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 |
 Professionalism
in Dialysis Care
 Patient-Centered
Care
 When
Patients Have Concerns
 Fistula
First
 Caring
Through the End |
Who is this Training For?
These modules are designed to be used by dialysis center staff
responsible for conducting in-service training, such as nurse
educators and trainers. The training topics were selected
and designed for patient care staff, specifically dialysis
technicians and LPNs who work on the floor. The trainings
aim to build their skills in communication to promote better
customer service and client satisfaction. You may find that
other levels of staff may also benefit from participating
in these sessions.
Each module includes exercises and handouts for patient care
staff. While the content may be useful for other purposes
and relevant to patients, the handouts were designed for LPNs
and technicians.
Finally, the modules are designed to be flexible enough to
express diversity in culture and variability in facility policies.
Trainers should review the modules prior to use to adapt or
revise as required to meet participants' needs or to be in
line with facility protocols or policies.
Communication Skills for Providing Quality Care
is a set of stand-alone modules, each with short learning
activities, such as games, brainstorming, small‑group
discussion, and practice group activities. These activities
are designed to facilitate discussion, problem solving, and
critical thinking among dialysis center staff who provide
patient care.
This kit contains five 45‑minute sessions that can
be presented during staff meetings or in-service training
breaks. Modules can be adapted and expanded as needed for
your facility.
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The modules are the following:
Module 1: Professionalism in Dialysis Care
The
first module defines professionalism in the dialysis center
and allows staff to identify ways to apply skills to increase
patient satisfaction and define boundaries.
By
the end of this module, participants will be able to:
ü Demonstrate,
through group discussion, an understanding of professionalism
within the following relationships-staff member to patient;
staff member to family; and staff member to staff member
ü Demonstrate,
through group discussion, an appreciation for how a high degree
of professionalism can improve patient compliance, increase
patient involvement in disease management, and reduce patient
and provider complaints, including lawsuits.
ü Demonstrate,
through role play, how to respectfully set limits (boundaries)
with patients
ü Demonstrate,
through group discussion, an understanding of the rationale
behind these concepts, and how they operate to achieve the
highest quality patient care.
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Module 2: Patient-Centered Care
This module defines patient-centered care, and helps participants
apply it to their daily work.
By the end of this module, participants will be able to:
ü Demonstrate,
through a verbal exercise, what the world is like through
their patients' eyes.
ü Demonstrate,
through role playing, at least three examples of courteous,
respectful ways to interact and communicate with patients
ü Describe
ways in which active patient participation improves treatment
outcomes.
ü Demonstrate,
through role-playing, a variety of methods for communicating
with patients in order to engage them in their continual care
planning.
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Module 3: When Patients Have Concerns
The module
allows participants to increase patient/customer satisfaction
through identifying and practicing helpful communication skills.
By the end
of this module, staff will be able to:
ü Determine
benefits of using good communication skills, and identify
effective management of patient's concerns.
ü Understand
how patients' involvement in their care improves outcomes.
ü Through
group discussion, identify patients' concerns and understand
techniques used to resolve such concerns.
ü
Demonstrate
through role-playing, how to effectively listen to patient concerns
to determine proper response and enhance the efficiency of patient
care.
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Module 4: Fistula First
This module provides patient care staff with an understanding
of the benefits of
arteriovenous fistulas (AVFs), and tips for helping patients care for
their AVFs.
By
the end of this module, participants will be able to:
ü
List
three reasons why an AVF is preferable over a graft or catheter.
ü Demonstrate,
through role playing, three ways to care for an AVF.
ü Describe,
in a group setting, how to educate patients on care of their
AVF.
ü Demonstrate,
through return demonstration, proper cannulation technique
(optional activity).
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Module 5: Caring through the End: Final Stage of Chronic
Kidney Disease
This module defines palliative care and helps participants
identify end-of-life issues that might arise in the facility
as well as possible resources and support.
By
the end of this module, participants will be able to:
ü
Describe through group discussion how to be a supportive listener
when a patient wants to talk about the end of their life.
ü
Describe, through shared, personal storytelling, what kind
of experiences technicians have had listening to patients
and addressing their concerns about end of life.
ü
Demonstrate, through group discussion, familiarity with various
support services, both on the unit and in the community, that
patients could be directed to when they have end-of-life concerns.
ü
Define "do not resuscitate" (DNR) orders and the clinic's
DNR policy.
ü
Describe, through group discussion, benefits to addressing
end-of-life issues-both for the patient, as well as the staff.
This module provides patient care staff with an understanding
of the benefits of arteriovenous fistulas (AVFs), and tips
for helping patients care for their AVFs.
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The last page of each module is an optional pre- and post-test.
You may wish to use this with your participants to assess
learning or to arrange for CEUs for your staff. Be sure to
allow extra time for participants to complete these sheets.
