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Most prior research on stress and hemodialysis has focused on physical, psychological and staff-patient dimensions. Little research has been conducted on the correlates of stress experienced by dialysis patients in th~ context of the family. The purposes of this investigation were to operationalize 12 propositions from a model synthesizing 50 years of family stress research and to determine the applicability of the propositions for a population of in-center dialysis patients. The two dependent variables were family vulnerability to stress and family regenerative power. The independent variables were selected on the basis of the relative absence in the dialysis literature, and the applicability to dialysis patients and their families. A 41-item closed-ended interview schedule was designed by the investigator, analyzed for validity and reliability by a panel of experts, and pretested on a small group of dialysis patients. Six dialysis centers in Western Virginia participated in the investigation and 207 of a possible 215 patient interviews were completed. Pearson product-moment correlation coefficients were calculated for each of the relationships within the hypotheses. Four hypotheses received strong support: the greater the amount of crisis, the greater the vulnerability; the greater the family positional influence, the less the vulnerability; the greater the personal influence, the greater the vulnerability; and, the greater the marital adjustment, the greater the regenerative power. Four hypotheses received moderate support: the greater the positional influence, the lower the family regenerative power; the greater the anticipation socialization, the less the vulnerability; the greater the extended familism, the greater the regenerative power; and, the greater the regenerative power, the greater the family level of reorganization. Several additional correlations were reported which helped explain the findings related to the hypothesis testing. Methodological, theoretical and practical implications were discussed and recommendations for future research were made. / Ph. D.

Text in Afrikaans / Summaries in Afrikaans and English / Psigonefrologie behels die studie von psigologiese faktore wat 'n rot speel by eindstadiumnierversaking. Nierversaking word beskou as 'n lewensbedreigende siekte, wat die lewensverwogting von die pasient verkort indien hy nie behandeling ontvang nie. Nierversaking kan ingedeet word in drie stadiums: Die pre-dialise, diatise, en oorplantingstadiums. Die onderskeibaorheid von hierdie stadiums is die gevotg von verski lie in mediese behandelingsmetodes. Nie een hiervon bring genesing nie, maar vertig simptome van die uremiese sindroom, verleng die tewensverwagting von die pasient, en is veronderstel om sy lewenskwaliteit te verbeter. DepresS,ie en angs, is algemene simptome wat by nierpasiente voorkom. Die redes hiervoor, is die pasient se psigologiese reaksie teenoor nierversaking, dialise, en/of 'n oorplanting. Verder moet hy ook die newe-effekte van die mediese behandeling trotseer. Aanpassings moet ook gemaak word in terme von beroep~ en sosiate funksionering. Nie net het eindstodiumnierversaking 'n psigososiate impok op die nierposient nie, maar word die gesonde moat ook daardeur be"invtoed. Daarom ervoar meeste egpore gesamentlik die impok von nierversaking op hulle huwelik- en gesinslewe. Vir optimale oanpassing by nierversaking moet egpore sekere oanpassingstoke bemeester, soos om nierversoking as 'n gedeetde probteem te hanteer, oan te pas by die rot von pasient en versorger. die verskillende behoeftes oan nobyheid en afstand tussen pasient en versorger, en die verwisseting in beroepsrolle hanteer, asook effektiewe kommunikasie met mekoar en die mediese span doarstel, en mekaor deurlopend instrumenteel en emosioneel ondersteun ten einde die huweliksverbintenis in stand te hou. Die resultate von hierdie ondersoek dui doarop dat huweliksverondertikes, soos 'n afnome in ontsponningsaktiwiteite en seksuatiteit, en gelykmakende rolle 'n belangrike rot speel om oanpassing by nierversaking te vergemaklik. Daarmee soam is gevind dat godsdiens 'n belangrike oanpossende funksie vir egpore het. Deurgoans speel'n ondersteuningsisteem, wat uit famitie en vriende, onder nierpasiente, die mediese span en 'n sielkundige bestoan 'n vernome rol om die egpoar met oanpassing te help. Uiteindelik blyk dit moonttik te wees vir egpare om hulle huwetiksverhouding in stand te hou, of setfs konstruktief te herstruktureer, asook groter huwelikstevredenheid te ervoar, ondanks die bedreiging von eindstadiumnierversaking. Meeste egpore ervoar die moeilike tydperk dan ook met 'n verdieping in hulle huwelik- en geloofslewe. / Psychonephrology is the study of psychological factors which are evident in end-stage renal disease (ESRD). ESRD is regarded as a life-threatening disease, which shortens the life-expectancy of a patient if he does not receive treatment. ESRD can be divided into three stages: the pre-dialysis, dialysis and transplant stages. These stages are signified by differences in medical treatment methods. None of these leads to a cure but all alle.viate symptoms of the uremic syndrome, increase the life-expectancy of the patient and are supposed to improve his quality of life. Depression and anxiety are general symptoms found in end-stage renal patients. The reasons for this are the patient's psychological reaction to renal disease, dialysis and/or transplant. Patients must also endure the side effects of medical treatment. Adjustment in vocational and social functioning is also evident. ESRD not only has a psycho social impact on the patient but also affects the healthy spouse. This is why most married couples together experience the impact of ESRD in their marital and family life. For optimal adjustment to ESRD couples need to master certain adaptational tasks, such as treating ESRD as a shared problem, adopt the roles of patient and caregiver, manage the various needs of closeness and distance between patient and caregiver and change of career roles, as well as effectively communicating with each other and the medical team, and instrumentally and emotionally support eac~ other in order to maintain the marital bonds. The results of this investigation show that marital variables, such as a decrease in recreation and sexuality and role equality, are important to ease the adjustment to ESRD. It was also found that religion has an important adaptational function for the married couples. A support system of family, friends, other renal patients, the medical team and a psychologist are also important to aid the couples' adjustment. Lastly it should be possible for renal couples to maintain, or even to positively reconstruct their marital relationship, and to experience marital satisfaction in the face of the threat of ESRD. Apparently most couples experience this ordeal as a time of intensification of their married and spiritual life. / Psychology / D.Litt. et Phil. (Psychology)

