Document Type : Original Article
Authors
- Leila Rafiee-Vardanjani 1, 2
- Shahnaz Nemati 3
- Shima Shirozhan 4
- Kobra Noorian 5
- Mehri Doosti-Irani 6
1 Nursing Department, Shahrekord University of Medical Sciences, Shahrekord, Iran
2 Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
3 Anesthesia Department, Shahrekord University of Medical Sciences, Shahrekord, Iran
4 Health in Emergency and Disaster Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
5 Nursing Department, University of Social Welfare and Rehabilitation Science, Tehran, Iran
6 Operating Room Department, Shahrekord University of Medical Sciences, Shahrekord, Iran
Abstract
Background: Hemodialysis patients encountered significant challenges during the COVID-19 pandemic. Frequent visits to dialysis centers increased their risk of exposure to the virus, and travel restrictions and lockdowns hindered access to these facilities. This heightened anxiety and fear of infection, leading some patients to miss essential treatments. Accordingly, this study aimed to examine the lived experiences of hemodialysis patients during the COVID-19 pandemic.
Methods: This qualitative study was conducted using Graneheim and Lundman’s content analysis on 12 patients receiving hemodialysis at the Hajar hemodialysis center in 2021 and 2022. Participants were selected through purposive sampling, and data were collected via 15 semi-structured in-depth interviews. The trustworthiness of the data was ensured using Lincoln and Guba’s method.
Results: The study included seven men and five women diagnosed with chronic renal diseases. Data analysis revealed two main categories including intrapersonal experiences and interpersonal experiences. The first category was further divided into several subcategories including adaptation to quarantine, near-death experiences, reassessment of life, enhanced spirituality, fear of the unknown, escalating daily life challenges, and reservations about vaccines and treatment. The second category encompassed several subcategories including fragility in social relationships, creating virtual connections to reality, external support, and changes in care and treatment routines.
Conclusion: Hemodialysis patients showed more adaptability to the COVID-19 pandemic than other patients due to their chronic condition. However, optimal adaptation in similar emergencies requires extensive support from healthcare staff and the wider community.
Keywords
- Rafiee Vardanjani L, Parvin N, Mahmoodi Shan G. The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients. Disabil Rehabil. 2016;38(8):768-72. doi: 10.3109/09638288.2015.1061601.
- Flahault A. COVID-19 cacophony: is there any orchestra conductor? Lancet. 2020;395(10229):1037. doi: 10.1016/ s0140-6736(20)30491-8.
- Reid C, Seymour J, Jones C. A thematic synthesis of the experiences of adults living with hemodialysis. Clin J Am Soc Nephrol. 2016;11(7):1206-18. doi: 10.2215/cjn.10561015.
- Jonasson K, Gustafsson LK. You live as much as you have time to: the experience of patients living with hemodialysis. Nephrol Nurs J. 2017;44(1):35-41.
- Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018;96(6):414-22D. doi: 10.2471/ blt.17.206441.
- Murakami N, Siktel HB, Lucido D, Winchester JF, Harbord NB. Disaster preparedness and awareness of patients on hemodialysis after Hurricane Sandy. Clin J Am Soc Nephrol. 2015;10(8):1389-96. doi: 10.2215/cjn.10181014.
- Chiaranai C. The lived experience of patients receiving hemodialysis treatment for end-stage renal disease: a qualitative study. J Nurs Res. 2016;24(2):101-8. doi: 10.1097/ jnr.0000000000000100.
- Kazemi M, Nikbakht-Nasrabadi A, Hasanpour M, Hassankhani H, Mills J. Experience of Iranian persons receiving hemodialysis: a descriptive, exploratory study. Nurs Health Sci. 2011;13(1):88-93. doi: 10.1111/j.1442- 2018.2011.00586.x.
- Han E, Shiraz F, Haldane V, Koh JJ, Quek RY, Ozdemir S, et al. Biopsychosocial experiences and coping strategies of elderly ESRD patients: a qualitative study to inform the development of more holistic and person-centred health services in Singapore. BMC Public Health. 2019;19(1):1107. doi: 10.1186/s12889-019-7433-6.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/s0140-6736(20)30183-5.
- Ikizler TA, Kliger AS. Minimizing the risk of COVID-19 among patients on dialysis. Nat Rev Nephrol. 2020;16(6):311-3. doi: 10.1038/s41581-020-0280-y.
- Malo MF, Affdal A, Blum D, Ballesteros F, Beaubien- Souligny W, Caron ML, et al. Lived experiences of patients receiving hemodialysis during the COVID-19 pandemic: a qualitative study from the Quebec renal network. Kidney360. 2022;3(6):1057-64. doi: 10.34067/kid.0000182022.
- Fu D, Yang B, Xu J, Mao Z, Zhou C, Xue C. COVID-19 infection in a patient with end-stage kidney disease. Nephron. 2020;144(5):245-7. doi: 10.1159/000507261.
- Oben P. Understanding the patient experience: a conceptual framework. J Patient Exp. 2020;7(6):906-10. doi: 10.1177/2374373520951672.
