Renal clinicians experience in establishing and maintaining a professional relationship: A systematic review

Background: People with end-stage kidney disease receiving haemodialysis interact with renal clinicians over many years, often decades. Both clinicians and patients have expressed the notion that a unique professional relationship occurs in a haemodialysis unit and this is like being part of an extended family.

Aim: To review studies about the experiences of renal clinicians in establishing and maintaining a professional relationship with people with ESKD who are receiving haemodialysis treatment.

Methods: A systematic review of qualitative studies was conducted using the Joanna Briggs Institute (JBI) methods. Six databases (PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library and JBI library) were comprehensively searched using keywords for studies published in English from January 2008 to January 2019.

Result: Three studies met the inclusion criteria and after meta-synthesis the following themes emerged: professional relationships need to be built on trust; renal clinicians established trust with patients to improve their quality of life, renal experience, and treatment adherence; and the creation of a trusting relationship which then precipitated a professional bond to evolve between a patient and clinician. Clinicians maintained this professional bond by demonstrating empathy to patients and by using emotional detachment as a strategy to protect their wellbeing whilst providing emotional support to patients.

Conclusions: Due to the longevity of ESKD, there is a heightened importance to maintain and sustain a professional relationship. Surprisingly, few recent studies have been conducted into this social process warranting further research.