Arrival at the new renal unit in Jonkoping Ryhov Hospital is a warm, friendly and relaxing experience. The Scandinavian timber building is modern, light and bright and set beautifully amongst old established trees and parklandesque areas of well-manicured grassland. Plenty of parking and easy access for specialized vehicles carrying wheel chairs with simple and direct access into this single story, purpose built unit through 3 access points. A feeling of quality and well thought out design is present everywhere and the automatic entry doors equipped with electronic safety systems give a secure feeling for safety and well being.
The entrances offer 3 main options to the unit for their relatively modest number of dialysis patients. To the left they can proceedto a small 3 bedded section reserved for Peritoneal Dialysis patients or to a larger 12 bedded area for Assisted Hemodialysis care. Turning right they can head into the newly developed 12-bed Shared Care (Self Care as they prefer) area, which is purposely separated, for patients freedom and independence.
All three areas hub around a central reception, which is an informal area that can be used for meetings, presentations, coffee breaks (yes they drink coffee, like all Europe), interviews, visitors and general relaxation etc. It is equipped with random selection of tables, large and small, informal chairs, sofas and a large refrigerator. There is also tea and coffee making facilities, a dishwasher, an audio system and a large wall mounted flat screen TV (prepared for laptop presentations). The cupboards appeared to be well stocked with snacks, drinks and equipment. This area was extremely popular and easy to understand why. It allows both patients and staff to come together in a very pleasant and informal area by breaking down hierarchical barriers in a simple and pleasant way.
Through my years on dialysis I became a bit of a hygiene freak and tended to measure units in this way but this unit is inspiring in it's apparent sparkling cleanliness. Everywhere is immaculate, clean, quality and purposeful. It is very reassuring in its appearance and both staff and patients alike seemingly take pride in maintaining this high standard.
The primary objective was to review the objectives and successes enjoyed by the Shared Care Unit. It was apparent this concept of self controlled dialysis had not been their primary objective until the young man known as Christian requested the right to dialyse himself 5 years ago. In this request a nurse champion supported him and together their achievement is impressive.
I liked very much the way in which the team of Nephrologists, Nurses, patients and management had worked together to achieve this obvious success. I liked the trust the Medics put in the patient to perform their own treatment and the logical, simple but uncomplicated and non-bureaucratic way in which they monitored and reported the results. It seemed the results were being used to improve the patients overall wellbeing.
The freedom patients enjoy is quite remarkable and emanates from an obvious trust and understanding on both sides. Patients with the freedom to book dates, times and duration of dialysis apparently enjoy better quality of both dialysis and life. They are left to their own devices on the strict understanding they will not cross lines of safety set by the medical team. Most patients choose to dialyse early in the morning (from 5am) with others preferring the evening. These obvious choices allow each patient the best from the day that can also be enhanced by 30/40 minutes in the very well equipped and easily accessed gymnasium. This highly flexible approach allows patients the ability to fit dialysis around their lives and not the other way round, an obvious benefit which ever way it is viewed.
Staff are available for consultation throughout a core period of the day 7am to 4pm if required. The actual dialysis stations benefit from being comparatively new but are spacious light and airy. Nikiso machines offer easy access and control for the patient, even at bed level.
All the necessary equipment for dialysis is available in a locked storeroom to which both patients and staff have electronic access. Patients readily draw what they need and record batch numbers, items, quantities and machine details on simple forms. Patient records are also kept in this secure area.
Self Care dialysis training although initially controlled by staff seems more and more to be in the hands of the self-care patients. Sharing of techniques is encouraged but left very much to the individual. I feel this is quite a brave move and not what I would recommend as it will have a tendency to pass on bad practice. For me a continual back to basics approach would ensure a more consistent and sustainable method of training.
Overall I felt the whole experience was impressive, uplifting and motivational. As an ex dialysis patient it seemed to be the almost perfect solution to fitting dialysis around your life. I could well imagine working full time with this arrangement and feeling well as a result. It is also impressive that there is a commitment from Management, Medical Staff and patients to continually cooperate in research to improve the situation even further.
Summary of Benefits
- A pleasant and relaxing experience – stress free treatment
- Flexibility of dialysis times – improved life style
- Independence of dialysis and techniques – personal satisfaction
- Increased knowledge and awareness – better quality of health
- Greater feeling of wellbeing – better quality of life
- Improved self esteem