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This article describes the development of a 6-item instrument that measures thirst distress. Items were developed following open-ended interviews with 10 subjects, a literature review, and development of a conceptual definition of thirst. A panel of experts established content validity. A convenience sample (N = 247) of adults receiving outpatient hemodialysis completed the scale. A panel of experts was used to assess content validity. Item analysis was used to select unrelated or redundant items for deletion. Cronbach's alpha was. 78. Construct validity was supported by confirmatory and exploratory factor analysis. Positive relationships between thirst distress and, respectively, thirst intensity and interdialytic weight gain provided additional evidence of construct validity. Overall, these preliminary data indicate that the thirst distress scale has sufficient reliability and validity for use in clinical studies.
In 1999, over 212,000 patients received outpatient hemodialysis in the United States (United States Renal Data System [USRDS], 2001). Although lifesaving, hemodialysis is a very restrictive treatment modality for patients with end stage renal disease (ESRD) because waste product and fluid removal occur only three times per week. Therefore, in addition to daily dietary restrictions and a complex medication regimen, these patients must limit their fluid intake. Fluid restriction is one of the most stressful components of treatment (Baldree, Murphy, & Powers, 1982; Gurklis & Menke, 1988; Welch & Austin, 1999), and as many as 95% of patients do not follow the recommended fluid restriction (Betts & Crotty, 1988). Noncompliance with fluid intake can have immediate consequences if excessive fluids are ingested, including dependent edema, shortness of breath, muscle cramping, or worsening hypertension (Christensen, Benotsch, & Smith, 1997). In addition, more serious consequences can occur, such as pulmonary edema or congestive heart failure (Everett, Brantley, Sletten, Jones, & McKnight, 1995). Moreover, poor fluid compliance has been linked to impaired physical abilities and higher rates of depression (Tracy, Green, & McCleary, 1987). To prevent these physical complications caused by excessive interdialytic weight gain (IWG), patients must successfully manage fluid intake.
Thirst is the most frequently occurring symptom in hemodialysis patients (Virga et al., 1998). Intervening to reduce the symptom of thirst (Welch, 2001), therefore, may provide a meaningful way to decrease IWG and prevent associated complications. Unfortunately, limited empirical work has been done to investigate the...