Exploring the Process of Adjusting to Diabetic Kidney Disease

Abstract

The psychological process of adjusting to diabetic kidney disease (DKD) has been afforded little attention within previous literature. This study aimed to explore the process of adjusting to DKD as a secondary condition to type 1 diabetes. A qualitative method was used in the study design. Eleven participants were interviewed using a semi-structured and exploratory approach. Through inductive thematic analysis, three super-ordinate themes were identified from the data: coming to an understanding over time, managing the impact of DKD and facing the future. The themes demonstrate that the DKD population has complex physical and psychological needs at all stages of their condition. Making sense of kidney disease as a secondary condition and integration of this information with existing beliefs was integral to the adjustment process. Attempts to manage uncertainty and change included asserting control of the situation and use of cognitive strategies. The results support the use of psychological models of adjustment in conceptualising the 'process' of adjustment and suggest the need for psychological interventions to support this population.

Teaching–learning partnership between nurses and long‐term patients undergoing peritoneal dialysis: A qualitative study

“…PD nurses with less experience tend to feel that “nurse knows best” while those with more experience feel that accommodating patients' needs lead to better results (McCarthy et al ). Patients tend to feel guilt and shame when an infection happens (Baillie & Lankshear ), and punitive judgment and rigid expectations often lead to feeling less inclined to access support or take recommendations (Reid et al ).…”

“…Overall, the literature has shown that favourable clinical outcomes are reliant on a few important factors: brief initial training; continuing education; competent educators; inclusion of family and on‐call support (Firanek et al ). Success appears to result from a positive collaboration between the patients and the providers (Reid et al ; Baillie & Lankshear ).…”

A qualitative analysis of eating behaviour change for patients with diabetes and non‐dialysis dependent chronic kidney disease stages 4–5

“…A physical decline was found to make the condition more tangible for people (Reid et al . ). However, this occurs in the more advanced stages of CKD where eating behaviour changes are unlikely to delay the onset of dialysis.…”

“…This study like others (Reid et al . ) found the absence of specific symptoms in earlier stages of CKD to influence the significance people placed on managing the condition, delaying the lifestyle changes that could reduce the progression of CKD and subsequent need for dialysis. A physical decline was found to make the condition more tangible for people (Reid et al .…”

“…Further, patients with diabetic kidney disease have reported difficulties with disease acceptance due to the asymptomatic nature of diabetes and CKD challenging the importance and urgency of eating behaviour change (Reid et al . ). With diabetic kidney disease now the leading cause of CKD in Australia and New Zealand (ANZDATA ), more people are entering CKD services with pre‐existing psychological barriers to eating behaviour change (Peyrot et al .…”