Coping Strategies Used by Family Members of Individuals Receiving Hemodialysis
Coping Strategies Used by Family Members of Individuals Receiving Hemodialysis
Coping Strategies Used by Family Members of Individuals Receiving Hemodialysis
http://dx.doi.org/10.1590/0104-07072014002220011
Fernanda Ribeiro Baptista Marques1, Marina Raduy Botelho2, Sonia Silva Marcon3, Jussara Simone Lenzi
Pupulim4
1
Doctoral student of Nursing at the Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil. Email: fernandarbm@hotmail.
com
2
M. Sc. in Nursing. Maringá, Paraná, Brazil. Email: raduybotelho@gmail.com
3
Ph.D. in the Philosophy of Nursing. Professor of the Undergraduate and Postgraduate Courses in Nursing, Universidade
Estadual de Maringá (UEM). Maringá, Paraná, Brazil. Email: soniasilva.marcon@gmail.com
4
Ph.D in Nursing. Professor of the Undergraduate Course in Nursing, UEM. Maringá, Paraná, Brazil. Email: jslpupulim@bol.
com.br
ABSTRACT: This descriptive, qualitative study aims to identify the coping strategies used most by the family members of patients
with chronic kidney disease receiving hemodialysis. The data were collected through interviews, with the Coping Strategies Inventory
questionnaire administered to ten family members, and were submitted to descriptive statistics and to thematic content analysis. The
strategy used most was escape-avoidance, demonstrating that the family members prefer not to face the situation. The second most-used
strategy was social support, ratified by the fact that they stated that they talk with other persons and professionals, seeking information
about the problem, and because they accept the support received positively. The third was problem resolution, represented by the
attitude of accepting responsibility for the care, either through strong affective bonds or through a feeling of responsibility established
prior to the disease. The families use coping strategies of different intensities, while, nevertheless, indicating involvement and major
participation in the care for the patient.
DESCRIPTORS: Renal dialysis. Behavior. Psychological adaptation. Chronic disease. Family relationships.
RESUMO: Estudo descritivo, de natureza qualitativa, que objetivou identificar as estratégias de enfrentamento mais utilizadas por
familiares de pacientes com doença renal crônica em hemodiálise. Os dados foram coletados por meio de entrevista, com aplicação do
Inventário de Estratégias de Coping a dez familiares, e submetidos à estatística descritiva e à análise de conteúdo temática. A estratégia
mais utilizada foi fuga e esquiva, demonstrando que os familiares preferiam não enfrentar a situação. A segunda estratégia mais usada
foi suporte social, ratificada ao afirmarem que conversaram com outras pessoas e profissionais buscando informações sobre o problema,
e por aceitarem positivamente o apoio recebido. A terceira foi resolução de problemas, representada pela atitude em assumir o cuidado,
seja pelo forte vínculo afetivo ou pelo sentimento de responsabilidade já estabelecido antes da doença. As famílias empregaram
estratégias de enfrentamento com intensidades diferentes, porém indicando envolvimento e grande participação no cuidado ao doente.
DESCRITORES: Diálise renal. Comportamento. Adaptação psicológica. Doença crônica. Relações familiares.
RESUMEN: Estudio cualitativo, que trató de identificar las estrategias de afrontamiento empleadas por las familias de los pacientes
con insuficiencia renal crónica en hemodiálisis. Se aplicó el Inventario de Estrategias de Afrontamiento y una questión abierta con diez
familiares. Los datos cuantitativos fueron sometidos a procedimientos estatísticos y análisis de contenido cualitativo. La estrategia de
mayor utilización fue el escape y evitación (oito), lo que demuestra que los miembros de las familisa preferían no tener que enfrentar
esta situación. La siguiente estrategia fue utilizada más apoyo social, ya hablé con otras personas y profesionales que buscan información
sobre el problema, y aceptar el apoyo positivo recibido. A terceira foi resolução de problemas, representada pela atitude em assumir
o cuidado, seja pelo forte vínculo afetivo ou pelo sentimento de responsabilidade já estabelecido antes da doença. Familias de las
estrategias de afrontamiento empleadas con diferentes intensidades, pero mostrando una gran implicación y la participación en el
cuidado del paciente crónico.
