Patients’ and Nursing Staff Perceptions and Experiences of Direct Patient Care: an ethnographic study in a haemodialysis unit
Wood, Alison F
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Background: Direct patient care is a term being used within nursing and healthcare. The term is used to explain what the nursing and clinical support staff are doing during a rostered shift. One particular area in which patients attend regularly and require a large amount of nursing support is the haemodialysis unit. Patients attend this department usually for three to six hours, with treatment lasting from three hours to over five hours. Patients require to attend three times a week to receive long but lifesaving treatment through one form of renal replacement therapy. Aim: This doctoral research was designed to explore the idea of ‘direct patient care’ within one specific context, where patients spend a great deal of time in a healthcare setting- the haemodialysis out-patient unit. This study aimed to explore nursing staff’s and patients’ experiences and perceptions of direct patient care in this area. Methods: The research used an ethnographic approach, using an insider as the researcher, due to holding an existing nursing position in the area, and was conducted between December 2013 - August 2014. The research considered both registered nurses and healthcare support workers, as well as patients, as participants. Data was initially collected using participant observation; using fieldnotes, informal questioning and photographs. Observation sessions lasted between 4-6 hours covering the different days and shifts. 27 Semi-structured interviews were also used in a small purposive sample of all participant groups. This variety of methods allowed for the views and experiences of haemodialysis patients, registered nurses and clinical support workers to be gained. Results/Findings: The analysis uncovered that direct patient care was the provision of safe, comfortable and individualised care. Direct patient Care was then identified to be delivered in two ways- actively or passively. Active care follows the more traditional understanding of time together, through engagement or interaction. Passive care identifies that staff being visible and available for patients, despite not being in close proximity or directly caring for patients, still allows a patient to be cared for, and in turn, staff feel they are caring for the patients during their time in this environment. Underpinning both of these ways of direct patient care delivery is the individual connection between the member of staff and the patient. The connections within the haemodialysis unit are part of this ability to deliver active and passive care. The individual connection between a patient and either a registered nurse or support worker facilitates this. The familiarity of each of these groups to each other, rapport, trust and being interested allow for this individual connection. Conclusion: Direct patient care in the haemodialysis unit can be understood using a conceptual model, where the process of delivering this direct patient care is either by active or passive care, with both allowing the provision of safe, comfort and individualised as part of direct patient care.