Thesis (M.Sc.), Memorial University of Newfoundland, Faculty of Medicine, 1998. / Restricted until June 1999. Bibliography: leaves 123-133.

Thesis (M.S.W.)--University of Hong Kong, 1982.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Medicine / Master / Doctor of Medicine

People living with renal failure experience enormous challenges, yet very little is known about life with this disease. The goal of this research was to gain an integrated understanding of the lives of people with renal failure. An understanding of life with renal failure that includes cultural, institutional and historical contexts may provide health care practitioners with the kind of information and insights necessary to improve medical practice. Thus far, medical practice has been based on a biomedical model of care that focuses almost exclusively on the physical aspects of illness. From this perspective, people with kidney disease are seen as autonomous and rational individuals. In this research, a sociocultural multiple case study approach was utilized in order to gain a situated understanding of life for four people with renal disease. This research revealed that life with renal failure is work. While it is the people living with renal failure who do the bulk of the work, friends and family also work to "live" with renal disease. Participants and their significant others learn about and become experts on life with this disease. A gap was found between practitioners' understanding of disease and participants' lived experience — resulting in many negative repercussions. Medical-based knowledge is lacking because it does not consider the three relevant sources of knowledge: practitioners, participants and participants' significant others. This research argues for a bridge between the home world and the hospital world, so that a broader community of practice is created. An account of the lived experience of people with renal failure that includes these factors can inform "best practice" because it provides a richer and more authentic picture of life with this illness. It is from this perspective that health care practitioners can begin to broaden their understanding of renal failure as it is "lived", and, so informed, can better provide the kinds of education and support that will enhance the lives of people with this illness.

INTRODUCTION AND AIM: Chronic renal failure patients are confronted with many challenges and often express feelings of being a burden to their families. Since the inception of haemodialysis in 1913, limited research has been conducted to explore the coping behaviours of the families of haemodialysed patients, especially in the South African context. The family’s inability to cope with the condition and treatment, may impact on their wellness as well as that of the family member on haemodialysis. In light of the limited research available on the coping behaviours of families of haemodialysed patients, this study set out to describe the coping behaviours using the mixed method. RESEARCH DESIGN AND METHOD: The study followed an explanatory mixed method approach with sequential design and was divided into two phases. Phase one addressed the first objective in identifying and describing the coping behaviours of the families using the Family Crisis Orientated Personal Scale (F–COPES) developed by McCubbin, Larsen and Olson. During phase two, the researcher conducted interviews to explore the coping behaviour identified in phase one. RESULTS: The mean scores of the subscales of the F–COPES scale ranged from 3.05 to 4.16 with reliability indices found to be within the normal range. The average mean score for the subscale “seeking spiritual support” measured highest at 4.16, followed by “mobilising the family to acquire and accept help” (M=3.94). “Acquiring social support” measured lowest at 3.05. Four categories emanated from the thematic analysis of the data from the second phase namely, challenges, coordinated care, support structures and beliefs about disease. CONCLUSION: The subscales “seeking spiritual support, mobilising the family to acquire and accept help, reframing and acquiring social support” showed concordance with the categories derived from the qualitative data analysis. Supporting evidence for “passive appraisal” as a sub–scale from the first phase and “challenges” as a category from the second phase could not be found. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

INTRODUCTION AND AIM: Chronic renal failure patients are confronted with many challenges and often express feelings of being a burden to their families. Since the inception of haemodialysis in 1913, limited research has been conducted to explore the coping behaviours of the families of haemodialysed patients, especially in the South African context. The family’s inability to cope with the condition and treatment, may impact on their wellness as well as that of the family member on haemodialysis. In light of the limited research available on the coping behaviours of families of haemodialysed patients, this study set out to describe the coping behaviours using the mixed method. RESEARCH DESIGN AND METHOD: The study followed an explanatory mixed method approach with sequential design and was divided into two phases. Phase one addressed the first objective in identifying and describing the coping behaviours of the families using the Family Crisis Orientated Personal Scale (F–COPES) developed by McCubbin, Larsen and Olson. During phase two, the researcher conducted interviews to explore the coping behaviour identified in phase one. RESULTS: The mean scores of the subscales of the F–COPES scale ranged from 3.05 to 4.16 with reliability indices found to be within the normal range. The average mean score for the subscale “seeking spiritual support” measured highest at 4.16, followed by “mobilising the family to acquire and accept help” (M=3.94). “Acquiring social support” measured lowest at 3.05. Four categories emanated from the thematic analysis of the data from the second phase namely, challenges, coordinated care, support structures and beliefs about disease. CONCLUSION: The subscales “seeking spiritual support, mobilising the family to acquire and accept help, reframing and acquiring social support” showed concordance with the categories derived from the qualitative data analysis. Supporting evidence for “passive appraisal” as a sub–scale from the first phase and “challenges” as a category from the second phase could not be found. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

The possibility that changes in membrane transport systems may contribute to the pathophysiology of the uraeraic syndrome has not been extensively studied. This thesis presents a study of eight erythrocyte membrane transport systems, namely the Na/K pump, the amino acid systems y⁺, ASC, gly, L and T, the nucleoside and choline transporters. The results indicate that, compared to normal controls, K⁺ flux through the Na/K pump was reduced in chronic renal failure patients (CRF), on haemodialysis (HD), and on continuous ambulatory peritoneal dialysis (CAPD), but was normal in functional transplant (FT) patients' erythrocytes. The number of Na/K pumps per erythrocyte was decreased in CRF and CAPD but showed no differences between HD, FT and Normal controls. The mean turnover rate per pump site was reduced in patients on HD, whereas other groups were not significantly different from controls. Cross-incubation experiments suggest that the lowered pump flux seen in the HD group was due to plasma factors since reversibility of the defect was achieved when those cells were incubated in normal plasma. The defect was completely reversed with a successful transplant. Erythrocytes from haemodialysis patients exhibited an increased uptake of L-lysine through the y⁺ system. The uptake of L-serine was decreased and the affinity of the ASC system for L-serine was increased in these patients compared with controls. The glycine transporter showed a significant increase in affinity for glycine. The flux of L-leucine and L-tryptophan showed no differences from control cells. Erythrocyte membrane transport of uridine was similar in normal control cells and in those obtained from uraemic patients. Choline influx rates were significantly increased and affinity of the transporter for choline reduced in dialysis patients' erythrocytes. Renal transplant and CRF patients showed variable influx rates which gave a significant negative correlation with creatinine clearance. These results show that there are selective abnormalities in some membrane transport system of the erythrocyte in patients with renal failure. The mechanism and possible significance of these changes are discussed.

Thesis (Ph. D.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains xvi, 184 p. : ill. Vita. Includes abstract. Includes bibliographical references.

Thesis (M.S.W.)--University of Hong Kong, 1982. / Also available in print.