Commitment to care: the most important coping strategies among family caregivers of patients undergoing haemodialysis

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Several studies indicate a significant worldwide growth in haemodialysis treatment as a maintenance therapy for patients with chronic renal failure 1. Haemodialysis is the main form of treating more than three million patients with chronic renal failure around the world 2. In 2008, about 12 000 people in Iran received haemodialysis treatment, although now more than 27 000 patients are regularly treated in 500 dialysis centres 3.
The long‐term treatment of chronic renal failure and frequent hospitalisation in the dialysis ward represent serious changes to the lives of patients and caregivers; the most dialysis patients and their caregivers experience anxiety, depression, sleep disorders and low quality of life 4.
The caregivers of the patients with kidney failure, who are treated with haemodialysis, should provide both emotional support and care for other needs whether at home or in the dialysis ward. Thus, caregivers may experience psychological, physical and social distress and numerous other problems as a consequence 7. The distress experienced by caregivers may result from the need to provide long‐term care, the long course of the disease, the potential for haemodialysis complications, newly arising needs and major changes in lifestyle, which can all create serious tensions and disrupt the structure of caregivers' families 9. Similarly, caregivers may also face a decline in income, sexual disorders and need to manage resulting psychological problems in addition to the possibilities of missing work, requesting compulsory leave or leaving the workplace early to take care of patients at home, thereby increasing the burdens and tensions experienced by family caregivers 11.
The increase in life expectancy of patients with chronic renal failure 13 and the severe restrictions on the kidney transplantation process have strengthened the increasing trend of haemodialysis treatment. In most cases, patients must heavily rely on family caregivers who experience an increased burden of care 4. Even though this can represent a heavy burden, family caregivers often inevitably hold this responsibility 16.
In addition, the spiritual and psychological health of caregivers can have a significant effect on the health and recovery of patients suffering from chronic renal failure 14. Furthermore, the caregivers' use of coping strategies and their methods of dealing with stress during the care process are important for their well‐being 18. The review of the results of different surveys indicates certain common characteristics that enable caregivers to improve their acceptance of the situation 14. Therefore, understanding these characteristics, the coping strategies of family caregivers and the incurred burden of care in addition to the effects of caregiving on the quality of life of caregivers can lead to recommendations that would help caregivers provide better care and improve the physical and psychological health of patients, and the design of an appropriate care model would thus reduce the negative burden of care 20. The strategies used by caregivers in coping with their situation can significantly affect their sense of burden and the quality of care provided to patients.
Despite the importance of recognising the motivations behind the provision of care and the coping strategies utilised by caregivers of haemodialysis patients, there are few studies on this topic 22. Most of these studies have been limited to quantitative studies concerning financial stress, care burden, performance and marital status, while less attention has been paid to the coping strategies of caregivers 11. Coping strategies form a social and interactive process and are influenced by ethnicity, values, attitudes, knowledge, culture and the social infrastructure governing the family 25.
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