This thesis describes coping in pacients with chronic musculoskeletal pain. It focuses especially on the cognitive evaluation of pain and coping strategies. Furthermore it deals with the emotional changes in chronic pain. The theoretical part consists of the development of access to pain and the overview of some current knowledge of biological and psychosocial determinant of pain. Emphasis is placed on a holistic, biopsychosocial approach to the issue. Empirical part consists of research aimed at assesing the important factors that contribute to cope life with pain, as in terms of personal dispositions of an individual, so in terms of environmental influence. The main aim of the research is to identity the most used coping strategies and to assess their effectiveness. Keywords: chronic disease, chronic pain, coping resources, coping strategies

O envelhecimento populacional vem sendo alvo de atenção no Brasil, uma vez que está ocorrendo um aumento significativo do número de idosos na população. Observa-se que juntamente com essa transição demográfica, ocorre a transição epidemiológica. A preocupação com doenças infecto-contagiosas perde lugar para a alta prevalência das doenças crônicas não-transmissíveis, e a população idosa é a mais acometida por essas doenças. Nesta situação, a família desempenha um papel fundamental na manutenção e controle da doença de seus membros, pois cabe a ela arcar com a continuidade do cuidado ao indivíduo no seu processo de viver. Assim, o estudo tem como objetivo construir um modelo conceitual de cuidado familiar ao idoso com condição crônica, com base nos significados construídos nas interações sociais, identificando, deste modo, como a família vivencia o processo de cuidar do idoso com condição crônica e interpretando os significados do cuidado familiar à este idoso. Utilizou-se como referencial metodológico a Teoria Fundamentada nos Dados e o referencial teórico do Interacionismo Simbólico. Participaram da pesquisa oito famílias de idosos com doença crônica não-transmissível. As famílias foram selecionadas a partir da Equipe de Saúde da Família 15 do município de Maringá-PR, sendo as mesmas acompanhadas no período de agosto de 2005 a maio de 2006. Para o desenvolvimento da pesquisa, utilizou-se como técnica de coleta de dados a observação participante, entrevistas e análise de documentos, realizadas nos domicílios das famílias. A participação em diferentes momentos da vida das famílias e seus membros idosos, bem como os depoimentos permitiram compreender a vivência do cuidado ao idoso com doença crônica, expressa através de conceitos desenvolvidos em três processos: A identificação da doença crônica do idoso, A convivência com a cronicidade da doença do idoso e Os serviços de saúde na vida das famílias. O primeiro processo é constituído por quatro categorias analíticas, sendo estas: A vivência das dificuldades na fase aguda da doença; O processo de adaptação; O reconhecimento da cronicidade da doença; e A perspectiva do futuro incerto. O segundo processo também é composto por quatro categorias: A presença do idoso independente na família; A vivência do cuidado ao idoso dependente; Estratégias utilizadas no cuidado do idoso; e Perceber-se vulnerável. O terceiro processo é formado por uma categoria analítica: O serviço público de saúde no cuidado ao idoso. A organização desse modelo teórico revelou que, na construção de significados sobre o viver e envelhecer com a presença da doença crônica, a capacidade funcional do idoso é um fator significativo e determinante no processo de cuidar e ser cuidado. / The population aging has turned into the target of attention in Brazil, since a significant increase of the number of the senior citizens is going on. It is observed that while the demographic transition happens, there is also the epidemiological transition. The concern with contagious diseases loses its position to the high prevalence of non-transmissible chronic diseases, and the elderly population is the most affected by those diseases. In this situation, the family has a fundamental role in the maintenance and control of the disease of its members, for it is the family duty to continue caring for the individual in the living process. Therefore, the present study aims to build a conceptual model of the care of the family towards the aged person in chronic condition, based on the meanings built in the social interactions, identifying, this way, how the family lives the process of caring for the elderly with chronic condition and interpreting the meanings of care of the family towards the elder. As a methodological reference the Grounded Theory and the theoretical reference of the Symbolic Interactionism were used. Eight families of senior people with non-transmissible chronic disease participated of the research. The families were selected through the Family Health Team 15 in Maringá, and they were followed from August 2005 through May 2006. For the evolution of the investigation, participant observation, interviews and documents analysis in the families\' residences were used as data gathering. The participation in different moments of the families and their seniors\' life, and also their testimonies permitted to understand the experience of caring for the elder with chronic disease, expressed through developed concepts in three processes: Identifying the chronic disease, Living with the chronicity of the disease and the Health services in the families\' life. The first process is constituted by four analytical categories. They are: Living the difficulties in the acute phase of the disease; The adjustment process; The recognition of the chronicity of the disease; and The perspective of an uncertain future. The second process is also formed by four categories: The presence of the independent aged in the family; The living of the care towards the dependent aged; Strategies used on the caring of the elder; and Perceiving oneself as vulnerable. The third process is formed by an analytical category: The health public service towards the caring for the elder. The organization of this theoretical model revealed that, in the construction of meanings about living and aging with the presence of a chronic disease, the capacity of the elder is a significant factor and it is determinant in the caring and being cared process.

