In the mid 1990’s dialysis was delivered for the Top End from the Community Centre at Nightcliff in Darwin, NT. Patient care was independence based but there was no official training program.

Patients from the Tiwi Islands (20 minutes North of Darwin by plane) lobbied the Federal and Territory Governments for self-care dialysis at Nguiu.

The go-ahead was given to build the unit at Tiwi with patients responsible for their own dialysis care.

A self-care training team was established and designated staff were rostered. A training manual was compiled for consistency of approach, which the patients had input into. The training program also prompted the need for competency assessment tools.

Other satellite patients were also interested to learn the machine despite not wanting to return home.

A new home dialysis training program at Nightcliff meant withdrawal of self-care in the satellite and teaching only home patients. No allowance was made for non-home patients. Staff and some patients expressed dissatisfaction and this gave opportunity to start self-care again in the satellite.

Measuring our success over the past 3 years since reintroduction of self-care training:
· 3 unsupervised patients without staff allocated
· 14 supervised patients (requiring needling only)
· 5 semi-supervised patients (doing what they can)
· 7 patients fast tracked to complete home training

Staff challenges:-
· Nurses to keep their hands off
· Trust assessment of patient independence
· Relinquish control

Outcomes include increased patient confidence and participation, and shortened home training times.