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

Bevan, Mark Thomas (2007) Experiencing dialysis: a descriptive phenomenological study of nurses and patients in dialysis satellite units. Doctoral thesis, University of Huddersfield.

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    Abstract

    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.

    Item Type: Thesis (Doctoral)
    Subjects: R Medicine > R Medicine (General)
    R Medicine > RC Internal medicine
    Schools: School of Human and Health Sciences
    Depositing User: Sara Taylor
    Date Deposited: 03 Jul 2008 14:51
    Last Modified: 28 Jul 2010 19:23
    URI: http://eprints.hud.ac.uk/id/eprint/963

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