- Coulter A. Engaging Patients in Healthcare. McGraw-Hill Education (UK); 2011.
- Caron-Flinterman JF, Broerse JE, Bunders JF. The experiential knowledge of patients: a new resource for biomedical research? Soc Sci Med. 2005;60(11):2575-84. doi: 10.1016/j. socscimed.2004.11.023.
- Holloway I, Galvin K. Qualitative Research in Nursing and Healthcare. John Wiley & Sons; 2023.
- Sun N, Wei L, Wang H, Wang X, Gao M, Hu X, et al. Qualitative study of the psychological experience of COVID-19 patients during hospitalization. J Affect Disord. 2021;278:15-22. doi: 10.1016/j.jad.2020.08.040.
- Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-88. doi: 10.1177/1049732305276687.
- Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105- 12. doi: 10.1016/j.nedt.2003.10.001.
- Speziale HS, Streubert HJ, Carpenter DR. Qualitative Research in Nursing: Advancing the Humanistic Imperative. Lippincott Williams & Wilkins; 2011.
- Lincoln YS, Guba EG. Naturalistic Inquiry. SAGE Publications; 1985.
- Natale P, Zhang J, Scholes-Robertson N, Cazzolli R, White D, Wong G, et al. The impact of the COVID-19 pandemic on patients with CKD: systematic review of qualitative studies. Am J Kidney Dis. 2023;82(4):395-409.e1. doi: 10.1053/j. ajkd.2023.04.001.
- Creput C, Fumeron C, Toledano D, Diaconita M, Izzedine H. COVID-19 in patients undergoing hemodialysis: prevalence and asymptomatic screening during a period of high community prevalence in a large Paris center. Kidney Med. 2020;2(6):716-23.e1. doi: 10.1016/j.xkme.2020.09.001.
- Centers for Disease Control and Prevention (CDC). Certain Medical Conditions and Risk for Severe COVID-19 Illness. CDC; 2020.
- Gedney N. Long-term hemodialysis during the COVID-19 pandemic. Clin J Am Soc Nephrol. 2020;15(8):1073-4. doi: 10.2215/cjn.09100620.
- Pakhchanian H, Raiker R, Mukherjee A, Khan A, Singh S, Chatterjee A. Outcomes of COVID-19 in CKD patients: a multicenter electronic medical record cohort study. Clin J Am Soc Nephrol. 2021;16(5):785-6. doi: 10.2215/cjn.13820820.
- Cozzolino M, Conte F, Zappulo F, Ciceri P, Galassi A, Capelli I, et al. COVID-19 pandemic era: is it time to promote home dialysis and peritoneal dialysis? Clin Kidney J. 2021;14(Suppl 1):i6-13. doi: 10.1093/ckj/sfab023.
- Musapur H, Changi Ashtiyani J, Kahrobaei Kalkhuran Alya M. Spiritual and existential growth and COVID 19 pandemic: a qualitative study. Journal of Research in Psychological Health. 2020;14(1):56-70. [Persian].
- Eisazadeh F, Saffari Nia M. The effectiveness of group spiritual therapy on depression, mental health and psychological capital in recovering from COVID-19 disease. Journal of Quran and Medicine. 2021;5(4):11-22. [Persian].
- Mousavi-Almaleki Z, Ghomian S, Roshan Chesli R, Bagherinezhad M. Psychological and spiritual dimensions of COVID-19 patients: a qualitative study. Clin Psychol Stud. 2020;11(41):17-42. doi: 10.22054/jcps.2021.55243.2434.
- Pashaii Sabet F, Nikbakht-Nasrabadi A, Karami Kabir N. Life with hemodialysis unit: a phenomenological study. Iran J Crit Care Nurs. 2011;4(2):59-66. [Persian].
- Shechory Bitton M, Laufer A. Fear of the unknown: does fear of terrorism differ from fear of contracting COVID-19? Front Psychol. 2021;12:660777. doi: 10.3389/fpsyg.2021.660777.
- Wang Y, Shi L, Que J, Lu Q, Liu L, Lu Z, et al. The impact of quarantine on mental health status among general population in China during the COVID-19 pandemic. Mol Psychiatry. 2021;26(9):4813-22. doi: 10.1038/s41380-021-01019-y.
- Crayne MP. The traumatic impact of job loss and job search in the aftermath of COVID-19. Psychol Trauma. 2020;12(S1):S180-2. doi: 10.1037/tra0000852.
- Dang HH, Viet Nguyen C. Gender inequality during the COVID-19 pandemic: income, expenditure, savings, and job loss. World Dev. 2021;140:105296. doi: 10.1016/j. worlddev.2020.105296.
- von Wachter T. Lost generations: long-term effects of the COVID-19 crisis on job losers and labour market entrants, and options for policy. Fisc Stud. 2020;41(3):549-90. doi: 10.1111/1475-5890.12247.
- Barnett-Howell Z, Watson OJ, Mobarak AM. The benefits and costs of social distancing in high- and low-income countries. Trans R Soc Trop Med Hyg. 2021;115(7):807-19. doi: 10.1093/trstmh/traa140.
