The nature of dilemmas in dialysis nurse practice


  • Sally Wellard RN MN BA(SocSc) Renal Certificate

    1. Lecturer in Nursing, School of Nursing, Victoria College, Burwood Campus, Burwood Highway, Burwood, 3125, Victoria, Australia
    Search for more papers by this author


Dilemmas are a part of nurse practice In situations where a problem potentially has two or more unsatisfactory resolutions, the nurse chooses which course of action to take The decision to choose constitutes a dilemma This study focuses on the dilemmas faced by nurses in dialysis units and the context in which they occur A qualitative design was employed, using open interviews with eight nurses currently employed in dialysis nursing This approach was taken in order to explore and gain in-depth understanding of the dilemmas in practice Analysis reveals that dilemmas encountered in dialysis nursing emerge from conflicts in relationships with other people in the work environment The dilemmas relate to the nurses’ perception of the limited power they have in the determination of their practice This powerlessness is reinforced by their perceived and real isolation from nurses working outside their area of practice Traditionally, literature on dilemmas in nursing has focused on the development of ethical frameworks to guide practice and the resolution of dilemmas However, the findings of this study suggest that if nurses are to deal with dilemmas effectively, both for the nurse and the patient, there must be an examination of the structural constraints affecting their practice Models that are employed by nurses to guide practice must account for the structural elements in the work environment