Teaching PD

Teaching Peritoneal Dialysis is a skill that is acquired over many years
In theory ratios of nursing staff need to be adequate to allow one-on-one training where required, but the reality of rosters does not always allow this. Commonly accepted ratios for PD are 1:25. It is recognised that indigenous and remote are factors that increase the need for lower patient ratios. QLD renal clinical network in 2010 determined a ratio of 1:10 for HHD and 1:15 for PD as desirable and for review in 2011.77 It is acknowledged that the skills of a PD trainer are augmented over a period of years.53

Patient Training Components
–  Demonstration and practice
–  Visual pictures detailing how to perform the practical skills required
–  Written/multimedia information re all aspects
–  Theory to support rationale
–  A check learning and competence component
–  Trouble shooting
–  Revision component

Training Curriculums and tools
–  A structured training curriculum to encompass all of the above53
Industry specific product training information and handouts
–  Training tools that are intellectually, language and culturally appropriate53,75
–  Strategies are required 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
Options for training locations should be considered to maximise the learning opportunities for the individual.53

–  The training unit has clinic rooms, demonstration equipment and support for the trainer.
–  For the frail, aged, and those with transport difficulties or social dependents there may be occasions when a home train is more effective.
–  The disadvantage for a home train is the travelling for the trainer and some environments that are not ideal for training. Flexibility is the key.

Start with getting to know the individual
Any fear has the potential to be a barrier to achieving success at training. Early identification, acknowledgement and then strategies to overcome these fears will limit the negative impact. Social concerns, depression, denial and language barriers will all limit the effectiveness of training. The best home training nurses will address these before training. Referral to a psychologist may help. Referral to an occupational therapist may help to determine if there are special training needs, psychological or physical.

Care partners or support partners
Support is essential but dependence on another often has negative consequences. Support partner burn-out, and support partners becoming unavailable is a high risk. Loss of earnings can be significant. Care partners can learn the trouble-shooting and how to support whilst their most important role may be socialisation. Care partners require referral to social workers to ensure they gain all relevant available financial support. Home dialysis patients often do not meet current centre-link requirements meaning their carers are ineligible for the carers’ pension.98

–  Support and carers You may need to share this information with your patient group.

Pre-Dialysis assessment tool
–  Pre-Dialysis Assessment Tool This tool is under development by Hunter New South Wales service – if you want more detail, simplys 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.

Collation of PD training tools and documentation from recommended sources is underway. If you have any contributions or suggestions, please email homedialysis@kidney.org.au

–  Royal Melbourne Childrens Peritoneal Dialysis protocols

Recommended weblinks
Procedures and protocols should meet the standards of relevant national guidelines and their recommendations.
–  CARI: Australian Guidelines
–  ISPD: International PD guidlelines

References for this page have all been taken from The Report on Home Dialysis

For all enquiries: homedialysis@kidney.org.au – or call 1800 454 363

Page updated 24 February 2014