Betsy Hauer has been a member of the Pediatric Dialysis Unit team since June 2014. She quickly developed an affinity for the chronic pediatric dialysis population and their unique needs. During the past four years, she has developed therapeutic relationships; which, has led to her developing trust with the patients. Betsy is extremely perceptive with the loss of control felt by our patients and families. She is an avid patient advocate.
In the PDU we do our best to provide the patients and families with as many choices as possible; however, there is still great loss felt when they start dialysis. While finding ways to offer control can be challenging, Betsy consistently empowers the patients to participate in their care and includes them in decision-making whenever possible. The patient's vascular access for hemodialysis is critical to many aspects of their care including but not limited to: how well we can clean their blood, the impact to their self-image, and the ability to provide them with control in their care. The optimal dialysis access is an arteriovenous fistula or an arteriovenous graft as this has the lowest risk for infections. Permanent central line catheters carry the greatest risks including infection, development of clots, and frequent bouts of catheter dysfunction to mention a few. This is one aspect where patients have the ultimate choice in their care.
There are a variety of reasons why a patient would choose one access over the other. We have had patients share with us they don't want the fistula because it is there forever, they are afraid of needles, they don't like the scars they see other children have developed due to cannulations, etc. The list is endless; however, these fears lead our patients to choose a catheter. Helping to educate on the risks and benefits of each option so they can make an informed decision is an expectation for all nurses and incredibly challenging with a teenager who is not thinking about life after today, tomorrow, or maybe next week. Oh, and they think they are invincible, so an infection is no big deal to them at the given moment. Betsy took on this challenge with one patient in particular and the outcome has been nothing short of an incredible success story.
The patient is one of eight children and consistently provides his own care. He routinely comes to dialysis alone and has for nearly two years. He was fearful when starting and expressed his fear along with anger which is a very normal teenage behavior. Betsy quickly developed a rapport with him, building trust and a relationship that has led to him asking to have a fistula and ultimately working toward the greatest accomplishment of cannulating himself for treatments. Yes, cannulating himself at age 16 for his own dialysis treatments. This is common in the adult world, but not in the pediatric world. This patient has hated coming to dialysis from the day he started and has been vocal about this at times. Quite frankly, I am not sure there is child or teenager excited to come to dialysis three days a week and disrupt their personal life, school life, or time with their friends.
Betsy continued to work with him on the importance of access for dialysis along with educating him on what a fistula entailed. Through her persistence and desire for his best interest, she provided him with all the tools and knowledge to make an incredibly mature decision at such a young age. She never gave up on him or his ability to make this decision. She knew early on that it had to be his decision or it would not be successful. He had some painful infiltrations with his fistula which added a component of fear to his cannulations and additional hesitation and frustrations with coming to dialysis.
Betsy started conversations of buttonholes with him and shared that with buttonholes he could cannulate himself. Buttonhole tracks are established by one person. This process is necessary because the sites are cannulated over and over until the track is developed and then others can access once established. Buttonholes offer the patient ultimate control over their access. If desired, they can cannulate themselves. Betsy had never established buttonholes before; she had cannulated them on other patients though. She knew this would be an incredible benefit to him, his confidence, and would empower him in many areas of his health care, and she was absolutely right.
When he agreed to buttonholes, she researched and educated herself on the process of establishing buttonholes, created a policy and made it happen for him. She went above and beyond to provide a level of care that was needed for this patient and others will benefit from in the future. She came in on her days off during the time the buttonhole tracks were being developed and ensure the patient and a couple others were confident in cannulating the buttonholes prior to going on vacation. It was all an incredible success because she had a vision and a way to help this patient become more autonomous in his care.
Because of establishing buttonholes, he now cannulates himself, has consistently had better control over his fluid gains in between dialysis treatments, and is really proud of himself for his accomplishment.
This success story was more than a year in the making and ends with him telling Betsy, "I don't hate coming to dialysis anymore. I am not afraid my fistula will infiltrate." He must have felt liberated to not have as much anxiety and fear about receiving care because of a prior experience, although common yet not pleasant. His improved self-confidence, collaboration in his health care, and decreased anxiety is a testament to Betsy's persistence and belief in him! Betsy's perseverance led to helping this child overcome his fear of a fistula and her courage in learning how to establish buttonholes led to his improved confidence and independence in his access care. This is why Betsy is so deserving of The DAISY Award. She exemplifies what the award stands for in the extraordinary, individualized, compassionate care she provides to the patients she serves.
Nelson Mandela said it best, "I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear." The patient and Betsy worked through uncharted territory together, were both courageous, and have shown great strength in believing in each other.
Courage and perseverance make difficulties disappear and obstacles vanish.