DESCRIPTORES: Diálisis renal. Conducta. Adaptación psicológica. Enfermedad crônica. Relaciones familiares.
informants, visits were made to the hospital’s He- (two items); Factor 7 – Planful problem-solving
modialysis Department over the course of one week (four items); and Factor 8 – Positive reappraisal
and during all three shifts (morning, afternoon and (nine items).
night), with the aim of establishing contact with All the questions are scored on a Likert-type
the patients, providing information regarding the scale, varying from 0 - I did not use this strategy;
study, and obtaining authorization to invite their 1 - I used it a little; 2 - I used it quite a lot; through
family member/main caregiver to participate in the to 3 - I used it very much, with the maximum
study. The family member was initially approached score possible being 198 points. The data obtained
by telephone and invited to participate in the study. through the administration of the inventory were
In cases of agreement, the interview was arranged recorded in a Microsoft Excel 2007 database, and
according to the participants’ availability. statistical procedures of descriptive analysis were
When the study was undertaken, 133 pa- undertaken through simple frequency and per-
tients were being attended in the institution, of centage frequency.
whom 34 met the age criteria established; three, For analysis of the quantitative data, a
however, refused to provide the address of a fami- comparison was made of the scores obtained in
ly member, and a further four did not appear at the each factor, with the strategies which obtained
hemodialysis sessions during the period arranged the highest scores being considered those most
for data collection. Of the 27 patients who provid- used. For the qualitative data, on the other hand,
ed the address of a family member, only 12 lived in the interviews were transcribed in full and later
Maringá, and two of these declined to participate subjected to a process of content analysis,11 com-
in the study, with the result that ten family mem- posed of a phase of pre-analysis and exploration
bers of patients in dialysis participated. of the data; followed by systematic organization
The data were collected in July 2010, during with identification of interference variables and
single visits to the family members’ homes, when meanings which led to indicators, which were
a semi-structured interview was held and the grouped according to similarity and discussed in
Coping Strategies Inventory was administered.9 the light of other studies.
The questionnaire used in the interviews aimed The study was undertaken in agreement
to collect socio-demographic data and included with the guidelines regulated by Resolution
the following guiding question: ‘what did you 196/96 of the Brazilian Ministry of Health, and its
do when you found out that your family member project was approved by the Standing Committee
would be dependent on hemodialysis?’ The re- for Ethics in Research with Human Beings, of the
sponse to this question was recorded and, later, State University of Maringá (Opinion n. 315/2010).
transcribed in full, the interviewees’ natural form All the participants signed the terms of consent
of speech being preserved. in two copies, and in order to safeguard their
The Coping Strategies Inventory9 was ad- identities, were identified with the letter “I” (for
ministered at the end of the interview. This in- ‘interview’) and a number indicating the order in
strument, adapted and validated for the Brazilian which the interview was held.
culture,10 is made up of 66 items which address
thoughts and actions which people use for dealing
RESULTS AND DISCUSSION
with internal and external questions in relation to a
specific stressing event, in addition to “distractive” The ten family members in the study were
questions (21 items), which are not scored on the aged between 20 and 61 years old (mean of 40
conversion scale. The inventory’s focus is on the years old) and all were female, showing that in
coping process for a particular situation, and not spite of the transformations which have occurred
on coping as a characteristic or description of the in family characteristics and roles, few changes are
persons in question.9-10 observed in relation to the woman’s caregiving
The scale addresses eight factors, also termed function. Some of the reasons for which the wom-
domains or categories of coping strategy, namely: en become the main caregivers are: being married
Factor 1 – Confrontive Coping (made up of six to the patient, the absence of another individual to
items); Factor 2 – Distancing (seven items); Factor 3 take on the role of caring, moral obligation related
– Self-control (five items); Factor 4 – Seeking social to religion or culture, and financial conditions.12
support (five items); Factor 5 – Accepting respon- In relation to the degree of kinship with the
sibility (seven items); Factor 6 – Escape-avoidance person receiving hemodialysis, three were wives,
