Sarah Thomas — Home Hemodialysis

How did you get to where you are now?
I’m originally from Ontario and came out to Vancouver around 1999 to find work. I’d heard great things about how PHC treats their staff and St. Paul’s Hospital sounded like an exciting place to be, being both an inner city hospital and a teaching hospital. I started there as a nurse in the renal unit and eventually began teaching other nurses about dialysis at BCIT. I fell in love with teaching, but after a while, I began to miss the contact and caring aspects of bedside nursing. When the home hemodialysis program started, I signed right up and helped a team from across the B.C. health authorities launch it.

What’s your role at PHC?
I am a clinical nurse leader & patient educator for home hemodialysis at the Richmond Community Dialysis Unit. Primarily my role exists to support patients who have suffered kidney failure and are self-dialyzing in their own home. I’m their go-to person if anything goes wrong or if they have questions but I’m also a part of their social support system and their link to the hemodialysis unit. I’m currently supporting 21 patients from White Rock to Dawson City.

What should people know about home hemodialysis?
If you’re a dialysis patient, coming into a clinic three times a week for four to five hours means you spend a lot of time travelling and sitting around in a hospital setting. Instead, we can install a machine in your home which allows you to dialyze whenever you want and keeps you in the comfort of familiar surroundings. Many patients rest or work on laptops while dialyzing, which is a lot more pleasant in your own bed or at your own computer desk.

Our program has been active for 12 years and we now have nearly 33 per cent of dialysis patients from B.C. and the Yukon on home hemodialysis or peritoneal dialysis.

What’s the biggest challenge you’ve encountered?
Some patients don’t want to have to stick themselves with a needle, so they continue to come to a clinic. Others are worried that they’ll be left on their own and not properly cared for if they don’t come into one of our units. The truth is that our patients have the equipment manufacturer and a nurse like myself on call almost 24/7. Their nurse contact follows them their entire life until they receive a transplant and no longer need dialysis. There’s also a myth that home hemo is expensive when in fact it’s completely free. Our patients get the same medication and equipment they would find in any dialysis clinic.

How have you customized care for your patients?
I had a patient who was legally blind, though not completely. We were able to use large stickers and bright colors which allowed him to self dialyze. We’ve installed clamps to help a patient who had only one hand. We have patients who are missing fingers, in wheelchairs, and we even have homeless patients who order their own supplies and run their own dialysis, their machine just happens to live in a hospital. The only real barriers we’ve run into are psychological disorders or addictions issues.

Every patient has a different knowledge base and learning style. For some, English is a second language, others are illiterate. We meet patients where they are and adapt our education to suit them, often making good use of Google translate and other online tools.

What’s the best part of your job?
The best part of the job is getting to be a part of these patients’ lives. I go to my patients’ homes to educate them and help them learn to operate their machine. This learning process can last up to four months, so we spend a lot of time together. I meet their family and friends, I listen to their worst fears and I experience what they’re going through. That creates a lot of trust.

As a result, I’m so close to my patients that I’ve been invited to birthday parties and weddings. They send me texts all the time, often on personal matters unrelated to their treatment. I become almost a part of these patients’ families. My colleagues and I might be closer to our patients than anybody else in health care, so to see them get well and achieve what they’ve been striving for is very rewarding.

If you could change one thing about your role what would it be?
I would have clinicians see home hemodialysis as a viable option for more of their patients. I think clinicians are often too quick to write off home hemo as an option, but it’s important to never underestimate a patient’s ability to self dialyze.

To learn more please contact the Richmond Clinic at 604-207-2562 or click here.