The elderly patients' right to participate in their haemodialysis treatment did not seem to be well incorporated into the social practices of haemodialysis units. Changing the social practices in the dialysis units from a paternalistic ideology to an ideology of participation will require consideration of the context, the dialogue and the process of shared decision-making with the patient.

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The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses' power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions.

This article examines the impact of professional education on students' dedication to and identification with a profession. The premise is that professional education is not only about knowledge acquisition and reasoning but also about attitudes and aspirations. In fostering dedication and identification, students' experiences of relevance seem to be important. The concept of coherence seen as an expression of relevance is introduced and measured by four kinds of interactions: TheoryÁpractice interaction, teacherÁstudent interaction, peer interaction and supervisorÁstudent interaction. Analysis indicates that coherence, particularly as theoryÁpractice interaction, peer interaction and supervisorÁstudent interaction, has a significant impact on dedication to and identification with a profession. Longitudinal survey data Á collected from students in colleges for teaching, nursing and social work Á are analysed.

The dominant part of the discourse as expressed by the next of kin seems to be a paternalistic ideology. Thus, finding ways to enable the next of kin to participate in the decision-making process seems to be a major challenge for the healthcare team in the dialysis units.

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