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Signifying the praxis of hemodialysis nurses: contributions to nursing care– Grounded Theory study

Genesis de Souza Barbosa – Universidade Federal do Rio de Janeiro.
Glaucia Valente Valadares – Universidade Federal do Rio de Janeiro.

This study is linked to the master program of post-graduate degree in Nursing, Federal University of Rio de Janeiro, aims to characterize the significance of nursing care to nurses who work in hemodialysis; Identify from nurses’ performance in hemodialysis: the context of care, strategies for action / interaction, intervening factors and the related implications for care, examine the dynamics of hemodialysis care in seeking the understanding of the distinction and complementarity between the expressive and procedural, to propose a substantive theory relating the meaning ascribed to nephrologist care by nurses with the care offered to clients on hemodialysis with a view to recovery of the human. Qualitative study of type Grounded Theory, using the theoretical Symbolic Interactionism. The scenario is a university hospital in Rio de Janeiro and the subjects are nurses working in hemodialysis. For data collection will be adopted semi-structured interviews and systematic observation. The analysis will follow the guidance of Grounded Theory.
Keywords: Nursing; Renal dialysis; Specialties, Nursing; Nursing care.

Problem situation and its significance:                             
The care practice represents a challenge for nursing, because each person has their own values ​​and principles that may influence the care service. Then it is necessary to consider that each client has a particular way of facing different situations, which might be quite stressful1. Thus, considering the fact that nursing care practice requires human interaction and the hemodialysis nurse requires the interactive process for carrying out the care service, there is a connection between the significance of nursing care for this professional (now configured as an object of study) and the Theory concerning the assumptions related to Symbolic Interactionism (SI), which was adopted as theoretical reference.
The SI understands the significance as a concept emerging from the interactive process established among people2. Therefore, it is evident that in SI, the significance is the central concept, in which the actions are built up during the interaction process among individuals, who define the actions and act on the social context they are in. Thus, the hemodialysis nurse receives and notices symbols from the scenario, work context, clients in question, which leads them to a constant
interactive process, from which their actions are based.

Objectives: To characterize the significance of nursing care for the nurse who works in hemodialysis; identify from the hemodialysis nurses' performance: the context of care, action / interaction strategies, the factors involved and the implications for the related care; analyse the dynamics of care in hemodialysis seeking the understanding of the distinction and complementariness between procedural and expressive; propose a substantive theory relating the significance of care given by the nephrologist nurse with the actual care offered to clients on hemodialysis with  the aim of human promotion. 

Guiding questions: How is the nursing care service offered by hemodialysis nurses considering the components: procedural and expressive? In which way the context relates to nurses' actions in this investigative field? What factors of daily dynamics are involved and influence this care process?

Methodology: This study uses qualitative approach as a theoretical reference to Grounded Theory (GT), which is a systematic method that aims at building a theory from the collected data to explain a given phenomenon present in reality3. The study setting will be the nephrology service at the university hospital of Rio de Janeiro and the subjects will be the nurses who work at the nephrology center, hemodialysis modality. The data collection will be done by semi-structured interviews and systematic participant observation. Information will be recorded and then grouped, classified and evaluated according to GT instructions: open coding, axial coding, selective coding and theory delimitation. This study was approved by the Ethics Committee in Research of University Hospital Pedro Ernesto, under the register nº. 2817/2010.

1. Barbosa GS, Valadares GC. Experimentando atitudes e sentimentos: o cotidiano hemodialítico como base para o cuidar em enfermagem. Esc Anna Nery Rev Enferm 2009; 13 (1): 17-23.
2. Lopes CHAF, Jorge MSB. Interacionismo simbólico e a possibilidade para o cuidar interativo em enfermagem. Rev Esc Enferm USP 2005; 39 (1):103-8.
3. Lorenzini-Erdmann A.Schaefer-Ferreira-de-Mello A.Andrade S.Drago L. Organization of care practices in the health network Online Brazilian Journal of Nursing [periódico online]. 2011 [Acesso em 2011 maio 8]; 10(1). Disponível em: http://www.objnursing.uff.br/index.php/nursing/article/view/3220

Project information:
Master’s degree dissertation from the post graduation program in nursing of the Universidade Federal do Rio de Janeiro approved in 14/07/2010 by the board of examiners comprising Profas. Dras. Glaucia Valente Valadares (President); Iraci dos Santos (1ª examiner); Sílvia Teresa Carvalho de Araújo (2ª examiner).
Aprovação no CEP em 02/02/2011. N. do parecer 2817/2010.
This research has not received any financial support.
Genesis de Souza Barbosa
Pós-Graduando (Mestrado) em Enfermagem. Membro do Núcleo de Pesquisa de Fundamentos do Cuidado de Enfermagem da Universidade Federal do Rio de Janeiro.

Glaucia Valente Valadares
Doutora em Enfermagem. Coordenadora do curso de Graduação em Enfermagem da Universidade Federal do Rio de Janeiro – Campus Macaé. Orientadora.


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