The Performance of Dialysis Care: Routinization and Adaptation on the Floor

Abstract

Previous studies of communication in dialysis centers primarily focused on communication between nurses and patients. In this study, ethnographic methods were used to explore the dominant communication performances enacted by dialysis staff members, including registered nurses, patient care technicians, technical aides, a social worker, and a dietitian. Findings suggest a dialectic between extreme routinization of care and continual adaptation. The dominant routine involved repeating the same preparation, treatment, and discharge process 3 shifts per day, thrice weekly for each patient. At the same time, near-constant adjustments to scheduling, coordination of tasks, and problem solving were needed to maintain the performance of repetition. The balancing of this dialectic has significant implications for new staff training and socialization, understanding the role of technology and routine in dialysis and in health care systems more generally, and in further theorizing the role of unbounded communication interactions in health care.

Notes

¹This figure includes paid Medicare claims and Medicare HMO costs. An additional $4.7 billion was spent for non-Medicare costs. Per the requirement of the USRDS, I hereby certify that data reported here have been supplied by the United Sates Renal Data System. The interpretation and reporting of these data are the responsibility of the author and in no way should be seen as an official policy or interpretation of the U.S. government.

²Patients interviewed were disproportionately European American, given the diversity of the unit's patient population. This is a function of being unable to obtain suitable interpreters to obtain informed consent from patients who do not speak English, which included a significant percentage of the non-White patients. Patient demographics were as follows. Sex: 8 women, 12 men; ethnicity: 1 African American, 1 American Indian (Apache), 1 East Indian, 1 Portuguese, 2 Latinos, and 11 European Americans. Age ranged from 42 to 84 (M = 66.85); educational attainment: 2 had some high school education, 6 had completed high school or the equivalent, 4 had taken some college courses, 1 had an associates degree, 3 had a BA or BS, 1 had an MA, and 1 had a JD.

³The quantity of data was somewhat disappointing, as I had expected patients to be more detailed in their responses, and the richness of the responses varied significantly between patients. However, I was able to garner several important insights from this data.