Critique of patient perceptions in renal replacement therapy choices

Nursing

Critique Qualitative Research

In the article Perceptions of Adult Patients on Hemodialysis Concerning Choice Among Renal Replacement Therapies the researcher looks at what influences patients to make the choices that they do in regards to treatment for kidney failure. I will look at this study in regards to five different criteria: descriptive vividness, methodological congruence, analytical and interpretative preciseness, philosophical and theoretical connectedness and heuristic relevance.

Descriptive Vividness

The aim of this study was to explore what patients on Hemodialysis recognize concerning their choices in regards to the three types of renal replacement therapies: transplantation, Hemodialysis, and peritoneal dialysis (Landreneau and Ward-Smith, 2007). The loss of kidney function can lead to serious illness that can affect many aspects of a person's physical well-being. The kidneys filter by-products of body chemistry and adjust the amount of liquid that is needed in the bloodstream. When the kidneys fail completely, a person cannot live for long unless you have dialysis or a kidney transplant. A transplant that works can relieve a person of kidney failure. Transplants are not always the answer for everyone. Dialysis is the process of artificially replacing the main functions of the kidneys. Hemodialysis is the process of filtering the blood through a machine. All of these procedures can be used to sustain life for years, but each procedure has its complications (Concerns about kidney failure, 2009).

Developing kidney failure means that a person has some decisions to make about their treatment. They may choose Hemodialysis, which requires a machine that is used to filter blood outside of the body; peritoneal dialysis, which uses the lining of a person's belly to filter blood inside the body; and kidney transplantation, in which a new kidney is placed in the body. (Kidney Failure: Choosing a Treatment that's Right for You, n.d.) Hemodialysis cleans and filters your blood using a machine to temporarily rid your body of harmful wastes, extra salt, and extra water. Hemodialysis helps to control a person's blood pressure and helps the body keep the proper balance of important chemicals such as potassium, sodium, calcium, and bicarbonate. Peritoneal dialysis is the procedure that removes wastes, chemicals, and extra water from the body. This type of dialysis uses the lining of the abdomen, or belly, to filter blood. This lining is called the peritoneal membrane and it acts as the artificial kidney and cleans the blood. Kidney transplantation is the surgically replacement of a healthy kidney from another person. The donated kidney does enough of the work that the two failed kidneys used to do to keep a person healthy and symptom free (Kidney Failure: Choosing a Treatment that's Right for You, n.d.) How a person goes about making the decision about what treatment to pursue is the main focus of the study that was conducted in this article.

Methodological Congruence

The study that was conducted was an exploratory, descriptive study using a phenomenological approach to describe what patients on Hemodialysis think about their choices in regards to renal replacement therapies. Studies that are done using qualitative methods provided the means to grasp and sense the lived experience of patients that are on Hemodialysis. After reviewing the literature and discovering a lack of research examining perceptions about choices among all renal replacement therapies, the research question used for this study was developed to an open ended guide (Landreneau and Ward-Smith, 2007).

Analytical and Interpretative Preciseness

In this study there were several operational techniques that were used to increase the likelihood that credible findings would be produced. First off they used open-ended interviewing techniques along with tape recordings and verbatim transcriptions that increased the accuracy of describing each participant's experience. Secondly they used peer debriefings that contained no changes in coding descriptions. Thirdly they used member checks in which participants were asked to comment on the data themes and the researcher's interpretations in a follow-up telephone call. Lastly an extensive literature review was conducted prior to the start of the research (Landreneau and Ward-Smith, 2007).

Heuristic Relevance

The researchers believed that future research surrounding this topic should focus on the areas of choice, education, and other dynamics that have been seen to impact a person's choice. Data obtained in this study provide a very important first step in the investigation of perceptions concerning choice of renal replacement therapy in patients on Hemodialysis. More research is needed to understand each type of renal replacement therapy, not just Hemodialysis. Choices and knowledge about them are essential features of the decision making process for patients on Hemodialysis and necessitate the inquiry that is treatment specific and include all treatments available to the patient (Landreneau and Ward-Smith, 2007).

Conclusion

The study that was done on the choices that people make in regards to kidney failure was ground breaking in the fact that no other like it had been done before. It looked at what factors influenced a person's decision when deciding on treatment. When a person is faced with kidney failure they have three options as to treatment. These include Hemodialysis, peritoneal dialysis and transplant. All of these procedures have their disadvantages and should be weighed heavily when making a decision.

This study found that the amount of information along with the order is which the patient was told about each choice greatly influenced what choice they made. This finding reflected the finding of another study that was done in regards to medical treatment choices that were not about kidney failure. The researchers have suggested that further research needs to be done in this area in order to completely understand the findings that were discovered here. The more that is learned the more information that can be not only passed on to patients but also to health care professionals so that they can better treat those who suffer from kidney failure. The area of treatment choice is so very important to a patient's quality of life that furtherer research is not only warranted but necessary in order to help patient's make the best decisions that they can.