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
Notice bibliographique
Résumé
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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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».