Concept Analysis of Fatigue in Hemodialysis Patients Based on Hybrid Model

혈액투석환자의 피로에 대한 개념분석 : 혼종모형

  • Received : 2017.05.10
  • Accepted : 2017.07.07
  • Published : 2017.07.31


This study was conducted to identify the conceptual definitions and attributes of fatigue in hemodialysis patients based on the Hybrid Model of concept development. The Hybrid Model was used to investigate the main attributes and indicators of the concept by applying three stages. After a literature review, data were collected through observation and interviews including qualitative research in the field work stage. The participants included 10 patients in hemodialysis center of two hospitals in Gwang-ju, Korea. The attributes of fatigue concept in the hemodialysis patients were divided into four dimensions, physical activity, affective mood, social role, and cognitive reflection. The definition of fatigue by hemodialysis patients was defined as 'subjective feeling usually experienced in four dimensions during the process to recognize and adjust energy deficiency and limited functions caused by uremia and repeated hemodialysis for chronic renal failure'. Considering the dimensions and attributes derived from this study, it may be possible to develop an effective intervention program for fatigue in hemodialysis patients.


Concept analysis;Fatigue;Hemodialysis;Hemodialysis patient;Hybrid model


  1. L. J. Carpenito, M.E. Briody, D. A. Jones, J. J. Fitzpatrick, Toward further understanding of nursing diagnosis: an interpretation, Nursing diagnosis, vol. 3, no. 3, pp. 124-128, 1992. DOI:
  2. T. Gordon, Fatigue in adapted systems, Overuse and underuse paradigms, In S.C. Gandevia, R. M. Enoka, A. L. Mccoms, D. G. Stuart, and C. K. Tomas(Eds.), Fatigue: Neural and Muscular Mechanisms, Chap.32, pp. 429-456, 1995. DOI:
  3. Letchmi Santhna, Srijit Das, Hasliza Halim, FaridAzizul Zakariah, Hamidah Hassan, Samsiah Mat, Ruth Packiavathy, Fatigue experienced by patients receiving maintenance dialysis in hemodialysis, Nursing & Health Sciences, vol. 13, no. 1, pp. 60-64, 2011. DOI:
  4. B. Cheema, H. Abas, B. Smith, A. O'Sullivan, M. Chan, A. Patwardhan, J. Kelly, A. Gillin, G. Pang, B. Lloyd, M. Fiatarone Singh, Randomized controlled trial of intradialytic resistance training to target muscle wasting in ESRD: the Progressive Exercise for Anabolism in Kidney Disease (PEAK) study, American Journal of Kidney Disease, vol. 50, no. 4, pp. 574-584, 2007. DOI:
  5. A. Jablonski, The multidimensional characteristics of symptoms reported by patients on hemodialysis, Nephrology Nursing Journal, vol. 34, no. 1, pp. 29-37, 2007.
  6. F. E. Murtagh, J. Addington-Hall, I. J. Higginson, The prevalence of symptoms in end-stage renal disease: a systematic review, Advances in Chronic Kidney Disease, vol. 14, no. 1, pp. 82-99, 2007. DOI:
  7. A. E. Horigan, Fatigue in hemodialysis patients: a review of current knowledge, Journal of Pain and Symptom Management, vol. 44, no. 5, pp. 715-724, 2012. DOI:
  8. E.Y. Choi, Fatigue Prediction Model for Hemodialysis Patients, Doctoral Degree, Kyung-Hee University Graduate School, p.132, 2005.
  9. D. Schwartz-Barcott, H. S. kim, An expansion and elaboration of the hybrid model of concept development, In B. L. Rogers & K. A. Knafl(Eds), Concept Development in Nursing, Foundations, Techniques and Applications philadelphia, PA: W. B. Saunders Co, pp. 129-159, 2000.
  10. B. B. Tack, Dimensions and correlations of fatigues in older adults with rheumatoid arthritis, University of california, Sanfrancisco, PH. O, 1991.
  11. A. L. Strauss, J. M. Corbin, Basics of qualitative research: Grounded theory, procedures, canons and evaluative criteria, Basic of Qualitative Sociology, vol. 13, no. 1, pp. 3-21, 1990. DOI:
  12. J. Barroso, J. G. Voss, Fatigue in HIV and AIDS: An Analysis of Evidence, Journal of the Association of Nurses in AIDS Care, vol. 24, no. 1, pp. 5-14, Jan/Feb. 2013. DOI:
  13. B. O. Lee, C. C. Lin, W. Chaboyer, C. L. Chiang, C.C Hung, The fatigue experience of haemodialysis patients in Taiwan, Journal of Clinical Nursing, vol. 16, no. 2, pp. 407-413, 2007. DOI:
  14. G. K. Sakkas, C. Karatzaferi, Hemodialysis fatigue: just "simple" fatigue or a syndrome on its own right? Frontiers in Physiology, 3, pp. 1-4, 2012. DOI:
  15. Y. S. Byeon, J. E. Gu, Correlates of Fatigue with Physiological Factors in Hemodialysis Patients, Journal of Korean Biological Nursing Science, vol. 5, no. 2, pp. 5-12, Dec. 2003.
  16. A. G. Williams, P. B. Crane, D. Kring, Fatigue in African American women on hemodialysis, Nephrology Nursing Journal, vol. 34, no. 6, pp. 610-617, 2007.
  17. M. Jhamb, S. D. Weisbord, J. L. Steel, M. Unruh, Fatigue in patients receiving maintenance dialysis: a review of definitions measures and contributing factors, American Journal of Kidney Diseases, vol. 52, no. 2, pp. 353-365, 2007. DOI:
  18. L. B. Krupp, N. G. LaRocca, J. Muir-Nash, A. D. Steinberg, The fatigue severity scale, Application to patients with multiple sclerosis and systemic lupus erythematosus, J. of Arch Neurology, vol. 46, no. 10, pp. 1121-1123, Oct. 1988.
  19. S. D. Weisbord, L. F. Fried, R. M. Arnold, A. J. Rotondi, M. J. Fine, D. J. Levenson, G. E. Switzer, Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index, J Pain Symptom Manage, vol. 27, no. 3, pp. 226-240, 2004. DOI:
  20. L. O. Walker, K.C. Avant, Strategies for theory construction in nursing, 2nd Ed. Norwalk, conn: Appleton & Lange, pp. 227, 1988. ISBN 0-8385-8680-5.