2. BACKGROUND
The clinical Nurse Consultant (CNC) for the HDU identified a number of instances where it seemed that the nurses were not providing patient centred care. Patients expressed feelings of despair and concern to the CNC regarding the diminished quality of life they were experiencing on haemodialysis. The CNC wanted to know why the patients were unable or unwilling to speak to other nurses about problems, which were causing them major concern. The study was conducted buy the CNC to gain a better understanding of nursing care provision and to identify any structural and cultural enablers or barriers to the provision of patient centred care in the HHU.
Prior to commencing this study there had been little literature exploring the work of nurses in HHUs. The literature establishes that the major role of the haemodialysis nurse is the provision of the dialysis. Bevan (1998) suggests the nurse has become “enframed” by the technology of dialysis [5]. The word enframed implies that the nurse is surrounded or enslaved by the technology. Without the technology, dialysis nursing would not exist. The enframing of the nurse by the technology results in the focus of the nursing work shifting away from caring for the patient to the operation of the machine and associated technology.
The significance of the technical role is reinforced by Polischek (2003) who contends that the dominant action in the renal setting is the provision of the dialysis treatment [6]. However, he identifies the unique contribution of the nurse in the haemodialysis unit is responding to the experience of the person who is living on dialysis. Nurses in an Australian haemodialysis unit have described their role as that of supervising dialysis treatments and teaching patients to