Objective: P300/CBP Associated Factor (PCAF) is a histone acetyltransferase, and has been reported to interact with nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) and to stimulate cyclooxygenase-2 (COX-2) transcriptional activation. The aim of this study was to determine the role of PCAF in chronic pain modulation. / Method: In an in vitro experiment, PCAF small-interfering RNA (siRNA) was used to knock down PCAF. Interleukin-1 β (IL1β) was applied as COX-2 inducer in SK-N-SH neuroblastoma cells. Luciferase assay and chromatin immunoprecipitation (ChIP) were performed regarding COX-2 promoter region. / In an in vivo experiment, PCAF was examined for its distribution in dorsal horn of Spraque-Dawley rats. COX-2 level in the spinal cord was determined after inhibition of PCAF in rats with Complete Freund's Adjuvant (CFA)-induced pain. ChIP was also performed. / Finally, we tested whether genetic variations in the PCAF gene affected the risk of chronic pain in a gene association study of 267 surgical patients. The associations of pain with genotypes (58 single nucleotide polymorphisms, SNPs)/haplotypes were analyzed by χ² and Fisher exact tests. / Results: Knock-down of PCAF reduced COX-2 level and NF-κB activity. PCAF and acetylated histone 3 lysine 14 (H3K14) were enriched at COX-2 promoter when IL1β was applied. / PCAF was expressed in neurons at superficial layers of rat dorsal horn. In the in vivo experiment, COX-2 was reduced with the inhibition of PCAF in CFA rats. PCAF was enhanced at COX-2 promoter when CFA was injected. Anacardic acid and PCAF siRNA significantly alleviated thermal nociception and mechanical allodynia. / In the gene association study, 6 SNPs and 5 haplotypes were significantly associated with higher risk of severe chronic postsurgical pain. Multivariable analysis showed that patients with a SNP rs6763504 had a higher risk of developing severe chronic postsurgical pain (p = 0.001). / Conclusion: PCAF regulated COX-2 transcription and reduction or inhibition in PCAF resulted in a decrease in COX-2 and less chronic inflammatory pain. Genetic variations in the PCAF gene increased risk of severe chronic post-surgical pain in patients. / 實驗目的：P300/CBP相關蛋白（PCAF）是一種組蛋白乙酰化轉移酶。這種蛋白已被報道可以和核因子活化B細胞κ輕鏈增強子(NF-κB)相互作用，以及增進環氧合酶-2（COX-2）的轉錄激活。本實驗的目的在於研究PCAF在疼痛調節中的作用。 / 實驗方法：在細胞實驗中，我們使用了小干擾RNA（siRNA）來降低PCAF的含量。同時我們使用了白細胞介素-1β（IL1β）來作為SK-N-SH神經母細胞瘤細胞中COX-2的誘導劑。我們使用了熒光素酶試劑和染色質免疫沉澱來研究COX-2啟動子區域。 / 在體內實驗中，我們檢測了PCAF在大鼠脊椎背角部位的分佈。在弗氏完全佐劑（CFA）致痛的大鼠模型中，我們在PCAF抑制的情況下檢測脊髓中COX-2的水平。我們還進行了染色質免疫沉澱。 / 最後，在招募了267位手術患者的基因關聯試驗中，我們對PCAF基因中的基因變異對慢性疼痛風險的影響進行了分析。我們運用卡方檢驗和費雪精確性檢驗對疼痛與基因型（58個單核苷酸多態性）和單倍型的關係進行分析。 / 實驗結果：減少的PCAF降低了COX-2的水平以及NF-κB的活性。當添加了IL1β時PCAF和乙酰化第三組蛋白14號賴胺酸（H3K14）在COX-2啟動子處富集。 / PCAF在大鼠脊椎背角部位的淺表層（第一層和第二層）的神經細胞里表達。在動物實驗中，注射了CFA的大鼠顯示COX-2會隨著PCAF的抑制而下降。大鼠注射了CFA后PCAF在COX-2啟動子處有所增加。漆樹酸和PCAF siRNA顯著地減輕了熱痛和機械痛提高了機械痛閾值。 / 在該基因關聯試驗中，我們鑒定出六個單核苷酸多態性和五種單倍型與較高風險的嚴重術後慢性痛有顯著的相關性。多元回歸分析表明在PCAF基因上具有rs6763504遺傳變異的病人在術後發展嚴重慢性痛的幾率會較高(p = 0.001)。 / 結論：PCAF調節COX-2的轉錄，而且PCAF的減少或者抑制導致了COX-2的降低同時慢性炎症痛的減少。PCAF基因上的遺傳變異提高了術後病人嚴重慢性痛的風險。 / Meng, Zhaoyu. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 117-134). / Abstracts also in Chinese. / Title from PDF title page (viewed on 30, December, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Chan, Hoi Sze Gloria. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 204-241). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese.

Made available in DSpace on 2016-04-28T20:38:32Z (GMT). No. of bitstreams: 1 Rosane Raffaini Palma.pdf: 822317 bytes, checksum: 7c6909cc60e18d23eb5eee218cc33e88 (MD5) Previous issue date: 2012-10-17 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / A new approach to the study of the processes and perceptions of life experiences is being taken by psychologists, with emphasis on the understanding of the healthy aspect of human beings, the resilience. Seeing the family as a dynamic system, the present study adopted the theoretical framework of systems thinking, in order to identify and understand the care provided by health teams with respect to the use of the concept of resilience with patients and their families when dealing with a disease. A focus group was used as qualitative research method, considering that the energy generated by the group would result in deeper and more diverse answers. A multidisciplinary health care team participated in the study, and was invited to discuss a fictional case, addressing complaints of chronic pain. The answers of the participants were analyzed