TY - JOUR
T1 - Dialysis Needle-Related Distress
T2 - Patient Perspectives on Identification, Prevention, and Management
AU - Duncanson, Emily L.
AU - Chur-Hansen, Anna
AU - Le Leu, Richard K.
AU - Macauley, Luke
AU - Burke, Anne L.J.
AU - Donnelly, Fiona F.
AU - Collins, Kathryn L.
AU - McDonald, Stephen P.
AU - Jesudason, Shilpanjali
N1 - Funding Information:
The authors acknowledge the nurse unit managers and nursing staff of the Central Northern Adelaide Renal and Transplantation Service who assisted with recruitment for this study, particularly Monique Borlace and Fiona Donnelly, and psychology student Bronwyn Harris for her preliminary work on the analysis. The authors also sincerely thank the people who volunteered to offer their time and share their personal experiences for this study. Funding support for this project was provided to SJ by the Royal Adelaide Hospital Research Committee Clinical Project Grant (MyIP ref#12879, March 2020) and Royal Adelaide Hospital Research Fund (April 2020) and Health Services Charitable Gifts Board (HSCGB)—reference number: 79-05-73-06-21. ED, ACH, AB, FD, KC, LM, RL, SM, and SJ contributed to the research idea and study design. ED contributed to data acquisition. ED, ACH, and SJ contributed to data analysis/interpretation. ED, ACH, and SJ contributed to manuscript preparation. ED, ACH, AB, FD, KC, LM, RL, SM, and SJ contributed to manuscript review and final approval.
Publisher Copyright:
© 2023
PY - 2023/12
Y1 - 2023/12
N2 - Introduction: Needle-related distress is common among people receiving hemodialysis and affects quality of life and treatment decisions, yet little evidence exists to guide management. This study explored patients’ experiences of needle-related distress to inform the development of prevention, identification, and management strategies. Methods: Semistructured interviews concerning dialysis cannulation, needle-related distress, and potential solutions were conducted with people with current or recent experience of hemodialysis (N = 15) from a tertiary hospital-based service. Interviews ceased at thematic saturation. Transcripts were analyzed thematically. Results: There were 4 themes and 11 subthemes generated: (i) uncovering a hidden source of distress (dismissal and minimization by others; suffering in silence to stay alive; preparation, assessment, and education); (ii) coping with cannulation pain and trauma (interaction between physical damage, pain, and distress; operator dependency—the importance of nurse skill and technique); (iii) the environment created by dialysis nurses (emotional transference; communication during cannulation; valuing empathy and person-centered care; a psychosocially supportive dialysis unit); and (iv) supporting patient self-management of distress (accessing tools to help themselves; distraction to reduce distress). Conclusion: Needle-related distress is an often-hidden element of the hemodialysis experience. Patients learn to tolerate it as an inevitable part of dialysis for survival. Nurses’ technical skills and the dialysis environment they create are key determinants of the patient cannulation experience. Proposed solutions include psychological screening, education for patients to self-manage distress, and training for nurses in communication and providing relevant psychological support.
AB - Introduction: Needle-related distress is common among people receiving hemodialysis and affects quality of life and treatment decisions, yet little evidence exists to guide management. This study explored patients’ experiences of needle-related distress to inform the development of prevention, identification, and management strategies. Methods: Semistructured interviews concerning dialysis cannulation, needle-related distress, and potential solutions were conducted with people with current or recent experience of hemodialysis (N = 15) from a tertiary hospital-based service. Interviews ceased at thematic saturation. Transcripts were analyzed thematically. Results: There were 4 themes and 11 subthemes generated: (i) uncovering a hidden source of distress (dismissal and minimization by others; suffering in silence to stay alive; preparation, assessment, and education); (ii) coping with cannulation pain and trauma (interaction between physical damage, pain, and distress; operator dependency—the importance of nurse skill and technique); (iii) the environment created by dialysis nurses (emotional transference; communication during cannulation; valuing empathy and person-centered care; a psychosocially supportive dialysis unit); and (iv) supporting patient self-management of distress (accessing tools to help themselves; distraction to reduce distress). Conclusion: Needle-related distress is an often-hidden element of the hemodialysis experience. Patients learn to tolerate it as an inevitable part of dialysis for survival. Nurses’ technical skills and the dialysis environment they create are key determinants of the patient cannulation experience. Proposed solutions include psychological screening, education for patients to self-manage distress, and training for nurses in communication and providing relevant psychological support.
KW - arteriovenous fistula
KW - cannulation
KW - hemodialysis
KW - patient perspectives
KW - qualitative research
KW - vascular access
UR - http://www.scopus.com/inward/record.url?scp=85173245009&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2023.09.011
DO - 10.1016/j.ekir.2023.09.011
M3 - Article
AN - SCOPUS:85173245009
SN - 2468-0249
VL - 8
SP - 2625
EP - 2634
JO - Kidney International Reports
JF - Kidney International Reports
IS - 12
ER -