Living on dialysis: concerns of clients in a renal setting

Background. This article reports a study that sought to understand the experience of a group of Caucasian men with end stage renal failure managing their own haemodialysis therapy in their homes. Methodology. The study used a critical interpretive methodology. The renal setting was critically viewed as a specialized health care context constituted by several interrelated discourses. Although established by the dominant professional discourse, it also includes a number of others, in particular an obscure client discourse that is a response to the dominant discourse. Methods. Initially participants' own interpretations of their individual experiences were outlined. These were then collectively reinterpreted by contextualizing them in terms of the critical view of the renal setting, in order to discern their own views as renal clients that were obscured by the language and ideas of the dominant discourse with which they had been enculturated. Findings. From an analysis of the set of accounts derived from interviews with six participants, four concerns of the renal client discourse were identified. Together these model their shared perspective, which underlies each of their individual accounts of their experience of illness and therapy. These concerns were: (1) suffering from continuing symptoms of end stage renal failure and dialysis; (2) limitations resulting from negotiating dialysis into their lifestyle; (3) ongoingness and uncertainty of life on dialysis; and (4) altered relationship between autonomy and dependence inherent in living on dialysis. Conclusion. One specific implication of this study is that the distinctive potential of the nursing role in renal settings lies beyond the performance of a range of technical tasks, in addressing the experience of people living on dialysis, described here as the concerns of the renal client discourse.