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two were mothers, two were sisters, two were for control of the emotions and the situation than
daughters and one was an aunt. It was ascertained confrontive actions. Based on data in the literature,
that the family unit is not always the point of ref- coping has been focused on emotion, as a strategy
erence for the patient, as in some cases, sisters and which is favorable and efficacious in coping with
aunts take responsibility for the care. In relation stressful situations.12
to marital status, five were married, one was sep- In the case of chronic illness in children, it
arated, three were single and one was a widow; is common for the parents to use the strategy of
they had various occupations such as housewife, distancing from the stressful situation with greater
secretary, administrative assistant, teacher, maid, frequency, which is configured as an alternative
and retired. due to the feeling of impotence. At the same time,
In relation to health care, only two families the parents seek to adopt attitudes to minimize the
did not use the Unified Health System (SUS), and emotional shock resulting from the perception of
mentioned fixed costs with medications/health their own limitations, also investing in adaptive
plans, between R$ 100.00 and R$ 1,000.00. The fam- strategies in the search to maintain the family
ilies’ mean income was R$ 2,000.00, this resulting balance.14
from the contributions of one to three people. In Table 1 presents the percentages of the re-
addressing this question, various families reported sponses to the Coping Strategies Inventory’s eight
that they still had not managed to obtain sickness factors of evaluation, in which one can observe
benefits for their loved ones, which reduced the that the factors used most by the caregivers were
family budget. The changes in income were broad- escape-avoidance (65%), agreeing with the results
ly coupled with the family dynamic, which in its presented by another study undertaken with 14
turn has a significant impact on the family in such families which had members receiving inpatient
a way that the financial question is decisive in treatment in Intensive Care Units.15 In the same
the practice of caring, leading the people to make regard, another study undertaken with family
changes in the home and in family life.13 members of patients in ICU, using the Jalowiec
All the interviewees reported a strong affec- Coping inventory, identified that the style of cop-
tive bond with their relatives, attributing an impor- ing used most was supportant (57.7%), which re-
tant and representative role in the family system; fers to the use of support for coping with problems,
two even mentioned that they did not sleep well followed by optimism (17.5%) and self-reliance
and needed medication, due to their worries and (8.75%).16 These results coincide with those found
tension from this situation. In speaking about in this study, given that both problem resolution
this situation of coping in relation to their family (60%) and positive reappraisal (52%), coping
member’s hemodialysis, the interviewees report- styles which are similar in the two inventories,
ed all their experience and needed to discuss the were also indicated as significantly-used ways of
situation in detail. coping (Table 1).
In relation to the score produced through the The differences observed in the choice and
administration of the inventory, it was ascertained use of the coping strategies probably result from
that only four subjects used fewer than 50% of the the variation in the interviewees’ profiles, the
strategies, with the lowest score obtained being 70, period in which they received treatment, and
and the highest 143; the mean of the scores was the stage of the disease, and the extent to which
108. This shows that the majority of the family such factors influence the concept regarding the
members interviewed used approximately half of disease. It is believed that the same family mem-
the strategies presented in the inventory as coping bers interviewed in this study, on other occasions
resources. during the progression of the disease and phase
In relation to the evaluation of the efficacy of of treatment, could – to a greater or lesser extent
the coping, it is necessary to observe not only the – use coping styles different to those indicated
resolution of the problem, but also the ability to during the administration of the inventory. Fur-
control it. This model of approach refers mainly thermore, it is understood that generally speaking
to situations which are impossible to resolve and the people use the resources available at specific
which are permanently stressful, as in the case moments, whether these are material and/or
of the chronic illnesses, in which the absence of human, for coping with or overcoming specific
possibilities of a cure requires more strategies stressful situations.
