manage their own dialysis and symptoms related to complications of chronic renal failure and dialysis [7]. Ran and Hyde (1999) suggest nephrology nurses should take up the challenge of looking beyond the technical expertise to form an empathetic therapeutic relationship with patients [8]. The nephrology nurse should function within a patient support role with emphasis on the additional functions of caregiver, educator, advocate, facilitator, mentor and referral agent.
Subsequent to commencing this research, an English study of the culture of haemodialysis units was published [9] . The ethnography aimed to determine themes that would help to understand the culture of dialysis units. The themes were survival, belonging-teams, them and us, leadership, communications and environment. From these themes, a theory of partnership emerged. These partnerships are forged between the patient and his/her diseased body, the patient and the machine as well as with other people such as the caregivers. Aswanden (2002) contends that a greater understanding of the culture of the haemodialysis unit could improve patients’ well-being. Through this concept of partnership there can be increased understanding about culture that could contribute to delivering improved patient care. Arguably, findings of the English study may not necessarily be generalised to every HHU.
Apart from the technological environment, the literature on the provision of nursing care to patients requiring hospital haemodialysis does not offer any other reason for nurses not providing patient centred care.
3. THE STUDY
3.1. Aims
The aims of the study were to investigate the culture of the HHU to acquire a comprehensive understanding of how nursing care was conducted and to identify the structural and interpersonal enablers or barriers to the provision of patient centred care within the HHU.
3.2. Methodology
The study method was ethnography. In a broad sense ethnography involves the researcher participating, overtly or covertly, in people’s daily lives for an extended period of time, watching, listening, asking questions and collecting whatever data are available to throw light on the issues that are the focus of the research [10].