Adapting the Modules for your Facility
As you read through each module, keep in mind who your trainees
are, who your patients are and what is appropriate for your
facility. The patients, technicians, nurses and nephrologists
who come into the clinic are from different neighborhoods,
regions or even countries. In short - we're all from different
places! In addition, different facilities will
have different policies, protocols and procedures. Trainers
are encouraged to adjust these modules to fit their audience's
needs. Use these modules in a way that reflects the unique
qualities of your technicians and patients. Here are some
examples of issues to consider:
Culture
The module called When Patients Have Concerns discusses
the importance of active listening, including direct eye
contact, as a way to let your patient know you are really
listening. But in some Asian cultures, direct eye contact
is considered rude. So if you conduct this training in San
Francisco's Chinatown, where most of the technicians and patients
are Asian, direct eye contact may not be something you want
to promote.
As
another example, the module on Professionalism in Dialysis
Care discusses the idea that professionalism includes
a businesslike manner. But imagine how dressing for work in
Washington, D.C., (where workers tend to dress fairly conservatively)
compares with Dallas, Texas, where wearing cowboy boots with
a suit and tie is considered appropriate business attire!
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Language and Slang
The trainer needs to be aware of language differences, too.
These modules were developed in English, but many of your
training participants and patients may speak different languages
or use different terminology.
Facility Protocols and Rules
Review each module to ensure that the information, recommendations
and exercises are consistent with your facility's protocols.
For example, in the Fistula First module, give your
trainees appropriate guidance on their role in promoting AVFs
as a member of the care team. The module on Caring Through
the End is an excellent opportunity to review your facility's
policies on DNRs and other guidelines for end-of-life care.
But if something in the module does not seem appropriate for
your facility or how the trainees actually work with patients
in your facility, alter the module as needed.
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Tips for Using the Modules
The modules use several key educational strategies to facilitate
critical thinking and encourage staff discussion. These strategies
include the following:
Short Activities
Most of the activities take only five to 10 minutes, to allow
staff to return to work in a reasonable amount of time. These
activities are designed to be implemented quickly, to keep
participants energized and interested. They are not designed
to promote long debates or discussion on the topics.
The purpose of quick activities is to impart the one learning
objective. Once that objective is met, the activity can be
ended. Stay aware of the participants' reaction to the activity.
Try not to lose their interest or engagement by taking too
long to provide information or by allowing discussions to
go off the topic.
Some activities lend themselves to in‑depth group discussions
that may take longer than the recommended amount of time.
It is up to the trainer to use time necessary to meet participants'
needs while balancing the importance staying on schedule.
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Facilitation of Learning
Most of the activities build communication skills. The activities
encourage participants to explore questions, answers and possible
connections. There are no "right" answers to the activities
and discussion questions. In fact, many activities may be
done "incorrectly", that is, participants may make mistakes
while practicing new skills, and will learn from each other.
The role of the trainer is to encourage exploration and to
help participants answer their own questions and try out different
tactics. Try not to feed answers or correct ideas. Allow discussion
among participants and encourage additional research after
the training to help answer participant's queries.
Model Open and Nonjudgmental Behavior
In order to be open to new ideas, your staff will need a
safe, non-threatening environment for learning. As a trainer,
your behavior with, and reactions to, the participants can
go a long way toward encouraging a supportive group. The following
tips help with group work cohesion:
n
Be
clear about your expectations for how group members treat
each other and how they participate
n
Respect participants' feelings and parameters
n
Respect patient and family confidentiality
n
Model
appropriate responses and behavior
n
Demonstrate concepts and use examples when possible
n
Encourage group members to share their experiences at their
own pace
n
Listen!
n
Let
group members react, think and analyze
n
Give
compliments
n
Demonstrate acceptance and respect for all participants, regardless
of race, religion, social class or sexual orientation
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Leading Role Plays
Most of the modules focus on communication skills, using
role plays to allow practice of new techniques. The activities
in these modules were designed to be very simple and so as
not to put staff on the spot. Role play activities divide
groups into pairs, so colleagues can practice with each other,
without having to perform in front of a group.
Here are some tips to lead a role play successfully:
n
Give
clear instructions on expectations of the activities, to make
participants feel more comfortable
n
Circulate around the room to provide tips on using skills
n
Provide positive feedback
n Thank
participants for their efforts
n
Debrief afterwards with a few questions to allow participants
to share what they learned, what was difficult, or what they
felt
n If
someone is left without a partner, pair the participant with
you, the trainer.
Because some staff may be resistant or uncomfortable with
the idea of a role play, the module activities are called
"case scenarios" or "practice." If some staff are still
resistant to the activity, allow other options to ensure that
they can still apply some of the learning's at their own pace.
Alternatives to role plays can be: writing down responses
to the scenario and sharing with a partner for feedback, or
discussing in pairs different options on how to respond to
a scenario and looking at pros and cons of various options.
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Created
by the
Academy
for Educational Development
http://www.aed.org/
and the
Mid-Atlantic Renal Coalition
with
funding from the
Centers for Medicare &
Medicaid Services
http://www.cms.hhs.gov/quality
Be sure to click here for
information on ESRD
projects.
