1 The assessment of patients to use home haemodialysis devices (HHDDs)
Hospital and home haemodialysis (HHD) centres have the responsibility to maintain a quality HHD training system, which supports nephrologists and dialysis nurses in making good decisions about whether patients are suited to HHD treatment. In general, decisions on whether patients have the autonomy to use HHDDS are based on two key factors: whether a patient has the emotional capacity, and whether a patient has the capability. A ‘patient’s emotional capacity’ is their motivation and if they feel they could use HHDDs by themselves, whereas a ‘patient’s capability’ is whether they are physically able to use HHDDs independently (Blagg, 2010). Further details on determining whether a patient can use HHDDs are covered in section 3. But first, it is worth briefly covering the qualifications of nephrologists and dialysis nurses, as well as targeted users of HHD and patient training providers.
2 Qualifications of nephrologists and dialysis nurses
In the UK, a nephrologist will have completed medical school, foundation year (FY1 and FY2), core medical training (CMT), and passed the Membership of the Royal College of Physicians (MRCP) exam before competing for a National Training Number (NTN) in kidney medicine. Typically, training takes five years and leads to a Certificate of Completion of Training (CCT) in kidney medicine and general medicine.
In the UK, most dialysis nurses are Registered Nurses (RN), or Advanced Practice Nurses (APRN) who can work within a hospital or hold a travelling position. Before being able to become a RN or APRN, a degree or diploma in nursing (associate’s or bachelor’s degree) is necessary. An associate’s degree program and a hospital-based diploma will require two to three years of study, and a bachelor’s degree will take four years. After finishing the degree or diploma in nursing, nurses must pass the national licensing exam of dialysis nurses. If nurses attempt to qualify, they are required to have at least one year of experience in dialysis nursing, as well as continue their education in the subject of dialysis nursing. Currently, on an international level, patient dialysis nurses are not required to have gained certification; however, some organisations such as the Board of Nephrology Examiners Nursing and Technology (BONENT) are urging for legislation that requires certification as a prerequisite for training patients.
3 Users of HHDDs and patient training providers
HHDDs are not suitable for everyone. The theory, as Blagg (2010) notes, is that anyone who can drive a car can operate HHDDs. This means that almost anyone can use HHDDs if “motivated, compliant, and willing and able to learn” (Blagg, 2010). However, whether patients can use HHDDs by themselves depends on an assessment from a nephrologist and kidney services home therapy team. Nephrologists will decide based on a patient’s individual situation, such as their stage of kidney disease, whether they have severe cardiovascular disease, any contraindications to using heparin, and their willingness to use HHDDs. If a patients’ physical situation is suited to the use HHDDs, and they also interested in using them, following a nephrologist’s recommendation, patients must pass HHD training before gaining a permit to use them.
Patients can be trained by training providers, which may be hospitals, HHD centres, dialysis clinics, and HHD companies and organisations. They guide and support patients to help them operate HHDDs step by step through the HHD training program. A brief account of the HHD training process is covered in the following article- The Assessment System of Home Haemodialysis (HHD) for Patients 2.
Blagg, C. (2010) The future of Home Hemodiaysis Dialysis and Transplantation, 39 (8), 335-337.