Table 1 - Distribution of the percentages of responses indicated for each one of the factors of the
Coping Strategies Inventory. Maringá, Paraná, 2010
Factor Didn’t use % Used little % Used quite a lot % Used very much %
Factor 1 - Confrontive 60 6 10 24
Factor 2 - Distancing 59 10 10 21
Factor 3 – Self-control 44 - 10 46
Factor 4 – Social support 20 8 11 61
Factor 5 – Acceptance of responsibility 46 8 22 24
Factor 6 – Escape-avoidance 20 10 5 65
Factor 7 – Problem resolution 8 7 25 60
Factor 8 – Positive reappraisal 18 8 22 52
So as to understand the strategies better, It was observed that the strategy of es-
the caregivers’ reports were analyzed and com- cape-avoidance did not appear explicitly, but was
pared with the responses of the inventory, such coupled with the defensive denial, articulated with
that excerpts from the reports can illustrate the positive illusions, functioning as a means of escape
discussions. against the extreme stress; in this way, translating
as persevering and optimistic attitudes for the res-
olution of the problem. Apparently, according to
Feelings and actions regarding the under-
the report of I7b, there was a positive reappraisal
taking of hemodialysis by a family member
of the situation, with acceptance of responsibility.
It is observed that the fact of undertaking he- It was also noted that the use of escape
modialysis treatment can trigger various reactions through fantasy could be related to the lack of
which depend on factors such as family members’ knowledge and difficulty in coping with the
concepts and prejudices, level of education, cul- chronic nature of the disease. This factor may be
ture, and also the way that this family member was observed in the account below, which expresses
approached by the health team on the occasion ignorance of the treatment:
when the need to undertake hemodialysis was
in the beginning, I didn’t understand it correctly,
defined. Caring for a family member with CKD
I thought he would have to receive inpatient treatment.
is a very difficult experience for the family as it
I was terrified, I was in despair, but then we talked, they
involves a chronic illness which requires continu-
explained what you have to do, the apparatus attached
ous care, with low quality and expectancy of life.4
up to him. Because in the beginning there was the
It was ascertained that on the occasion of catheter and I was scared, I had never seen that before,
discovering that the family member in question nobody in my family had had this, I thought that it
had the illness, the strategy used most by the would stay in him all the time, I thought, my God, it’s
family members was escape-avoidance, showing going to be difficult. Then they explained that it is only
that they would like, in some way, not to have to for a while, that later you have to come to do it, that it’s
face this situation. In parallel, one can note in the no big deal, that life can be normal, and this calmed us
reports the effort made by some family members down, things calmed down (I3b).
to avoid or circumvent this stressful factor, also
The people, even though knowing little
expressing the wish for a rapid or magical solution
about the disease, instinctively use the notion that
for the situation.
it is good or bad, demonstrating that they have the
We have faith, for God nothing is impossible. For ability to judge and that they are able to preserve
so many people, the kidney resumed functioning and the life of the individuals and of their family in the
they stopped having to do [hemodialysis] [...] (I3b). perspective of the care, the practical knowledge,
[...] I hope that the miracle happens of him man- the cautiousness and the consideration.4
aging to receive a kidney. But for me this would be a Although the feelings of denial and hope
miracle [...] (I7b). predominated in the reports, Table 1 shows that
Even now I ask myself, my God, why did this six family members indicated that they had not
happen to me? But I never abandoned ship, I always adopted the strategy of distancing; on the contra-
carried on, always, to give him strength. Because I knew ry, they neither withdrew from the situation nor
that I had to be stronger than him (I7b). ceased being concerned about it. That is, the fam-
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ilies became closer to the circumstances, making it. Sometimes we forget, but remember that the person
all the effort necessary, so as to adapt to the new with a problem is here [...] (I3b).
situation. In this way, the members altered and/ When you go to the beach, first you have to ring
or adapted various aspects of their lives, such as, the hospital which does hemodialysis to see if there is
for example, habits and routines: a space, so, that is to say, we learn, you know, to live
[...] before, if I had to leave the house or had to with this, but in the beginning it’s difficult [...] (I8b).
wash clothes or clean the house, I had to get everything Other studies have also observed that the
tidy in order to go out, I could never leave anything presence of a chronic disease requires a series of
for later when I returned. But with his disease, I have changes in the family structure, for there to be ad-
let things go, let the house go, so many times. He lived aptation to the new needs resulting from the health
here with me for five months, and there were so many problem. The changes which occur due to the
things to do for him, that I dropped everything (I9b). presence of CKD and its treatment affect not only
It may be perceived that, implicitly, the ac- the ill person, but all the people around them.5,13
ceptance of responsibility for the health and life By contrast, the family members also mani-
of the individual receiving hemodialysis occurs fest some negative feelings and attitudes, demon-
normally for the family members, in spite of the strating a wish to forget the unpleasant situation,
need to change domestic routines, include a new as if refusal to have contact with the de-structuring
member in the family, and even change city, seek- fact were capable of resolving the problem.
