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
Bibliographic record
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".