Amsterdam UMC, location VUmc, Department of Ethics, Law and Humanities, Amsterdam, the Netherlands.
Amsterdam UMC, location VUmc, Department of Ethics, Law and Humanities, Amsterdam, the Netherlands.
Int J Nurs Stud. 2021 May;117:103884. doi: 10.1016/j.ijnurstu.2021.103884. Epub 2021 Jan 21.
Although fatigue among the dialysis population is known as a severe and debilitating health problem, this symptom is often under recognized and undertreated.
This qualitative study aimed to gain a better understanding of how dialysis nurses and renal health professionals perceive and address dialysis patient's fatigue in renal care practice.
We conducted a qualitative descriptive study to explore how nurses and renal health professionals perceive and address dialysis patients' fatigue in their daily health care practices. A constructivist grounded theory approach guided analysis and conceptualisation of findings.
SETTING(S): This study took place at 13 academic and regional settings across the Netherlands. The study was approved by the Medical Ethics Committee (2015.049), on behalf of VU University medical center in Amsterdam.
Twenty-one renal health professionals of various disciplines took part in interviews: ten dialysis nurses, four nephrologists, two physician assistants, five medical social workers.
Semi-structured interviews were conducted in order to gain in-depth insight into the perspectives of dialysis nurses and renal health professionals. An inductive thematic analysis provided insight into health professionals' stances toward dialysis patients' fatigue in light of their daily care context and practices.
Two main themes emerged; 1) 'Fatigue in the background': Shows there is strong focus on medical-technical aspects of the disease. All health professionals perceive fatigue as an intangible symptom that is difficult to address, and falls outside their scope of responsibility and competence. Communication about fatigue among professionals and with patients is limited, pushing fatigue further into the background. 2) 'Vulnerabilities in the background': Especially nurses and social workers signal the accumulating vulnerabilities of dialysis patients and associate these with fatigue (old age, multimorbidities, financial and social problems). Although the need for psychological support is acknowledged, multiple vulnerabilities increase the complexity and intensity of care, and further strengthens the medical-technical focus of care and treatment.
There is a need to enable renal health professionals to communicate about the complex nature of fatigue in renal patients and stimulate interdisciplinary exchange and shared responsibility. Dialysis nurses have frequent contact with patients during dialysis treatment and are the first to notice when patients' fatigue increases and their overall condition deteriorates. They can play an important role to go beyond the technological imperative of care and understand the lived experiences of patients within their social contexts.
尽管透析人群中的疲劳是一种严重且使人虚弱的健康问题，但这种症状往往未被充分认识和治疗。
本定性研究旨在更好地了解透析护士和肾脏健康专业人员如何在肾脏护理实践中感知和处理透析患者的疲劳。
我们进行了一项定性描述研究，以探讨护士和肾脏健康专业人员如何在日常的医疗保健实践中感知和处理透析患者的疲劳。一个建构主义扎根理论方法指导了分析和发现的概念化。
本研究在荷兰 13 个学术和地区地点进行。该研究得到了阿姆斯特丹 VU 大学医学中心代表的医学伦理委员会（2015.049）的批准。
21 名不同学科的肾脏健康专业人员参加了访谈：10 名透析护士、4 名肾病学家、2 名医师助理、5 名医务社会工作者。
进行半结构化访谈，以深入了解透析护士和肾脏健康专业人员的观点。一个归纳主题分析提供了对健康专业人员在日常护理背景和实践中对透析患者疲劳的立场的见解。
出现了两个主要主题；1）“疲劳在背景中”：表明对疾病的医学技术方面有强烈的关注。所有的卫生专业人员都认为疲劳是一种难以处理的无形症状，而且超出了他们的责任和能力范围。专业人员之间以及与患者之间关于疲劳的沟通有限，进一步将疲劳推向了背景中。2）“背景中的脆弱性”：特别是护士和社会工作者表明了透析患者不断增加的脆弱性，并将这些与疲劳联系起来（老年、多种疾病、经济和社会问题）。虽然承认需要心理支持，但多种脆弱性增加了护理的复杂性和强度，进一步加强了护理和治疗的医学技术重点。
需要使肾脏健康专业人员能够就肾脏患者疲劳的复杂性质进行沟通，并促进跨学科交流和共同责任。透析护士在透析治疗期间与患者有频繁的接触，并且是第一个注意到患者疲劳增加和整体病情恶化的人。他们可以发挥重要作用，超越护理的技术必要性，了解患者在其社会背景中的生活经历。
