An ethnographic journey to uncover the culture of dialysis units

Abstract

A major challenge of the 21st century for the health-care professionals is to provide care for the ever-expanding population of people with renal-failure. Patient numbers are rising and specialist nurses, who are the pivotal factor in haemodialysis units, are becoming increasingly scarce. In this context it has become essential to understand the dynamics and functioning of haemodialysis units. The aim of this research project is to increase understanding of the lives of patients and carers by uncovering the culture of haemodialysis units.

Ethnography, from the naturalistic paradigm, is a holistic study of culture, developed out of classical philosophy. This study examines the entire social world of the dialysis unit. It describes the ethnographic journey made over twenty-four months' research in two different dialysis units. The participants were amongst patients and carers from these two units. The fieldwork, which facilitated data collection, was based on a participatory process of observation, interviews and participant feedback. These data were analysed into domains and themes using Spradley's Research development sequence (1980) and the reflexive process. Through the theme-based analysis used during the research and writing of this ethnographic study an emergent theory of partnership in care became apparent. Such a theory contributes to our understanding of the culture of the dialysis unit.

Uncovering the culture of dialysis units will not prevent the increase in numbers of people needing Renal Replacement Therapy. It does, however, shed light on the condition of living with renal failure and the nature of partnerships developed in the haemodialysis unit. It is these partnerships between people, machines and the environment that sets the dialysis unit apart in the hospital, giving it its own particular culture. Partnership means shared care where patients and carers work towards mutual goals. The realisation of these common goals leads towards the overall objective of better treatment outcomes.

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