Lived experiences of haemodiaysis patients with erectile dysfunction : a phenomenological study

Abstract

"Hearing is one of the body's five senses. But listening is an art." (Tyger, 2005 : para.1). While working in the haemodialysis unit in KwaZulu-Natal, I observed that patients preferred not to disclose their experiences of erectile dysfunction with the professional nurse practitioners but to the health care workers and to other patients in the unit. The nondisclosure served as a barrier to the patients receiving the assistance and support they required to be able to cope with erectile dysfunction. Added to this, there were no therapy groups or supportive groups available for the patients to allow them the platform to voice their experiences of erectile dysfunction and to provide them with strategies to cope with these experiences. The professional nurse practitioners lacked the knowledge and skills to assist the patients to cope with their experiences of erectile dysfunction. Therefore, there was a shortcoming in the provision of holistic nursing care to these patients, threatening their mental health specifically. The Theory for Health Promotion in Nursing (University of Johannesburg [UJ], 2009:4) states that a person is seen holistically in interaction with the environment in an integrated manner therefore the need for holistic nursing care. From the problem identified above I envisioned the need to conduct a study on the lived experiences of patients with erectile dysfunction from a holistic perspective that includes a mental health perspective. The overall aim of this study was to generate an in-depth understanding of the lived experiences of patients with erectile dysfunction who were on a haemodialysis programme in three units of a renal disease management organisation in KwaZulu-Natal. The aim was achieved by exploring and describing the patients’ lived experiences of erectile dysfunction. My understanding of the lived experiences of these patients formed the basis for proposing recommendations to facilitate the mental health of patients with erectile dysfunction in the context of this study with reference to nursing practice, education and research. The facilitation of mental health care to the patients in the haemodialysis units would require the provision of holistic nursing care to be implemented by the professional nurse practitioners with the assistance and support of the advanced psychiatric professional nurse practitioner. A phenomenological research design that was qualitative, explorative and contextual was followed to achieve the aim and objectives of the study. Purposive sampling was used for the sample selection based on the inclusion and exclusion criteria. The number of participants selected for this study was guided by data saturation. The total number of participants selected for this study was nine. The data collection methods utilised were phenomenological interviews, naïve sketches and field notes. In the phenomenological interview the participant was asked: “How is it for you to live with erectile dysfunction?” Thereafter the participants were requested to “Write a story on living with erectile dysfunction.” The field notes included observational, methodological, theoretical and personal notes. The phenomenological interviews were audiotaped and transcribed. An independent coder and I analysed the transcribed phenomenological interviews, written naïve sketches and field notes. I made use of Creswell’s method of data analysis (Creswell, 2007:156) in analysing the data. The measures taken to ensure trustworthiness in this study included credibility, dependability, confirmability, transferability and authenticity. The three primary ethical principles articulated by the Belmont Report (beneficence, respect for human dignity and justice) and the Declaration of Helsinki guided this study. There were two major themes with sub-themes that emanated from the collection of multiple data. The first major theme was that the participants’ lived experiences of erectile dysfunction reflected psychological, physical and social losses that seemingly negatively influenced their mental health. An alternative story of two of the participants’ acceptance of living with erectile dysfunction which positively influenced their mental health emerged as the second major theme. Therefore the essence of most of the participants’ experiences of erectile dysfunction was reflected by losses in the psychological, physical and social dimensions that seemingly negatively influenced their mental health. However, two participants had embraced the challenges of erectile dysfunction and managed to deal with the losses in the psychological and social dimensions. Based on the findings and the literature control recommendations were proposed for nursing practice, education and research. The recommendations were guided by the Theory for Health Promotion in Nursing from the University of Johannesburg (2009:1). These recommendations served as a frame of reference to enable the professional nurse practitioner to facilitate the mental health of patients who experience erectile dysfunction within the context of rendering holistic nursing care. The advanced psychiatric nurse practitioner has both developmental and consultative roles to implement in the haemodialysis unit. In implementing these roles, the professional nurse practitioner is assisted by the advanced psychiatric nurse practitioner to mobilise the internal and external resources to meet the patient’s needs on a holistic level. A psychiatric nursing qualification for professional nurse practitioners treating patients in the haemodialysis units is recommended to assist and support the patients to cope with their experiences of erectile dysfunction, thus facilitating their mental health. Copyright