Stigma Experiences in Clients with a Vascular Access for Hemodialysis

Aim. The aim of this presentation is to discuss the experience of clients with renal failure on hemodialysis negotiating living with a vascular access.

 Background. A vascular access is required for hemodialysis (HD) and currently an arteriovenous fistula is the medical access of choice. The issue is that findings from a recent study found that clients object to having a fistula and other vascular accesses for several reasons and one of the reasons is stigma.

 Method. In this qualitative, ethnographic study, data were collected during fieldwork and semi-structured interviews modeled according to Spradley (1979). Constructivism and a cultural negotiation model provided frameworks for the study. Data were analyzed according to Miles and Huberman (1994). Strategies of data validation, reflexivity, and debriefing sessions were used to assure trustworthiness.

 Findings. The study’s findings indicate that from the informants’ perspective, caring for and maintaining a vascular access is complex, and nephrology nurses need to be aware of these complexities. Even though clients may have the knowledge and skill to care for their vascular access, they may not do so for many reasons. Additionally, informants indicated that if their arteroivenous fistula or graft ceased functioning they refused to have another and consented for only a catheter. One reason that informants may not care for their fistula and/or graft and refuse to have it replaced is that they experience stigma from within and from others.

 Conclusions. As nephrology nurses understand clients’ perspectives and experiences with stigma of vascular access, nurses can design interventions for clients to facilitate coping with, caring for, and maintaining the integrity of their vascular access. Also nephrology nurses can develop appropriate educational and behavioral programs and materials that can ultimately contribute to successful self care and use of vascular access for dialysis.