COGNITIVE APPRAISAL OF STRESS AND COPING OF INTRADYALITIC EVENTS IN PERSONS ON HEMODIALYSIS

Abstract

Although hemodialysis (HD) has the propensity to preserve and maintain life, the person on HD is at risk for adverse intradialytic events (IDEs) during the treatment such as cramping, loss of consciousness, and death. A few studies have explored stressors and coping strategies of persons on HD, yet none have specifically focused on stress appraisal and coping strategies related to IDEs. Thus, the purposes of this study were to: a) describe the types and associations of IDEs to stress and examine primary cognitive appraisals of IDEs on stress towards HD; and b) examine the association between coping strategies and HD stress. A cross sectional correlational design was used. A convenience sample of persons (N = 73) on HD consented to participate in the study and completed the Hemodialysis Demographic Form, the Dialysis Symptom Index, the Cognitive Appraisal of Health Scale, the Ways of Coping Questionnaire, and the Hemodialysis Stress Visual Analog Scale. The majority of the sample was African American (95%) and male (52%). The mean age was 57 (SD = 11.98) years and participants averaged 41 (SD = 31.55) months on HD. Frequently reported IDEs were lack of energy (70%), followed by dry skin (64%), and itching (54%). Women reported higher stress towards HD and were more bothered by IDEs than men. Additionally, women used more emotion focused coping and younger aged participants used confrontive coping compared to older participants. When controlling for age, sex, and months on HD, primary cognitive appraisal explained 22% of the variance in stress towards HD related to an IDE (F (7, 65) = 2.58; p = .021) and coping strategies explained 34% of the variance in stress towards HD (F (11, 61) = 2.89; p = .004) with escape avoidance (p = .37), sex (p = .03), and planful problem solving (p = .02) contributing to the model. Understanding coping strategies associated with IDE stress will allow the healthcare team to formulate interventions to support the physiological and psychological wellbeing of persons undergoing HD, thus improving their quality of life.