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Bevan, Mark Thomas
Languages: English
Types: Doctoral thesis
Subjects: RC, R1
Experiencing Dialysis: A Descriptive Phenomenological Study of Nurses and Patients in\ud Dialysis Satellite Units\ud Dialysis satellite units (DSU) have been a method of treatment delivery in the UK since the\ud 1980s. Units were developed to expand dialysis provision and serve a number of patients\ud from specific geographical areas.\ud There is a dearth of research related to satellite unit dialysis. Most research related to\ud haemodialysis usually incorporates satellite unit patients in their findings. Available research\ud is related to measurable parameters of medical treatment. At the start of the research there\ud was no research related to nursing experience on satellite units. Nursing experience was\ud examined generally and specifically around aspects such as stress. Research relating to patient\ud experience is based upon methodologically accepted approaches such as measuring stress,\ud coping, compliance and quality of life. These methods frequently reduce experience into\ud statistics that, while they have a range of application, often miss the depth of meaning related\ud to experience.\ud Patients express a great deal of satisfaction about their experiences of satellite units and are\ud reluctant to return to a main unit for treatment. This expression of experience stimulated the\ud research question ‘What is the experience of patients and nurses in dialysis satellite units?’\ud The research aims to examine the subjective experience of both nurses and patients. The\ud research will aim to describe structures of experience to shed light upon expressions of\ud satisfaction and reluctance.\ud The means for examining subjective experience required the use of a qualitative research\ud method. The descriptive phenomenology of Husserl was chosen for its distinct structure and\ud theory free approach to studying phenomena of the Lifeworld.\ud The method of data collection was provided by a novel phenomenological interview structure\ud which incorporated the use of imaginative variation. Observation as a method of data\ud collection was also used because it provided aspects of experience that would remain hidden\ud through interview method alone. Spradley’s (1980) descriptive matrix was used to guide\ud observations. A combination of both methods increases phenomenological adequacy. Three\ud DSUs provided the field of study. A total of twenty five patients and twelve staff members\ud were interviewed. Ethical approval was obtained for the research.\ud 5\ud Data analysis was undertaken with a modified version of Giorgi’s (1985) phenomenological\ud method of data reduction by meaning units and generalization. Imaginative variation was\ud applied for structural clarity and structural coding was applied for adequacy.\ud Four general structures of experience were synthesised to provide a constitution of\ud phenomena.\ud 1. Experiencing Illness. Illness is context structure that gives meaning to dialysis.\ud Minimalization of illness is structured through the absence of doctors, not seeing\ud illness and distancing illness by referral to the main unit.\ud 2. Time Saved. Time is saved for the patient through fewer patients for dialysis, time\ud distraction, and absence of illness. Staff save time through preparation and planning\ud and making time available for patients.\ud 3. Feeling Safe: Repetition, routine, familiarity, predictability, nearness and closeness,\ud being known, knowing others and not thinking of illness all provide an experience\ud structure of feeling safe.\ud 4. Freedom to Practice: Making a difference. Feeling isolated and an awareness of\ud responsibility leads to decision thoughtfulness. Thoughtfulness enhances decision\ud making giving a sense of autonomy, confidence and freedom to practice. These facets\ud of experience enable nurses to make a difference to patient care.\ud The findings of the research identify the patient desire to avoid experiencing illness improves\ud coping ability. Satellite unit nurses develop enhanced skills and expertise that enables quality\ud patient care. The experience of nurses is congruent with other nurse-led units. Implications for\ud practice are the development of autonomy and responsibility which would enhance service\ud provision for patients. An innovative application of phenomenology involving observation\ud and imaginative variation can produce accurate descriptions of structure of experience.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 5.9.2 Problems with process
