Wong and coworkers explored patient training experiences related to the self-administration of hemodialysis at home. The researchers used a qualitative study using semi-structured interviews and a focus group. The setting was a hospital-based patient education program in Toronto, Ontario, Canada. Qualitative interviews and focus group study were conducted with 23 patients (who had end stage renal disease) and caregivers who have participated in Toronto General Hospital's Nocturnal Home Hemodialysis training program to learn how to operate a hemodialysis machine and to administer their own treatments at home without the supervision of clinicians. Experience as a trainee in the Nocturnal Home Hemodialysis program was framed by five diverse themes: (a) patients' perceptions of anxiety; (b) peer support; (c) clinician empathy; (d) understanding learning while ill, and (e) the compatibility of learning preferences with training practices employed. The study revealed the complexity of the patients' experience with being prepared for a self-treatment regime at home. Although it was anticipated that the most important barrier to patient preparation would be the challenges of managing complex medical technology, psychosocial dimensions of their experiences were the primary factors impacting on the patients' ability to learn and to take on self-care responsibility.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that if the trend of patient self-treatment at home continues to increase, it is important for clinician educators to be attentive to self-treatment as a socially situated activity.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The knowledge and performance of any self-management skill can be altered by the context in which you use these techniques. A supportive environment has long been recognized a factor that will encourage your behavior. If that is unavailable, then it is up to you to learn to perform self-management skills in a context that you create. Acquiring self-efficacy regarding your performance will help you effectively perform self-management skills over time and across settings.

J Wong et al. Patients' experiences with learning a complex medical device for the self-administration of nocturnal home hemodialysis. Nephrology Nursing Journal, 2009;36:27-32.