ing social support. These observations reinforce [...] I knew the traumatic side of the situation
the responses related with those indicated with more than the beneficial side. So, I – in particular – had
the greatest frequency in the inventory. to struggle against the trauma which I had. It’s not easy,
[...] and that is when we moved here [...] (I2b). is it, young lady? [...] (I11b).
I brought [brother’s name] to live with me, [...] ah, I slept. I slept for about three days in a
because I think that he needs more special care, it was row. So much so that I left the hospital and even now
difficult [...] (I8b). I don’t remember how. I slept a lot, a lot, a lot, I think
I wanted to bring him to Parana, because in Rio for approximately a month [...] (I8b).
de Janeiro things are very difficult, whereas here we Even with all the stress of the discovery and
know the people, and there everything is very far away, confirmations of the illness, and often, the feeling
difficult. So, he came to Maringá and went straight to of denial followed by anger, 60% of the responses
the hospital (I9b). indicated that various family members do not use
Among so many factors which form part of confrontation as a strategy, as the majority did
family coexistence, coping with illnesses is one of not demonstrate anger, neither at the causes of
those which must be understood as part of this the problem nor at other people, and much less
experience, being characterized by a variety of withdrew from people/situations in general.
acts, behaviors and feelings. It is important to em- We are not angry, we are sad [...] (I11b).
phasize that the process of coping with the disease We are having to be patient, I asked my children
in the family depends on some factors such as the to be patient. They think it is that he wants attention
family’s stage of life, the role performed by the ill [...]. Even I, who was not a patient person, learnt to be
member in the family, the implications which the so, because the disease doesn’t choose anybody, today
disease’s impact causes in each one of them, and we are here and tomorrow we might be in that person’s
the way the family organizes itself regarding the place (I3b).
disease. Family re-adaptation – the situation in Avoiding facing up to the situation can mean
which all the members come to perform tasks and the use of challenging, impulsive and aggressive
take on roles in such a way as to permit the smooth attitudes, perhaps as a way of trying to overcome
functioning of the family system – demonstrates the situation,13 or the exercising of self-control,
good adaptation to the situation.5 which corroborates with 46% of the responses to
In this context, the person responsible for the inventory. However, in some cases the family
caring for an ill member is also charged with car- member describes feelings and manifestations
ing for all the other family members, whether in such as anger and aggressive ways for altering
education, their food, or leisure activities.5 situations, so as to resolve problems.
Our eating habits changed. I had to change salt I’m angry with his doctor to this day. I look
use gradually, because I always used a lot, and we like for somebody to blame, and I still blame him now. I
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Coping strategies used by family members of individuals... - 921 -
didn’t have experience, and he didn’t know how to The closest family member experiences situa-
advise me (I7b). tions which teach her to coexist with the suffering
[...] We only waited nine hours for him to be of the other, on most occasions having to disguise
hospitalized [sarcasm], I had to face up to the security or hide her own feelings, which – almost always
stuff, he was lying down outside on the bench from – are emotional pain, as they feel impotent, while
so much pain. Those enormous buildings [...]. I said: being responsible for doing everything, even
if anything happens to my brother, I’ll prosecute the though often they don’t have the knowledge or
hospital because this is negligence. He was in terrible the preparation for this.17 However, the presence
pain because he needed to pass urine and couldn’t. They of love, tranquility and dedication can cause the
had to catheterize him, and took out 2 liters. He was in suffering and distress caused by the concerns to
hospital for 25 days, nobody discovered the problem, be mitigated, both for the caregiver and for the
he was catheterized the whole time until he came to patient, favoring more effective care.
