title: Barriers to and facilitators of care for hemodialysis patients; a qualitative study.
abstract: BACKGROUND
  Patients undergoing hemodialysis require direct and continuous care. Identifying the barriers to and factors facilitating hemodialysis care can improve care quality.
  
  
  OBJECTIVE
  The aim of this study was to assess the barriers and facilitators of care for hemodialysis patients.
  
  
  METHODS
  This study was conducted as a qualitative study and it utilized content analysis approach. The study was performed in hemodialysis ward of Kowsar hospital in Semnan, in 2014. We used purposive sampling method with maximum diversity. Semi-structured interviews with open questions were used to collect data from a total of 20 participants.
  
  
  RESULTS
  The main topic of health care challenges was divided into two main categories, including the facilitators and barriers of hemodialysis care. The facilitators of hemodialysis care had four subcategories, including "intimate relationship", "basic knowledge", "hemodialysis skills", and "experience". The category of barriers had eight subcategories, including "shortage of nurses and heavy workload", "weak authority of the head nurse", "ignorant director of nursing", "shortage of nephrologists", "lack of vascular surgery expert", "lack of nurse's aide and nursing assistant ", "unskilled staffs", and "interference by patients' caregivers".
  
  
  CONCLUSIONS
  The findings of this study showed that access to human resources and their abilities were among the factors facilitating care. However, lack of qualified medical staff at each level of care delivery was one of the barriers to hemodialysis care. Hence, it is of great importance for policy makers, managers, and program designers to recruit human resources who have the characteristics and competencies required for providing hemodialysis care.
authors.affiliation: Nursing Care Research Center, Faculty of Nursing and Paramedical, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Monir
authors.initials: M
authors.lastname: Nobahar
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Tamadon
keywords: Barriers; Caring; Facilitators; Hemodialysis; Nursing; Patients; Qualitative research