Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Patricia A. Roth, EdD, RN, Chair; Mary Jo Clark, PhD, RN; Marry Rose Mueller, PhD, RN


End-stage Renal Disease, Grounded theory, Hemodialysis, nursing, Socio-cultural context, Thai


The purpose of the study was to explore how Thai end-stage renal disease (ESRD) patients manage the challenges of living with hemodialysis. The participants were Thai ESRD patients, who were receiving hemodialysis in one of the central provinces in Thailand. A grounded theory approach was employed in this study as it focuses on social processes grounded in individual experiences of participants in the study. The participants included 30 ESRD patients, aged 26-75, who had been undergoing hemodialysis from 6 months to 12 years. Individual in-depth interviews were audio-recorded and transcribed. Data were analyzed by using Atlas.ti. Data analysis revealed "a path through an unknown world" as a central perspective that represented a holistic view of how Thai ESRD patients experienced their illness. Participants' experiences started by "entering the unknown world" as the context of this study. The "loss of a normal life" including sub-themes of emotional upheaval, changes in life styles, and financial insecurity" reflected causal conditions. "Tamjai: Coming to terms" served as a salient process. The strategies used to cope with their illness under their socio-cultural circumstances consisted of accepting the reality, adjusting their lifestyles, and overcoming financial struggles. "Life goes on" described the consequences of living with ESRD that included having sense of normalcy, attaining self-worth, and ongoing struggles. These findings provide an insight into how the participants were dealing with the illness within a socio-cultural context and the limitations of the health care system in Thailand.

Document Type

Dissertation: Open Access



Included in

Nursing Commons