Date of Award

5-1983

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Graduate Department of Clinical Psychology

Abstract

Twenty-eight patients with renal failure who were receiving hemodialysis at a private hemodialysis center vollllltered as subjects for this study. A global adjustment score was formulated for each subject by averaging their scores on three instruments: Linkowski Acceptance of Disability Scale, Productive Use of Time, and the Beck Depression Inventory. A C:Ompliance With Treatment questionnaire was originally designed to be part of the global adjustment scores. However, it did not correlate with the other adjustment measures, and therefore was not incorporated into the global adjustment scores. Adjustment scores were then compared or related to demographic variables, cognitive appraisals, coping behaviors, assertiveness, spiritual well-being, and family adaptability and cohesion. A significant difference was folllld between well-adjusted and poorly adjusted subjects according to marital status and education. More well-adjusted subjects were married and had more years of education than poorly adjusted subjects. Although the distributions of well-adjusted and poorly adjusted subjects did not differ according to primary and secondary cognitive appraisals, the distributions of these appraisals for the total sample were different than expected by chance. Generally, the subjects appraised hemodialysis as distressing and something that had to be accepted. As a total group the subjects did not use more emotion-focused coping than problem-focused coping. Well-adjusted and poorly adjusted subjects were compared on their utilization of eight coping behaviors, and no differences were found. Short-term and long-term hemodialysis users were also compared on their utilization of eight coping behaviors, and no differences were found. Although religious coping behavior was frequently utilized, it was not used as much as the average of the other coping behaviors assessed. A positive correlation was found between spiritual well-being and adjustment. Similarly, a positive correlation was found between assertiveness and adjustment. A multiple regression of spiritual well-being and assertiveness on adjustment indicated .that spiritual well-being could predict adjustment with a moderate degree of confidence. It was shown that assertive subjects using hemodialysis longer than six months were better adjusted than assertive subjects using hemodialysis less than six months. Assertive subjects also became better adjusted over time on hemodialysis, whereas non-assertive subjects became less adjusted over time on hemodialysis. Although a predicted curvilinear relationship between family adaptability and adjustment was not found, the subjects perceived their families as having little capacity to constinctively deal with stress but rather as becoming chaotic or rigid in response to stress. Although a predicted curvilinear relationship between family cohesion and adjustment was not found, the subjects perceived their families as being emotionally distant or intensely emotionally bonded but not in between these extremes. A variety of other non-predicted findings were also reported and discussed in terms of the previous research on the psychological adjustment of patients to hemodialysis. Predicted and non-predicted findings were discussed in both theoretical and practical terms.

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