‘Doing dialysis at home’: client attitudes towards renal therapy

Abstract

Aim. This paper reports a study seeking to describe characteristic attitudes towards their treatment regime among a group living on home dialysis. Background. 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. Methods. 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. Results. 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. Conclusion. 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. Relevance to clinical practice. 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.

Older peoples' satisfaction with home‐based dialysis

“…Qualitative research undertaken with patients (aged 24-77 years) dialysing at home, has identified how home-dialysing patients can integrate dialysis into their lives in a way that allows them to follow a 'normal' lifestyle. 24,25 The qualitative component of our study demonstrated the value attached to having an approachable staff, 19 who were willing to be contacted at any time for support and advice when managing dialysis at home. Satisfaction extended to the entire team: doctors, nurses and the technicians installing and maintaining the home-HD machines.…”

“…In our study, with the exception of eight patients still in training for home dialysis and one patient who had chosen self‐dialyse in the nephrology unit, all our study participants were dialysing at home. Qualitative research undertaken with patients (aged 24–77 years) dialysing at home, has identified how home‐dialysing patients can integrate dialysis into their lives in a way that allows them to follow a ‘normal’ lifestyle 24,25 …”

Nurse–patient Communication While Performing Home Dialysis: The Patients’ Perceptions

“…Ashwanden (2002) studied the effects of the diagnosis of ARF on the patient's close relatives, emphasising how their reactions do affect the patient's response to his/her illness; and this study also analysed the importance of partnership between the specialist renal nurse and family on the effectiveness of the patient's care. Polaschek (2007) concluded that the patient does not follow exactly what is taught by professionals: through a negotiation process, the patients seek to integrate renal therapy into their way‐of‐life, thus seeking a normal lifestyle. The importance of establishing a genuine dialogue with patients is emphasised so that professionals can effectively support and help them achieve autonomy.…”

Editorial: Renal studies inJCN

“…Recently, we have published other qualitative papers (Bonner & Greenwood 2006, Darbyshire et al. 2006, Polaschek 2007) a documentary analysis (Ziegert et al. 2007) and a clinical practice paper (de Andrade & Ferriera 2007).…”

“…2008). It should also be noted that these papers include one from our new supplement Journal of Nursing and Healthcare of Chronic Illness (Polaschek 2007).…”