%0 Journal Article
%T Challenges encountered by patients with end-stage kidney disease in accessing symptom management services: A narrative inquiry.
%A Ng MSN
%A Hui YH
%A Law BYS
%A Wong CL
%A So WKW
%J J Adv Nurs
%V 77
%N 3
%D Mar 2021
%M 33249651
%F 3.057
%R 10.1111/jan.14678
%X <B>OBJECTIVE: </B>To understand the storied experiences of accessing symptom management services of patients with end-stage kidney disease (ESKD) who are receiving maintenance dialysis.<BR><B>METHODS: </B>Narrative inquiry.<BR><B>METHODS: </B>Ten patients with ESKD who were receiving dialysis were recruited at two regional hospitals in Hong Kong and interviewed three times each between July 2017-July 2018 to capture their narratives. The data were analysed using the narrative inquiry approach from the perspective of Levesque's framework of access to care.<BR><B>RESULTS: </B>Five themes emerged from the participants' narratives. The first theme illustrated access to care as a process by which symptom management needs were met. However, clinicians occasionally identified patients based on their diseases instead of their needs and this process was affected differently by interpersonal and system factors. The themes 'building trust' and 'facilitating communication' described interpersonal factors that were essential to maintaining a constructive patient-clinician partnership. The themes 'balancing efficiency' and 'navigating fragmented system' described system-related factors.<BR><B>CONCLUSIONS: </B>This study identified the factors that influenced the delivery and/or reception of symptom management services for patients with ESKD who were receiving dialysis. The results suggest that healthcare services should be streamlined based on patients' needs and that this process should address the important elements of trust and communication.<BR><B>CONCLUSIONS: </B>The study's results suggest potential improvements to symptom management services that would enable patients' needs to be addressed in a timely and humanistic manner.<BR>目的: 了解接受维持性透析的终末期肾病(ESKD)患者获得症状管理服务的经历。 设计: 叙事研究 方法: 在2017年7月至2018年7月期间, 在香港两家地区医院招募了10名正在接受透析的ESKD患者, 并分别对每名患者进行了三次访谈, 以记录其叙述。从Levesquee获得护理框架的角度, 采用叙述式调查方法对数据进行分析。 结果: 参与者的叙述中出现了五项主题。第一项主题说明获得护理是满足症状管理需求的过程。但是, 临床医生偶尔会根据患者的疾病而非其需求来识别患者, 并且这一过程受到人际和系统因素的不同影响。‘建立信任’和‘促进沟通’两项主题对维持建设性的患者--临床医生伙伴关系所必需的人际因素进行了说明。‘平衡效率’和‘导航碎片化系统’对系统相关因素进行了说明。 结论: 本研究确定了影响接受透析的ESKD患者提供和/或接受症状管理服务的因素。研究结果表明, 医疗保健服务应根据患者的需求进行精简, 而这一过程应考虑到信任和沟通等重要因素。 影响: 该项研究的结果表明了症状管理服务的潜在改进, 将使病人的需求得到及时且人性化的解决。.