title: CARE OF A PATIENT'S VASCULAR ACCESS FOR HAEMODIALYSIS: A NARRATIVE LITERATURE REVIEW.
abstract: BACKGROUND
  Patients requiring haemodialysis have diverse clinical needs impacting on the longevity of their vascular access and their quality of life. A clinical practice scenario is presented that raises the potential of unsafe cannulation of a patient's vascular access as a result of minimal patient empowerment. Vascular access care is the responsibility of everyone, including the patient and carer.
  
  
  OBJECTIVE
  The aim of this narrative literature review (1997-2014) is to explore the current understanding of what factors influence the care of vascular access for haemodialysis.
  
  
  METHODS
  A narrative literature review allows the synthesis of the known literature pertinent to the research question into a succinct model or unique order to enable new understandings to emerge. The bio-ecological model was used to guide the thematic analysis of the literature.
  
  
  RESULTS
  The narrative literature review revealed five themes related to care of vascular access: patient experience; relationships-empowerment and shared decision making; environment of healthcare; time; and quality of life as the outcome of care.
  
  
  CONCLUSIONS
  The management of vascular access is complicated. Current available literature predominantly concentrates on bio-medical aspects of vascular access care. Contextualised vascular access care in the complex ecology of the patient and carer's lives has the potential to enhance nursing practice and patient outcomes.
authors.affiliation: University of Tasmania, Launceston, Tasmania, Australia.|Central Coast Local Health District, Gosford, New South Wales, Australia.
authors.forename: Debi
authors.initials: D
authors.lastname: Cowan
authors.affiliation: University of Tasmania, Launceston, Tasmania, Australia.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Smith
authors.affiliation: University of Tasmania, Launceston, Tasmania, Australia.|South Western Sydney Local Health District, Sydney, New South Wales, Australia.|University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Josephine
authors.initials: J
authors.lastname: Chow
mesh_terms: D001315:Australia; D004869:Equipment Safety / Q000379:methods* / Q000523:psychology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D011788:Quality of Life; D006435:Renal Dialysis / Q000295:instrumentation*; D062666:Vascular Access Devices / Q000009:adverse effects / Q000592:standards*
keywords: Bioecology; Empowerment; Haemodialysis; Kidney Disease; Vascular Access