Stressors, Family Functioning, Family Resilience and Family Adaptation in Maintenance Haemodialysis: A Structural Equation Modelling

ABSTRACT Aim This cross‐sectional correlational study aimed to develop a structural equation model (SEM) to elucidate the associations among stressors, family functioning, family resilience and family adaptation in maintenance haemodialysis (MHD) patients. Background The stress burden experienced by patients undergoing MHD has received increasing attention. Stressors may adversely affect family adaptation, making the adaptation process more complex. However, evidence regarding the factors associated with family adaptation among patients undergoing MHD remains limited. Design A cross‐sectional study. Methods A total of 412 patients with MHD were recruited from December 2023 and July 2024 at three hospitals in Hunan Province. Data on stressors, family functioning, family resilience and family adaptation were collected using the haemodialysis stressor scale, APGAR, Shortened Chinese version of the family resilience assessment scale, and the Chinese version of the family adaptability and cohesion evaluation scales. SEM was employed to test the study's hypotheses. This study was reported in accordance with STROBE guidelines. Results The findings revealed that stressors were negatively associated with family functioning, family resilience and family adaptation. Stressors demonstrated an indirect relationship with family adaptation through family functioning and family resilience. Conclusions This study identified the structural relationships among the four variables under investigation. Family functioning and family resilience were found to be potential mediators in the association between stressors and family adaptation. Relevance to Clinical Practice Stressors are an important concern for patients undergoing MHD. Given the associations observed among stressors, family functioning, family resilience and family adaptation in this study, nephrology nurses may consider both patients' individual needs and their perceptions of family‐related factors when assessing adaptation to long‐term dialysis, rather than focusing exclusively on individual patient needs. In routine nephrology nursing practice, assessment of stressors and family‐related factors may help nurses identify patients who may require additional family‐oriented support and facilitate communication with patients and their families. These findings may provide a basis for developing more targeted, evidence‐informed approaches to support patients and their families, while further intervention studies are needed to determine the effectiveness of such approaches. Patient or Public Contribution No patient or public contribution.