Breaking Through the Glass Ceiling--Having That Conversation: A Constructivist Grounded Theory Study Exploring the Experiences of Nephrology Nurses' Practice in Kidney Supportive Care in Canada
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Authors
Bachynski, Jovina Concepcion
Date
2024-08-21
Type
thesis
Language
eng
Keyword
Peritoneal dialysis , Hemodialysis , Nurses , Kidney supportive care
Alternative Title
Abstract
Background: Kidney failure rivals cancer for its significant morbidity and mortality, and symptom burden. Treatment includes kidney replacement therapy (KRT) such as dialysis or kidney transplantation, or conservative kidney care that excludes KRT. People living with kidney failure would benefit from kidney supportive care (KSC)—considered palliative care in kidney disease—that integrates the relief and prevention of symptoms alongside disease-modifying treatments such as dialysis and subsumes advance care planning (ACP) through which there is ongoing communication between the patients and the health care team about the patient's values, goals, and preferences about care. Evidence indicates KSC incorporating nephrology nurse engagement in conversations with patients about their goals of care, is not routinely happening or is initiated late in the illness, potentially resulting in patients receiving care that is not aligned with their preferences. Purpose and Methodology: Charmaz’s constructivist grounded theory method (GTM) was used to develop a substantive theory explicating the process of engagement in KSC by nephrology nurses working in dialysis in Canada and to explore factors influencing this engagement. Purposive, snowball, and theoretical sampling were used to recruit 23 nurses working in hemodialysis and peritoneal dialysis settings from across Canada to participate in at least two interviews using Zoom© teleconferencing. Concurrent data collection and comparative data analysis methods were completed. Results: In the theory, “Breaking Through the Glass Ceiling—Having That Conversation,” the process of engagement by nephrology nurses in KSC is comprised of: (1) the boundary between professionalism and familiarity with patients; (2) multidimensional contextual factors; and (3) three stages of engagement (Transactional, Intentional, Actional), the latter stage of which culminates in the “breaking through the glass ceiling” of engagement wherein ACP conversations are normalized in practice. Implications: Study findings have implications for nursing practice and education regarding how nephrology nurses acquire the needed communication skills training. From a public policy perspective, this theory highlights the necessity of a common understanding of KSC. Conclusion: Nephrology nurses have a vital role in how KSC is operationalized. Multidimensional support is required to normalize ACP conversations in clinical settings to facilitate empowerment of nurses to deliver quality, timely KSC.
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ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.