The primary nursing care delivery system within a haemodialysis context – experiences of haemodialysis primary nurses in Sweden

Abstract

Background: Primary nursing is a widespread organisational system for nursing that aims to reduce fragmentation of patient care. The system is implemented in haemodialysis care, but the system was not originally designed for this type of clinical practice. This study explored the model's adaptation to a haemodialysis setting as well as its emotional impact on the primary nurses. Methods: Nurses were recruited through criteria-based sampling until saturation. Data were collected through semi-structured interviews, and a contextual analysis within a phenomenographic approach was used to process the data. Results: Primary nurses' pedagogical role needs to be clarified, and the nurses have to be aware that they should provide education to the patients. The outcome space contained experiences of flexible, unclear duties, a sense of sole and overriding responsibility for all aspects of the patient's well-being and management, and unclear professional boundaries. The role was experienced as emotionally demanding. Conclusions: The primary nursing system needs to be adapted to haemodialysis nursing. Regular counselling should be used as an intervention to improve the primary nurses' emotional situation.

Analisis Situasi Dan Optimalisasi Pelaksanaan Metode Asuhan Keperawatan Primer Di Rs Anak Dan Bunda Di Jakarta

“…Metode asuhan keperawatan primer dikembangkan untuk mengurangi fragmentasi perawatan pasien, meningkatkan status profesional keperawatan, dan menciptakan batasan profesional (Johansson, Lundström, & Heiwe, 2015). Metode asuhan ini merupakan pemberian asuhan langsung terhadap pasien, di mana perawat primer mengelola sekelompok pasien selama perawatan dengan berfokus pada pasien, bertanggung jawab dan bertanggung gugat terhadap keputusan, perencanaan dan pelaksanaan suatu tindakan (otonomi), dan bertanggung jawab terhadap kualitas asuhan pasien.…”

“…Tanggung jawab asuhan berpusat pada pasien dapat dipenuhi dengan membuat perencanaan perawatan yang individual berdasarkan kebutuhan pasien dan memadukan kebutuhan pasien dengan kemampuan perawat. Sedangkan tanggung jawab edukasi pasien dilakukan dengan menguasai kemampuan pedagogi dalam memberikan edukasi terhadap pasien dan keluarga, membuat suatu kesimpulan atau ringkasan dasar yang dapat digunakan sebagai tool edukasi, panduan dalam melakukan pengkajian, dan evaluasi intervensi yang telah diberikan (Johansson et al, 2015& Bergh et al, 2015.…”

Institutional ethnography of hemodialysis care: Perspectives of multidisciplinary health care teams in Nepal

“…The everyday practices of nurses and other healthcare professionals in hemodialysis are influenced by the work context, including hospital infrastructure, human resources, service organization, number of patients, and work shifts (Ponce et al, 2019 ). Lack of dialysis machines, poor nurse-to-patient ratio, inadequate physical space (Tranter et al, 2009 ), limited staff including nephrologists (Nobahar & Tamadon, 2016 ), technicians (Shahdadi & Rahnama, 2018 ), and unclear duties and professional boundaries (Johansson et al, 2015 ) have affected in hemodialysis care. These constraints affect the quality of care, ultimately affecting the patient’s QOL (Stavropoulou et al, 2017 ).…”