Patient-Centered Hemodialysis Nursing Care: An Interpretive Description
Bibliographic record
Abstract
Background Patient-centred care originated in the 1950s, gained popularity in the 1990’s, and is a professional regulatory, clinical practice guideline, governmental health policy, and perhaps organizational expectation of every nurse in Canada. The term is used liberally on the Health Canada website, and in 2011 the Canadian Institutes of Health Research launched the Strategy for Patient-Oriented Research. Also in 2011, the Canadian Nurses Association (CNA) and Canadian Medical Association (CMA) jointly identified patient-centred care as the first principle to guide healthcare transformation. In 2018, patient-centred care was adopted by Accreditation Canada through the addition of patient surveyors. Patient-centred nursing care could benefit people with end-stage kidney disease (ESKD) however the philosophical ideals of the approach may not consistently align with the everyday reality of hemodialysis nursing. Purpose of Study The study purpose was to describe the experiences and perspectives of hemodialysis nurses in their provision of patient-centred care. Methods A qualitative interpretive description design was used, with purposive sampling of hemodialysis nurses from hospital and satellite hemodialysis units in urban and rural areas registered with the College of Nurses of Ontario and currently employed full or part-time for more than three months. Semi-structured interviews were held, and transcripts were analyzed. Results Ten RNs participated and five themes were constructed through interpretation of their comments during interviews: Knowing, Applying, and Sustaining, plus Promoters and Detours of Patient-Centred Hemodialysis Nursing Care. Conclusions Patient-centred hemodialysis nursing care is a complex process with multiple promoters such as therapeutic relationships, reflective nursing practice, collaboration, and the satellite unit context. Nurses needed to navigate detours that interfered with the provision of patient-centred care related to patients, nurses, and unit, organizational, and system processes. Various interconnections occur within patient-centred hemodialysis nursing care, and certain ethical aspects require consideration. Implications for Nephrology Care Implications and recommendations for nephrology nursing education, practice, policy, and future research are identified.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.029 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.009 | 0.021 |
| Scholarly communication | 0.011 | 0.008 |
| Open science | 0.003 | 0.008 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".