Meet Registered Practical Nurse (RPN) Irina Segura. Irina has spent 10 of her 12 years at SHN supporting dialysis patients, currently working on the hemodialysis unit at SHN’s General Hospital. This unit is one of four clinics serving Scarborough and beyond, including a hemodialysis unit at Centenary Hospital and three at satellite locations in community settings.
Here, Irina recalls her experiences offering support, education, and treatment, as well as how the pandemic affected the unit’s staff, patients, and families.
What was it like working in the in-centre hemodialysis unit when the pandemic first started?
It felt chaotic. We were all scared of the unknown. I was scared, my patients were scared, and it was very tiring by the end of a shift because we were learning about this new disease, how to stop it from spreading and how to protect patients.
At the beginning, I think a lot of my patients were angry and frightened. They had a lot of questions about COVID, what screening measures were in place to keep them safe, and what it meant for their health and for their families.
I think there was a lot of fear at the beginning of the first year, when everything started. No one really understood what was going on. We were doing a lot to support our patients and each other through talking, understanding, and by just being there for each other. It was – and is – a big challenge.
Through it all though, we were committed to maintaining services in our nephrology program because patients on dialysis are at a higher risk for contracting the disease, and many of them have varying degrees of immunosuppression – which also means, they could develop more complications.
We were able to offer CKD patients and their loved ones early access to vaccinations, in an effort to maintain the safest environment for them.
Recently, it’s gotten better, and we have a good understanding of what we’re doing and dealing with. At least everybody can see the light at the end of the tunnel now.
What is the typical experience for a patient coming in for dialysis, and how has it changed during the pandemic?
We have over 60 patients every shift: morning, noon and evening. We are a big community and it’s incredible how we can handle so many patients.
Patients usually come in three to four times per week. We only have a handful of patients who come twice a week. Each session lasts about four hours.
Most of our patients take Wheel-Trans to the hospital. Once they arrive, they come into their station and get weighed before the treatment.
We connect them to a machine, which removes the blood through a needle in the arm and filters it through a dialyzer. We do this because the kidneys don’t filter blood they way they should, and it is important to remove waste and other toxins in the bloodstream.
We try to ease our patients’ nerves by having a conversation with them. We like to get them talking about themselves, but it’s usually a little bit of information at a time until they are comfortable with us. Once they see our face and begin to recognize us, it’s nice.
Through the pandemic we had to make some changes. Not only are we masking, but we’re equipped with facial shields and other personal protective equipment (PPE). The extra PPE can be very warm and uncomfortable, especially by the end of a full shift.
It is important to monitor staff and patients, and support isolation, as well. If an individual on the unit was exposed to COVID-19, we all needed to be tested to ensure the safety of everyone on the unit, including patients, staff and loved ones.
It’s been a complete change.
What is the most important quality of the care experience for kidney patients?
It’s about making our patients feel comfortable and that takes patience and time. There’s a lot of factors to consider. Each patient has a different story, perhaps speaks a different language, and circumstances vary about why and how they arrived at SHN.
It’s also about being there to resolve any doubts. Our patients are just like us;  they have their good days and they have their bad days. You have to be able to help them and be compassionate in those kinds of situations.
During the pandemic, we continue to support the health needs of patients, and we ensure we’re available to answer any additional questions or concerns.
In general, over time, we find most of the patients do open up to us. As RPNs, we communicate with each other and the physicians about the patient; for example, their demeanour or preferences, to ensure they feel safe and comfortable in their experience.
What would you say to a patient to alleviate their nerves and to reassure them exceptional care is being provided, even considering a global pandemic?
It’s okay to feel whatever you feel. A lot of new CKD patients feel frustrated and angry. For them, they feel like they’re saying goodbye to the life they knew. After the treatment, they will also feel very drained and tired.
It’s important to know our SHN team is here for you. We are a very close team, and will support you every step of the way.
The advice I always tell my patients, don’t worry – let’s take it one treatment at a time. Focus on today and don’t worry about tomorrow.
Anything additional you would like to add?
Over the past 10 years I’ve seen a lot of changes, including increases in capacity and new technology and equipment. As the program has grown, I’ve grown with it, and that’s a good thing.
Most of our patients come from the Greater Toronto Area. However, we have patients that want to be in our care who come from as far as Barrie. We are catering to a big community and we will never deny anyone of care.
Since I’ve started, we have noticed trends in patient health. The difference today is that many of our patients are more chronically sick.  They are older and less responsive to treatment compared to 10 years ago. We’ve added new machines and more spaces, including accessible satellite sites to meet treatment demands. We are the largest regional program in the province.
Over the last decade, I’ve not only become a better nurse, but a better person. I would say my patients have impacted my life greatly. They’ve seen me pregnant, they’ve seen my kids grow. They have really become my second family.