Experiences of stress appraisal in hemodialysis patients: A theory-guided qualitative content analysis

Chronic renal failure and prolonged hospitalization for the treatment of renal disease incur immense stress and anxiety in patients. Considering the increased prevalence of renal failure, the present study aimed to explain the experiences of stress assessment in hemodialysis (HD) patients based on the transactional model of Lazarus and Folkman. The data collection method was semi-structured interview with 22 patients from dialysis centers in Tehran. Sampling was purposive and continued until data saturation. Data were analyzed using the directed content analysis method. Data analyzed to the extraction of 80 codes that were classified into two predetermined categories of appraisal structures in the transactional stress model, including primary and secondary appraisal, and also seven subcategories (perceived susceptibility, perceived severity, motivational relevance, casual focus, perceived control over outcoms, perceived control over emotions, and self-efficacy). During this study, 15 sub-subcategories were obtained for the stress appraisal in HD patients. The results showed that the subcategories of perceived susceptibility, perceived severity, and casual focus were the most effective factors in the stress appraisal in HD patients. According to the results, an arrangement should be made so that HD patients can evaluate the stressful conditions properly. patients need help to improve their evaluation in subcategories of motivational relevance, perceived control over outcomes, perceived control over emotion, and self-efficacy. In this regard, one of the best models that can be used to identify the appraisals in HD patients and design appropriate interventions for them is the transactional model.