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Article Excerpt
Goal
To provide an overview of the ability of patients and caregivers to learn nocturnal home hemodialysis.
Objectives
1. Explain how successful nocturnal home hemodialysis can improve patients' and caregivers' lives.
2. Identify anxieties, concerns, and levels of understanding as expressed by participants in this qualitative study.
3. Describe how this study may serve to identify patient education as a domain when providers instruct patients on the use of technology required for their treatments.
Over the past two decades, the movement of medical care out of institutional settings into patients' homes has increased in most industrialized countries as part of the general emergence of self-care options in the healthcare field (Lehoux, Saint-Arnaud, & Richard, 2004). The transfer of treatment from the clinic to the home has also been introduced within renal replacement therapy. In-hospital treatment requires patients with end stage renal disease (ESRD) to go to the hospital or a clinic for treatment 3 times a week, for 3 to 4 hours per session. In spite of this, patients undergoing conventional hemodialysis are often plagued by significant symptoms and complications that can impact their quality of life (Pierratos, 2004). Furthermore, conventional hemodialylsis continues to be associated with high morbidity and mortality (Meyer & Hostetter, 2007). In recent years, an alternative option, known as nocturnal home hemodialysis (NHHD), has become increasingly available for patients with ESRD. Patients on NHHD self-administer hemodialysis at home, for 6 to 8 hours, 5 to 6 nights per week. At Toronto General Hospital, training for patients who elect to join the NHHD program is presently conducted "hands-on" during conventional hemodialysis sessions. The training program lasts 6 weeks, with training sessions scheduled on Mondays, Wednesdays, and Fridays. There are 3 to 4 nurse trainers in the clinic during training sessions, and patients are typically taught on a one-on-one basis. Patients are taught how to set up the machine, prepare their access point, interact with the machine while it is in operation, and conduct emergency procedures. At the end of the 6-week training program, patients must pass a written examination before they are allowed to dialyze at home on their own. A full description of the NHHD procedure is described elsewhere in the literature (Chan, 2004).
Studies have suggested the improved cardiovascular health outcomes associated with NHHD--better blood pressure control, regression of left ventricular hypertrophy, and a decrease in the use phosphate binders after conversion from conventional hemodialysis to NHHD (Chan, Floras, Miller, Richardson, & Pierratos, 2002; Culleton et al., 2007). It is anticipated that widespread NHHD may also impact on medical expenses in general, including the number of hospital admissions and the amount of prescription medications required (Komenda, Levin, & Manns, 2007).
There are, however, a number of important considerations associated with an increase in such home self-treatment, particularly the need to ensure that patients have the capability required to administer their own therapies using complex medical technology safely and without clinical supervision. A variety of educational programs have been developed to this end. Despite the vast amount of literature pertaining to patient education, few studies have investigated the consequences of this process from the patient's perspective; in particular, what is the experience of learning to operate medical technology and of preparing for self-treatment at home, away from the supervision of clinical practitioners? The purpose of this study was to explore and better understand the experience of being trained to perform NHHD from the patient's perspective.
Method
The qualitative design used for this study was composed of semi-structured interviews and a focus group to explore patients' comprehension and experiences of NHHD training. Two data collection methods were employed to increase the diversity of data and situational contexts. In particular, the goal of the focus group was to enrich and elaborate the findings from analysis of the interview data, and to explore additional dimensions of interest that might surface in group interaction.
Sampling
A maximum variation and theoretical sampling strategy from the grounded theory tradition of qualitative inquiry was used (Coyne, 1997; Glaser & Strauss, 1967; Patton, 1986). The participants were theoretically sampled (a sampling method that purposefully selects participants and research settings based on specific characteristics to vary the perspectives, isolate patterns, and formulate and...
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