I spent the last two weeks between the Kidney Care Centre (KCC) in New Westminster and the peritoneal dialysis (PD) unit at Royal Columbian Hospital to learn about the nutritional management of renal disease. Much like my placement during the diabetes education centre, the renal rotation focused on preventing the progression of a chronic disease and/or symptom management through dietary approaches.
The biggest challenge to dietary counselling for chronic disease (in my opinion) is inspiring a desire to change in patients. Just because food, nutrition, and health are important to me, doesn’t mean that every patient is going to share the same beliefs. Sometimes, diet is the last thing they want to talk about. How do we do what’s best for the patient when faced with this reality? One of my preceptors really emphasized to always start the conversation by asking the patient if there’s anything I can do for them, if they have any questions I can help answer. I think that’s a great way to start the conversation, establish rapport, and understand patient’s priorities. Sometimes, she said that she doesn’t end up talking about diet at all with a patient, and that’s okay. Another point I learned is to ask patient them if there’s anything they would be willing to do to meet a certain goal. This is part of assessing readiness for change and can help to make sure the goals are realistic for patients.
One thing that I’ve been trying to work on is talking about making dietary changes with compassion and understanding. Patients are going through so much — chronic renal disease robs people of energy, and most of the patients are also experiencing other co-morbidities: diabetes, heart failure, hypertension, depression… the last thing they (or anyone) need is criticism about what they’ve been eating. Making suggestions in a gentle way, using positive rather than negative language, and explaining how the suggested change can impact what they care about are some strategies I picked up.
I learned about more medical stuff as well, like drugs commonly prescribed for dialysis/ renal failure patients, how peritoneal dialysis works, and fluid assessment in patients. Overall, I enjoyed learning about the complexities of renal disease, and it’s been a great couple of weeks.