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The impact of starting dialysis on patients with renal failure requires nurses to draw on their educational, pedagogical and interpersonal skills. It is important to monitor the patients in their daily lives to support them and encourage them to comply with their prescribed therapy.

Faced with patients with end-stage chronic renal failure treated by peritoneal dialysis or haemodialysis, the full range of nurses' skills are brought to bear, from the highly technical through to the interpersonal.

The goal of this article was to develop an educational tool for nurses working in an acute care hospital in the hope of improving quality of care for hemodialysis patients. In Canada, the prevalence of end stage renal disease is increasing by approximately 10% annually (Mendelssohn et al., 1999). Today, the hemodialysis patient is often older than previously, and may well have multiple comorbidities resulting in hospital admissions in a multitude of settings. Hemodialysis patients are not always admitted under the nephrology service due to lack of beds or medical necessity. For example, a hemodialysis patient with an acute myocardial infarction would be admitted to a cardiology unit, where the cardiology staff are better able to treat the patient's primary diagnosis. When patients are transferred among the various hospital units, effective communication of knowledge and expertise between nursing staff is essential for care of the hemodialysis patient to be seamless.

The objectives for the predialysis clinic were to help patients and their families cope with chronic renal failure and to provide information so that patients could choose the method of dialysis that best suited their lifestyle. The clinic was started on April 26, 1995. The patients' visits were divided into three phases. Phase one consisted of three visits to complete a biophysical, psychosocial assessment. A multidisciplinary team provided information to assist the patient and family understand renal disease as well as the options available for dialysis. The patients learned about continuous ambulatory peritoneal dialysis (CAPD), self-care hemodialysis, and in-centre hemodialysis. Criteria to start this phase one were chronic renal failure with a creatinine clearance rate of 20 ml/min. Phase one usually lasted two to three weeks.