Compliance in peritoneal dialysis: a qualitative study of renal nurses.

End-stage renal failure is a life-threatening condition, often treated with home-based peritoneal dialysis (PD). PD is a demanding regimen, and the patients who practise it must make numerous lifestyle changes and learn complicated biomedical techniques. In our experience, the renal nurses who provide most PD education frequently express concerns that patient compliance with their teaching is poor. These concerns are mirrored in the renal literature. It has been argued that the perceived failure of health professionals to improve compliance rates with PD regimens is because 'compliance' itself has never been adequately conceptualized or defined; thus, it is difficult to operationalize and quantify. This paper examines how a group of Australian renal nurses construct patient compliance with PD therapy. These empirical data illuminate how PD compliance operates in one practice setting; how it is characterized by multiple and often competing energies; and how ultimately it might be pointless to try to tame 'compliance' through rigid definitions and measurement, or to rigidly enforce it in PD patients. The energies involved are too fractious and might be better spent, as many of the more experienced nurses in this study argue, in augmenting the energies that do work well together to improve patient outcomes.

'Marking' the white terrain in indigenous health research: literature review.

AIM: This paper is a report of a literature review of the concept of whiteness in relation to research partnerships with indigenous Australian healthcare professionals, participants and community members. BACKGROUND: As researchers, we were confronted with the visibility of our whiteness and the oppressive, discriminating history on our indigenous partners wrought by the colour of our skin. This personal discord began an intensely provocative, reflective journey accompanied by a search of the literature on 'whiteness'. METHODS: The EBSCOhost, InfoTrac, Blackwell Synergy, ScienceDirect, SAGE Full-Text Collections and CINAHL databases were searched in 2004. The primary keywords were 'whiteness', 'white studies' and 'white privilege'. Secondary keywords: 'culture', 'race', 'racism', 'indigenous', 'indigenous communities', 'race relations' and 'colonialism'. No date restrictions were imposed, but most of the literature dated from the 1990s. FINDINGS: Exposure to the literature on 'whiteness' and the experience of working with indigenous Australians challenged us to recognize and address the privilege and power historically and contemporaneously conferred on us as white women. Largely invisible to white people is the structural advantage conferred by the 'white' standpoint and the set of 'unmarked' cultural practices that are usually set as the default positioning. CONCLUSION: To achieve useful research outcomes that influence the well-being of indigenous populations necessitates that non-indigenous researchers and healthcare providers stringently examine their own racial and social positioning. Without doing this we, consciously or otherwise, uphold white hegemony and racialist inequality.

'A politics of what': the enactment of peritoneal dialysis in indigenous Australians.

This paper explores, on the one hand, the requirements of the technologies and practices that have been developed for a particular type of renal patient and health network in Australia. On the other, we examine the cultural and practical specificities entailed in the performance of these technologies and practices in the Indigenous Australian context. The praxiographic orientation of the actor-network approach - which has been called 'the politics of what' (Mol 2002) - enabled us to understand the difficulties involved in translating renal healthcare networks across cultural contexts in Australia; to understand the dynamic and contested nature of these networks; and to suggest possible strategies that make use of the tensions between these two disparate networks in ways that might ensure better healthcare for Indigenous renal patients.

Australian consumers' expectations for expanded nursing roles in general practice--choice not gatekeeping.

While research has focussed on the current and potential role of the practice nurse (PN) in Australia, the acceptability of this role by consumers has not been investigated. In 2002, two independent studies were carried out into consumer perceptions of PNs. A disscussion between the two groups of researchers at the inaugural National Pratice Nurse Conference in 2003, identifiied significant similarities in the findings of the tese studies. This article reports the combined findings as they relate to consumer's desire for access to the health practitioner of their choice, and their concern that PNs may assume a Gatekeeping role. These perceptions may have significant impact on the acceptance of PNs across Australia.

Experiences of regional and rural people with cancer being treated with radiotherapy in a metropolitan centre.

This paper explores the issues related to rural people with cancer whose choice of radiotherapy treatment necessitated travel and accommodation in a metropolitan centre. Semi-structured interviews with 46 participants, from the Toowoomba and Darling Downs region of Queensland, Australia, were conducted and the data thematically analysed. The specific themes identified were: being away from loved ones, maintaining responsibilities whilst undergoing treatment, emotional stress, burden on significant others, choice about radiotherapy as a treatment, travel and accommodation, and financial burden. This study supports the need for a radiotherapy centre in the location of Toowoomba as a way of providing some equity and access to such treatment for the rural people of Queensland.

Dialysis-dependency: the reformulated or remnant person.

Being dependent on dialysis is a potentially overwhelming experience where life as previously known is permanently altered. A dialysis-dependent individual may reformulate their identify or perceive that they are a remnant of their former self. This paper will explore and expand Morse and Penrod's (1999) model as a useful way to understand how a person might reconstruct their identify. Grounded in a narrative methodology, interviews of those on haemodialysis and peritoneal dialysis were thematically analysed. It was found that dialysis dependency brings an acknowledgment of a lost past, an inescapable present and an unknowable future, filtered through hope and despair. Nurses need to understand the suffering, wrought by such a struggle, to facilitate the positive re-envisioning of those who are dialysis dependent.

Being dialysis-dependent: a qualitative perspective.

technology of renal dialysis offers a way in which life can be sustained, so it is not surprising that the complex, diverse and evolving iatrogenic aspects of dialysis-dependency continue to be researched. However, there has been a tendency to take for granted the human process of making sense of the intrusiveness of dialysis. This study was designed to explore the meanings of dialysis-dependency. The study sample was 10 participants: five female, five male; five on peritoneal dialysis, five on haemodialysis; whose ages ranged from 22 to 68 years. Using a narrative methodology the following methods were used: in-depth interviews, narrative and thematic analysis, fieldwork/notes from five renal units, participant validation, and journal reflections. A thematic analysis revealed the continuum themes of Freedom-Restrictions, Being Normal-Being Visible, Control-Acquiesce, Hope-Despair and Support-Abandon. The themes portrayed as continuums serve to remind health care professionals that those with chronic illnesses strive to make sense of what is happening to them. Variations within each of these themes can occur daily, weekly or monthly. Acceptance may never be reached or may be tentative. Some clients will strive for control and freedom to choose for themselves, others will acquiesce to the overwhelming changes wrought in their lives. Thus, health care professionals might consider placing the personal meanings of those who are dialysis-dependent to the fore, being sensitive to the sufferings wrought by the regime, which treats but does not cure, which sustains life but does not heal.

Initiation into a dialysis-dependent life: an examination of rites of passage.

The purpose of this article is to explore the conceptual and empirical application of the rites of passage model in contemporary health care for those who are dialysis dependent. This study used a collective case study design and narrative methodology. A purposive sample yielded 10 participants who were receiving dialysis. Prolonged observation and immersion in the culture of dialysis dependency occurred in the settings of the participants' home and renal units in Queensland, Australia. In-depth interviews and narrative analysis were used. The criteria of reflexivity, voice, and verisimilitude established the rigor of the study. The findings illuminated the three stages of rites of passage (ROP), separation, liminality, and reincorporation, with each stage evident in the participants' stories. Commencing dialysis is an initiation that delineates the transition from one social status to another. It is argued that there is a metaphoric usefulness of the application of the ROP model that might influence the quality of care to dialysis initiates.