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Subgroups of haemodialysis patients in relation to fluid intake restrictions: a cluster analytical approach
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. (Caring Sciences)ORCID iD: 0000-0003-1289-9896
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 21-22, 2997-3005 p.Article in journal (Refereed) Published
Abstract [en]

Aims

 To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self-efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain vary between patients in groups with different cognitive profiles.

Background

 Theory-based research suggests that cognitive factors (e.g. self-efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions.

Design

 Explorative cross-sectional multi-centre survey

Methods

 The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self-report form and data on interdialytic weight gain was also used. Two-step cluster analysis was used to identify subgroups. One way analysis of variance (ANOVA) or Pearson’s chi-square test were used for comparing subgroups.

Results

 Three distinct subgroups were found and subsequently labelled: 1) low self-efficacy, 2) distraction and depressive symptoms and 3) high self-efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output, or in receiving any fluid intake advice.

Conclusions

 Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self-efficacy, attentional style and depressive symptoms.

Relevance to clinical practice

 Based on this study we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient’s fluid control, is introduced.

Place, publisher, year, edition, pages
2010. Vol. 19, no 21-22, 2997-3005 p.
Keyword [en]
attentional style, depressive symptoms, fluid overload, haemodialysis, hierarchical clustering, self-efficacy
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-121765DOI: 10.1111/j.1365-2702.2010.03372.xISI: 000282874400006PubMedID: 21040006OAI: oai:DiVA.org:uu-121765DiVA: diva2:306504
Available from: 2010-03-30 Created: 2010-03-30 Last updated: 2017-12-12
In thesis
1. Excessive Fluid Overload Among Haemodialysis Patients: Prevalence, Individual Characteristics and Self-regulation of Fluid Intake
Open this publication in new window or tab >>Excessive Fluid Overload Among Haemodialysis Patients: Prevalence, Individual Characteristics and Self-regulation of Fluid Intake
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective.

The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate.

The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings.

Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake.

In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload.

This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 89 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 551
Keyword
Behavioural medicine, fluid overload, adherence, haemodialysis, self-efficacy, attentional style, depressive symptomatology, cluster analysis, tailored treatment, quasi-experimental single-case design, Fluid Intake Appraisal Inventory (FIAI), renal nursing
National Category
Urology and Nephrology Nursing
Research subject
Medical Science; Caring Sciences
Identifiers
urn:nbn:se:uu:diva-121983 (URN)978-91-554-7782-0 (ISBN)
Public defence
2010-05-19, Sal IV, Universitetshuset, Övre Slottsgatan 2, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-04-28 Created: 2010-04-03 Last updated: 2010-04-28Bibliographically approved

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