Maringá. He caught an infection which could’ve killed This resource emerged from the wish to
him (I9b). maintain emotional control and not to show loss of
This reaction was not related only to the heart or failure, even more so in front of the patient
non-acceptance of the disease, but also to the late or the rest of the family, as the role of caregiver
diagnosis, and to delays in the attendance. In some was perceived as synonymous or coupled with the
families, this situation provoked attitudes of hos- presence of strength and stability for these persons,
tility and/or aggression regarding some services using self-control as a coping strategy.
or professionals, at the same time as it reflected Nevertheless, a considerable proportion of
the perception of their own impotence regarding the family members’ responses (44%) indicate the
the situation. non-use of this strategy. They mention allowing
the others to know of the true situation, although
Seeking emotional support and stability they always seek to see the positive side arising
from the illness.
The family members do not react to a chron-
The best thing which happened was moving here
ic disease in the same way, especially when it is
and getting to know new people (I2b).
a limiting disease, whose treatment is complex,
requiring frequent commutes and therapy in- Due to having experienced an extremely
volving sophisticated equipment. In addition, stressful situation, the family members undergo
each member or each family has beliefs, values ambiguous experiences, emotions and feelings.
and principles relating to illness, and experiences In such an improvement, they tend to transmit
them differently. This fact reinforces the family positive aspects to the patient, controlling their
members’ need to seek resources which helps them emotions so that they may find solutions to the
to deal with the demands made by the disease, situation.13 The maintenance of the family’s emo-
without risking affecting the disease’s progression tional structure, however, may also be related to
and without affecting the family as a system.13 social support strategies, represented in 61% of
the family members’ responses, given that they
As a result, self-control, which includes ef-
conversed with other people about the problem
forts for regulating one’s own feelings, thoughts
and sought professional help and further informa-
and actions, the use of rationality and self-suffi-
tion regarding the situation, as well as accepting
ciency, was reported by 46% of the family mem-
peoples’ support positively.
bers as a way of facing the situation, above all
in not letting one’s own emotions influence the God, we always relied on each other, a little here,
situation. a little there [...] (I7b).
[...] I cry when I want to, I complain, but not to I was very stressed, very tired, a lot of mental
him, for him I always try to be positive. Recently he preoccupation, so I went to the doctor and the psychi-
said: ‘Ah, Mom, I am at an age when things have to atrist. I’m taking medication for anxiety and in order
happen now, and if they don’t, I don’t know what will to sleep. I’m under a lot of tension, this problem has
be of my life’. There is light at the end of the tunnel, and really affected my metabolism, but now I’m okay (I9b).
I can see it. But of course, sometimes I complain, I cry, This house’s landlady always helps us, our broth-
sometimes we can’t stand it. But for him, no. Here at ers from the church also always help, since we moved
home, never. I try to be stronger than the two of them here. We don’t need to buy fruit or vegetables. This is
together [her two sons who live with her] (I7b). the most important thing, because we don’t have any
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family, we don’t have children, we rely on good people, treatment and coping with the situation, and with
good neighbors (I2b). the family member’s active participation through
With the aim of finding support and external creative actions to overcome the adversities, which
support as bases for the feelings of protection and required a flexible emotional structure, to identi-
relief, this strategy was represented by the help fy the possibilities for helping the patient, other
of persons from the social support network, such members of the family, and oneself. This dynamic
as friends and relatives and others. These reports is reflected in the availability to be ahead with the
endorsed the responses indicated in the inventory care, either through believing in one’s potential for
by the family members interviewed. the function, or through having been elected by the
family as the person best prepared for this position
or for taking on the main role in decision-making.
Facing the situation and adopting coping
strategies Even considering all of the families’ difficulty
in experiencing the illness of a loved one19 and
The routine, like the stressful experiences of all the obstacles for dealing with the treatment
living side-by-side with the chronically ill person, process, 52% of the responses indicate that the
led the family to re-evaluate its knowledge and family members positively re-evaluated the situ-
practices, constructing different meanings, such as ation, re-discovered their importance in life, made
changes in the standards of life and actions which personal changes, indicated personal growth, and
enabled them to adjust to the suffering, reviewing developed new beliefs.
their dreams and expectations in the light of the
[...] but I think I learned a lot, I had to learn to
reality of the illness. In this context, the family
be able to help and even to accept, even not wanting
members take responsibility for the care, learning
to (I8b).
to seek resources which facilitate these changes,
both in the environment and among the people I had to become stronger, to let my strength in-
with whom they live.18 crease. Can you imagine if he was there needing help,
Thus, the family members also chose to use and you standing there, not being able to? (I7b).
the factor of problem resolution (60%) to cope with Through this strategy, one can notice that
the disease, which consisted of the description of there was an internal reorganization of the facts,
actions, planning, creativity, active participation which allowed those involved to find support,
and seeking solutions for the problem, so as to think of solutions, and value the positive aspects
do what is possible to help the situation, without of the situation, with the intention of mitigating
counting the cost. This strategy was represented the severity and reducing the occurrence’s emo-
by the attitude of the family member interviewed tional load.10 This is evidenced when they mention
in taking responsibility for the care, either through seeking relief in prayer and in religious beliefs.
the strong affective link or due to the responsibility [...] I prayed a lot. Every night I pray to God, but
for the family member, established prior to the it is difficult (I8b).
start of the illness.
I pray for him a lot, the time is set by God, I leave
There were no days off and no weekends, it was everything in His hands. He is covered by the grace of
a struggle. What we went through with him was very God (I9b).
difficult. Always doing whatever was needed for him,
Thus, the strategy of positive reappraisal
I became involved in his situation, I committed myself
met one need of the family, by giving meaning to
to his state and always did things willingly, whole-
the crisis which was being experienced, after the
heartedly, whatever is necessary, I do it for him (I9b).
various questions which required answers.19 As a
I do whatever’s necessary. My son is alive because result, in order to promote adaptation to new chal-
I did this [...] (I7b). lenges imposed by the disease, the family members
We tried to give support for what he needs, even find satisfactory meanings in the adversity and can
going beyond our abilities. Everything is there for him, rely on spiritual practices and beliefs to overcome
food, tranquility at home, we try to save him from situations, cope with changes and achieve quality
worrying, it’s even bad, but we try to save him from of life. Through prayers, participation in rituals
worrying. Not causing him more stress than he already and maintenance of belief, the family members
has, you know? And also not to speak much about the recover, as these meetings provide comfort and
subject, you know, ‘I’m here if you need me’ [...] (I10b). hope that the situation may improve, leading
This process is related to the adherence to the them to accept the situation from a more flexible
Text Context Nursing, Florianópolis, 2014 Oct-Dec; 23(4): 915-24.
Coping strategies used by family members of individuals... - 923 -
doença crônica: o contexto do cuidador. Rev convivendo com condição crônica de saúde. Rev
Diversitas Perspectivas En Psicología. 2009; 5(1):97- Rene. 2008 Out-Dez; 9(4):49-56.
110. 19. Caetano JPM, Fernandes MV, Marcon SS, Decesaro
15. Borges KMK. Famílias de pacientes graves MN. Refletindo sobre as relações familiais e os
internados em terapia intensiva: descrevendo suas sentimentos aflorados no enfrentamento da doença
estratégias de enfrentamento [dissertação]. Rio de crônica. Cienc Cuid Saúde. 2011 Out-Dez; 10(4):845-
Janeiro: UFRJ, Faculdade de Medicina; 2008. 52.
16. Dreffs FML, Stumm EMF, Winkelmann ER, Ubessi 20. Moreno V. Familiares de pacientes em hemodiálise:
LD. Mecanismos de coping utilizados por familiares convivendo com condição crônica de saúde. Rev
de pacientes em terapia intensiva. Rev Ciência Saúde Rene. 2008 Out-Dez; 9(4):49-56.
Porto Alegre. 2013 Jan-Abri; 6(1):52-8. 21. Rocha NS, Fleck MPA. Avaliação de qualidade
17. Centenaro GA. A intervenção do serviço social ao de vida e importância dada à espiritualidade/
paciente renal crônico e sua família. Ciênc Saúde religiosidade/crenças pessoais (SRPB) em adultos
Coletiva. 2010 Mar; 15(1):1881-5. com e sem problemas crônicos de saúde. Rev Psiq
18. Moreno V. Familiares de pacientes em hemodiálise: Clín. 2011; 38(1):19-23.