THE IMPACT OF INTERNAL AND EXTERNAL RESOURCES ON FUNCTIONAL OUTCOME IN CHRONIC ILLNESS (RENAL DISEASE, HEMODIALYSIS, PERITONEAL DIALYSIS, TRANSPLANT, STRESS).
Contributors: University Of Rochester School Of Nursing.
Published: 1994
Number of pages: 136
Subjects: Health Sciences, Nursing.; Psychology, Psychobiology.
Description: Chronic illness disrupts the lives of about one-third of Americans. There are significant amounts of psychological and physical stress associated with chronic illness. The purpose of this research was to determine if internal and/or external resources could deter the negative consequences of the physiologic stress in people with end-stage renal disease (ESRD). Resource theory was used to test the relationships over time among stress, distress and resources. Direct, mediating, and moderating relationships were tested.

Secondary analysis was used to test the hypotheses; the data set used contained data collected at three points in time, each one year apart. There were 112 subjects with four different treatment types (hemodialysis, continuous ambulatory peritoneal dialysis, related donor transplant, and cadaveric transplant). The subjects were predominantly married, white, high school graduates, not currently working, with ESRD duration of about 2 years from a variety of causes.

Stress was operationalized as physiologic stress and was measured by the type of treatment and number of comorbidities. Distress was operationalized as functional outcome and measured by physical dysfunction and number of hospital nights. Well-being was the measure of internal resources, and social resources was the measure of external resources. All instruments had adequate reliability and validity.

There were significant relationships found between the stress and distress measures. More intrusive treatment types (dialysis treatments) were strongly associated with higher levels of physical dysfunction. Higher numbers of comorbidities were moderately correlated with number of hospital nights. A combined resource score (internal plus external resources) did not have direct, mediating or moderating effects on the stress/distress relationship. Combined resources were unable to reduce the deleterious effects of physiologic stress on functional outcomes.

There was a significant interaction effect for well-being at year one and comorbidities at year 2 on hospital nights at year 3. Patients with high comorbidities and low well-being had significantly higher number of hospital nights between the second and third year. High levels of well-being were subsequently protective in patients with high comorbidities against high numbers of hospital nights. Higher levels of well-being also were associated with lower levels of dysfunction.

This study supported previous research in patients with chronic illness that functional outcomes are largely determined by preexisting levels of function, and internal and external resources have little or no impact on this relationship. There was some suggestion in this study that people with very high levels of stress may benefit from high levels of internal resource; this finding requires further validation.
Notes: Source: Dissertation Abstracts International, Volume: 56-12, Section: B, page: 6674.

Thesis (PH.D.)--UNIVERSITY OF ROCHESTER SCHOOL OF NURSING, 1994.

School code: 1242.