Routines that ease the pain: The information world of a dialysis clinic

Patients with kidney failure who receive hemodialysis must spend 12 hours per week in a clinic setting to stay alive. We conducted an ethnographic study in a dialysis clinic in a Midwestern state that included 51 hours of observation and in-depth interviews with 9 clinic patients. Using Chatman's--Theory of Life in the Round", we examined how staff and patients in the dialysis clinic exchanged information about the disease. Information exchanged in this world was oriented towards making illness and treatment tolerable. Through immersion, staff and patients demonstrated how to live on dialysis, often with the aid of escapism and gentle banter. They also developed a taken-for-granted worldview marked by psychological acceptance and a local, everyday focus. This worldview was supported by the establishment and repetition of routines that reinforced the taken-for-granted quality of dialysis. Informational routines in the clinic also helped to convey this worldview, while systematically informing patients about how to live on dialysis. Patients generally stepped outside of this information world only if they received a kidney transplant, experienced a new health crisis, or came to distrust their health care providers. Implications for information behavior theory and clinic-based information services are discussed.