SATELLITE HAEMODIALYSIS NURSES’ PERCEPTIONS OF QUALITY NURSING CARE: A CRITICAL ETHNOGRAPHY

Author: Paul Norman Bennett

Bennett, Paul Norman, 2009 SATELLITE HAEMODIALYSIS NURSES’ PERCEPTIONS OF QUALITY NURSING CARE: A CRITICAL ETHNOGRAPHY, Flinders University, School of Nursing & Midwifery

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Abstract

People living with end stage kidney disease require dialysis or kidney transplantation to maintain life. Of those receiving dialysis in Australia, most people receive this treatment in satellite haemodialysis centres that are nurse-run, community-based clinics. Nurses provide the majority of care in these clinics with little or no on-site medical support, yet there has been minimal research exploring nursing care, or perceptions of nurses, in the satellite haemodialysis context. The major aim of this study was to explore satellite dialysis nurses’ perceptions of quality care. Fundamental to this aim was the premise that to improve nursing care, nurses need to understand the factors influencing satellite dialysis nursing care. A critical ethnography exploring the culture of one satellite haemodialysis clinic, focusing on the nurse’s perception of quality was undertaken, with a focus on issues of power that influenced satellite dialysis nursing care. Over a period of twelve months, interviews with nurses, non-participant observation and document analysis were conducted. Of particular concern was the satellite dialysis nurses’ struggle with the dominant medical discourse of quantitative measurement of quality. Bourdieu’s notions of habitus, field and practice provided a vehicle to explore nurses’ dispositions that operated within the institutional conditions of the medicalised discourse and physical structure of the satellite dialysis environment. Findings about nurses’ perceptions of quality dialysis care were categorised into three broad themes: what is quality; what is not quality; and what affects quality. Nurses considered technical knowledge, technical skills and personal respect as characteristics of quality. Long-term blood pressure management and arranging transport for people receiving dialysis treatment were not seen to be quality priorities. The person receiving dialysis treatment, management, nurse and environment were considered major factors influencing and determining quality dialysis nursing care. Acceptance by nurses about their position and their reluctance to challenge medical power was revealed. Aspects of power and oppression operated for nurses and people receiving dialysis treatment within the satellite dialysis context, and this environment was perceived by the nurses as very different from hospital dialysis units. Bourdieu’s notions of habitus and subconscious reproduced practices were embedded in the satellite dialysis nurses’ behaviour and were conveyed to other nurses. In order to improve nursing care in this context, ten recommendations were proposed: 1) implementing a concordance nursing care model; 2) using a goal-setting framework; 3) increasing staff rotation between dialysis units; 4) improving satellite dialysis unit design; 5) educating satellite dialysis nurses in internet and database skills; 6) using new technologies in staff education programmes; 7) recognising increased patient acuity; 8) research exploring residential dialysis facilities; 9) introducing advanced practice nurses in a satellite collaborative model of care; and 10) requiring a structured programme of reflective practice. Facilitating change in dialysis nursing practice was fundamental to this study and consistent with a critical approach. New understandings for the nurses may not result in practice change however, unless there is a collective review and uptake of these practices. This study offers new knowledge about quality nursing in satellite haemodialysis units, enabling nurses to critically reflect on, and improve, the quality of care they provide.

Keywords: dialysis,nursing,ethnography,renal,technology,quality
Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2009
School: School of Nursing & Midwifery
Supervisor: Dr Jane Neill