The Teaching-Learning Partnership Between the Nurse and the Long-Term Peritoneal Dialysis Patient: A Qualitative Study

Purpose: Peritoneal dialysis (PD) is one modality of renal replacement therapy for those with end-stage renal disease (ESRD). Depending on other co-morbidities and potential qualification for a kidney transplant, treatment can be life-long. The main reason for failure of PD therapy, and a significant cause of morbidity, is peritonitis (USRDS, 2017). Long-term PD patients have been found to alter their regimen from what they had initially been taught (Lam, Lee, & Shiu, 2014) and since alterations have been associated with a higher risk of peritonitis, this qualitative study focused on the long-term patients who rely more on the continuing re-education and partnering support of the nurse. As is evident from the literature, the teaching process, and especially the teacher, is a crucial element of successful PD (Baillie & Lankshear, 2015; Firanek, Sloand, & Todd, 2013; Tong et al., 2013). There are some studies describing the relationship between the PD patient and the RN educator, but no studies addressing both aspects. This study explored the patients’ and nurses’ perceptions of the teaching-learning partnership and how it impacted the ability to remain infection-free. The first objective of the study was to describe the patients’ and nurses’ perception of their teaching and learning partnership. The second objective was to describe and better understand similarities and differences between the perceptions and insights on the long-term health outcomes.

Methods: The study consisted of individual semi-structured interviews of four PD patients who had been performing treatment more than one year and three nurses of any years’ work experience who functioned as PD educators. After approval of the Institutional Review Board (IRB ID: 1006138-3), subjects were recruited through a local PD training facility. Individual interviews with four open-ended questions were conducted from September 2017 until December 2017. The questions were developed based on the literature and were constructed to be as non-judgmental as possible and to be broad enough to allow a narrative to occur. Each interview was audio-recorded and transcribed verbatim by a certified transcriptionist. The interview data were analyzed using qualitative content analysis methods (Polit & Beck, 2017) to describe, compare and contrast similarities and differences between the PD patients’ and their nurses’ perceptions of the teaching-learning partnership and insights on health outcomes. The inductive content analysis steps were:

1. immersion in the data by reading and re-reading the transcripts;
2. open coding and constant comparison of the labels;
3. creation of categories and sub-categories to compare and contrast the similarities and differences of the content; and
4. abstraction of data to create themes and sub-themes.

The data were managed using MAXQDA software.

Results: Three females and one male patient were interviewed for the study (mean age: 61.5 years, mean duration of PD: 1.6 years, causes of kidney failure: diabetes, polycystic kidney disease, urinary reflux, and unknown reason for one patient). All the interviewed nurses were female (mean age: 44.7 years, mean work experience: 22 years, and as PD nurse: 11.5 years). Two themes and three sub-themes emerged exclusively in patients: motivation to initiate PD through “finding meaning in life and situation” and "staying healthy to avoid pain and to qualify for a transplant”, and also acceptance “of diagnosis and choosing to initiate PD”. Furthermore, three shared themes and seven sub-themes emerged: acceptance was characterized the “modification and integration into daily life”, the presence of support arose from “family and friends”, and also from “professional care and understanding of the individual”, including “customized and re-iterative education”. Evolving partnerships were comprised of “exposure”, “rapport”, the “necessity of working together” in order to find the best method to support the patient and/or to maintain positive health outcomes.

Conclusion: The findings of this study describe complex and evolving teaching-learning partnerships. The knowledge garnered from this research encourages PD nurses to support their patients in finding the motivation to initiate PD, to facilitate acceptance of their diagnosis, and to help them to create safe modifications in integrating PD into their daily life. From a clinical perspective, these findings are helping to better understand these partnerships in an effort to improve health outcomes.