- Mattioli AV, Sciomer S, Cocchi C, Maffei S, Gallina S. Quarantine during COVID-19 outbreak: changes in diet and physical activity increase the risk of cardiovascular disease. Nutr Metab Cardiovasc Dis. 2020;30(9):1409-17. doi: 10.1016/j.numecd.2020.05.020.
- McDowell CP, Herring MP, Lansing J, Brower C, Meyer JD. Working from home and job loss due to the COVID-19 pandemic are associated with greater time in sedentary behaviors. Front Public Health. 2020;8:597619. doi: 10.3389/ fpubh.2020.597619.
- Hosseini SJ, Nosrati S, Nezhadi S, Ghasemi S, Vszini Taher A. Relationship between health-related behaviors change after COVID-19 outbreak with psychological distress. Journal of Military Health Promotion. 2020;1(3):147-55. [Persian].
- Wiysonge CS, Ndwandwe D, Ryan J, Jaca A, Batouré O, Anya BM, et al. Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future? Hum Vaccin Immunother. 2022;18(1):1-3. doi: 10.1080/21645515.2021.1893062.
- Khankeh H, Pourebrahimi M, Hosseinabadi-Farahani M, Farrokhi M, Khanjani MS, Shojafard J, et al. Comparison of vaccine hesitancy during the low and high points of COVID-19 in a population under international sanctions: a longitudinal mixed-methods study in Iran. Front Public Health. 2022;10:958899. doi: 10.3389/fpubh.2022.958899.
- Masoudi R, Khayeri F, Rabiei L, Zarea K. A study of stigma among Iranian family caregivers of patients with multiple sclerosis: a descriptive explorative qualitative study. Appl Nurs Res. 2017;34:1-6. doi: 10.1016/j.apnr.2016.11.012.
- Saffari M, Koenig HG, O’Garo KN, Pakpour AH. Mediating effect of spiritual coping strategies and family stigma stress on caregiving burden and mental health in caregivers of persons with dementia. Dementia (London). 2018:1471301218798082. doi: 10.1177/1471301218798082.
- Kazemi M, Nikbakht-Nasrabadi A, Hasanpour M, Hassankhani H, Mills J. Experience of Iranian persons receiving hemodialysis: a descriptive, exploratory study. Nurs Health Sci. 2011;13(1):88-93. doi: 10.1111/j.1442- 2018.2011.00586.x.
- Davidson B, Schmidt E, Mallar C, Mahmoud F, Rothenberg W, Hernandez J, et al. Risk and resilience of well-being in caregivers of young children in response to the COVID-19 pandemic. Transl Behav Med. 2021;11(2):305-13. doi: 10.1093/tbm/ibaa124.
- Alexander GC, Qato DM. Ensuring access to medications in the US during the COVID-19 pandemic. JAMA. 2020;324(1):31- 2. doi: 10.1001/jama.2020.6016.
- Kokabisaghi F. Assessment of the effects of economic sanctions on Iranians’ right to health by using human rights impact assessment tool: a systematic review. Int J Health Policy Manag. 2018;7(5):374-93. doi: 10.15171/ijhpm.2017.147.
- Kohler JC, Mackey TK. Why the COVID-19 pandemic should be a call for action to advance equitable access to medicines. BMC Med. 2020;18(1):193. doi: 10.1186/s12916-020-01661-3.
- Engels D, Austin M, Doty S, Sanders K, McNichol L. Broadening our bandwidth: a multiple case report of expanded use of telehealth technology to perform wound consultations during the COVID-19 pandemic. J Wound Ostomy Continence Nurs. 2020;47(5):450-5. doi: 10.1097/won.0000000000000697.
- Hong YR, Lawrence J, Williams D Jr, Mainous IA. Population-level interest and telehealth capacity of US hospitals in response to COVID-19: cross-sectional analysis of Google search and national hospital survey data. JMIR Public Health Surveill. 2020;6(2):e18961. doi: 10.2196/18961.
- Alleaume C, Verger P, Peretti-Watel P. Psychological support in general population during the COVID-19 lockdown in France: needs and access. PLoS One. 2021;16(5):e0251707. doi: 10.1371/journal.pone.0251707.
- Socías CO, Brage LB, Nevot-Caldentey L. Family support against COVID-19. SciELO [Preprint]. May 3, 2020. Available from: https://europepmc.org/article/ppr/ppr459109.
- Mariani R, Renzi A, Di Trani M, Trabucchi G, Danskin K, Tambelli R. The impact of coping strategies and perceived family support on depressive and anxious symptomatology during the coronavirus pandemic (COVID-19) lockdown. Front Psychiatry. 2020;11:587724. doi: 10.3389/ fpsyt.2020.587724.
- Noce EM, Brereton L, Zorzanello M, Aklilu A, Anders E, Bernal M, et al. Dialysis patient experiences during the COVID-19 pandemic: a survey study. Kidney Med. 2023;5(7):100673. doi: 10.1016/j.xkme.2023.100673.