The attachments and relations of dialysis patients: rediscovering embodied relational chaplaining

Kidney disease is a chronic illness that presents its patients with numerous challenges. The challenges include physiological, psychological, emotional, and spiritual elements. Under the surface of dialysis patients’ illnesses are what some call ‘unsayable needs’ (Schick Makaroff, 2013); day-to-day complex, but sometimes recognisable, issues. Unfortunately, most hospital chaplains have little or no knowledge of what dialysis patients go through and how to support them. This study explored how an understanding of these patients’ significant relations and attachments might enable chaplains to respond to their spiritual and religious needs.

This thesis presents ethnographic professional qualitative research that is discovery-oriented and intentionally reflexive. The philosophical and theoretical underpinnings of the study were social constructionism and attachment theory. A combination of different but complementary qualitative data collection methods was employed. These include journaling, observation, shadowing, semi-structured interviews, and the chaplain’s pastoral conversations recorded as verbatim accounts.

The rigorous analysis of the data revealed three core themes: 1. reminiscing about the past; 2. inhabiting the present; and 3. hoping for the future. Participants’ engagement and management of ruptures and disturbances in their attachments and relations highlighted the complex, ambiguous, and ambivalent nature of spirituality and the spiritual and religious needs, and care, within chronic illness such as kidney failure.

The findings stand in contrast to the conventional and widely accepted premise in the vast majority of research that spirituality is an innate or essential human trait that can be described in terms of identifiable needs that can be met by specific strategies employed by professionals. An alternative, but in some ways rather long-established, approach to conceptualising spirituality and spiritual and religious care in healthcare settings was offered; an embodied mutuality and dynamic co-creation of need and care and incarnational relationality between the chaplain and patients, which serve as an end in themselves.