Results: When analyzing the data five key themes appeared: ’respectful participation in their own treat-ment’, ’taking responsibility for their own treatment’, ’the experienced and inexperienced nurse’, ’indulgence, duty and responsibility for the training of nurses’ and ’trust a necessity for coopera-tion’ (figure 3).

Figure 3. The five key themes

Conclusion: This study has found, in the light of the described literature that the experienced HD patient is ex-periencing participation as an integral part of their treatment. Being able to take responsibility is natural and necessary to manage and control treatment. They experience a respectful cooper-ation with nurses who support them and support them in the choices they make. Patients expe-rience a sense of security and trust by working with the nurse in an equal way. They get the op-portunity to manage the treatment they deem fit them best. They experience the opportunity for training and counseling to deal with the practical and technicality in their treatment, but also to get training in understanding the link between technology and the way they feel it affects them. Patients see it as a duty and their responsibility to put their body for use, when new nurses need to be trained. Here they assume an indulgent and proactively to deal with it the start of a new nurse not always just goes smoothly, but that they find comfort in that there is close cooperation in between the nurses, so there is always a backup. The nurses experience is not of great im-portance, but it is the cooperation between the younger and older nurses and the way it is done in, that give them reassurance and confidence to handle, no matter who starts their dialysis.

Application to practice: Patients experience a good working relationship with the nurse, despite of the nurses’ experi-ence. Therefore, the focus is about how patients are greeted and given the opportunity to work with nurses and have control over their own treatment and not whether it is an experienced or in-experienced nurse. This makes it relevant to focus more on how we meet the patients, especial-ly when they are encouraged to participate.In a HD department, we meet patients three times a week for many years and if we focus on the meeting with the patient, we first have to recognize the challenges we face as nurses and what nursing in 2015 has become. We must realize that the cross-pressures we are in - between de-mands from the top to give a consistent, evidence-based care and demands from below with complex patient needs, cannot be solved from the same standards - is not one that will be less in the future, rather on the contrary. It is important here with an objective approach, which re-quires education of all staff. One way could be to invite patients to joint meetings in the depart-ment and discuss the challenges the department faces and how best to solve them together. By doing this, patients will be in on shaping the culture of the department, creating the perfect dial-ysis ward where there is room for everyone.

Reference:Bæk B, Pedersen BD, Poulsen B, Agerskov H. ”Sygepleje ved hæmodialyse - patientens og personalets perspektiv”. 2011; 1(1)Cahill J. “Patient participation-a review of the literature”. Journal of Clinical Nursing 1998 March; 7(2)Carter MA. “Trust, power, and vulnerability: a discourse on helping in nursing”. Nursing Clinic North America 2009 December; 44(4)Delmar C. “The phenomenology of life phenomena-in a nursing context”. Nursing Philosophy 2006 October; 7(4)Eldh AC. “Patient participation - what it is and what it is not”. Örebro: Örebro Universitetsbibliotek; Örebro University; 2006.Hagren B, Pettersen IM, Severinsson E, Lutzen K, Clyne N. “Maintenance haemodialysis: patients’ experiences of their life situation”. Journal of Clinical Nursing 2005 March; 14(3)Henderson S. “Influences on patient participation and decision-making in care”. Professional Nurses 2002 May; 17(9)Henderson S. “Power imbalance between nurses and patients: a potential inhibitor of partnership in care”. Journal of Clinical Nurs-ing 2003 July; 12(4): s.501-508.Larsson IE, Sahlsten MJ, Sjostrom B, Lindencrona CS, Plos KA. “Patient participation in nursing care from a patient perspective: a Grounded Theory study”. Scandinavian Journal of Caring Science 2007 September; 21(3) Nygardh A, Malm D, Wikby K, Ahlstrom G. “The experience of empowerment in the patient-staff encounter: the patient’s perspec-tive”. Journal of Clinical Nursing 2012 March; 21(5-6)Richard CJ. “Living with an arterio-venous fistula for hemodialysis”. The University of Texas Health Science Center At Houston School of Nursing May 2008.Sahlsten MJ, Larsson IE, Sjostrom B, Lindencrona CS, Plos KA. “Patient participation in nursing care: towards a concept clarification from a nurse perspective”. Journal of Clinical Nursing 2007 April; 16(4)Sorlie V, Torjuul K, Ross A, Kihlgren M. “Satisfied patients are also vulnerable patients--narratives from an acute care ward”. Journal of Clinical Nursing 2006 October; 15(10)Wilson B, Harwood L, Oudshoorn A, Thompson B. “The culture of vascular access cannulation among nurses in a chronic hemodi-alysis unit”. CANNT Journal 2010 July -September; 20(3)Wilson B, Harwood L, Oudshoorn A. “Moving beyond the “perpetual novice”: understanding the experiences of novice hemodialy-sis nurses and cannulation of the arteriovenous fistula”. CANNT Journal 2013 January - March; 23(1)

Introduction: This study is about the chronic kidney patients on haemodialysis (HD). To understand how they perceive the interaction with the experienced and inexperienced nurses during their treatment and how they handle collaboration. Their incidence is increasing annually by about 700 new pa-tients on dialysis in Denmark and because of this, the frequency of the patient and nurse inter-actions increase. Moreover, there is focus on the patient’s perspective and life values, with the inclusion of their experiences with their own illness, as it affects their overall health. The staff’s ability to identify and relate to patients’ experiences seem to affect his/her overall health. This forms the basis for the nursing relevance, as nurses must have an understanding of the chronic patients’ experiences.

