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

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.
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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.