Fielding, Catherine
(2024)
Understanding patients’ experiences of cannulation for haemodialysis, by healthcare staff.
PhD thesis, University of Nottingham.
Abstract
Haemodialysis is a life-sustaining treatment for people with end stage kidney disease. Approximately 70% of patients on haemodialysis use arteriovenous access to provide access to the circulation, which requires cannulation (insertion of two needles) thrice weekly before each haemodialysis treatment. Patients struggle to cope with regular cannulation, for some throughout their time on haemodialysis, but studies exploring patients’ experiences of this cannulation are sparse. Therefore, this thesis aims to understand patients’ experiences of cannulation for haemodialysis as performed by healthcare professionals. This is completed through three studies described below.
The first study is a qualitative systematic review exploring what is currently known about patients' experiences of cannulation for haemodialysis. A comprehensive literature search identified twenty-six studies with findings related to patients’ experiences of cannulation, including both studies on cannulation performed by healthcare professionals and carer or self-cannulation. These studies underwent critical appraisal, identifying that the quality of studies varied. A meta-aggregation of findings from studies identified that cannulation is an unpleasant procedure associated with pain, abnormal appearance, vulnerability and dependency. The necessity of the procedure to receive a life-sustaining treatment caused worry about its success. People survived this necessary, repetitive and unpleasant procedure, with feeling safe and in control making this easier. However, some patients still tried to avoid cannulation for haemodialysis.
The second study developed the 'Patient’s Perspective of Needling Questionnaire' (PPN), designed to capture the consequence of cannulation from the patients’ perspective, for use in research evaluating interventions to improve cannulation for haemodialysis. This was designed with six patient representatives, using the results from the systematic review. Face validity tests led to the removal of some questions. The final PPN had 17 questions around pain, worry and problems related to cannulation. Further reliability and validity tests were completed with 99 participants from two renal centres. The results of these tests are: 1) Internal consistency = 0.937 (95% CI 0.917-0.954, p<0.001); 2) Convergent validity using the Short Form Vascular Access Questionnaire = -0.347 (-0.146-0.521, p<0.001). The negative correlation was predicted; 3) Test-retest reliability = 0.856 (0.788-0.904, p<0.001); 4) Group smallest detectable change (95% CI) = 0.135.
The third study was a qualitative study exploring what influences patients' experiences of cannulation. Semi-structured interviews were completed with thirty participants from two renal centres. Constant comparison analysis, intensive interviewing and theoretical sampling were used to add depth to findings. The analysis created three categories: 1) Trying to make cannulation more comfortable, through familiarity, avoiding or minimising pain, increasing predictability and reducing anxiety; 2) Preserving humanity and individuality during cannulation through empathy and trust in the cannulator; 3) The necessity of cannulation forces coping, with acceptance, stoicism and contributing to cannulation facilitating coping. These categories were formed into a model describing a person coping with cannulation.
These studies have developed understanding of cannulation for haemodialysis by healthcare professionals. This has created recommendations for both clinical practice and research.
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