Dialysis nurses discussing advance care planning and death and dying with patients

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Hay, Sandra
Author ORCID Profiles (clickable)
Master of Nursing
Eastern Institute of Technology
Thompson, Shona
Harding, Thomas
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
New Zealand
dialysis nurses
dialysis patients
advance care planning (ACP)
kidney disease
renal disease
death and dying
ANZSRC Field of Research Code (2020)
Hay, S. B. (2017). Dialysis nurses discussing advance care planning and death and dying with patients. (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand.
BACKGROUND Dialysis nurses in New Zealand look after dialysis patients dealing with a chronic life-limiting illness: end stage kidney disease. The nurses often develop close relationships with their patients and become involved in discussions about death and dying with them and their families. These discussions are often awkward and nurses may not think they are the right people to have the discussions. Previous overseas studies have shown that dialysis patients and their families want to have the opportunity to talk about their prognosis and expected length of life on dialysis. AIM The aim of this study was to investigate the experiences of dialysis nurses when discussing advance care planning (ACP), and death and dying with their patients. More specifically, the study sought to understand the factors which impact on nurses’ ability to have such conversations. METHOD A qualitative descriptive approach underpinned the study. Using purposive sampling, seven dialysis nurses from four New Zealand District Health Boards were recruited as participants. They were interviewed by telephone using a semi-structured interview guide, and the transcribed audiotaped data was then subject to thematic analysis. The interview asked questions about the nurses’ experiences with ACP and death and dying conversations, and about their feelings when discussing such topics. FINDINGS The findings revealed an overarching theme about what was necessary to get the discussion about ACP, and death and dying right for patients. There were four associate sub-themes: the right time; the right place; the right person; and, the right resources. CONCLUSION Discussing ACP and death and dying with patients can be uncomfortable for dialysis nurses. The nurses struggled to find the right time and most appropriate place to embark on the conversations. They spoke of how the doctors are often the health care professionals that initiate the conversation about ACP with dialysis patients, but that it is not necessarily done at the right time for the patient in order for them to absorb the information. Having the right resources to support the discussions is important for the success of ACP, as is accurate documentation that ACP conversations have taken place. The nurses and other renal healthcare disciplines require initial and on-going education on ACP to ensure it is offered to all dialysis patients at the most appropriate time in the patients’ illness trajectory. The nurses require support from employers and managers to carry out the discussions to ensure it is successful for the patients. A renal specific framework on ACP would provide structure to the ACP process, and guide renal health care professionals to understanding ACP, and undertaking ACP discussions.
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