Problems experienced by haemodialysis patients in Greece L Kaba, P Bellou, P Iordanou, S Andrea, E Kyritsi, G Gerogianni, S Zetta, V Swigart Abstract Even though Greece has a disproportionate number of haemodialysis stations for the treatment of end-stage renal disease (ESRD), and a rapidly raising number of patients on dialysis, there has been no study of the lived experience of haemodialysis treatment in Greece. ESRD and dialysis drastically impact patients' everyday life, therefore expectations and desires play a major role in adapting to alterations and restrictions. An understanding of these culturally-influenced expectations and desires is essential for the delivery of holistic nursing care. This study aimed to explore how Greek patients receiving long- term haemodialysis perceived their problems and to describe the impact of haemodialysis on their lives. Using a grounded theory approach, 23 patients with ESRD receiving haemodialysis were purposively recruited from two hospital dialysis centres in Athens, Greece. Data were collected during 2006 by personal interviews. Given a distinctive patient experience of haemodialysis, some insight into their common concerns can facilitate provision of healthcare services that adequately meets their needs. By developing an understanding of the experience of renal iUness and therapy for a group of people using dialysis, this study was intended as a contribution towards enabling healthcare professionals to provide more effective support to people who are Uving with this chronic condition. Key words: Grounded theory • Haemodialysis • Interview • Life situation • Qualitative research 7he use of haemodialysis to prolong the lives of patients with end-stage renal disease (ESRD) has become a common application of biomedical technology in developed countries. In Greece the number of ESRD patients using haemodialysis has increased approximately 7% each year over the last 10 years (Kaitelidou et al, 2004).This progressive, debilitating chronic Evridiki Kaba is Scientific Fellow, Department of Nursing, Technological and Educational Institute of Lamia, Greece; Panagiota Bellou is Professor; Panagiota Iordanou is Assistant Professor in Nursing A Department; Stavroula Andrea is Associate Professor in Nursing B Department; Eleni Kyritsi is Professor in Nursing A Department; Georgia Gerogianni is Scientific Fellow in NursingA Department,Technological and Educational Institute of Athens, Greece; Stella Zetta is PhD student. University of Dundee, Scotland, UK; andValerie Swigart is Assistant Professor of Nursing, Shool of Nursing, University of Pittsburgh, Pennsylvania, United States Accepted for publication: July 2001 illness requires intensive nursing and medical interventions in addition to dialysis. Quantitative research, using primarily American, Scandinavian or European subjects, has documented the impact of ESRD and dialysis on quality of life, functional status, independence, general wellbeing, personal relationships and social functioning (Lok, 1996; Fallon et al, 1997; Blake et al, 1999; Suet-Ching, 2001; Bakewell et al, 2002). Qualitative research studies have provided an early understanding of the impact of being dependent on a machine for life, having strict dietary and fluid restrictions and spending considerable time on treatment (Polaschek, 2003). Due to the impact that BSRD and dialysis have on the patient's everyday life, expectations and desires for everyday life play a major role in adapting to alterations and restrictions. An understanding of these culturally-influenced expectations and desires is essential for the delivery of holistic nursing care. In-depth interview and systematic analysis of patients' reports of their experiences living with ESRD and dialysis can provide the base for delivering culturally-sensitive hohstic nursing care. Background and aims Patients with ESRD have to receive dialysis therapy routinely for survival. These patients not only face treatment-related stressors, but also have to deal with changes in their concept of self and self-confidence, reversal in family roles, and loss of dignity (Lubkin, 1998).The disease not only affects body image, diet and quality oflife (Lok, 1996; Mok and Tam, 2001; Welch and Austin, 2001), it also has an important influence on physical and psychological functioning and wellbeing (Lazarus and Folkman, 1984). Although there is a large body of evidence addressing the wellbeing of people with ESRD, few studies have sought to understand the lived experience of prolonged dialysis treatment. Polaschek (2003) investigated the experience of New Zealand patients who were using home dialysis. Hagren et al (2001, 2005) interviewed Swedish ESRD patients and identified the existing struggle imposed by prolonged haemodialysis treatment, including the negative impact of life restrictions and use of time. Dekker et al (2005) described the moral challenges of living with ESRD for Dutch patients, and Lin et al (2005) explored the process of decision-making regarding haemodialysis for 12 Taiwanese individuals. Only the latter study actively considered the impact of culture and the haemodialysis experience. Even Greece has a disproportionate number ofhaemodialysis stations for the treatment of ESRD, and a rapidly rising 868 British Journal of Nursing, 2007. Vol 16, No 14