based on the studies of family resilience, according to Walsh. The team showed interest in addressing the needs of the fictional patient by using the concept of resilience, and more than that, was willing to put themselves in the place of the family. The group took into account the extraction of meaning from the family adversities and the connection between the patient and her relatives, considering the possible emotion instability resulting from the recent loss, and the physical distance between the patient and her relatives. They also focused attention on aspects such as overcoming adversities, flexibility, clarity of information, social and financial resources, open emotional expression and collaborative resolution of the problems of the patient, but with less emphasis, considering a perspective of work related to the care unit. No suggestions were made by the group with regards to religious or spiritual practices to cope with the complaint / Um novo enfoque vem sendo adotado pela psicologia, ao estudar processos e percepções das experiências da vida, com ênfase na compreensão do aspecto saudável do ser humano, que é a resiliência. Por considerar a família um sistema em movimento, o presente estudo adotou o referencial teórico do pensamento sistêmico, com o objetivo de identificar e compreender os cuidados que as equipes de saúde prestam em relação à utilização de práticas ligadas à resiliência para o paciente e sua família, ao lidar com uma doença. O grupo focal foi utilizado como método de pesquisa qualitativa, considerando que a energia gerada pelo grupo cria profundidade e diversidade de respostas. Uma equipe multiprofissional de saúde participou do estudo, à qual foi proposta a discussão de um caso clínico fictício, abordando queixa de dor crônica. As respostas dos participantes foram analisadas por meio dos estudos sobre resiliência familiar segundo Walsh. Para dar acolhimento às necessidades da paciente fictícia ligadas à resiliência, a equipe mostrou-se interessada e, mais do que isso, disposta a ocupar um lugar que originalmente caberia à família. O grupo levou em conta a extração de significado na adversidade familiar e a conexão entre a paciente e seus familiares, considerando a possível fragilidade emocional decorrente de sua viuvez recente e a distância física entre a paciente e os familiares. Mostrou ainda atenção à superação da adversidade, flexibilidade, clareza nas informações, recursos sociais e financeiros, expressão emocional aberta e resolução colaborativa dos problemas da paciente, porém, com menos ênfase, considerando uma perspectiva de trabalho ligada à unidade de cuidado. Não foram identificadas sugestões pela equipe participante quanto às práticas ligadas à religiosidade ou espiritualidade no enfrentamento da queixa

Fibromyalgia (FM) is a musculoskeletal and neurological disorder that causes constant pain, cognitive problems with short term memory, and sleep disorders. There are more females diagnosed with FM than males, and research has therefore primarily been conducted with females. Because little is known about African American males with FM, biopsychosocial theory was used in this phenomenological study to examine how African American males with FM are affected biologically, psychologically, and socially. Eight African American males diagnosed with FM were recruited from Houston, Texas and were interviewed about their lived experiences with FM, including experiences with the healthcare system, and how they used the internet to seek information about FM. Individual interview transcripts, conduct open coding, and thematic analysis led to identification of the following themes: (a) lengthy multiple medical evaluations to receive a diagnosis and various symptoms; (b) physical challenges, physical limitations, emotional issues, and cognitive issues experienced with FM; (c) limited physical and emotional support from family and friends; (d) hopeful about work and plans; (e) trust and confidence in healthcare providers and medical information obtained by asking questions; (f) limited internet search and not involved in online FM forums. The study showed that African American males with FM may experience debilitating symptoms and may use faith-based beliefs as one way to cope with FM. These results may bring positive social changes by providing caretakers with a better understanding of how FM affects the quality of life of African American males with FM, and provide new data to assist healthcare providers in diagnosing, treating, and serving this population.

