about peritoneal dialysis as an option for patients should enable the entire team to support the patient to make informed choices. This is a fertile area for further research.

Notes

[1] Beth Piraino, MD, is professor of medicine at the University of Pittsburgh School of Medicine and Judith Bernardini, RN, is adjunct assistant professor at the University of Pittsburgh School of Nursing and Medical School.

References

1.Buettner K, Fadem SZ. The internet as a tool for the renal community. Adv Chronic Kidney Dis 2008; 15:73–82.

2.Piraino B, Bernardini J, Wilson T, et al. Assessment of depression in patients with chronic kidney disease (CKD) and impending dialysis. J Am Soc Nephrol 2003; 14:448A.

3.Devins G, Mendelssohn D, Barre P, et al. Predialysis psychoeducational intervention and coping styles influence time to dialysis in chronic kidney diseae. Am J Kidney Dis 2003; 42:693–703.

4.Harwood L, Wilson B, Sontrop J, et al. Chronic kidney disease stressors influence choice of dialysis modality J Adv Nurs 2012, in press.

August 2012 (Vol. 4, Number 8)