The primary nursing care delivery system within a haemodialysis context – experiences of haemodialysis primary nurses in Sweden

Abstract

Background: Primary nursing is a widespread organisational system for nursing that aims to reduce fragmentation of patient care. The system is implemented in haemodialysis care, but the system was not originally designed for this type of clinical practice. This study explored the model’s adaptation to a haemodialysis setting as well as its emotional impact on the primary nurses. Methods: Nurses were recruited through criteria-based sampling until saturation. Data were collected through semi-structured interviews, and a contextual analysis within a phenomenographic approach was used to process the data. Results: Primary nurses’ pedagogical role needs to be clarified, and the nurses have to be aware that they should provide education to the patients. The outcome space contained experiences of flexible, unclear duties, a sense of sole and overriding responsibility for all aspects of the patient’s well-being and management, and unclear professional boundaries. The role was experienced as emotionally demanding. Conclusions: The primary nursing system needs to be adapted to haemodialysis nursing. Regular counselling should be used as an intervention to improve the primary nurses’ emotional situation.