Table Of ContentThe Experience and Self-Management of Fatigue in Adult Hemodialysis Patients
by
Ann Elizabeth Horigan
Nursing
Duke University
Date:_______________________
Approved:
___________________________
Julie Barroso, Supervisor
___________________________
Diane Holditch-Davis
___________________________
Susan Schneider
___________________________
Sharron Docherty
Dissertation submitted in partial fulfillment of
the requirements for the degree of Doctor of Philosophy in
Nursing in the Graduate School
of Duke University
2012
ABSTRACT
The Experience and Self-Management of Fatigue in Adult Hemodialysis Patients
by
Ann Elizabeth Horigan
Nursing
Duke University
Date:_______________________
Approved:
___________________________
Julie Barroso, Supervisor
___________________________
Diane Holditch-Davis
___________________________
Susan Schneider
___________________________
Sharron Docherty
An abstract of a dissertation submitted in partial
fulfillment of the requirements for the degree
of Doctor of Philosophy in
Nursing in the Graduate School
of Duke University
2012
Copyright by
Ann Elizabeth Horigan
2012
Abstract
Fatigue is a common and debilitating symptom for adult patients with end-stage
renal disease on hemodialysis and has been associated with decreased survival and
quality of life. Patients on hemodialysis must find ways to manage their fatigue and
mitigate its effects on their lives. Currently, there is no description of the experience of
fatigue for American hemodialysis patients, nor is there any description of the ways in
which they manage their fatigue. The purpose of this qualitative descriptive work was to
describe the experience and self-management of fatigue as well as how fatigue changes
over time from one dialysis session to the next. Several themes were identified which
included: the nature of fatigue, management of fatigue, consequences of fatigue, and
factors associated with fatigue. Further, hemodialysis patients experience two types of
fatigue, post-dialysis fatigue only, fatigue that occurs acutely after the dialysis session
and resolves after sleep or rest, and continuous fatigue, a persistent, underlying fatigue
that patients experience at all times and worsens after the dialysis session usually
requiring a prolonged period of recovery.
iv
Dedication
This work is dedicated to mom and dad who supported me in every way imaginable; to
Jim and John who reminded me that it’s not always about me; to The Babies, my favorite
dogs, Atilla, Chewy, Teddy, Taffy and Chi Chi who walked every step of the way with
me, never asking questions, never complaining, and always ready to give me kisses when
I needed them the most; and to Wally and Hazel who couldn't be here when I finished my
"report".
v
Contents
Abstract..................................................................................................................... .i
Dedication v
List of Tables............................................................................................................. xi
List of Figures............................................................................................................ xiii
Acknowledgements ...............................................................................................xiiii
1. Dissertation Introduction 1
Literature Review 4
Experience of End-Stage Renal Disease 5
Chronic Kidney Disease 5
Changes in Health and Lifestyle 6
Causes of Fatigue in Patients on Dialysis 7
Definition of Fatigue 7
Measurement of Fatigue in Patients on Dialysis 9
Interventions to Help Alleviate Fatigue in Patients on Dialysis 16
Physical Activity 16
Correction of Physiological; Deficiencies 18
Erythropoeitin 18
L. Carnitine 20
Adjustment of Dialysis Related Variables 21
Alternative Therapies 25
Summary 27
Experience of Fatigue in Chronic Illness 28
vi
Fatigue Management in Chronic Illness 29
Experience of Fatigue in Patients on Dialysis 31
Fatigue Management in Patients on Dialysis 32
Summary 33
2. Fatigue in Hemodialysis Patients: A Review of Current Literature 35
Methods 36
Results 36
The Experience of Fatigue 36
Post-Dialysis Fatigue 37
Factors That May Contribute to Fatigue 38
Demographic Factors 38
Psychosocial Factors 39
Physiological Factors 40
Sleep 42
Discussion 43
Implications for Future Work 45
Conclusion 46
3. The Experience and Self-Management of Fatigue in Adult Hemodialysis
Patients 55
Introduction 55
Causes of Fatigue in Patients on Dialysis 56
The Experience of Fatigue in Patients on Dialysis 56
Fatigue Management in Dialysis Patients 57
vii
Methods 59
Design 59
Setting and sample 60
Procedures 60
Instruments 62
Data collection 63
Data analysis 64
Rigor 65
Findings 65
Nature of Fatigue 67
Physical Fatigue 67
Mental Fatigue 68
Management of Fatigue 68
Rest After Dialysis 69
Adjustment or Adaptation of Routine 69
Management of Comorbidities and Related Symptoms 70
Consequences of Fatigue 70
Socialization is Negatively Affected 70
Time Spent with Children is Comopromised 71
Participation in Activities is Difficulty 72
Factors Associated with Fatigue 72
Discussion 74
Limitations 79
viii
Implications for Practice 80
Implications for Research 81
4. A Comparison of the Temporal Patterns of Fatigue in Hemodialysis Patients 83
Introduction 83
Methods 86
Design 86
Setting and Sample 86
Procedures 87
Instruments 88
Data Collection 91
Data Analysis 93
Findings 96
Dialysis Patients with Continuous Fatigue 98
Dialysis Patients with Post-Dialysis Fatigue Only 101
Discussion 105
Limitations 108
Implications for Research 109
Implications for Practice 109
5. Chapter Five 111
Sampling in Qualitative Research 111
Age versus Illness Effects 114
Policy 115
Model Expansion and Preliminary Theorizing 117
ix
References 126
Biography 150
x
Description:holding my feet to the fire, for bringing me in from the ledge and for having a sense of transcutaneous electrical acupoint stimulation (TEAS) on fatigue. TEAS is Similarly, Cho and Tsay (2004) found that acupressure and massage . patients in the development and utilization of these techniques.