This study explores the phenomenon of the relationships between practitioners and families who have a child with a chronic illness. Using a heremeneutic phenomenological method informed by the writings of Martin Heidegger [1889-1976] and Hans-Georg Gadamer [1900-2002], this study provides an understanding of the meaning of 'being in relationship' from the perspective of both families and practitioners.Study participants include ten family groups who have a child with a chronic illness and twelve practitioners from the disciplines of nursing, medicine, dietetics, physiotherapy and speech therapy who work with children with chronic illness. Narrative audiotaped interviewing was the means by which the participants told their stories about times that relationships worked well and when they did not. These stories uncover the every day realities of 'being in relationship' and provide another understanding of the relationship between family and practitioner.The findings of this thesis suggest that chronic childhood illness 'throws' families and practitioners together into a web of relationships that must work for the sake of the child. The relationship is primarily conducted between adults. Children are usually excluded. In order to understand and manage the child's illness, practitioners and families 'go around' and act 'in-between' relationships. While the quality of the relationship from the family perspective is not essential to the chronic illness journey, relationships are more successful when practitioners recognise the uniqueness of each family web. The nature of the relationship is often simple, yet it co-exists with complexity. This thesis proposes that a 'companion relationship' between practitioners and family may offer a more effective and satisfying way of working. It also challenges practitioners to consider the voice of children within health care relationships.

The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.

Chronic Fatigue Syndrome (CFS) is a debilitating condition in which severe, ongoing fatigue is the most prominent of a complex of somatic, psychological and neuropsychological symptoms. The aetiology of CFS remains uncertain and, to date, efforts to distinguish a clear pathophysiological profile for the disorder have been unsuccessful. Current evidence suggests that, rather than being a discrete disease entity with a single cause, CFS is a clinical condition resulting from the interaction of a number of pathophysiological factors, including acute infections, stress and psychiatric disorder. Recently, there has been some interest in the proposition that disordered circadian time-keeping may contribute to the development and/or course of the illness. The rationale for the investigation of circadian factors in CFS is based on the fact that disorders known to be associated with circadian dysregulation, such as jet lag and shiftwork related syndromes have a high degree of symptomatological overlap with CFS. Also, the presence of circadian disturbance could account, in part, for other phenomenological aspects of CFS, including the high rates of comorbid affective disturbance, and the reports of low-level immune dyregulation among sufferers. While several recent studies have produced some evidence of chronobiological dysregulation in CFS patients, much work remains before conclusions can be drawn about the presence, nature and clinical significance of circadian disturbance in CFS. This thesis describes a series of studies that were designed to systematically investigate: 1. whether CFS is associated with a state of circadian dysregulation, and 2. whether circadian dysregulation contributes significantly to the symptomatology of CFS. The first of the 5 studies reported here compared the circadian patterns of sleep-activity of CFS sufferers with those of healthy controls. Results indicated that CFS patients' sleep-activity cycles were significantly phase delayed compared to controls, and that some aspects of their circadian profiles of sleep-activity were related to some measures of sleep-disturbance and well-being. Studies 2 and 3 investigated the relationship between rhythms of sleep-wake and core temperature in CFS patients and healthy controls. The major finding from these studies was that sleep-wake and core temperature rhythms appear to be less effectively synchronised. Further evidence was collected that suggested that there was a relationship between circadian parameters and symptom measures in