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Women's perceptions of factors that enhance and inhibit adaptation to chronic hemodialysis when renal transplantation is not an option Maxwell, Lynne


Factors Influencing Women's Adaptation to Hemodialysis When Renal Transplantation is not an Option The intent of this study was to explore and describe factors that influence adaptation from the perspective of women on hemodialysis for whom renal transplantation is not an option. Phenomenology was the research design selected for this study in order to understand the experience of these women clients. Data were collected during audio-taped interviews of eight women and were analyzed concurrently with data collection to identify common themes. Two central themes emerged: the adaptation process and the theme of connectedness. The adaptation process was described as a six-phase process. Connectedness was defined as being connected to others and/or sources of life's energy. Several key factors that either facilitated or interfered with adaptation were identified for each of these two themes. Key factors that facilitated adaptation throughout the adaptation process Included a first run on dialysis, experience with adversity, emotional and instrumental support, coping behaviors such as asserting control and reframing the situation, diversions, adequate rest and confidence in health-care professionals. Factors interfering with adaptation to hemodialysis throughout the adaptation process included the gradual and ambiguous nature of renal disease, increasing dependence, reduced energy, transportation to dialysis, compromised somatic health, difficulty with assertiveness, prolonged stressors and lack of confidence in health-care professionals. Specific factors that influenced connectedness were identified. The facilitating factors identified were satisfactory relationships, nurturing others, normalizing, a harmonious atmosphere on the hemodialysis unit and pleasurable activities. Key factors interfering with adaptation related to the connectedness theme were isolation from others, unsympathetic others, ineffective communication with health-care professionals, and exclusion from activities. The findings relative to the adaptation process were discussed in the light of the literature on adapting to illness and stress. Connectedness was discussed primarily in relation to the literature exploring the socialization of women. Implications for nursing practice, education and research arising from these findings were outlined.

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