Strategies for coping with stress related to intradialytic events utilized by patients on hemodialysis at the renal unit, Kenyatta National Hospital.

Abstract

BACKGROUND: Chronic Kidney Disease (CKD) prevalence has increased immensely, estimated at 8-16% globally, consequently resulting in large numbers of patients with end stage renal disease (ESRD) requiring renal replacement therapy (RRT). Hemodialysis (HD) is mostly used in the developing countries like Kenya. Hemodialysis is linked with complications that affects the quality of life of these patients. These complications are stressful to the patients, requiring them to cope. Coping mechanisms are broadly categorised into problem focused and emotion focused. Most patients on HD tend to use emotion-oriented coping strategies to cope with stress. Emotion focused strategies have been associated with poor therapy outcome and low health related quality of life. This study aimed at identifying the strategies utilised by patients on hemodialysis at Kenyatta National Hospital to cope with stress related to intradialytic complications. OBJECTIVE: To identifying the coping strategies used by patients to cope with intradialytic related stress, and to also determine the common types of intradialytic complications experienced at the renal unit as well as the level of stress. METHODOLOGY: Quantitative cross-sectional study design was used to meet the objectives of this study. A researcher administered questionnaire was used to obtain demographic and clinical data. Jalowiec coping scale was used to identify coping strategies. 96 respondents were recruited using random sampling method. RESULTS: Majority (61.5%) of the respondents were male, married (58.3%) and aged (33.3%) between 40 to 49 years. Respondents with hypertension were the majority (63%). Majority (89.6%) of the respondents reported to have experienced IDEs more than once in the past 3 months. Most (51%) respondents reported that they had never been guided on ways of coping with stress related to IDEs. Muscle cramps (55%), headaches (54%) and hypertension (47%) were the most common experienced intradialytic complications among the respondents. The mean level of stress was rated at 5.13±2.1 and the commonly used coping strategies were confrontive (45%), fatalistic (46%) and supportant (48%). There was a statistical significance (p≤0.05) found in the relationship between the level of stress experienced and the use of coping strategies. CONCLUSION: Hypertension is the main cause of CKD among the patients. Central venous catheters are the main venous access used by the patients for HD. Muscle cramps, headaches and hypertension are the most common intradialytic complications experienced. Patients are not adequately informed of the intradialytic complications and are not trained on stress coping mechanisms. There is need for trainings on stress management and coping. Emphasis on use of problem focused coping strategies is required through tailored counselling services.