Adjustment to End Stage Renal Failure (ESRF) has been the topic of a vast number of studies, however a clear picture of adjustment and the process of adjustment has yet to emerge. The purpose of this Grounded Theory study was to investigate the conceptualisations of adjustment of patients with ESRF. A sample of ten subjects with ESRF were interviewed, five of which had been receiving treatment for ESRF for six weeks and five for twelve months. In addition, six of the patients' partners/relatives and three home dialysis nursing staff, involved in their care, were also interviewed. The findings of this study indicated that they key process in adjustment was 'Taking on board a new approach to being and living'. This process involved participants accepting their illness at a cognitive and affective level, in addition to integrating illness into their identity. Four other processes subsumed under the above key process, namely, Getting back to life, Making adaptations to accommodate illness and treatment, Coping skills and Experiencing losses. These encapsulated the social, emotional, behavioural and cognitive facets of adjustment. Implications for theory, health care practice and future research are discussed.