As care moves beyond the clinic and into patients’ daily lives, nurses are doing far more than delivering treatment. They are building capability, confidence and ensuring continuity. They are helping patients understand what treatment means, what it requires, and how it can be adapted to fit around real life. In that sense, independence is not something patients are simply given. It is something nurses can help make possible.
That is why the evolution of home therapies and shared care matters so much. Home haemodialysis and peritoneal dialysis are often described as alternatives to in-centre treatment. In practice, they represent something more fundamental: a shift from care being done to the patient, to care being built increasingly with the patient.
For nurses, that changes their role in meaningful ways. Supporting a patient to move towards greater independence requires more than technical knowledge. It requires education, encouragement, and judgement - knowing when to step in, when to step back, and how to build confidence over time.
Peritoneal dialysis (PD) offers flexibility and can integrate more naturally into daily life, but it depends on strong patient education, careful technique and early problem recognition. PD training typically takes about a week, with automated PD often requiring around 10 days of learning. Home haemodialysis offers a different kind of independence, enabling personalised schedules and greater control. However, it requires more intensive preparation, usually taking 8 to 12 weeks.
Shared care models play a different but equally important role, because they provide a structured middle ground where patients gradually take on aspects of in-clinic treatment supported by nurses. Its impact is tangible: in one of our UK multi-site programmes, participation in shared haemodialysis care increased from 4% to 43%. What connects these models is that they succeed when patients feel supported enough to participate, and safe enough to take on more responsibilities.
In Europe, home dialysis remains a minority model, but policy direction is becoming more explicit. Spain, for example, has set a target for at least 30% of new dialysis patients to start treatment at home by 2028, while countries such as the UK have formalised shared care through structured programmes.
In Latin America, home-based and self-managed care is often shaped by workforce and access constraints. Peritoneal dialysis remains important, but progress has been limited by staffing, financing and policy barriers. That makes nursing even more critical, as patient independence must be actively taught, reinforced and made safe.
There are real constraints, from reimbursement and infrastructure to workforce capacity. But these are precisely the conditions that make the nursing role so important. Education also plays a key role in giving patients the knowledge to understand their condition, the confidence to take on new responsibilities and the ability to make more informed decisions about their own health. Programmes that include patient and family education and engagement with patient associations, have an important place.
Ultimately, the goal is not to move every patient towards the same therapy. It is to ensure that every patient has the opportunity and the support to take on as much ownership of their care as is right for them. That kind of independence does not happen by chance. It is built carefully, over time, through the work of nurses who do far more than administer treatment.
This is why this year’s International Nurses Day theme feels especially relevant. When nurses are empowered to educate, guide and lead, patients are better able to take a more active role in their own care, making independence practical and sustainable.
Suzanne Pearce
Corporate Nursing Director
Europe & LatAm
