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Understanding the bioecological determinants of vascular access for haemodialysis therapy : a case study in one satellite haemodialysis community

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Cowan, D (2016) Understanding the bioecological determinants of vascular access for haemodialysis therapy : a case study in one satellite haemodialysis community. Research Master thesis, University of Tasmania.

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Abstract

This research project utilised a case study methodology to investigate the
bioecological factors influencing the management and care of patients with a vascular
access (VA) for their haemodialysis therapy. In Australia in 2012, 61% of patients
receiving haemodialysis therapy were treated by a satellite haemodialysis unit
(SHDU) (ANZDATA 2013). The boundary for this single case study was one SHDU
in Australia and the people associated with this community. This included people
living with ESKD receiving a regimen of haemodialysis therapy, those who care for or
have an interest in the care of the patient and their VA, their family and or friends as
carers and healthcare professionals in the SHDU during the period of data collection.
The bioecological model of process, person, context and time (PPCT)
(Bronfenbrenner & Ceci, 1994) was used throughout the case study to guide the
research method, analysis and presentation of results.
The case study report commences with the articulation of the descriptive
theory – the articulation of what is known about the phenomenon (Tobin, 2010, pg.
288). This descriptive theory utilised an emic perspective to embed the researcher
into the parameters of the case and included three works of scholarship. Firstly a
narrative literature review was undertaken with the aim to explore the current
understanding of what factors influence the care of patients with a VA for
haemodialysis. The narrative review revealed five themes related to care of a
patient’s VA: patient’s experience; relationships-empowerment and shared decision
making; environment of healthcare; time; quality of life as the outcome of care.
Secondly, a reflection on past clinical practice using a single person case study
approach was completed. Thirdly, a review of the journey typically travelled by a person with ESKD and their family and friends as carers was documented by the
researcher drawing on clinical experience as a nephrology (renal) haemodialysis
nurse and current available literature.
This case study collected data through a self-administered questionnaire
comprising of open ended questions that varied between the participant groups and
Likert scale questions for the patient participants of a range of pertinent variables
identified through the descriptive theory. These included physical and mental
wellbeing as measured by the SF-36v2® (physical health component and mental
health component), empowerment, family strengths and the SHDU ecology. The
questionnaires were completed by 32 patients, 8 family or friends as carers and 14
healthcare professionals anonymously.
The mixed methods case study findings demonstrated that the outcomes of
managing a patient’s VA is influenced by everyone in the ecology of care – the
patients, their family and or friends as carers and healthcare professionals.
Subsequently, significant and previously unexplored relationships between the three
participant groups within the SHDU community emerged. Arising from this research is
the recommendation that clinical practice guidelines which concentrate on the
biological factors of nursing care should be supported by bioecological domains.

Item Type: Thesis (Research Master)
Keywords: Patients, haemodialysis, vascular access care, satellite unit, bioecology
Copyright Information:

Copyright 2016 the author

Additional Information:

Chapter 2 appears to be the equivalent of a post-print version of an article published as: Cowan, D., Smith, L. & Chow, J., 2016, Maintaining a viable vascular access for haemodialysis in an elderly person with diabetes: a journey to live, not just to stay
alive, Clinical case reports, 4(2), 203-208 DOI:10.1002/ccr3.459

Chapter 3 appears to be the equivalent of the peer reviewed version of the following article: Cowan D., Smith L., Chow J., (2016). Care of a patient’s vascular access for haemodialysis: a narrative literature review, Journal of renal care, 42(2), 93-100, which has been published in final form at http://dx.doi.org/1111/jorc.12139 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Date Deposited: 14 Oct 2016 01:53
Last Modified: 14 Oct 2016 02:01
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