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Implications for nursing practice and research
▪ This small (n=16) qualitative study showed that people undergoing dialysis were focused on receiving a kidney transplant. Renal nurses should have open and honest discussions about kidney transplantation with patients who are receiving dialysis, as waiting time for a transplant can be lengthy with mixed outcomes.
▪ Nurses should support people on dialysis by helping them to integrate dialysis into their lives rather than ‘being on hold’ while waiting for a transplant.
▪ Information given about likely transplantation waiting times should be realistic and individualised. For example, people from ethnic minority groups wait on average three times as long for a kidney transplant, compared with the White population.1
Context
The aim of the study was to explore the experiences of patients who were having haemodialysis. This study was undertaken on a purposive sample of 16 patients with end-stage kidney disease (ESKD) having hospital-based haemodialysis therapy in the Ireland. It is estimated that the prevalence of chronic kidney disease in the UK is currently around 6–8% although only around 0.4% of the population may eventually require dialysis or a renal transplant.2 ,3 In Ireland, the total number of patients treated for ESKD by dialysis was 1601 (377 pmp) at the end of 2008.4
Methods
A qualitative research methodology, hermeneutical phenomenology, was used in this study. Two interviews were conducted, 1 year apart, with each participant either at home (n=2) or while on dialysis (n=14). Interviews were audio-recorded, transcribed and analysed using a qualitative interpretive approach.5
Findings
The experience of waiting for a kidney transplant was found to be the main overarching pattern, whereas three other themes identified were living in hope, uncertainty and being on hold.
Commentary
The method was appropriate, and potential difficulties with rigour (because the interviewer had worked as a renal nurse) were overcome by other members of the research team being involved in thematic analysis of data. The study was small and was not clear whether new themes might have emerged (saturation)6 if more patients had been interviewed. It was also not clear whether those who were interviewed were on the transplant waiting list; the emergent theme of living in hope might not have been so strong if interviewees were not actively awaiting a transplant. Further research is needed to compare the experiences of those on dialysis who are awaiting kidney transplant with those who are not. Some discussion on the possible differences between the interview findings of those undertaken at home compared with hospital might have been useful. This is because interviews undertaken while patients are on dialysis are not always completely confidential and patients may also be distracted by dialysis machine alarms and concurrent symptoms.
Few previous studies have explored the lived experience of people undergoing dialysis. An earlier literature review of eight qualitative studies7 that sought to understand the experience of people living on dialysis did not identify the same patterns as the study by Moran and colleagues. Three pertinent conceptual categories emerged from another recent study of 10 people undergoing dialysis8 (including a restricted life and ways of coping). However, in this group, the same emphasis on transplantation was not apparent although the participants described their lives as being ‘on hold’.
It is likely that small phenomenological studies that explore the lived experience of people on dialysis are not likely to elicit similar findings because of the diversity of the dialysis population (age, ethnicity, length of time on dialysis and length of time awaiting transplantation). However, further studies of this nature are warranted.
Footnotes
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Competing interests None.