Text in Afrikaans / Summaries in Afrikaans and English / Psigonefrologie behels die studie von psigologiese faktore wat 'n rot speel by eindstadiumnierversaking. Nierversaking word beskou as 'n lewensbedreigende siekte, wat die lewensverwogting von die pasient verkort indien hy nie behandeling ontvang nie. Nierversaking kan ingedeet word in drie stadiums: Die pre-dialise, diatise, en oorplantingstadiums. Die onderskeibaorheid von hierdie stadiums is die gevotg von verski lie in mediese behandelingsmetodes. Nie een hiervon bring genesing nie, maar vertig simptome van die uremiese sindroom, verleng die tewensverwagting von die pasient, en is veronderstel om sy lewenskwaliteit te verbeter. DepresS,ie en angs, is algemene simptome wat by nierpasiente voorkom. Die redes hiervoor, is die pasient se psigologiese reaksie teenoor nierversaking, dialise, en/of 'n oorplanting. Verder moet hy ook die newe-effekte van die mediese behandeling trotseer. Aanpassings moet ook gemaak word in terme von beroep~ en sosiate funksionering. Nie net het eindstodiumnierversaking 'n psigososiate impok op die nierposient nie, maar word die gesonde moat ook daardeur be"invtoed. Daarom ervoar meeste egpore gesamentlik die impok von nierversaking op hulle huwelik- en gesinslewe. Vir optimale oanpassing by nierversaking moet egpore sekere oanpassingstoke bemeester, soos om nierversoking as 'n gedeetde probteem te hanteer, oan te pas by die rot von pasient en versorger. die verskillende behoeftes oan nobyheid en afstand tussen pasient en versorger, en die verwisseting in beroepsrolle hanteer, asook effektiewe kommunikasie met mekoar en die mediese span doarstel, en mekaor deurlopend instrumenteel en emosioneel ondersteun ten einde die huweliksverbintenis in stand te hou. Die resultate von hierdie ondersoek dui doarop dat huweliksverondertikes, soos 'n afnome in ontsponningsaktiwiteite en seksuatiteit, en gelykmakende rolle 'n belangrike rot speel om oanpassing by nierversaking te vergemaklik. Daarmee soam is gevind dat godsdiens 'n belangrike oanpossende funksie vir egpore het. Deurgoans speel'n ondersteuningsisteem, wat uit famitie en vriende, onder nierpasiente, die mediese span en 'n sielkundige bestoan 'n vernome rol om die egpoar met oanpassing te help. Uiteindelik blyk dit moonttik te wees vir egpare om hulle huwetiksverhouding in stand te hou, of setfs konstruktief te herstruktureer, asook groter huwelikstevredenheid te ervoar, ondanks die bedreiging von eindstadiumnierversaking. Meeste egpore ervoar die moeilike tydperk dan ook met 'n verdieping in hulle huwelik- en geloofslewe. / Psychonephrology is the study of psychological factors which are evident in end-stage renal disease (ESRD). ESRD is regarded as a life-threatening disease, which shortens the life-expectancy of a patient if he does not receive treatment. ESRD can be divided into three stages: the pre-dialysis, dialysis and transplant stages. These stages are signified by differences in medical treatment methods. None of these leads to a cure but all alle.viate symptoms of the uremic syndrome, increase the life-expectancy of the patient and are supposed to improve his quality of life. Depression and anxiety are general symptoms found in end-stage renal patients. The reasons for this are the patient's psychological reaction to renal disease, dialysis and/or transplant. Patients must also endure the side effects of medical treatment. Adjustment in vocational and social functioning is also evident. ESRD not only has a psycho social impact on the patient but also affects the healthy spouse. This is why most married couples together experience the impact of ESRD in their marital and family life. For optimal adjustment to ESRD couples need to master certain adaptational tasks, such as treating ESRD as a shared problem, adopt the roles of patient and caregiver, manage the various needs of closeness and distance between patient and caregiver and change of career roles, as well as effectively communicating with each other and the medical team, and instrumentally and emotionally support eac~ other in order to maintain the marital bonds. The results of this investigation show that marital variables, such as a decrease in recreation and sexuality and role equality, are important to ease the adjustment to ESRD. It was also found that religion has an important adaptational function for the married couples. A support system of family, friends, other renal patients, the medical team and a psychologist are also important to aid the couples' adjustment. Lastly it should be possible for renal couples to maintain, or even to positively reconstruct their marital relationship, and to experience marital satisfaction in the face of the threat of ESRD. Apparently most couples experience this ordeal as a time of intensification of their married and spiritual life. / Psychology / D.Litt. et Phil. (Psychology)

The purpose of this study was to identify determinants of compliance behavior. Since compliance among dialysis patients increases survival rate, it is important for social workers to identify patients who are at risk of noncompliance.

The purpose of a study of spirituality and its relationship to the compliance of hemodialysis patients is to consider changing the approach of the treatment team in the dialysis setting. The interdisciplinary treatment team at the dialysis center consists of physicians, nurses, dietitians, and social workers. One of the many roles of the dialysis social worker is to facilitate the adjustment to and acceptance of the patient's need for dialysis.