Context: Stress is a common comorbid disorder among hemodialysis patients, and diverse factors contribute to stress perception in such individuals. Although numerous findings have been consistent across the literature, there has been a lack of consensus on which factor is the most influential on stress perception. This systematic review aimed to provide an executive review on factors contributing to stress perception among hemodialysis patients.
Evidence Acquisition: A detailed search was carried out on Cumulative Index to Nursing and Allied Health Literature, PubMed, EBESCOhost, Google Scholar, Medline, and Web of Science databases. Rigorous search narrowed to 16 observational studies (n=3,567 participants) on factors determining stress perception among hemodialysis patients. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was incorporated. The selected 16 articles were used in the qualitative synthesis.
Results: Stressors were grouped as biological, psychological/behavioral, or social/environmental factors. It was revealed that the effects of socio-demographic factors on stress perception were scarce and inconsistent, while fatigue and itching were distressing biological factors. Limitations on time and place on vacation, limitation of food and fluid are psychological stressors and decrease in social life with substantial economic burden were enlightened as social stressors.
Conclusion: Multidisciplinary factors were found for stress perception among hemodialysis patients. Nursing care plans should address the holistic nature of stress with appropriate nursing interventions. Although this review adopted the strict selection criteria, it remains difficult to conclude determinants due to methodological drawbacks. Therefore, future research in this scope is highly appreciated with prospective longitudinal nature to produce solid clinical conclusions.
Picariello F, Moss-Morris R, Macdougall IC, Chilcot J. The role of psychological factors in fatigue among end-stage kidney disease patients: a critical review. Clin Kidney J. 2017;
(1):79-88. doi: 10.1093/ckj/sfw113. [PubMed: 28638608].
Selye H. The evolution of the stress concept: Stress and cardiovascular disease. Am J Cardiol. 1970;26(3):289-99. doi: 10.1016/0002-9149(70)90796-4. [PubMed: 4990110].
Holmes TH, Rahe RH. The Social Readjustment Rating Scale.
J Psychosom Res. 1967;11(2):213–8. doi: 10.1016/0022-3999(67)90010-4. [PubMed: 6059863].
Suls J, Rothman A. Evolution of the biopsychosocial
model: prospects and challenges for health psychology.
Health Psychol. 2004;23(2):119-25. doi: 10.1037/0278-6126.96.36.199. [PubMed: 15008654].
Engel GL. The need for a new medical model: a challenge
for biomedicine. Science. 1977;196(4286):129-36. doi: 10.1126/science.847460. [PubMed: 847460].
Cukor D, Cohen SD, Peterson RA, Kimmel PL. Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. J Am Soc Nephrol. 2007;18(12):3042-55. doi: 10.1681/ASN.2007030345. [PubMed: 18003775].
Rojas JN. Stress and coping mechanisms among hemodialysis patients in the gulf and neighboring countries: a systematic review. Int J Adv Res Technol. 2017;6(4): 36-40.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9. doi: 10.7326/0003-4819-151-4-200908180-00135. [PubMed: 19622511].
Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. Educ Inf. 2018;34(4):285-91. doi: 10.3233/EFI-180221.
Shinde M, Mane SP. Stressors and the coping strategies among patients undergoing hemodialysis. Int J Sci Res. 2014;3(2):266-76.
Bukhary FE, Sayied NE, Abo-El-Magd MH, Saber EH. Psychological stress and coping strategies among chronic hemodialysis patients at el-Minia university hospital. Al-Azhar Assiut Med J. 2013;11(3):1-48.
Tchape OD, Tchapoga YB, Atuhaire C, Priebe G, Cumber SN. Physiological and psychosocial stressors among hemodialysis patients in the Buea Regional Hospital, Cameroon. Pan Afr Med J. 2018:30:1-7. doi: 10.11604/pamj.2018.30.49.15180. [PubMed: 30197740].
Ahmad MM, Al Nazly EK. Hemodialysis: stressors and coping strategies. Psychol Health Med. 2015;20(4):477-87. doi: 10.1080/13548506.2014.952239. [PubMed: 25158058].
Cormier-Daigle M, Stewart M. Support and coping of male hemodialysis-dependent patients. Int J Nurs Stud. 1997;34(6):420-30. doi: 10.1016/s0020-7489(97)00035-7. [PubMed: 9559392].
Cristóvão F. Stress, coping and quality of life among chronic haemodialysis patients. EDTNA ERCA J. 1999;25(4):36-9. [PubMed: 10827598].
Ekelund ML, Andersson SI. Elucidating issues stressful for patients in predialysis and dialysis: from symptom to
context. J Health Psychol. 2007;12(1):115-26. doi: 10.1177/1359105307071745. [PubMed: 17158845].
Lok P. Stressors, coping mechanisms and quality of life among dialysis patients in Australia. J Adv Nurs. 1996;23(5):873-81. doi: 10.1046/j.1365-2648.1996.00893.x. [PubMed: 8732512].
Mok E, Tam B. Stressors and coping methods among chronic haemodialysis patients in Hong Kong. J Clin Nurs. 2001;10(4):503-11. doi: 10.1046/j.1365-2702.2001.00500.x. [PubMed: 11822498].
Yeh SCJ, Huang CH, Chou HC. Relationships among coping, comorbidity and stress in patients having haemodialysis.
J Adv Nurs. 2008;63(2):166-74. doi: 10.1111/j.1365-2648.2008.04659.x. [PubMed: 18537842].