    • 5.9.3 Imaginative Variation and Induction
    • 5.9.4 Imaginative variation and Phenomenological Psychology
    • 5.9.5 Nursing Phenomenological Misrepresentation of Imaginative
    • Variation 5.10 Phenomenology and Description
    • 5.10.1 Description and Interpretation
    • 5.10.2 Giorgi's Descriptive Method 5.11 Chapter Six Data Collection Methods 6.0 Data Collection Methods 6.1 The interview Process for Eliciting Experience 6.2 The Interview Experience of the Researcher 6.3 Phenomenological Interview Method 6.4 Phenomenological Structure to the Interview Process
    • 6.4.1 Providing Context
    • 6.4.2 Apprehending the Phenomenon
    • 6.4.3 Clarifying the Phenomenon 6.5 Observation as a Data Collection Method
    • 6.5.1 A Phenomenological Rationale for Using Observation
    • 6.5.2 Participant Observer Role
    • 6.5.3 Observational Data Collection Method 6.6 Participant Observation Method
    • 6.6.1 Space
    • 6.6.2 Objects
    • 6.6.3 Events
    • 6.6.4 Acts & activities
    • 6.6.5 Goals & Feelings
    • 6.6.6 Time
    • 6.6.7 Signs
    • 6.6.8 Actors
    • 6.6.9 Sensuous Intuition 6.7 Summary Chapter Seven Data Analysis 7.0 Introduction to Analysis of the Data 7.1 Management of the Data 124 126 128 132 134 136 137 137 138 140 143 145 148 151 155 156 159 161 168 168 170 171 173 173 174 176 176 180 181 181 7.2 Use of QSR NVivo for data analysis and management 7.3 Data Analysis
    • 7.3.1 Data Reduction: Developing Meaning Units
    • 7.3.2 General Description Units and Provisional Thematic Structures
    • 7.3.3 Crisis of Representation
    • 7.3.4 Clarification of Structures of Experience: Imaginative Variation
    • 7.3.5 Analysis of Observed Data
    • 7.3.6 Combining interview and Observational Data Chapter Eight Research Findings:
    • Descriptions of the Units 8.0 Descriptions of the Satellite Units 8.1 Description of Satellite Unit One 8.2 Description of Satellite Unit Two 8.3 Description of Satellite Unit Three 8.4 Descriptions of structural Aspects of Satellite Units
    • 8.4.1 Preparation Phase
    • 8.4.2 Commencing Treatment: 'Putting On'
    • 8.4.3 Intradialysis Phase
    • 8.4.4 Going Off
    • 8.4.5 Completing Treatment: 'Taking Off' Phase
    • 8.4.6 Preparing for the Next Patient.
    • 8.4.7 The Nurse's Station Chapter Nine Research Findings:
    • Structures of Experience 9.0 Structures of Experience 9.1 Experiencing Illness The Lived Experience Context
    • 9.1.1 Describing Illness Horizons: Vague and Unknown Illness
    • 9.1.2 Sudden Illness
    • 9.1.3 Known Illness
    • 9.1.4 Presence and Absence of Illness
    • 9.1.5 Absence and Presence of Doctors 9.2 Feeling Safe
    • 9.2.1 Routine and Repetition
    • 9.2.2 Nearness and Closeness
    • 9.2.3 Being known, Knowing Others and Knowing What to Expect
    • 9.2.4 Being in Safe Hands
    • 9.2.5 Experiencing Community 9.3 Time Saved
    • 9.3.1 Dialysis Time
    • 9.3.2 Time Saved
    • 9.3.3 Time Lost
    • 9.3.4 Time Made Available 9.4 Freedom to Practice: Making a Difference
    • 9.4.1 An opportunity to practice
    • 9.4.2 Isolation, Caution and Responsibility
    • 9.4.3 Nursing & Illness
    • 9.4.4 Presence of autonomy
    • 9.4.5 Nursing Time: for patients & treatment
    • 9.4.6 Ownership Chapter Ten Discussion and Conclusions 10.0 Discussion 10.1 Making a difference: The Satellite Nurse 10.2 Understanding Experience and Implications for Clinical Practice
    • 10.2.1 Fear, illness and the observation of others 10.3 Satellite Unit Management Implications
    • 10.3.1 Providing Control and Autonomy
    • 10.3.2 Encouraging Creativity and Quality 10.4 Implications for Policy
    • 10.4.1 Conditions for Development 10.5 Issues regarding Phenomenological Research
    • 10.5.1 Explicit Application of Method
    • 10.5.2 Novel and effective use of imaginative Variation
    • 10.5.3 Observation as Phenomenological Methodological Necessity
    • 10.5.4 Phenomenological Interview structure
    • 10.5.5 Signitive Acts 10.6 Credibility, dependability, Transferability, Limitations of
    • the research and recommendations 10.7 Some Personal reflections References Glossary of Terms Appendices Appendix 1 Outline of ethical approval
  • No related research data.
  • No similar publications.

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