Patient participation in the clinical pathway—Nurses’ perceptions of adults’ involvement in haemodialysis

Abstract

Aim To develop knowledge of nurses’ perceptions of participation for patients treated with haemodialysis and their next of kin. Design A qualitative study with a hermeneutic approach. Methods The data were collected in 2015 through focus groups with 13 nurses in Central Norway. Results The nurses reported that patient participation ranging from non‐involvement to shared decision‐making was related to whether dialysis was initiated as acute or scheduled. The restrictions required in chronic haemodialysis limited participation. The next of kin were not involved. The nurses highlighted interventions on both the individual and system levels to strengthen participation. Conclusion Dialysis units should develop strategies for participation related to individual needs and design treatment in cooperation with patients and their families, ensuring involvement early in the clinical pathway. Further research is needed on issues related to next of kin, including their desired level of involvement.

Exploring the hospital patient journey: What does the patient experience?

“…With the integrated use of these methods it was possible to identify which touchpoints are most critical for the patient, when family closeness is most effective, and how professionals can provide for the needs shown by patients over the entire journey. If on one hand the study of clinical pathways is now heading towards the active involvement of patients in decisions related to their own health issues [43], on the other hand the analysis of the hospital journey from a patient perspective can lead organizations to improve cross-hospital processes by creating procedures and focusing healthcare professionals on overall patient experience.…”

Narratives of patient participation in haemodialysis

“…Policy documents in developed countries widely emphasise patient‐centred care, while the health services largely focus on productivity and efficiency (Holmqvist & James, 2019). This may be prominent within busy haemodialysis units designed for efficiency (Andersen‐Hollekim, Kvangarsnes, Landstad, Talseth‐Palmer, & Hole, 2019). If the main focus is on production, professionals may not acknowledge patients’ experiential knowledge of illness.…”

Influences of Nursing Professionalism, Empathy, and Clinical Decision-Making Ability on Shared Decision-Making Awareness among Hemodialysis Nurses

“…Te complexity and criticality of the current healthcare system require shared mental models to enhance safe and efective patient/ client care [8,9]. Each member's action can have an advantage in terms of efciency, function, and strategy by using clear communication and guidance among team members in the shared decision-making process, and by sharing an understanding of goals and expectations towards a better quality of life for the patient [7,[9][10][11]. In a previous study [6], it was mentioned that the role of nurses in the shared decisionmaking process included being a health educator, spokesman, data collector, symptom and side efect manager, information sharer, and psychological supporter.…”

“…Since hemodialysis nurses spend several hours a week with long-term dialysis patients during treatment, a close therapeutic relationship can be formed [14,15] and, thus, occupies a key position in terms of patient involvement [16,17]. Likewise, nurses' awareness of patient participation is important as they play various roles in the entire hemodialysis process [10,18]. An important factor that can contribute to patient compliance during hemodialysis treatment is the hemodialysis nurse's attitude toward patient participation [19].…”

“…Nursing professionalism is a necessary competency in the process of multidisciplinary shared decision-making [14,24] and provides high-quality nursing through cooperation with various experts in the clinical feld, and this allows nurses to perform efcient work [16,25]. Furthermore, through the establishment of correct professionalism, patients are not excluded from decisions about treatment, but the right to know and autonomy are respected so that they can actively exercise their right to selfdetermination [10,26]. Empathy refers to the necessary skills and abilities to understand and alleviate the sufering of others [24].…”