Coping strategies and stressors in patients with hemodialysis

SHU-CHUAN JENNIFER YEH ,P HD, AND HSUEH-CHIH CHOU, RN, MBA Objectives: To investigate the stress related to undergoing hemodialysis (HD) and the relationship between these stresses and the coping strategies used by patients with end-stage renal disease. Methods: We used the Hemodialysis Stressor Scale and the Jalowiec Coping Scale to interview 2642 patients (mean age 57 years; 53.5% female) receiving HD. The Hemodialysis Stressor Scale measures the level of stress related to stressor subscales: daily activity, physical condition, dependency on medical staff, fluid and food restriction, role ambiguity, blood vessel problems, and reproductive system functioning. The Jalowiec Coping Scale identifies the use of the following coping strategies: problem-oriented, emotion-oriented, support seeking, avoidance, and isolated thoughts. Data were analyzed using Hierarchical Linear Modeling. Results: Daily activity subscale scores were positively associated with using emotion-oriented, avoidance, and isolated thoughts as coping styles and negatively related to support seeking from professionals. The higher the perceived stress related to physical symptoms, dependency on medical staff, and blood vessel problems, the more the patients used emotion-oriented, support seeking, avoidance, and isolated thoughts to cope. Fluid and food restriction and role ambiguity subscales were found to be positively associated with emotion-oriented, avoidance, and isolated thoughts coping strategies. Reproductive system functioning was positively associated with emotion-oriented, avoidance, and isolated thoughts coping strategies. Patients on HD seldom use problem-oriented strategy to ease their stresses. Support seeking was another infrequently used coping strategy. Conclusions: The most commonly used coping strategies in our patients were emotion-oriented, avoidance, and isolated thoughts. The choice of coping strategy depended on the types of stressor. Key words: stressor, coping, dialysis, end-stage renal disease.