'Doing dialysis at home': client attitudes towards renal therapy

This paper reports a study seeking to describe characteristic attitudes towards their treatment regime among a group living on home dialysis.

Although there are many papers about the problem of renal patient compliance and a number describing the experience of living on dialysis, studies have not focused on client attitudes towards their therapy.

The study used an interpretivist methodology. Twenty home dialysis clients from one renal service were interviewed for an hour each in 2004. Texts of the taped interviews were analysed to formulate a number of themes that summarize the client perspective.

During the initial period of adjustment to treatment many participants learned their need for treatment by experimenting with the therapeutic prescription. They then used their knowledge of the therapy to alter their treatment regime to maintain their normal lifestyle. Having modified their therapeutic prescription, participants' motivation to continue meeting the continuing demands of the treatment regime was influenced by their individual life situation, including their relationships, work and personal attitudes towards life.

Health professionals have interpreted renal client behaviour in relation to their therapy in terms of compliance, because effectiveness of treatment depends on their cooperation. From a client perspective their attitudes are better understood in terms of negotiation. Renal clients do not simply follow professional advice but, through a process of negotiation, seek to integrate therapy into their pattern of regular activities to maintain their normal lifestyle. Renal clients' motivation to meet the ongoing demands of treatment is not related solely to their health status, but is affected by their general life situation.

Understanding client attitudes towards therapy enables nurses to support people living on dialysis better. Through enhancing their relationships with clients, nurses can assume a key role in service to people living with chronic conditions.