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Det är inte som att öppna en kran och tömma ett badkar: En intervjustudie om dialyssjuksköterskors kliniska beslutsfattande avseende ultrafiltration
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2012 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Syfte: Syftet med studien var att undersöka hur dialyssjuksköterskor motiverar de kliniska beslut de fattar avseende ultrafiltration (UF), och att undersöka på vad de baserar sin bedömning om vad som är rimlig ultrafiltrationshastighet (UFR).

Metod: Studien är kvalitativ, med explorativ design. Sex sjuksköterskor på en dialysmottagning i Mellansverige intervjuades, och insamlat data analyserades med kvalitativ innehållsanalys.

Resultat: Genom analysen definierades fem kategorier och 14 subkategorier, som speglar meningsenheternas manifesta innehåll. Huvudkategorierna var: datainsamling, kommunikation, erfarenhet och kompetens, åtgärder för att förebygga dialysrelaterade komplikationer samt förutsättningar för implementering av UFR som kvalitetsvariabel.

Slutsats: Sjuksköterskornas beslut avseende UF påverkades i hög grad av både patienters och kollegors åsikter, medan ansvarig läkare i ringa utsträckning var delaktig i beslutsprocessen. Beslutet komplicerades av att både ankomstvikt och torrvikt ofta var inkorrekta. Informanterna kände, och tog genom egna initiativ, ansvar för att förebygga dialysrelaterade komplikationer. De använde sig ofta av tekniska hjälpmedel som till exempel blodvolymsmätning (BVM) och isolerad UF, men det var ovanligt att dialystiden förlängdes. Bedömning av vad som är rimlig UFR baserades i större utsträckning på tradition och intuitiv erfarenhet än på evidens, men vissa informanter efterlyste bättre direktiv och riktlinjer.

Abstract [en]

Aim: The aim of this study was to investigate how nurses responsible for dialysis treatment justify their clinical decision making regarding ultrafiltration (UF), and to explore the factors underpinning their assessment of an adequate ultrafiltration rate (UFR).

Method: The study is qualitative, and of exploratory design. Six nurses, serving in a Swedish dialysis ward, were interviewed and the assembled response data was analyzed using qualitative content analysis.

Results: Through analysis five categories and 14 subcategories, reflecting the manifest content of the meaning units, were identified. The main categories were: data collection, communication, experience and competence, measures to prevent dialysis related complications and presumptions for implementation of UFR as a quality indicator.

Conclusion: The nurses' decision making regarding UF was influenced by the opinions of both patients and colleagues, while the responsible physician to a lesser extent was involved in the decision making process. The decision making was complicated by both arrival weight and dry weight often being inaccurate. The informants felt, and took through own initiatives, responsibility for preventing dialysis related complications. They often used technological aids, such as blood volume measurement (BVM) and isolated UF, but the session length was rarely prolonged. The assessment of what a suitable UFR would be was based on tradition and intuitive experience rather than on evidence, but some informants called for better directives and guidelines.

Place, publisher, year, edition, pages
2012. , 32 p.
Keyword [en]
hemodialysis, ultrafiltration rate, nurses, qualitativ methodology
Keyword [sv]
hemodialys, ultrafiltrationshastighet, sjuksköterskor, kvalitativ metod
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-175819OAI: oai:DiVA.org:uu-175819DiVA: diva2:533194
Subject / course
Caring Sciences
Educational program
Freestanding course
Uppsok
Medicine
Supervisors
Examiners
Available from: 2012-06-13 Created: 2012-06-13 Last updated: 2012-06-13Bibliographically approved

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