From silence to storm – patient illness trajectory from diabetes diagnosis to haemodialysis in Taiwan: a qualitative study of patients' perceptions


  • I-Chen Yu RN MSN,

    Instructor, Doctoral Student
    1. School of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
    2. Graduate Institute of Clinical Medical, Chang Gung University, Tao-Yuan, Taiwan
    Search for more papers by this author
  • Yun-Fang Tsai PhD RN

    Chair and Professor, Consultant, Corresponding author
    1. School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
    2. Department of Nursing, Chang Gung Memorial Hospital in Keelung, Keelung, Taiwan
    • School of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
    Search for more papers by this author

Correspondence to Y.-F. Tsai:e-mail:



This article is a report of a study that explored the perceptions of patients as they experienced their diabetes illness trajectory, and their initial decisions to undergo dialysis, in an effort to provide further complementary guidance for nurses and healthcare practitioners.


Diabetes leads to higher morbidity and mortality when patients develop renal failure resulting from diabetic nephropathy. An effective self-care regimen and multidisciplinary team approach are required to avoid or delay the serious chronic complications of the disease. Patients and healthcare practitioners must be aware therefore of psycho-physiological adjustment when seeking to delay the onset of complications.


A qualitative design was used for data collection through semi-structured interviews.


Data were analysed using content analysis. Participants were 25 diabetes patients undergoing initial haemodialysis who were recruited from diabetes and nephrology wards at a medical centre in northern Taiwan. Data were collected from December 2010–August 2011.


The core theme describing the illness trajectory derived from face-to-face interviews with people undergoing hemodialysis was ‘from silence to storm’. There emerged also five phases of patient experience that resulted from the development of diabetic nephropathy: (1) diabetes onset stage; (2) stable stage; (3) burden stage; (4) shock stage; and (5) coping stage.


Patients suffer with diabetic nephropathy for a long-term period. Our findings may enhance the understanding of nurses regarding the experiences of patients with diabetic nephropathy, and will help them provide diabetes care that promotes healthy life for those individuals.