Toward a trajectory of adjustment in women with end-stage renal disease on haemodialysis.

AIMS: To examine the lived experiences of community-dwelling women with end-stage renal disease undergoing haemodialysis treatment. BACKGROUND: End-stage renal disease is a chronic progressive disease with renal transplantation as a major treatment option. However, the majority of patients choose haemodialysis as their primary treatment. In this disease, many changes occur in the body that demand adjustment in every aspect of these patients' lives. The turbulent trajectory of adjusting to this disease and treatment has been under-researched. Given the increased number of patients requiring haemodialysis, a fuller understanding of the experienced disease course is essential in guiding clinical efforts. METHOD: Descriptive phenomenology was used as it suited the purpose of this study. DESIGN: Sixteen adult women from two large haemodialysis centres in a large Midwestern city in the USA were interviewed. All data were analysed using Colaizzi's methodological interpretation. FINDINGS: Three major themes emerged supporting a possible adjustment trajectory: initiation-the initial phase of adjustment; appreciation-the middle phase of appreciating haemodialysis treatment; and grappling-the later phase of dealing with adverse effects from haemodialysis. The findings, however, suggest that experiences in the adjustment trajectory are interwoven, circular and ongoing, rather than linear. CONCLUSION: More research is needed in this under-researched area to guide practice for meeting the demands of this growing patient population. RELEVANCE TO CLINICAL PRACTICE: These results provide knowledge that can assist nurses to implement care that is tailored to support adjustment, thus minimizing setbacks and improving patients' well-being.

Women's experience of spirituality within end-stage renal disease and hemodialysis.

The purpose of this descriptive, phenomenological qualitative study is to describe women's lived experiences of spirituality within end-stage renal disease (ESRD) and hemodialysis. The purposive volunteer sample of 16 women regularly attended two outpatient dialysis centers in a large Midwestern city. Audiotaped, transcribed interviews were analyzed using Colaizzi's method. These women affirmed that spirituality was extremely important in living with their illness and necessary treatment regime. Four major clusters of themes pertaining to the women's spiritual experience within their illness emerged: acceptance, understanding, fortification, and emotion modulation. Findings show that spirituality is of great importance in living with ESRD while receiving hemodialysis and suggest that spirituality may be a significant consideration in nursing and interdisciplinary health care. These findings may be used to improve holistic nursing practice and education in related areas.

Concept analysis of forgiveness with a multi-cultural emphasis.

AIM: This paper is a report of a concept analysis of forgiveness. BACKGROUND: Worldwide interest in and funding for forgiveness research has brought about a body of knowledge from many disciplines that could be clinically useful to nursing. At this time, nurse scholars are beginning to challenge one another to focus on this important area of inquiry. To date, however, most scholarship on forgiveness has been conducted in related disciplines, rather than in nursing. Conceptual and theoretical work is needed in nursing to promote knowledge development in this area. METHOD: The CINAHL, Medline and PsycInfo databases were searched for papers published between 1990 and 2007 using the keywords, forgiveness, forgive, or reconciliation in the title or abstract. The non-linear evolutionary process of concept analysis was used to identify the concept of interest, its origins, realm, attributes and context, characteristics, and implications. Forgiveness was also explored from an international multi-cultural perspective. An exemplar is included to illuminate the concept. A total of 34 scholarly works from a variety of disciplines were included in the analysis. FINDINGS: A definition of forgiveness emerged from the analysis, as well as a multi-cultural understanding of the concept. Three important attributes of forgiveness are that it is the relinquishing of a negative response, replacing the negative response with a benevolent response, and a process that occurs over time. Multi-cultural attributes centre on group harmony, re-establishing harmonious connections between people, and the morality of considering others as worthy of love and understanding. CONCLUSION: A multi-cultural understanding of forgiveness may provide the impetus for further theory development and research in nursing, and could be used to educate nurses on beginning interventions in this area.

Perceptions of incorporating spirituality into their care: a phenomenological study of female patients on hemodialysis.

This phenomenological study was aimed at understanding how women with end stage renal disease undergoing hemodialysis want nurses to address their spirituality. Interviews were conducted with 16 women from outpatient hemodialysis centers in a large Midwestern city. Eighty-three significant statements yielded meanings representing four theme clusters, highlighting how these women prefer nurses to incorporate spirituality into their care: (a) displaying genuine caring, (b) building relationships and connectedness, (c) initiating spiritual dialogue, and (d) mobilizing spiritual resources. Participants expressed that nephrology nurses are uniquely positioned to understand their individualized spiritual needs and implement spiritual care.

Coming to the cultural "in-between": nursing insights from a Hmong birth case study.

This article discusses the historical background and traditional beliefs of the Hmong. Cultural conflict occurs when traditional Hmong beliefs and Western health care ideologies are misunderstood. A specific case study focuses on care of a Hmong woman and her husband after a precipitous birth, hemorrhage, and surgical intervention. Nursing insights are identified from "in-between" the cultures. Establishing cultural awareness is an essential first step toward cultural competence.

Adjustment, spirituality, and health in women on hemodialysis.

End stage renal disease (ESRD) is progressive, requiring adjustment. This descriptive correlational study examined levels of and relationships between adjustment, spiritual well-being, and self-perceived health in women with ESRD. The sample included 65 women aged 24 to 82 receiving hemodialysis at five outpatient centers in a large metropolitan area. Frequencies, central tendencies, and correlations were used for analyses. Overall, these women were fairly well adjusted as measured by the Psychosocial Adjustment to Illness Scale-Self-Report. They demonstrated fairly high levels of religious, existential, and overall spiritual well-being. Self-perceived health was good Spiritual well-being variables were all positively and significantly related to overall psychosocial adjustment and psychological distress adjustment. Self-perceived health variables were all positively and significantly related to overall psychosocial adjustment. Few significant relationships were found between spiritual well-being and other adjustment domains and between self-perceived health and other types of adjustment.