Rural dialysis nurses’ experiences with challenging patients: a thematic qualitative analysis

Background: This study explored the experience of nurses encountering challenging patient behaviour while working at a rural hospital-based haemodialysis unit. Methods: Focus groups were conducted with haemodialysis nurses at a rural hospital. Five participants across two focus groups were asked questions regarding their experiences of challenging patients, including impacts that the experiences may have had on their ongoing professional practice. Transcripts of the focus groups were analysed thematically. Findings: Three themes arose from the focus group discussion - experiencing challenging behaviour, long-term relationships with patients, and nursing professionalism. Participants described challenges arising when caring for patients who were aggressive, did not comply with self-management, or caused avoidable logistical challenges. Long-term caring relationships presented challenges as patients could become emotionally dependent upon one nurse, making it difficult to share workloads with other nurses. Participants reported decreased confidence, being near tears, being angry, and experiencing 'burnout' when caring for patients with difficult behaviour over extended periods. Participants managed challenging behaviours by identifying triggers, allocating staff to specific patients, and trying to understand the patient's motivation for action. 'Not taking work home' and 'not taking things personally' were ways in which nurses attempted to look after their own wellbeing, although this was not always possible. Participants stressed the importance of working as a team and having supportive management and inter-professional relationships. Significance: Participants' perceptions of working in the nursing profession were more related to their ability to work as a team and manage challenging behaviour exhibited by patients in a supportive environment than the presence of patients exhibiting challenging behaviour.