The Concerns of Pakeha Men Living on Home Haemodialysis: a Critical Interpretive Study

Abstract

This nursing study seeks to understand the experience of one group of people with chronic renal failure using renal replacement therapy, Pakeha men living on home haemodialysis. It is based on the assumptions that people living on dialysis have distinctive experiences that are characterized by common concerns reflecting their shared position as subjects of renal illness and therapy, but that these are not easy to discern because they are obscured by the professional viewpoint that is dominant in the renal setting. In order to understand the experience of people living on dialysis this study develops a critical interpretive approach, seeking the participant's own interpretation of their individual experiences, but then reinterpreting them from a critical standpoint, recognizing that they can only be adequately understood by contextualizing them, in order to discern the common perspective underlying them in contrast to the dominant professional viewpoint in the renal setting. Using some ideas derived from the thought of Michel Foucault this study develops a critical nursing view of the renal setting, as a specialized healthcare context that is constituted by several interrelated discourses, primarily the dominant professional discourse, but also by several other discourses, in particular a client discourse that is a response to the dominant discourse. The different discourses reflect contrasting perspectives based on the different positions of various groups within the renal context. The study presents accounts, derived from interviews, of the experience of six Pakeha men living on home haemodialysis. Reflecting on these accounts as a set, by contextualizing them in terms of the critical nursing view of the renal setting, I outline four concerns of Pakeha men living on home haemodialysis. Together these make up the renal client discourse that models the distinctive perspective from their position within the renal context, underlying each of their individual accounts of their experience of illness and therapy. These concerns include symptoms from chronic renal failure and dialysis, limitations resulting from the negotiation of the therapeutic regime into their lifestyle, their sense of ongoingness and uncertainty of living on dialysis, and the altered interrelationship between autonomy and dependence inherent in living on dialysis. The study suggests that the individual accounts can be understood as resulting from the interaction of the various dimensions of their own personal social locations, including their gender and ethnicity, with the concerns of client discourse, reflecting their common position as people living on dialysis. One important implication of this understanding is that the role of nursing in the renal setting can be articulated as a response to the experience of the person living on dialysis. The nurse can support the renal client in seeking to integrate the requirements of the therapeutic regime, reflecting the dominant discourse, into their personal situation, reflecting the interaction of their own personal location with their position as a person living on dialysis, outlined in the client discourse.