Table 3.
Verbatim quotes defining the patients’ views on nursing care during hemodialysis.
| Theme | Sub-Theme | Quote | Patient |
|---|---|---|---|
| 1. Physical care | 1a. Preserving dignity | It is annoying when someone is trying to make fun of you… I do not allow that to anyone… sometimes people they use black humor… it depends on their character and culture, but it’s annoying… I do not accept it… I want to preserve my dignity… I don’t want anybody to irritate me, or stress me, I want to be respected. | Moira |
| 1b. Demonstrating technical skills | It is important… the way that (a nurse) inserts the needle in your skin, the way she takes it out… it is important to have the skills to prevent vein damaging. | Natalia | |
| It happened twice… they (nurses) are either reckless or they do not know how to do it… I suffered during catheterization. | Moira | ||
| … the way a nurse inserts the catheter in your vain… Sometimes the nurse is in a rush and damages my veins... | Steve | ||
| Overall, nurses love us, but some of them are not skillful in using the needles, they try… but do not have the skills, damaging our arms. They (nurses) are not cautious when inserting the needle… I don’t know what they are thinking. They are present but at the same time they are absent… Most of the nurses are very experienced… They look at your arm, searching with their fingers for the best place to insert the needle and then they do it…. | Glenn | ||
| Some of us (the patients) complain about their (nurses) abilities and skills concerning catheterization… I understand the situation… It’s difficult for them… They (nurses) aim for the best, despite their workload, they are struggling every day in order to provide the best care. | Alex | ||
| Some focus on simply doing their job, whereas others are completely indifferent. I have noticed that nurses want the easy way… so they put the needle at the same position. But this is wrong… the vain loses its elasticity. Normally they should insert the needle in different positions, but I do not know… it may be easier for them to use the same position… Some of them do not care and this is quite obvious... others are not interested in anything, and others just lack knowledge. | Marvin | ||
| 1c. Reassuring safe practices | The quality of the equipment is important. In some hospitals the equipment is better than others. Here, they have a blood pressure system that keeps checking every half hour… that is important. | Moira | |
| In another hospital where I was treated, the equipment was superior, however the environment was impersonal. What matters the most is following a right and safe procedure, ensuring that everything is sterilized and, if something wrong happens, to be looked after according to safety procedures… I prefer the nurses to be impersonal rather than to incapable… The incapable can cause you damage and I want to be safe… An impersonal nurse might be much better than one showing love but does not know how to provide care resulting in patients feeling unsafe… | Steve | ||
| The quality of care here is high… People are friendlier and more compassionate. They love you more than the Italians… the Italians are more impersonal, but they are more consistent to following protocols. | Marvin | ||
| 1d. Maintaining a responsive environment | Around me there are several inpatients in a dire state… some of them close to dying. This affects me psychologically. | Adam | |
| 2. Psychological Support | 2a. Showing empathy and acceptance | They (nurses) gave me so much strength… I returned to my house and I was thinking about seeing again those beautiful, lovely people… They care so much. They are responsible professionals and I know they care and know everything. They look after me… they do everything to make me feel comfortable. | Natalia |
| Some care for you and others are sticking to a more professional attitude, they do not care what you have been through… | Steve | ||
| What they do for me is satisfactory. I do not believe they can do anything extra. They do their work. | Elliot | ||
| 2b. Developing interpersonal relationships | I have no complaints…nurses and doctors, they love me and I love them back… | Daniel | |
| They accept me with so much love… people (nurses and doctors) that I have not met before. I did not want to start hemodialysis, instead, I wanted to die. But when they embraced me with such love, all these people… I will not forget their faces, their kindness. Awesome experience! They supported me psychologically. I see their faces and I think… they are all my children. Through all these I loved everyone in the unit, the patients too… I looked at them with so much empathy… | Natalia | ||
| They are all very good to me and I admire their courage to struggle with so difficult situations | Belinda | ||
| 2c. Communicating effectively | Good communication… it is not perfect, but also not that bad. Everything is OK, when I need something, I have it. In general, it is not like being next to you all the time. I have lived this experience too, not here though… Some people are more emotional, they stand by you, helping a lot by discussing things… this helped me a lot psychologically when I was in a terrible state. | Moira | |
| It is their duty to communicate with the patients… we understand however the burdens. This is the reality… | |||
| The heavy workload impedes communication… doctors cannot be with you every single day. Sometimes you can realize the lack of communication… they (doctors) cannot stay next to you to ask how you are doing … They have a heavy workload, some are tired, others are very interested in you, others are a bit indifferent. | Moira | ||
| 3. Education | 3a. Personal Effort | They told us a few things, but they do not teach us every day… They gave us some advice and we are responsible for ourselves. There is an exchange of information between patients, the more experienced ones pass information to the newcomers… that’s how the others did it, so I do it the same way… | Adam |
| I was asking things... Yes, when I went to the unit I had information, not enough, thus I was asking for more... I think that education is a personal effort... I trust myself, I have enough experience to know what I can eat and what I drink. | Steve | ||
| It is a personal effort… you learn on your own, from the internet, from reading, from renal patient groups... Mainly I learn from the internet… doctors do not tell you much. | Marvin | ||
| 3b. Professional skills | I was lucky because I was trained by (states the nurse’s name) and this girl is talented, that is not a compliment, it’s true. She knows very well what one should do and why, and she was very good at conveying knowledge and information. She helped me immensely. | Adam | |
| They did not give me enough information, in order not to scare me… But I think I attained adequate information… I know what I ought to know. | Belinda | ||
| What we do not like is that they (nurses) do not inform you when they replace filters, or when one has to undergo an on-line procedure. They do it without asking permission, which annoys me. When a procedure that might affect you is altered, you have the right to be informed. Sometimes, it takes two, three sessions to notice a change… No information was provided. | Marvin | ||
| I do not feel I got any education at all… At the beginning, they gave me a leaflet with nutrition guidelines, a very good leaflet with advice. This included basic information, now if I want to ask something, I go ahead and do it. I did not get any formal education or attend seminars in order to understand the process and the supportive practices, so that I know what to do and what to expect. | Moira | ||
| Education was sufficient. There are, though, some organizational problems that impede good organization in this context. I was not trained for the hemodialysis process. Something that could be done in two days, it took me eight months… they could not find two days to train me… there were moving the unit to another place but they had to consider my case and pay some attention to me in terms of training. | Adam |