More than 562,000 Americans are on dialysis, according to the American Kidney Fund. Typically, these patients receive therapy in a dialysis center or at home. A small number of patients receive training and perform their dialysis in the center, with minimal support from staff. Although this mode of therapy has proven to have significant benefits, both for the patient and for the centers, it is not readily accessible to the majority of people with kidney failure.
Nancy Harold, ’73, wishes this were different. More than 40 years ago, she partnered with Dr. Thomas Talley, a nephrologist at Highland Hospital in Rochester, N.Y. (an affiliate of the University of Rochester Medical Center) to open a self-care dialysis unit at the hospital, a groundbreaking idea at the time.
Harold had extensive experience with dialysis patients, which started during a rotation at Roswell Park Cancer Institute while she was still a student in Niagara University’s College of Nursing. Following graduation, she obtained positions as a senior staff nurse in the acute dialysis unit at New York Hospital/Cornell Medical Center (now New York-Presbyterian), and at Downstate Medical Center in Brooklyn, N.Y., where she worked with renowned nephrologist Dr. Eli Freidman, inventor of the “suitcase kidney” and advocate of federal funding for dialysis treatment. She also spent considerable time observing the day-to-day operation of New York Hospital’s Rogosin Renal Laboratories, one of the first self-care dialysis units in the country, while working on her thesis for a master’s degree in nursing.
Harold was working as an in-service coordinator for a large chronic dialysis facility at Monroe Community Hospital when Dr. Talley recruited her to establish a self-care, in-center dialysis unit at Highland.
Harold accepted the job immediately.
“I was so intrigued,” she said. “I loved the idea of this project and this challenge.”
Over the course of about eight months, Harold transformed an area of the hospital into a comfortable place where dialysis patients were empowered to administer their own treatment. Working with an architect and an interior designer, Harold created a clubhouse-like atmosphere that encouraged socialization among the participants, as they were called, as well as a small area where acute dialysis could be performed.
She also developed policies and procedures—“safety was paramount,” Harold said—and worked with regulatory agencies to approve equipment and supplies. She hired staff, including a technician who oversaw the installation and maintenance of the machines, and interviewed and educated the participants, who ranged in age from 13 to 80.
“The only requirement was that they had to have the dexterity to set up and prime their own machines using the sterile technique I put in place,” Harold said, noting that about a third of the participants even inserted their own IV needles, which they found was less painful than having a nurse do it for them.
The benefits to the patients were seen immediately, Harold noted.
“They had the sense that they were taking control of their own destiny,” she said, which resulted in fewer secondary complications and reduced hospitalizations. “They were able to carry on their normal life and felt less like patients.”
The self-care process also allowed nurses time for tasks such as patient education, care plans, and referrals. In addition, labor costs were cut in half, because nurses could care for up to six patients in the self-care center, instead of three, as in a typical dialysis center.
As word spread about this unique clinic, Harold was invited to speak about the project, which had even garnered the admiration of a representative from the U.S. Department of Health and Human Services, who asked, during a site visit, why there weren’t more of these kinds of clinics.
After more than two years with the clinic, Harold resigned when her husband’s job transferred them to New Jersey.
“I hated leaving,” she said, “but I felt like I had completed my objective. It was the opportunity of a lifetime for this Niagara graduate!”