Nurses' perceptions of patient participation in hemodialysis treatment.
The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses' power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions.
Aalesund University College, Norway. ea@hials.no
Elin Margrethe
EM
Aasen
Marit
M
Kvangarsnes
Kåre
K
Heggen
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D022143:Family Nursing / Q000941:ethics / Q000523:psychology*; D005260:Female; D006299:Health Services for the Aged / Q000941:ethics*; D006436:Hemodialysis Units, Hospital; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D009722:Nurse Practitioners / Q000523:psychology* / Q000706:statistics & numerical data; D009723:Nurse-Patient Relations / Q000941:ethics*; D010358:Patient Participation / Q000523:psychology*; D026684:Personal Autonomy; D011209:Power, Psychological; D017009:Professional Autonomy; D036301:Qualitative Research; D006435:Renal Dialysis / Q000941:ethics / Q000523:psychology*; D051437:Renal Insufficiency / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors