http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-2.xsd
influence of attachment style on coping and adaptation in adults on hemodialysis
Applying a theoretical framework to the study of coping and adaptation to hemodialysis is warranted given the variability in success that individuals encounter in adapting to life on dialysis (Sensky, 1993). Attachment theory posits that interpersonal experiences with caregivers during times of distress create templates through which children, and later adults, come to learn how to regulate arousal (Kobak & Sceery, 1988). Consequently, this study tested hypotheses that attachment indices influence dialysis patients' perceptions of their environments, appraisals of distress, and choices of subsequent coping strategies. Hemodialysis patients were recruited from 4 different dialysis clinics in rural and urban areas of south, central Texas. A sample of 101 patients responded to questionnaires while undergoing dialysis during one of their weekly treatments. Analyses revealed that insecure attachment indices were positively predictive of overall stress, poor attitudes toward being on dialysis, poor relationships with family, and negative psychological adjustment to dialysis. In contrast, secure attachment indices were positively related to hopefulness, perceived health competence, and perceived social support. In the realm of coping, insecure attachment was associated with trying to wish away the stressor, and criticizing or lecturing oneself. Secure attachment was related to attempting to find the positive in difficult situations, refusing to get too serious about the problem, talking to others, expressing negative feelings about the stressor, and making and following a plan of action. Interestingly, both secure and insecure attachment were related to the strategy of suppression of feelings. Generally, coping strategies related to insecure attachment styles were associated with poor adaptation. In addition to theoretical constructs, the impact of demographic factors was also explored. Women appeared to have more psychological resources with which to deal with the stressors of dialysis than did their male counterparts. In comparison to younger individuals, older people tended to have more success in abiding by fluid restrictions. Moreover, African-American patients and patients from urban clinics reported better attitudes about being on dialysis. Possible explanations for these and other differences are provided in the text. Finally, limitations of this study are described and implications for health care workers are discussed.
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Includes bibliographical references (leaves 129-144).