Background: Health policy in Denmark supports that patients are involved in their own care and treatment, but there is a discrepancy in the ideal nursing to be based on the patient’s perspective and involve-ment, and the actual practiced nursing. HD is a high-tech specialist care, where the increase in patients and new treatments is a continuous professional challenge for nurses. HD patients are dependent on their vascular access, which they describe as their “lifeline”. They are aware of their access when cannulated. At times conflict between the patient and the nurse when to insert a cannula occur. Especially when it is difficult or it is a new nurse. Studies show that HD patients are concerned about the meeting with the nurse, which focus-es on the nurses’ skill and experience. They do not feel seen or heard by the nurses; they ex-perience a distancing in the meeting with the nurse. They express anxiety and frustration in the meeting. Patients want to be involved and seen as individuals with knowledge about their body and treatment. They are asking for respect and trust, as they are vulnerable in their dependency of the nurse and her skills. They easy develop distrust of the nurse’s ability, based on the expe-rience they have, which means that some react with anger when something goes wrong. The nurse’s focus on cannulation is purely technical and the issues in what can go wrong. The patients’ needs are often not taken into account in the situation. The nurse is described as ner-vous and feels a pressure from the patient. Nurses expressed that as new; this is difficult be-cause they lack professional security, where the experienced nurses largely are trying to include participation by the patient. It leads to a tense and stressful relationship between the patient and nurse.

Aim: To investigate how the experienced hemodialysis patient, experience the interaction with the in-experienced and experienced hemodialysis nurse, during the beginning of a dialysis session, and how patients handle the cooperation on this startup.

Method: This study has a qualitative approach with a phenomenological perspective. Phenomenology, in Husserl’s conception, is primarily concerned with the systematic reflection on and study of the structures of consciousness and the phenomena that appear in acts of consciousness. Data were collected through semi-structured individual interviews. A semi structured interview guide was used to insure all topics where covered. The focus was on how the informants learn and ex-perience the topics in this study. The idea of an interview guide is to promote positive interaction during the interview and thus stimulate the patient to talk about his/her experiences. The locations is at a university hospital with 200 HD patients.

The empirical data are four HD patients (figure 1). The number was chosen because this study is part of a finally thesis so resources where limited.

Figure 1.

With help from the clinical specialist connected to the department, the informants were chosen for the study (figure 2).

Figure 2.

The interviews were transcribed by the author, and analysed by using Kvales 5 steps for meaning condensation. From there on the data was simplified and interpreted from the interviews point of view using the phrases: what is being said, how they say it, what is the content and what is the significance.

Informant A Informant B Informant C Informant D

70 years oldSenior citizen Widower5 kidsDM type 2AtrieflimmerPD for 5 yearsHD for 4 tearsConsidered for TX

76 years oldSenior citizen Widower2 sonsHypertensionHD for 4 years

69 years oldSenior citizen MarriedDM type 2HD for 2 years

46 years oldWorking part-time + unemployment benefitsSingle Nefrotisk syndromHypertensionDM type 2HD i 4 yearsOn TX list

Inclusion criteria Exclusion criteria

That they speak and understand Danish That they have been dialysis patients in more than a year That they have had more than one vascular access

Patients who starts dialysis by them self (selfcare/HHD)Patients diagnosed with dementia and/or mental illness

Respectful partici-pation in their own treatment

Taking responsi-bility for their own treatment

The experienced and inexperienced nurse

Indulgence, duty and responsibility for the training of nurses

Trust a necessity for cooperation

Men

ings

kond

ensa

ter

The patient wants and is comfortable with the participation

Saying yes to do more things themselves - they take on more tasks

It makes no difference who starts the dialysis

Patients are aware of how the nurse responds

They are cute, nice and helpful and they want us the best

There is time for the individual patient and its the priority of the nurse

There is the opportunity to actively participate under the guidance of the nurse

There are always two nurses with different experience’s level who help each other

Patients are indulgent and see it as their duty and responsibility to give the new nurse space to be trained

Trust in the nurse - a positive approach and confidence in the nurse is required

Dialogue and information with / of the nurse is important for participation

The treatment is natural and necessary

The inexperienced nurses are more inquiring as they are not as secure

No one are putting the needles in wrong intentionally

Secure in cooperation

Wants to be heard and their choices respected when they are involved

Taking responsibility for learning to live with and manage the disease

The experienced nurses are more driven and confident in what they do

Nurses enjoying their work affects patients

The interaction between the experienced and inexperienced nurseAuthor: Maria Fettouhi, RN, SD, MCN

Odense University Hospital, Denmark, Department of NephrologyE-Mail: maria.fettouhi@rsyd.dk