Experiencing dialysis : a descriptive phenomenological study of nurses and patients in dialysis satellite units

摘要

Experiencing Dialysis: A Descriptive Phenomenological Study of Nurses and Patients in Dialysis Satellite Units Dialysis satellite units (DSU) have been a method of treatment delivery in the UK since the 1980s. Units were developed to expand dialysis provision and serve a number of patients from specific geographical areas. There is a dearth of research related to satellite unit dialysis. Most research related to haemodialysis usually incorporates satellite unit patients in their findings. Available research is related to measurable parameters of medical treatment. At the start of the research there was no research related to nursing experience on satellite units. Nursing experience was examined generally and specifically around aspects such as stress. Research relating to patient experience is based upon methodologically accepted approaches such as measuring stress, coping, compliance and quality of life. These methods frequently reduce experience into statistics that, while they have a range of application, often miss the depth of meaning related to experience. Patients express a great deal of satisfaction about their experiences of satellite units and are reluctant to return to a main unit for treatment. This expression of experience stimulated the research question ‘What is the experience of patients and nurses in dialysis satellite units?’ The research aims to examine the subjective experience of both nurses and patients. The research will aim to describe structures of experience to shed light upon expressions of satisfaction and reluctance. The means for examining subjective experience required the use of a qualitative research method. The descriptive phenomenology of Husserl was chosen for its distinct structure and theory free approach to studying phenomena of the Lifeworld. The method of data collection was provided by a novel phenomenological interview structure which incorporated the use of imaginative variation. Observation as a method of data collection was also used because it provided aspects of experience that would remain hidden through interview method alone. Spradley’s (1980) descriptive matrix was used to guide observations. A combination of both methods increases phenomenological adequacy. Three DSUs provided the field of study. A total of twenty five patients and twelve staff members were interviewed. Ethical approval was obtained for the research. 5 Data analysis was undertaken with a modified version of Giorgi’s (1985) phenomenological method of data reduction by meaning units and generalization. Imaginative variation was applied for structural clarity and structural coding was applied for adequacy. Four general structures of experience were synthesised to provide a constitution of phenomena. 1. Experiencing Illness. Illness is context structure that gives meaning to dialysis. Minimalization of illness is structured through the absence of doctors, not seeing illness and distancing illness by referral to the main unit. 2. Time Saved. Time is saved for the patient through fewer patients for dialysis, time distraction, and absence of illness. Staff save time through preparation and planning and making time available for patients. 3. Feeling Safe: Repetition, routine, familiarity, predictability, nearness and closeness, being known, knowing others and not thinking of illness all provide an experience structure of feeling safe. 4. Freedom to Practice: Making a difference. Feeling isolated and an awareness of responsibility leads to decision thoughtfulness. Thoughtfulness enhances decision making giving a sense of autonomy, confidence and freedom to practice. These facets of experience enable nurses to make a difference to patient care. The findings of the research identify the patient desire to avoid experiencing illness improves coping ability. Satellite unit nurses develop enhanced skills and expertise that enables quality patient care. The experience of nurses is congruent with other nurse-led units. Implications for practice are the development of autonomy and responsibility which would enhance service provision for patients. An innovative application of phenomenology involving observation and imaginative variation can produce accurate descriptions of structure of experience.