In this exploratory/descriptive study, the authors examined processes involved in some kidney patients’ability to survive on dialysis. Through long semistructured interviews with 18 dialysis survivors, they identified four self-affirmations that characterized participants’ restructuring of self and four sets of illness experiences that required restructuring within the context of their extant worlds. The denouement involved the participants’ transformation into comprehensive, active self-managers of their disease, its treatment, and its manifestations. The authors describe the participants’affirmations and adaptations leading to transformation. Understanding this process paves the way for research into the timing and sequence entailed in transformation and lays the groundwork for the development of interventions to guide kidney failure patients to the positive outcome of transformation: comprehensive, active self-management.
Get full access to this article
View all access options for this article.
References
1.
Antonoff, A. , & Mallinger, M. (1991). Vocational rehabilitation: Limitations and resistance of renal patients. Dialysis & Transplantation, 20(10), 604-609.
2.
Avram, M. M. , Sreedhara, R., & Mittman, N. (1998). Long-term survival in end-stage renal disease. Dialysis & Transplantation, 27(1), 11-21, 24.
3.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.
4.
Bush, D. M. , & Simmons, R. G. (1981). Socialization processes over the life course. In M. Rosenberg & R. H. Turner (Eds.), Social psychology: Sociological perspectives (pp. 133-146). New York: Basic Books.
5.
Carpenter, J. S. , Brockopp, D. Y., & Andrykowski, M. A. (1999). Self-transformation as a factor in the selfesteem and well-being of breast cancer survivors. Journal of Advanced Nursing, 29(6), 1402-1411.
6.
Charmaz, K. (1983). Loss of self: Afundamental form of suffering in the chronically ill. Sociology of Health and Illness, 5(2), 168-195.
7.
Charmaz, K. (1987). Struggling for self: Identity levels of the chronically ill. In J. Roth & P. Courad (Eds.), Research in the sociology of health care (pp. 289-321). Greenwich, CT: JAI.
8.
Coward, D. D. (1990). The lived experience of self-transcendence in women with advanced breast cancer. Nursing Science Quarterly, 3(4), 162-169.
9.
Curtin, R. B. , Kutner, N. G., Oberley, E., & Sacksteder, P. (1997). Renal rehabilitation for the 21st century. Nephrology News and Issues, 11(2), 59-61.
10.
DeOreo, P. B. (1997). Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization, and dialysis-attendance compliance. American Journal of Kidney Diseases, 30(2), 204-212.
11.
Dimond, M. (1979). Social support and adaptation to chronic illness: The case of maintenance hemodialysis. Research in Nursing and Health, 2, 101-108.
12.
Fielding, D. , Moore, B., Dewey, M., Ashley, P., McKendrick, T., & Pinkerton, P. (1985). Children with end-stage renal failure: Psychological effects on patients, siblings and parents. Journal of Psychosomatic Research, 29(5), 457-465.
13.
Fife, B. L. , & Wright, E. R. (2000). The dimensionality of stigma: A comparison of its impact on the self of persons with HIV/AIDS and cancer. Journal of Health and Social Behaviors, 41(1), 50-67.
14.
Gilchrist, V. (1992). Key informant interviews. In Crabtree, B., Miller, W. (Eds.), Doing Qualitative Research (pp. 70-89). Newbury Park, CA: Sage.
15.
Goldman, J. B. , & Maclean, H. M. (1998). The significance of identity in the adjustment to diabetes among insulin users. Diabetes Education, 24(6), 741-748.
16.
Gregory, D. M. , Way, C. Y., Hutchinson, T. A., Barrett, B. J., & Parfrey, P. S. (1998). Patients’ perceptions of their experiences with ESRD and hemodialysis treatment. Qualitative Health Research, 8(6), 764-783.
17.
Harris, S. , & Brown, E. (1998). Patients surviving more than 10 years on haemodialysis. The natural history of complications of treatment. Nephrology Dialysis Transplantation, 13(5), 1226-1233.
18.
Henry, G. T. (1990). Practical sampling. Newbury Park, CA: Sage.
19.
Hewitt, J. P. (1979). Self and society: A symbolic interactionist social psychology. Boston: Allyn & Bacon.
20.
Ifudu, O. , Mayers, J., Matthew, J., Tan, C. C., Cambridge, A., & Friedman, E. A. (1994). Dismal rehabilitation in geriatric inner-city hemodialysis patients. Journal of the American Medical Association, 271(1), 29-33.
21.
Ifudu, O. , Paul, H., Mayers, J., Cohen, L., Brezsnyak, W., Herman, A., et al. (1994). Pervasive failed rehabilitation in center-based maintenance hemodialysis patients. American Journal of Kidney Diseases, 23(3), 394-400.
22.
Kearl, M. C. , & Gordon, C. (1992). Social psychology. Boston, MA: Allyn & Bacon.
23.
Kvale, S. (1996). Interviews: An introduction to qualitative research interviewing. Thousand Oaks, CA: Sage.
24.
Life Options Rehabilitation Advisory Council (1993). Renal rehabilitation: Bridging the barriers. Madison, WI: Medical Education Institute.
25.
Lincoln, Y. S. , & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
26.
Lowrie, E. G. , & Lew, N. L. (1990). Death risk in hemodialysis: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. American Journal of Kidney Diseases, 15(5), 458-482.
27.
Mapes, D. (1992). Self-management, compliance and quality of life in chronic hemodialysis patients. Unpublished dissertation, University of California, San Francisco.
28.
McCall, G. J. , & Simmons, J. L. (1978). Identities and interactions. New York: The Free Press.
29.
McCracken, G. (1988). The long interview. Beverly Hills, CA: Sage.
30.
McGrath, J. M. (1999). Physicians’ perspectives on communicating prescription drug information. Qualitative Health Research, 9(6), 731-745.
31.
Moch, S. D. (1989). Health within illness: Conceptual evolution and practice possibilities. Advanced Nursing Science, 11(4), 23-31.
32.
Molzahn, A. , & Shields, L. (1997). Qualitative research in nephrology nursing. American Nephrology Nurses’ Association Journal, 24(1), 13-21.
33.
Morse, J. (1997). Responding to threats to integrity of self. Advanced Nursing Science, 19(4), 21-36.
34.
Paterson, B. , Thorne, S., Crawford, J., & Tarko, M. (1999). Living with diabetes as a transformational experience. Qualitative Health Research, 9(6), 786-802.
35.
Rittman, M. , Northsea, C., Hausauer, N., Green, C., & Swanson, L. (1993). Living with renal failure. American Nephrology Nurses’ Association Journal, 20(3), 327-331.
36.
Rubin, H. J. , & Rubin, I. S. (1995). Qualitative interviewing: The art of hearing data. Thousand Oaks, CA: Sage.
37.
Steckler, A. , McLeroy, K. R., Goodman, R. M., Bird, S. T., & McCormick, L. (1992). Toward integrating qualitative and quantitative methods: An introduction. Health Education Quarterly, 19(1), 1-8.
38.
Taylor, S. E. , & Brown, J. D. (1988). Illusion and wellbeing: A social and psychological perspective on mental health. Psychological Bulletin, 103(2), 193-210.
39.
Yoshida, K. K. (1993). Reshaping of self: A pendular reconstruction of self and identity among adults with traumatic spinal cord injury. Sociology of Health and Illness, 15(2), 217-245.
