Authors (including presenting author) :
Sung KMD, Lee PY, Wong HSJ , Leung TK
Affiliation :
Renal Unit, department of medicine, Queen Elizabeth Hospital
Introduction :
The Home Haemodialysis (HHD) training program includes theoretical education on HHD, machine handling and maintenance, principles of infection control, management of complications, self-care strategies, and self-cannulation techniques. Mastering self-cannulation is the most challenging and time-intensive aspect of the training process. Functional Vascular Access (VA) with successful self-cannulation are critical determinants of clinical outcomes and training program efficacy. However, patients’ overall readiness and proficiency in self-cannulation techniques are equally significant. In response to these challenges, we have developed an innovative training program by implementing Skilled-based Simulation Training (SST) incorporating high-fidelity simulators, multimedia elements as part of a Restructured Training Curriculum (RTC).
Objectives :
Modernizing the teaching and learning process aims to enhance patient safety while minimizing the physical and psychological distressing experiences throughout the skill transfer journey. Our goal is to reduce the average training duration from 16 weeks to a more efficient 6-8 weeks.
Methodology :
Historically, self-cannulation training was conducted on patients' actual VAs, which was a stressful experience for both patients and nurses. A failed attempt could traumatize the VA, leading to prolonged training durations and negatively impacting the clinical outcomes. The RTC approach integrates adult learning theory with SST, allowing for unlimited hands-on practice in a safe environment. Learning through positive experiences and reflective practices, fostering patient confidence and readiness for self-cannulation.
Result & Outcome :
In the initial phase of the implementation, the first two patients trained under the RTC with SST successfully self-cannulated their VAs on their first attempt using a rope ladder soft catheter. This innovative training model led to a significant reduction in the average training duration(in weeks) by approximately 60% and the average number of training sessions was reduced by about 38% when compared to traditional training methods without SST. Feedback from both patients and nursing staff was positive and encouraging. The RTC with SST has transformed the training journey into distinct phases that optimize available resources and create a collaborative environment for all stakeholders involved. By identifying barriers to learning and promoting active engagement, we have significantly enhanced HHD patients' confidence and empowerment. This reduction in training duration not only facilitates workforce reallocation but also improves the overall quality of home-based and hospital-based nursing services. Ultimately, successful self-cannulation skills are paramount for HHD patients to initiate treatment effectively, ensuring optimal clinical outcomes and reducing the demand of the clinical support.
