Jonkoping Ryhov Hospital caters for a population of approximately 140,000 and the hospital provide an acute and chronic service to its inhabitants. The Renal unit is set within the grounds of the hospital that appears to provide acute and chronic services. The renal unit cost £500,000 to build and comprises of a 12 station haemodialysis unit, a PD unit that currently has approximately 21 patients at home and a self care unit.
The renal unit is spacious, airy and gives the feeling of space (Building Regulations in the UK may be different to European ones!!). There are 3 different entrances: the main entrance to the unit that patients to the self care unit can access, an entrance to the renal unit which they called- assisted haemodialysis and a separate entrance to the isolation unit for patients with blood borne viruses.
The lay out to the unit is appears to flow well but I am unsure of how well it fits into the LEAN principles for the productive ward scheme, that is used in the UK. Access into the building is via a swipe card and the patients involved in self care have been given access to come in at any time they choose to.
The unit looked very clean, uncluttered and had a sterile appearance. There were no posters on display of infection prevention measures i.e. saving lives etc and no evidence of alcohol gel dispensers to the entrance of the unit or bays. The number of sinks for hand washing also seemed less than in a hospital in the UK. The nursing staff did not all wear personal protective equipment mainly visors when taking or putting patients on haemodialysis.
Ethos of the Unit
The atmosphere in the renal unit was friendly and relaxed similar to that of a satellite unit as opposed to a main unit in the UK. The staff that spoke to us informed us that patients were taught according to their speed and level and as they became competent they were left to their own devises but called the nurses if they required assistance. The nurse in charge did not employ any structural approach to competencies, or assessments. Medicines management and the safe storage of medicines did not appear to be an issue for them as it is for us in the UK.
The nursing ratios in this unit were higher than the nursing/patient ratio recommended in the workforce planning for renal units in England (British Renal 2005). The staffing ratio in the self care unit comprised of 5 Registered Nurses (RN) for approximately 8 self care patients. Health Care Support workers are not part of the nursing workforce. There are 3 RN s working within PD, I RN for the outpatient's (unsure of numbers) and approximately 19 RN s for the assisted HD unit which currently has 28 patients.
The nursing shifts and patient attendance at the unit do not necessarily coincide. The patients can attend the unit at anytime for their haemodialysis treatment and some come in at 5.00 am in the morning. The RN s start work at 7.00 and finish at 4.00 pm.
The most impressive thing for me was how motivated and at ease the 3 patients we met seemed to be with undertaking their haemodialysis treatments. There seemed a lot of flexibility in the system and they could dialyses whenever they wanted to. The patients dialysed more than three times a week (the current norm in the UK). This was facilitated by the fact that they had capacity and flexibility within their system to accommodate this because their patient's numbers are low. Population of Sweden is 11 million compared to 60 million in the UK. There is a gym that the patients can access whilst waiting for their haemodialysis machines to be ready. We were informed that the patients undertaking self care had to sign a contract. 60 % of patients undertake self care and this included their PD patients.
The staff told us that they and the patient's problem solved and learnt together. A booklet has been devised with pictures and instructions so patients can follow this if they are stuck. Unfortunately we did not witness any training.
Nursing Exchange Programme
I would like to set this up but will need to discuss this with our Chief Nurse in the first instance. Given the right objectives and appropriate goals the development of a shared care approach could enhance nursing experiences in both units.