the CFS group. While this indicated that circadian dysregulation is linked in some way to the symptoms of CFS, assessment of the actual clinical significance of circadian disturbances required the use of a prospective methodology. The final two studies, therefore, report on a placebo-controlled trial of clinical interventions that were designed to restore circadian integrity to CFS patients, in order to see whether this would lead to a reduction in symptom number or severity. Results indicated that, although patients experienced improvements across a range of measures of symptoms and functional capacity, these were small in magnitude, of unlikely clinical significance, and no greater, in general, to improvements reported by patients who underwent placebo treatment. These results, along with those of the earlier studies, are discussed with respect to their implications regarding the presence and significance of circadian dysregulation. It is concluded that, while they provide evidence that CFS is associated with a degree of both internal and external circadian desynchrony, these findings suggest that circadian dysregulation is likely to be only a peripheral, contributor to the processes that generate and maintain the symptom complex. These findings are discussed with respect to how they contribute to our overall understanding of this multi-dimensional condition, and the implications they have for the continuing effort to investigate the causes and treatment of CFS.

<p>Det finns lite forskning om livskvalitet hos patienter med kronisk njursvikt som ännu inte startat i dialysbehandling och det är viktigt att ha kunskap om hur livskvaliteten påverkas hos dessa patienter. Syftet med litteraturstudien var att belysa olika faktorers påverkan på livskvaliteten hos patienter med kronisk njursvikt som inte startat i dialys. I studien har 16 vetenskapliga artiklar granskats och analyserats. I resultatet framkom att Hb-nivå, nutrition, sjukdomens svårighetsgrad och komorbiditet var faktorer som kunde påverka livskvaliteten. Även patienters upplevelser av antal och svårighetsgrad av symtom var påverkande faktorer. Ålder, kön, civilstånd, utbildning och arbetsstatus visade sig också kunna påverka livskvaliteten. I faktorer som patienterna kunde påverka, framkom copingstrategier och egenvård. I livskvalitet relaterat till planerad vård och omvårdnad framkom vårdplanering och specialistsjuksköterske-mottagning som faktorer som kunde påverka livskvaliteten. Genom kunskap inom detta område kan sjuksköterskan ge information och stöd till patienter och närstående och via omvårdnadsåtgärder förebygga och lindra symtom för att förbättra patienternas livskvalitet. Undersökningar av livskvalitet hos patienter med njursvikt som inte startat i dialys kan vara av värde vid utvärdering av vård och omvårdnad. Mer kvalitativ forskning om livskvalitet, coping och egenvård inom detta område behövs och sjuksköterskor behöver mer utbildning inom dessa områden för att kunna förbättra omvårdnaden.</p> / <p>There is little research on quality of life in patients with chronic renal failure not undergoing dialysis and it is important to know how the quality of life is affected in these patients. The aim of this literature review was to illustrate the impact of different factors on the quality of life in patients with chronic renal failure not undergoing dialysis. This study has been reviewed 16 scientific articles and analyzed. The result showed that the Hb-level, nutrition, the severity of the disease and co-morbidity were factors that could affect the quality of life. Also patients' perceptions of the number and severity of symptoms were influencing factors. Age, sex, marital status, education and work status also appeared to affect the quality of life. Among factors that patients themselves could affect were coping strategies and self-care. Well planned care and care delivered by specialist nurses did also affect the quality of life. The patients‟ quality of life may improve by the acts of the nurse, for example by providing information and support to patients and relatives, and by different nursing interventions directed towards prevention or relief of symptoms. Studies of quality of life in patients with renal failure not started in dialysis may be useful in the evaluation of health care and nursing. There is a need for more qualitative research on quality of life, coping and self-care in this field and nurses need more training in these areas in order to improve the nursing care.</p>