“Jeg har aldrig fået at vide, at min nyresygdom er livstruende”

Resumé
Baggrund
Patienter i hæmodialyse lever med en kronisk livstruende sygdom, men samtaler om sygdommens alvor, prognose og livsperspektiver finder ofte ikke sted eller foregår usystematisk. Tidlig palliativ indsats anbefales, men er fortsat sparsomt integreret i nefrologisk praksis.
Formål
Formålet med masterprojektet var at undersøge, hvordan sygeplejersker i Klinik for Dialyse forstår og oplever samtaler med patienter i hæmodialyse om det at være konstateret livstruende syg samt at identificere barrierer og behov knyttet hertil.
Design og metode
Projektet er et kvalitativt studie med fænomenologisk-hermeneutisk tilgang. Data blev indsamlet gennem semistrukturerede interviews med sygeplejersker i klinikken og analyseret efter Kvale og Brinkmanns analysemetode.
Resultater
Analysen viser, at livssamtaler ofte afholdes tilfældigt og afhænger af den enkelte sygeplejerskes erfaring, værdier og mod. Manglende fælles struktur, redskaber og organisatorisk opbakning samt bekymring for at fratage patienten håb opleves som væsentlige barrierer.
Konklusion og implikationer
Masterprojektets fund førte til udvikling og implementering af strukturerede livssamtaler som en systematisk praksis i Klinik for Dialyse. Forandringsprojektet har styrket sygeplejerskernes faglige tryghed, understøttet en palliativ kultur og bidraget til mere individuelt tilpassede og sammenhængende patientforløb.

Nøgleord: Livssamtaler, hæmodialyse, kronisk livstruende nyresvigt, palliativ indsats, relationel sygepleje, fundamentals of care, praksisudvikling, sygeplejerskers oplevelser

English abstract

"I have never been told that my kidney disease is life-threatening". Implementation of Life Conversations in the Dialysis Clinic: A Qualitative Study of the Need for Palliative Focus and Structured Conversation Tools

Background
Patients in haemodialysis live with a chronic life-threatening illness, but conversations about the severity of the disease, prognosis, and life perspectives often do not take place or occur unsystematically. Early palliative care is recommended but remains sparsely integrated in nephrological practice.
Aim
The aim of the master's project was to examine how nurses in the Dialysis Clinic understand and experience conversations with haemodialysis patients about living with a diagnosed life-threatening illness, and to identify related barriers and needs.
Design and Methods
The project is a qualitative study with a phenomenological-hermeneutic approach. Data were collected through semi-structured interviews with nurses at the clinic and analysed using Kvale and Brinkmann's analytical method.
Results
The analysis shows that life conversations often occur randomly and depend on the individual nurse's experience, values, and courage. Lack of shared structure, tools, and organisational support, as well as concern about depriving the patient of hope, are experienced as significant barriers.
Conclusion and Implications
The master's project findings led to the development and implementation of structured life conversations as a systematic practice in the Dialysis Clinic. The change project has strengthened nurses' professional confidence, supported a palliative culture, and contributed to more individually tailored and coherent patient pathways.

Keywords: Life conversations, haemodialysis, chronic life-threatening kidney failure, palliative care, relational nursing, fundamentals of care, practice development, nurses' experiences.