Exploring Haemodialysis Nurses' Perceptions on Kidney Replacement Therapy Modality Education: A Framework Analysis

Abstract

Background: Many people with kidney failure start and remain on in-centre haemodialysis treatment despite evidence of improved outcomes with home dialysis. To make an informed modality decision patients must receive frequent, high-quality modality education. This education is inconsistent in the in-centre haemodialysis setting, where patients spend the most time with nurses while receiving haemodialysis treatments. Objectives: The aim of this study was to examine in-centre haemodialysis nurses' perceptions around modality education for patients receiving in-centre haemodialysis using the COM-B model of behaviour change. Design: We used framework analysis as a research method, applying the COM-B model as a theoretical framework to understand nurses' perceptions of modality education. Participants: We interviewed 13 in-centre haemodialysis nurses in a single province in Canada. Approach: We completed semi-structured interviews via Zoom, which ranged from 30 to 60 min. Findings: Participants reported knowledge deficits, lack of experience or exposure to other dialysis modalities, and lack of resources to support modality education practices. In-centre haemodialysis nurses reported some factors that enhanced modality education, including strong nurse–patient therapeutic relationships and previous experience in other dialysis modalities. Conclusions: Nurses could have a role in modality education but had different views on what this role should be. Nurses faced barriers in modality education such as knowledge deficits, a lack of experience with home modalities, and limited patient teaching resources. Factors that favoured modality education were strong nurse–patient relationships and previous experience with other modalities.