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The relationship between uncertainty and coping strategies used by long-term kidney transplant patients Swanson, Dorothy Roberta


This descriptive correlational study was done to describe the perceptions of uncertainty and coping strategies used by adult kidney transplant patients. In addition, the study was designed to identify relationships between uncertainty and coping strategies used by long-term kidney transplant patients. The stress, appraisal, and coping theory developed by Lazarus and Folkman (1984) served as the theoretical framework. A convenience sample of 88 subjects who received either a living-related or cadaveric donor kidney transplant and were three and more years post-transplant completed the Uncertainty Stress Scale (USS), the revised Jalowiec Coping Scale (JCS), and a patient information sheet. The subjects were mailed the questionnaire. For the majority of patients, this was their first kidney transplant. The number of years that patients had lived with their current kidney transplant ranged from 3.1 to 20.9 years with the majority of patients transplanted under 10 years. Overall, long-term kidney transplant patients perceived moderately low levels of uncertainty. The nature of uncertainty appears to be primarily generated by the indeterminateness of the situation. Numbers of health or medical problems aside from renal disease and educational level appear to be significant factors in the uncertainty of patients with a long-term kidney transplant. More health problems and lower levels of education appear to be associated with higher levels of uncertainty. Kidney transplant patients use various coping strategies to manage uncertainty and the stress it generates. There was a preference to use optimistic, self-reliant, and confrontive coping. There was also a general tendency to use problem oriented forms of coping. Patients appear to concentrate on the elements of hope, positive thinking, control, and a rational and constructive approach to problem-solving. Significant positive relationships between uncertainty and coping strategies supported the stress, appraisal, and coping theory. Findings indicate that patients with higher levels of uncertainty generally tend to use emotion-focused strategies such as evasive, fatalistic, and emotive coping. Long-term kidney transplant patients perceived low levels of stress generated by their uncertainty. The direction and the magnitude of the relationship suggests a significant positive association between uncertainty and stress (r =.94, p =.00). Based upon the findings of this study, implications were suggested for new directions for the provision of effective health care for kidney transplant patients. It is recommended that further research is needed to identify and explore relationships among appraisal, coping strategies, and outcomes of patients with kidney transplants over time.

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