Development of the thirst distress scale. (Commentary and Response).
How often have you had your patients say, "But I'm really thirsty"? While we as nurses are concerned about high interdialytic weight gains (IWG), we have paid little attention to assessment of thirst, which to patients, is the main reason for drinking fluid. Janet Welch is to be congratulated for developing an instrument that will help us assess the distress caused by thirst. The instrument is short and can easily be used in practice.
Dr. Welch has gone to considerable lengths to demonstrate that this measure of thirst is reliable and valid. What does this mean to us? It means that the instrument is really measuring what it is supposed to (thirst distress) and that it does so with accuracy and consistency. Dr. Welch has used sophisticated statistical methods, such as exploratory and confirmatory factor analysis, to demonstrate the construct validity of the measure. These procedures illustrate that the measure behaves as hypothesized. While more detail could have been provided to researchers regarding the underlying assumptions and models tested in these analyses, it appears that the instrument is a good measure of symptom distress.
Because some of the initially developed questions did not meet commonly used scientific parameters for inclusion, questions relating to frequency and duration of thirst were not included. While some might argue that this indicates that the tool does not describe the symptom experience fully, it may be that thirst is a different type of symptom than pain, which may be more intermittent. Many renal failure patients report being thirsty all the time, rather than having thirst patterns that vary over time. Intensity of thirst, however, can be accurately measured, as noted with use of the Visual Analogue Scale, and it may be useful to add a dimension to the instrument that measures intensity or severity of the problem.
There is never a research instrument that is perfect in every sense, but this instrument will be very useful to nurses and researchers who are interested in learning more about their patients' thirst. Further testing in other settings is always advisable, since testing from one region of the country will not necessarily produce the same results as it would in other areas. However, I value having another tool available for use that can be used to assess a symptom and is specific to renal failure.
Anita E. Molzahn, PhD, RN Professor, School of Nursing Dean, Faculty of Human and Social Development University of Victoria Victoria, BC, Canada
I would like to thank Dr. Molzahn for offering her thoughtful comments and insights about the thirst distress scale. Although the self-management of fluid intake is a major component of treatment, there are few investigations that examine the experience of thirst in hemodialysis patients and no intervention studies that test the effects of recommended self-management strategies. In order to implement effective interventions in the clinical setting, more research in this area is needed. The development of reliable and valid instruments is one step in this journey.
Janet L. Welch, DNS, RN
This Commentary and Response includes the research commentary and investigator's response. Application of findings to practice will be highlighted when appropriate. The opinions and assertions contained herein are the private views of the contributors and do not necessarily reflect the views of the American Nephrology Nurses' Association. For further information or to express interest in writing for this department, contact the Editor through the ANNA National Office; East Holly Avenue/Box 56; Pitman, NJ 08071-0056.
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|Author:||Molzahn, Anita E.|
|Publication:||Nephrology Nursing Journal|
|Article Type:||Brief Article|
|Date:||Aug 1, 2002|
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