Cinar S, Barlas GU, Alpar SE. Stressors and coping strategies in hemodialysis patients. Pak J Med Sci. 2009;25(3):447-52.
Shahrokhi Z, Rayyani M, Sabzevari S, Haghdoost AA. Stressors and Coping strategies of dialysis patients. J Crit Care Nurs. 2014;6(4):184-93.
Tarachand JS, Lee P. Understanding the Experience of stress on initiation of Haemodialysis: a phenomenological study. Int J Nurs Stud. 2014;3(1):11-9.
Logan SM, Pelletier‐Hibbert M, Hodgins M. Stressors and coping of in‐hospital haemodialysis patients aged 65 years and over. J Adv Nurs. 2006;56(4):382-91. doi: 10.1111/j.1365-2648.2006.04015.x. [PubMed: 17042818].
Tu HY, Shao JH, Wu FJ, Chen SH, Chuang YH.
Stressors and coping strategies of 20–45-year-old hemodialysis patients. Collegian. 2014;21(3):185-92. doi: 10.1016/j.colegn.2013.02.003. [PubMed: 25632712].
Heidari Gorji MA, Mahdavi A, Janati Y, Illayi E, Yazdani J, Setareh J, et al. Physiological and psychosocial stressors among hemodialysis patients in educational hospitals of northern Iran. Indian J Palliat Care. 2013;19(3):166-9. doi: 10.4103/0973-1075.121533. [PubMed: 24347907].
Horigan AE. Fatigue in hemodialysis patients: a review of current knowledge. J Pain Symptom Manage. 2012;44(5):715-24. doi: 10.1016/j.jpainsymman.2011.10.015. [PubMed: 22743156].
Artom M, Moss-Morris R, Caskey F, Chilcot J. Fatigue in advanced kidney disease. Kidney Int. 2014;86(3):497-505. doi: 10.1038/ki.2014.86. [PubMed: 24694985].
Seo NS, Kang SJ, Kim JH, Kim SJ. Relationships between fatigue, sleep disturbance, stress, self-efficacy and depression in hemodialysis patients. J Korean Clin Nurs Res. 2013;19(2):285-97. doi: 10.22650/JKCNR.2013.19.2.285.
Stewart M. Narrative literature review: sexual dysfunction in the patient on hemodialysis. Nephrol Nurs J. 2006;33(6):631-4. [PubMed: 17219725].
Ebrahimi H, Sadeghi M, Amanpour F, Dadgari A. Influence of nutritional education on hemodialysis patients' knowledge and quality of life. Saudi J Kidney Dis Transpl. 2016;27(2):250-5. doi: 10.4103/1319-2442.178253. [PubMed: 26997377].
Sahaf R, Ilali ES, Peyrovi H, Akbari Kamrani AA, Spahbodi F. Uncertainty, the overbearing lived experience of the elderly people undergoing Hemodialysis: a qualitative study. Int J Community Based Nurs Midwifery. 2017;5(1):13-21. [PubMed: 28097174].
Firoz MN, Shafipour V, Jafari H, Hosseini SH, Charati JY. Sleep quality and depression and their association with other factors in hemodialysis patients. Glob J Health Sci. 2016;8(8):1-7. doi: 10.5539/gjhs.v8n8p121. [PubMed: 27045404].
Bray SH. Self-Care in-center hemodialysis. in present and future therapies for end-stage renal disease. Artif Cells Nanomed Biotechnol. 2010;2:95-107. doi: 10.1142/9789814280037_0007.
Abram HS. Survival by machine: The psychological stress of chronic hemodialysis. Psychiatry Med. 1970;1(1):37-51. doi: 10.2190/u6n8-n115-naga-ppjh. [PubMed: 5526722].
Nasiri M, Kheirkhah F, Rahimiyan B, Ahmadzadeh B, Hasannejad H, Mohamad Jahfari R. Stressful factors, coping mechanisms and quality of life in hemodialysis patients. Iran J Crit Care Nurs.2013;6(2):119-126.
Moran A, Scott PA, Darbyshire P. Existential boredom: the experience of living on haemodialysis therapy. Med Humanit. 2009;35(2):70-5. doi: 10.1136/jmh.2009.001511. [PubMed: 23674698].
Mohajer S, Yoong TL, Chan CM, Danaee M, Mazlum SR, Bagheri N. Development of a geriatric nursing-specific Mini-CEX and evaluation of the professional competence of nursing students: a novel approach to clinical evaluation in implementing case study. Iran Red Crescent Med J. 2022;24(5):1-9. doi: 10.32592/ircmj.2022.24.5.1836.
Mohajer S, Yoong TL, Chan CM, Danaee M, Mazlum SR, Bagheri N. Evaluation of professional self-concept and its relationship factors: a study among nursing students in mashhad university of medical sciences, iran. study. Iran Red Crescent Med J. 2021;23(12):1-8. doi: 10.32592/ircmj.2021.23.12.1638.
Mokhtar ZH, Wong LP, Chong MC, Al Raimi AM, Al Ajeel LY, Mohajer S. Quality of communication between cancer patients and doctors. Iran Red Crescent Med J. 2021;23(12):1-7. doi: 10.32592/ircmj.2021.23.12.1452.
Ghasemi A, Karimi Moonaghi H, Mohajer S, Mazlom SR, Shoeibi N. Effect of self-management educational program on
vision-related quality of life among elderly with visual impairment. Evid Based Care J. 2018;8(1):35-44. doi: 10.22038/EBCJ.2018.28999.1717.