Delivery of Safe Patient Care is a Team Effort.
Okay, you ask, "Who is the team?"
The team consists of those (health care professionals) providing delivery of care, as well as, the patient receiving the care. Dialysis staff (health care professionals) consists of Physician, Registered Nurses, Licensed Vocational/Practical Nurses, Dialysis Technicians, Social Workers and Dieticians.
Okay, you ask, "Why is this needed?"
In order to provide safe care there must be a functioning team in place.
A team that is functioning, at full capacity, must have patient input. Input consists of being able to discuss symptoms, voice concerns (and complaints,) as well as, ask questions with a comfort level that does not produce any anxiety.
More, than not, I have heard from patients and family members that they do not want to question anything a nurse or doctor does. For whatever reason, many do not question, in any way, shape or form. However, as a patient, it is your body and you have the right to know what is being done to your body. The End!
Hopefully, most dialysis staff will want input from the patient, as well as encourage patients and family members to be involved. It is a good dialysis staff that encourage patient/family/loved one participation.
Okay, you ask, "Why is this comfort communication needed?"
Communicating with ease is the basis for a good patient/health care provider relationship. In order for dialysis patients to receive appropriate delivery of care, they must be able to provide information relative to their treatment(s). Being able to question why something is being done is part of the education process. Dialysis Unit Staff need to have input from the patient. They need to know what the patient is experiencing.
Dialysis, like a rare violin, takes time to fine tune. Then, and, only then can the music delight one’s ear. In order for dialysis to be appropriate, for each patient, there must be fine tuning. As many dialysis patients are aware, the process is one of ‘trial and error.’ Without the patient’s input and being part of the team, there is no fine tuning. Fine tuning consists of doctors, nurses (RN, LV/PN, Tech,) dietitians and social workers who desire input from the patient. They want to know how the patient is, not only during the treatment, but between treatments. They have an honest interest in knowing how the patient is tolerating dialysis, not only during but between treatments. . It is only, in this way that the patient can benefit from dialysis, For without this communication, the fine tuning process of dialysis can not be reached.
Okay you ask, "But what about the staff?"
Additionally, dialysis staff must feel this level of comfort. Just as patients have anxiety and are human, so are dialysis staff. Just as patients have feelings and emotions, so do dialysis staff. Just as patients have concerns and questions, so do dialysis staff. Dialysis treatment is a speciality, in, and, of itself. We have to give them credit for what they do and appreciate the situation they are experiencing.
Okay, you ask, "What makes a good health care dialysis professional?"
A dialysis health care professional (doctor, RN, LVN, LPN, technician, social worker, dietician) who takes time to listen to the patient, as well as, understand what the patient is experiencing is one who cares.
The dialysis professional who objectively (without feeling personally attacked) listens to a patient’s questions or concerns is one who cares.
The dialysis professional who encourages patient/family member participation is one who cares.
The dialysis professional who allows the patient to express feelings, fears and anxieties, related to treatment, without judgement, is one who cares.
The dialysis professional who teaches and educates is one who cares.
The dialysis professional who allows the patient to be themself is one that cares.
The dialysis professional who has a sincere desire to provide quality delivery of care.
Okay, "Now tell me more about communication."
Communicating, with ease and comfort, allows the patient/family member to discuss all issues related to treatment. Communication must be at the level of understanding demonstrated by the patient and family member, or loved one.
Often effective communication is hampered by restrictions (time restraints, patient emergencies, phone calls, questions from patients, new patients needing additional time, as well as other circumstances.) These are what I call the realistic restrictions.
Restrictions are obstructions that interfere with treatment of the patient. Those dialysis staff that do not have time to lend an ear to the patient are part of the restrictions that hamper treatment. Then, there are those staff that do not, in any way, understand what the patient is experiencing,, nor do they want to understand. They have built a wall around them and they are robots for their shifts. They do not allow the patient to really and truly be part of the team. They run from one dialysis machine to another without ever noticing who is attached to the other end of the machine. They don’t go the extra inch. Do they really care? One would wonder if they have lost their sensitivity of taking care of a sick patient. One would wonder why they are even in the health care profession. They do not take the time to explain what they are doing, nor ask the patient if there are any questions. They don’t have time to stop and answer the questions that will help develop a trusting relationship that the patient needs to have with the staff. They forget the patient is part of the team. They forget the patient is in the chair. Maybe we need to take a magic wand and turn them into a patient. Maybe these staff need should be a patient and feel what it is like. However, with some it might not make a difference, for they are the ones who should not be working in health care.
One of the biggest restrictions is when the patient is not comfortable discussing concerns with staff. No patient should feel uncomfortable communicating with dialysis staff. Patients, being humans, therefore, do feel uncomfortable, for whatever reason, and there are hundreds of reasons. Needless to say, health care professionals, being human might feel the same. We, as humans, bring with us all our past health care experiences to a relationship (patient-health care provider.) The same goes for those who are providing our care. Remember, they are human also. We would like to think they are angels from above.
Okay, you say, "Why does the patient have fears?"
Entering a life long situation is, for many, a devastating experience. Patients are placing themselves in the hands of individuals they have never seen before. Hoping and praying that these people have the expertise to care for them. The hope that when they need the nurse/technician they will be there to help them. Trusting that these individuals have the compassion and understand what they (patient) are going through. Hoping that these people they have never seen before will treat them as if they were treating one of their family. The fear of the unknown is present for many. Those entering dialysis, who experience this fear, hope that this person (they have never seen before) will allay their fears and anxieties.
A life long situation, a situation of unknown.
The Social Worker can help with support and assist the patient and family to adjust to a new way of living. It takes a caring person to be in this role. Social Workers are an integral part of the team. A patient who needs additional emotional support and can work through their own process of accepting dialysis will be a better member of the team.
The Dietician evaluates and re-evaluates the patient’s nutritional status and provides guidance with dietary needs. Obtaining information on details of foods allowed, or not, plays a huge part in dialysis treatments.
Okay, you ask, "How and who drives the treatment process?"
Each dialysis treatment is driven by the physicians, nurses and technicians assessment. The dietician plays an active role in this assessment, but not on a daily basis, for the most part. The nurses and technicians are the seeing eye dog for the doctor and provide valuable information in determining the dialysis prescription. Physicians who take time to meet with patients and discuss their care are those who are concerned about the well being of the patient. Input from the patient regarding what was experienced (symptoms)during, as well as, between dialysis treatments is a major part of the prescription.
Effective communication is the beginning of a trusting relationship with the dialysis staff. This relationship is of utmost importance, as it will be for the rest of the patient’s life.
Every patient, (being human,) experiences different emotions in reaction to content of information being provided by a nurse or doctor, depending, naturally, on whether the information is good or bad. Thus, those providing care must be able to realize with what the patient is contending. This is difficult, unfortunately, for some health care professionals.. Getting in touch with one’s own feelings, is hard enough for some, let alone understanding what a patient might be going through. Being patient and validating feelings, listening to concerns and easing anxieties is part of this process. Unfortunately, not every healthcare professional is able to provide these qualities. Being compassionate and considerate is part of this process.
Remember, developing a trusting relationship does not come overnight. It takes time and understanding on both parts, the patient and staff. It takes, both the staff and patient to make it work.
Note: Those patients who are unable to provide information are at a disadvantage. They rely on family members, loved ones, or caregivers at hospitals or nursing homes. (This is another story that will be addressed in further articles.)
As I used to tell my nursing students, put yourself in the patient’s place. Treat every patient as you would want yourself, family or loved one treated. End of story!..........
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