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4.5 Patient/Carer Experience 4.5.1 General Support The onset of ESRF requires adaptation to major life changes. The patient must cope with new dependencies on doctors, nurses and other agencies and perhaps dependence upon a machine and a restricted lifestyle. The latter can lead to job loss, job changes and pressures on family, sexual and social relationships. In a survey of 24 UK units, 23.5% of all dialysis patients reported two or more areas of difficulty in self care, 68.4% reported that social/personal relations were seriously affected and 29.6% reported that they were unable, or less able, to perform usual activities (ref.79). Success of RRT is linked to the effectiveness with which these stresses are combated. Lack of adaptation can lead to depression and non compliance with treatment. Staff attitudes are important. Patients may find it more difficult to adapt when clinicians devote their energies to the technical aspects of care at the expense of personal interaction. There is evidence that loss of independence and disruption of life style can be compensated for by a caring approach by staff (ref.80). ESRF treatment is intensive and time consuming and it is therefore important that the process is made as convenient and as responsive as possible. Support from the family and carers is critical. Families, partners and friends can amplify anxieties of patients or they can absorb stress and provide a positive influence on the perception of the patient and become their major support. Patients, families and carers should have their needs assessed on a regular basis to ensure that service and support programmes are targeted effectively. This in turn requires that services should have a sufficient complement of staff to allow time for personal interaction with patients. The care environment should be as comfortable and welcoming as possible. Renal services should strive to provide continuity of care. Minimising staff turnover helps to achieve this aim.  |