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This study assessed the psychological problems associated with hemodialysis and included an investigation of the differences and similarities between (1) dialysis patients' and medical staff's perceptions of patients' problems, and (2) the problems of hemodialysis patients and spinal cord injury patients. Data were collected from 31 adult hemodialysis patients, 34 dialysis medical staff and 32 spinal cord injury patients at the Miami, Florida Veterans Administration Medical Center. The scaling technique of magnitude estimation was used to measure patients' and staff's perceptions of the relative seriousness of various illness-related problems. Depression and anxiety in hemodialysis patients and spinal cord injury patients were measured by standardized self-report inventories. Among the most significant findings were that: (1) Dialysis patients judged problems concerning lifestyle changes (e.g., inability to travel and work) and loss of body function (e.g., reduced levels of physical activity) to be more serious or emotionally distressing than other problems they experienced. (2) Dialysis patients and medical staff differed significantly in their perceptions of the seriousness of most problems associated with hemodialysis; moreover, there was less agreement between patients and physicians than between patients and other types of staff (e.g., nurses and technicians). (3) There were no significant differences between dialysis patients and spinal cord injury patients in their scaled problem judgments. (4) Depression in hemodialysis patients and spinal cord injury patients was greater than for the general population, with the majority of both patient groups meeting criteria for diagnosis of clinical depression. In addition, although dialysis patients and spinal cord injury patients did not differ significantly in their total mean depression scores, dialysis patients endorsed somatic components of depression more frequently and/or with greater intensity than spinal cord injury patients did. (5) Anxiety in dialysis patients was not greater than for the general population and was significantly less than for spinal cord injury patients. (6) Depression and anxiety were positively related to most problems for hemodialysis patients, while anxiety, but not depression, was significantly associated with most problems for spinal cord injury patients. A major contribution of this study is the comparison, for the first time, of patients' and medical staff's scaled problem judgments.

This study examines the relationships between three aspects of adjustment to hemodialysis (i.e. activity levels, mood states and severity of symptoms) and four demographic variables (i.e. age, occupation, education and length of time on dialysis). The sample consisted of 37 patients on hemodialysis. Activity levels, mood states and severity of symptoms were measured by the activity inventory, profile of mood states and symptom questionnaire, respectively. A personal history questionnaire was employed to assess the demographic variables. The data was analyzed using the Pearson Product-Moment Correlation Method with a one-tailed test of significance. Activity levels were found to be negatively correlated with age at a statistically significant level, but were not significantly correlated with occupation, education or length of time on dialysis. Total mood disturbance was not significantly correlated with any of the demographic variables. Total severity of symptoms were negatively correlated with education at a statistically significant level, but no significant correlations were discovered between this aspect of adjustment and the other demographic variables. A few supplemental findings were also deemed important. Total severity of symptoms were both negatively correlated with activity levels and positively correlated with mood states at statistically significant levels. However, mood states and activity levels were not significantly correlated. Finally, a significant positive correlation was found between education and occupational level. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

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Thesis (MA (Psychology))--University of Stellenbosch, 2005. / The first objective of the present study was to determine whether the Theory of Planned Behaviour (TPB) could predict dietary and fluid adherence among in-centre hemodialysis patients attending government hospitals in the Western Cape.

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This descriptive, correlational designed study was concerned with noncompliance with therapeutic regimens, a pervasive clinical problem which is confounded with the lack of a strong link among theory, research and practice. The focus was on one of the constructs included the Reciprocal Interaction Model of Compliance Behaviors, which was derived using a modified grounded theory methodology and following various theory building prescriptions. The overall purpose was to begin to evaluate the goodness-of-fit of this empirically, qualitatively and retroductively generated explanation of compliance behaviors. The specific aims were to develop, refine and test a 6-point response, 64-item Likert-type instrument, Olivas' Health Motivation Scale - OHMS, that adequately measures the construct, Health Motivation: the force within the patient which is developed as he/she gains experience with his/her illness as a function of time. It has two major dimensions: expectations and values. Health Motivation as indexed by an expectations/values interaction was predicted to impact compliance as measured by dietary and medication measures, both objective and subjective estimates. Using trait and nomological construct perspectives, the OHMS was systematically evaluated by internal and external association criteria and therefore validity and reliability estimates, with a purposive sample of 84 heterogeneous hemodialysis patients who represented two cultures (Anglo and Hispanic), varying in gender, age and length in hemodialysis. Internal consistency reliability and trait construct validity were derived through Cronbach's alpha and principal components factor analysis. Refined OHMS Scales had alphas and thetas ranging from .58 to .89. Explained scale variance ranged from .54 to .84. Epistemic coefficients, the validity links between concept and operational measures, ranged from .76 to .94. Internal validity of the design, estimated through multiple regression, was concluded to be satisfactory. External association assessment via multiple regression produced mixed findings. Select expectations, in linear combination with select values, explained varying degrees of the variance, in select compliance measures, R² = .11 to .44. Through empirical modeling via path analysis, select subject characteristics (ethnicity, length on dialysis, age) were found to have direct or indirect relationships with compliance. Theory, research, and practice based limitations and recommendations were made from the results of the study. (Abstract shortened with permission of author.)

M.A. / Modern health-care services in general hospital settings are often characterised by mUltidisciplinary and interdisciplinary approaches to patient care. The underlying rationale of these approaches lies in the potential pooling of specialised medical resources from a variety of medical fields. Consequently there is usually an increase in the diagnostic procedures available, theoretically offering a more comprehensive health service. Whilst the above approach is seen to be effective when the health-car~ team specialists subscribe to one encompassing paradigm, it is hypothesised that the existence of other alternative paradigms may affect the efficacy of team work. Using the interface between the Psychology and Renal units of J.G. Strijdom Hospital as an example, this study describes the effect of paradigmatic differences within a team approach on the conceptualisation of problems and treatment choices. The traditional medical approach is contrasted against a systems based psychological approach. The existence of the two approaches within a single team encounters difficulty in the gaining of consensus regarding the level of focus.

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The purpose of this study was to evaluate certain factors that affect the quality of life experienced by the chronic hemodialysis patient population served by the Artificial Kidney Unit at Good Samaritan Hospital and Medical Center, Portland, Oregon. The intent of the study was to discover if there was a significant difference in quality of life between patients who dialyzed at home and patients at the Artificial Kidney Unit (center patients). For the purposes of this study, House, Livingston and Swinburn’s definition of quality of life was used. Their definition states that quality of life is a function of the perceived conditions affecting a selected population and the subjective attitude toward those conditions held by persons in that population. The perceived conditions with which this study is concerned are: activities of daily living, work and finances, physical condition, emotional state, supportive relationships, spiritual aspects, and choices in life. The patients’ perceptions of themselves in relation to each of these areas constitutes their subjective attitudes about them.