Negotiating living with an arteriovenous fistula for hemodialysis

Texas Woman's University Houston, Nelda C. Stark College of Nursing, Houston, TX, USA.
Nephrology nursing journal: journal of the American Nephrology Nurses' Association (Impact Factor: 0.62). 01/2010; 37(4):363-74; quiz 375.
Source: PubMed

ABSTRACT The purpose of this study was to examine how clients with end stage renal disease on hemodialysis negotiate living with an arteriovenous fistula. A fistula is the preferred access for hemodialysis, and clients must continually monitor and protect their fistula. In this qualitative, ethnographic study, data were collected during fieldwork and semistructured interviews. Constructivism and a cultural negotiation model provided frameworks for the study. Fourteen clients were interviewed; interviews lasted 1.5 to 4 hours. Results revealed new insights into informants'perspectives and experiences with a vascular access. The overarching theme was vulnerability, and underlying themes were body awareness, dependency, mistrust, and stigma. The response to vulnerability was to be continually vigilant and assertive to protect the holistic self Stigma of the vascular access was an important issue for informants and evoked the greatest emotional responses.

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    • "In particular, the younger patients experienced a change in their body image and selfconcept , which resulted in them avoiding social interactions with others. Other studies of patients with end-stage renal failure also found that worrying about changes in one's appearance affected this group's social life, creating a psychological stress that reduced the quality of life (Al-Arabi, 2006; Richard & Engebretson, 2010). A major finding of this study was that the hemodialysis device created limitations in the patients' freedom, as a dependency on medical equipment created a trap. "
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    ABSTRACT: Patients living with end-stage renal disease experience different levels of physical and psychological disability that can impact on the type and level of social interaction in which they engage with others. The researchers concurrently collected and thematically analyzed the interview data that were generated from 21 participants who were undergoing hemodialysis in Iran. Four major themes were constructed from the analysis of the transcripts: living with fatigue; changes in self-image; patients' dependency on the device, place, and time of hemodialysis; and hiding the disease. The results from this study showed that the patients who were living with hemodialysis in Iran experienced altered social interactions with others. The culture of Iran resulted in the participants trying to hide their disease from others, which led to social avoidance, thus reducing the participants' social interactions with others. It is recommended that nurses include a comprehensive assessment of the social interactions of persons who are receiving hemodialysis in their overall nursing assessment and that this is reviewed on a regular basis.
    Nursing and Health Sciences 01/2011; 13(1):88-93. · 1.04 Impact Factor
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    ABSTRACT: A vascular access for hemodialysis is the client's lifeline. It must be protected and used only for hemodialysis. Clients are knowledgeable about their vascular access and need to be listened to about its care. These clients' greatest fear is that their vascular access will be damaged and rendered nonfunctional. All health care personnel who come in contact with the vascular access and the client need to properly care for the vascular access with the goal of preserving its function. The purpose of this article is to explain the different types of vascular access for hemodialysis and how nurses can preserve and care for them. The vascular access and adjacent body areas need to be assessed regularly for circulatory, neurological, and muscular functions. Adequate perfusion helps to preserve the vascular access. Clients with end-stage renal disease will undergo many invasive procedures to establish and maintain a vascular access. Therefore, it is important to preserve the integrity of the existing vascular access as well as the surrounding vessels for future accesses. Nurses in acute care settings can assist to reduce the human and economic burden of vascular access.
    Critical care nursing quarterly 01/2011; 34(1):76-83. DOI:10.1097/CNQ.0b013e3182048ca4
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