As we know, the dialysis unit is special field so the orientation program duration will be schedule for twelve weeks

in order to make the new nurse become competence in the skills required for their roles and responsibilities and that the professional standard are maintained. Besides that, this period also to make them knowledgeable about the renal disease and haemodialysis treatment to increase their confident level and felt empowered. However the duration of orientation could be shorten or extent according to the new nurse capability. The new nurse will introduce to the staffs in the organization and also will explain about organization information in first weeks. After that they will be attach with senior renal nurse as her mentor or preceptor for the rest weeks. The new nurse will also in same shift with her mentor to allowed the mentor to teach, guide and observe her all the time without any problems. This is because, to have are multiple mentor or preceptor will cause more confusion and frustration to the new nurse due to different of opinion and routine doing their job. The mentee will observe her mentor do any clinical procedures first before she allowed performing the clinical skills with close supervision and slowly with minimal observation. Lastly, the mentor will free her mentee to do the clinical procedures alone when she was expert or confident enough with it. Other than that, mentor also to make sure the patient felt secure and trust the new nurse to treat them to prevent misunderstanding. Days Items Venue Working Shift Week one Orientation to the Haemodialysis (HD) centre : Explain the unit Vision, Mission, Goal and Values Explain the Organization Chart and reporting system in centre Explain the set up of HD centre Explain the centre Policy Explain service provided in centre Explain the infection control policy Explain on use of telephone system Meeting room Office hours Lecturing / Discussion Approach

Introduce to staffs in the HD unit Explain on HD centre safety orientation Explain on how to handle emergency situation Explain the objective of dialysis Explain schedule and frequency of HD treatment Explain on patient care or education Explain Manager, Sister, Renal Nurse, Staff Nurse, Medical Assistant, Dialysis Assistant and office staff job description

Week two

Identify the various dialysis equipments : Haemodialysis Machines eg, Fresenius 4008, Braun, Nikkiso, Toray, Nipro Surdial and Dialog Blood Pump Heparin Pump Disposable items, dialyizers, Polysulfone, High Flux, Lowflux, Polyflux, Bloodlines, Needles, Syringe, Blood bottle and etc.

HD unit/ Treatment room/ store

Morning shift Mentoring / Self Direct Learning

Week three

Detail parts of haemodialysis machines How to start the machines and disinfected the machines after used How to kick in the patient data, UF amount and etc in machines screen Monitoring, alarms, blood leak detector and bubble detector

HD unit/ Treatment room/ store

Morning shift Mentoring / Self Direct Learning

How to handle when no power supply What to do when alarm occurs

Week four

Familiar self with other items commonly used e.g. Normal saline, drip set, needle, stopper, forceps, kidney dish, dressing sets, paper towel, disinfectant used Explain method of taking blood pressure, temperature and body weight and why need of accuracy Calculate patient water extraction (UF) and familiar self with patient by knowing patients suitable UF level Do observation before and after haemodialysis Personal hygiene Hand washing before and after all procedures Area of cleanliness Preparation dilution of heparin, AVF needles and Dialysis Dressing Set Setting up New Dialyzer and Bloodlines to machine priming procedures, flushing (rinsing) recirculation

HD unit/

Afternoon

Mentoring / Self Direct Learning

Treatment shift room/ store

Week Five

HD unit/

Morning

Mentoring / Self Direct Learning

Treatment shift room/ store

Going on to machine and connecting all monitor lines Setting up the required monitoring limit

Week Six

Observation while on Dialysis Attend patient in case of alarm and learn what should do to handle the problems

HD unit/

Afternoon

Mentoring / Self Direct

Treatment shift

Clinical observation general condition of patient, common dialysis complications e.g. hypotension, cramps, bleeding, giddiness, headache, short of breath and fever. Learn how to make decision on patient treatment regarding the problems Practice of steps or procedures to overcome in case of emergency situation (Code Red)

room/ store

Learning

Week Seven

Charting of clinical parameters and machines parameters Reporting of any abnormal of parameter Taking off procedure (terminating dialysis) Care of patient after off procedures Cleaning of used dialyzers Sterilization of Dialyzers (Reprocessing of Dialyzer) Storage of Reprocessed Dialyzers- Labelling (name / identification number / signature )

HD unit/ Treatment room/ store

Morning shift Mentoring / Self Direct Learning

Week Eight

Cannulation Learn how to access the immature or mature AVF (Venous Fistula), IJC, Femoral Catheter Arterio-Venous Fistula (AVF) needle proper needle (size) Choice of site Practical aspect Observation signs of infection/ weak fistula/ steal syndrome

HD unit/

Afternoon

Mentoring / Self Direct Learning

Treatment shift room/ store

Week Nine

1. Water system Reverse Osmosis Water Treatment System (RO System) Quality Control Assurance Monitor of RO Water Quality Daily Disinfecting of the system Maintenance of the System

HD unit/ Treatment room/ store

Morning shift Mentoring / Self Direct Learning

2. Haemodialysis Machines maintenance Services

Week Ten

Decision making 1. Complication during haemodialysis - make decision whether need to terminated the haemodialysis treatment or not when happened of: a. sign of shock b. Reactions e.g. Pyrogenic reaction c. Septicemia d. Cramps e. Severe hypotension f. Traumatised AVF g. Massive bleeding

HD unit/

Afternoon

Mentoring / Self Direct Learning

Treatment shift room/ store

Week Eleven

In charge To make sure everything running well and all procedures and order were implemented during shift: a. Medication during dialysis treatment b. Blood transfusion c. Injection Erythropoietin d. Intravenous medication (IV Iron or IV Venofor) e. Renal medication f. Renal Diet Do & Dont / Limitation/ Interaction with Dietition g. Do referral letter to Doctor if there are problem 1. Patient progress monitoring (clinical) Dialysis Clinical Chart 2. Monitoring and preparing Laboratory and radiological Investigation 3. Prepared patient information or record as needed monthly or quarterly for visiting Nephrologists to review and assess.

HD unit/

Morning

Mentoring / Self Direct Learning

Treatment shift room/ store

Week Twelve

HD unit/

Afternoon

Mentoring / Self Direct Learning

Treatment shift room/ store