For kidney patients there are fundamental existential dilemmas around life and death, free will and determinism and the phenomenological challenges of making sense of one’s world.
Systemically, patients have to accept being cared for and told what is best for them by staff on the Renal Unit. There is a whole process of adjustment for patients and their families relating to personal and social loss. Equally, staff on the Unit have their own experiences of loss, expectations and Unit culture. Attitudes of both patients, carers and staff can be moulded around these underlying issues of loss and control.

Personal history, one’s life-story or narrative, formulates one’s sense of ‘ self ’ one’s identity. It is well known that groups can reflect family experiences but in the renal world the family ‘carer’ may become the ‘patient’, the ‘adventurer’ may be constrained and the ‘optimistic’ nurse may become ‘disillusioned’ as all efforts to ‘ care’ are resisted by certain patients.
The experience of loss relates to a redefinition of one’s self and one’s expectations and hopes.
Grieving is generally viewed as a process, where the shock, sadness and sense of helplessness/frustration mellows and plateaux over time. It would seem that this can be true of established dialysis patients but, equally, the above issues can be re-invoked, for example, a patient may be unable to continue work on health grounds or suffer a series of medical complications. Psychological and social support at any time in the process can be both affirming and empowering