{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:08:09Z","timestamp":1772168889295,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.158482.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000}}],"reference-count":50,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Indonesia Endowment Funds for Education"},{"name":"The Center for Higher Education"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"Background Hemodialysis patients are highly vulnerable during the COVID-19 pandemic and face multiple challenges that affect their physical, psychological, social, and economic well-being. Objective This study aims to thoroughly investigate the experiences of end-stage renal disease patients undergoing hemodialysis during the COVID-19 pandemic. Methods A qualitative descriptive design was applied. Fifteen participants were recruited purposively from Wahidin Sudirohusodo Hospital and Hasanuddin University Hospital. Data were collected through in-depth interviews and analyzed thematically, guided by Roy\u2019s Adaptation Model to capture adaptive and maladaptive responses. Result There are three themes produced in this research: 1) various responses to the COVID-19 pandemic, 2) various impacts, and 3) coping mechanisms developed. Conclusion The findings underscore the importance of holistic nursing interventions, psychosocial support, and continuous professional development for dialysis nurses to strengthen patient resilience during current and future health crises.<\/ns3:p>","DOI":"10.12688\/f1000research.158482.2","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T16:15:07Z","timestamp":1758557707000},"page":"1404","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the experiences of the hemodialysis patients during the COVID-19 pandemic: A qualitative study"],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3851-0471","authenticated-orcid":false,"given":"Dewiyanti","family":"Toding","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masfuri","family":"Masfuri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agung","family":"Waluyo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sri","family":"Yona","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-4731","authenticated-orcid":false,"given":"Reflin","family":"Mahmud","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5613-1227","authenticated-orcid":false,"given":"Sri","family":"Nining","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Effita","family":"Piscesiana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8554-2673","authenticated-orcid":false,"given":"Wasal Desrial","family":"Siregar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1294-1652","authenticated-orcid":false,"given":"Rico Maulana","family":"Nugroho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7089-9432","authenticated-orcid":false,"given":"Ropika","family":"Ningsih","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4236-3558","authenticated-orcid":false,"given":"Ida Ayu Md Vera","family":"Susiladewi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2-5","DOI":"10.3389\/fpubh.2020.00429","article-title":"Social Stigma: The hidden threat of COVID19.","volume":"8","author":"A Abdelhafiz","year":"2020","journal-title":"Front. 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As indicated below, we have tried to do our best to respond to all the queries. All the revisions & answers are stated below: Major Comments:<\/b><\/i> Comment 1 : Please describe qualitative descriptive design more thoroughly and rationalize its use for this particular study. Answer 1 : A description about qualitative descriptive design was added to the methods and study design. Comment 2 : \u201cThe determination of participants is based on data adequacy\u201d (p. 3).  Clarify this decision, specifically what data adequacy means. A reference is required. Answer 2 : An explanation about data adequacy was added in the paragraph, in the method section, setting and participants. With the statement below: \n\u201cAdequate data refers to data that is sufficient to address the research questions, indicated by the achievement of data saturation, where no new information or insights can be obtained from the participants\u201d Comment 3 : <\/i>\u201cOnce data saturation is reached, whereby no new insights or information can be derived from the participants\u201d (p. 3). The Bradshaw et al. reference provides a great description of the rationales for data saturation, but the argument for its use was not provided in this article. Considering that participants were recruited from two hospitals using data collection methods differently, explain how saturation can be affected or met. \nAnswer 3 : <\/i>Participants were recruited from two hospitals using the same data collection method, explanation about how saturation can be affected or met, was added in method section, setting and participants, below : \u201c\nData saturation was determined independently at each location, based on the absence of new information that aligns with the unique characteristics of participants<\/i>\u201d Comment 4 : There were two instances where the principal researcher noted they gained practical experience with data collection: 1) \u201cShe has also practised conducting interviews with hemodialysis patients, though not with the specific participant\u201d (p. 3), and 2)\u201cThe outcomes of these preliminary interviews were documented and reviewed with the supervisors\u201d (p. 4). These are great acknowledgements to the school, but unless they refer specifically to data that contributes to this study, these comments should be removed. In acknowledgment of the relationship with the research team members, the authors may choose to note this in a section about rigor. Answer 4 : The comments about how the author gained practical experience was already been removed, and added to rigor\u2019s explanation, at section of method, data collections, stated below: \u201c\nRigor of this research was using framework of Lincoln and Guba (<\/i>\nGunbayi, 2024<\/i>\n). Credibility implemented by conducted preliminary interviews with three patients who were not part of the study. Researcher spent 6 weeks in average in each site to gain thrustworthies with all participants.  <\/i>\nThe interviewer was the first author, a dialysis nurse with 10 years of experience. She holds certification in dialysis nursing competency, master of nursing degree, has completed qualitative research courses and proficient in data collection through interviews<\/i>. \nTwo experts oversaw the research, and its validity was assessed through a thesis examination conducted by two expert examiners,with nursing master's students serving as reviewers. This comprehensive process ensured the research's quality and reliability. <\/i>\nThe research proceeded only after obtaining expertise approval to continue the interviews. <\/i>\nTranscribed data were returned to participants for confirmation and clarification before being processed further.<\/i>\n To ensure transferability in this research, we provided clear and detailed information about the content about the study. Additionally, all statements originally made in local languages<\/i> \nhave been translated into English to ensure that the research is accessible and understandable to all readers.\u201d<\/i> \nComment 5 : <\/i>\u201cRoy\u2019s theory,\u201d (p. 11). The authors allude to the integration of nursing theory late in the paper without any explanation or reference. At minimum, cite. However, it would be prudent to include a description of Roy\u2019s theory and how the lens is employed during data analysis in the methodology section. This would also add some credence to what is presented in the discussion. \nAnswer 5 : S<\/i>ource of citations was added, in page 11 and also in the references: Roy, C.(2009). The Roy Adaptation Model. 3. Upper Saddle River, NJ: Pearson Education, Inc. And explanation about Roy\u2019s adaptation theory is already stated in part of discussion. \nComment 6 : <\/i>This sentence in the discussion is a random reference to \u2018personality\u2019 that has not been addressed anywhere else in the paper. This must be addressed earlier, or it must be addressed more thoroughly prior to bringing it up in this way. \u201cThis is relate to the research conducted by Bacon & Corr (2020) and Carvalho et al. (2020) state that personality functions influence adaptive and coping strategies related to health problems during the COVID-19 pandemic.\u201d (p. 11) \nAnswer 6 : <\/i>The differences in participants' personalities could be a factor that influences coping strategies in this research. But eventually we decided that it wasn't the point of research\u2019s discussion and so it didn\u2019t fully explained, but we decided to keep it, rather as a supporting opinions regarding the factors that influence coping strategies. \nComment 7 : <\/i>The references in the discussion could be updated to reflect a more recent reality of COVID. The authors may consider writing a reflective section on how the evidence has changed from the time of this study to what has since been reported for this specialty. \nAnswer 7 : <\/i>Explanation about current condition and previous outbreak, was added in the limitation section \u201c\nDuring the period when this study was conducted, compared with the current context, the COVID-19 pandemic as the issue of this research, has changed significantly. Because it\u2019s no longer as severe as it was. However, the findings from this research provide valuable new insights into the needs of hemodialysis patients when dealing with challenging condition<\/i>\u201d \nMinor Comments:<\/b> Comment 8 : <\/i>The paper requires a rigor section which is a required component of qualitative research. Rather than presenting this as a student paper, the following statements should be reworded to reflect rigor criteria: 1) \u201cThe research proceeded only after obtaining supervisor approval to continue the interviews.\u201d (p. 4), and 2) \u201cTwo experts oversaw the research, and its validity was assessed through a thesis examination involving two expert examiners and nursing master\u2019s students as reviewers. This comprehensive process ensured the research\u2019s quality and reliability.\u201d (p. 4), and 3) \u201cThe findings were shared with participants for verification.\u201d (p. 4). Please ensure to follow a rigor framework such as Lincoln and Guba (or others). \nAnswer 8 : <\/i>An explanation about rigor was added in the paragraph, following Lincoln and Guba framework (credibility, transferability, dependability and confirmability) in the section of method, data collections. \nComment 9 : <\/i>Allusion to a purpose of providing suggestions for nursing interventions but the implications section is superficially written. Articulate specific clinical practice interventions. \u201cTherefore, the researchers aimsto capture these perspectives to develop more suitable nursing interventions for them..\u201d (p. 3) \nAnswer 9 : <\/i>Nursing implication was explained in the discussion section, in the 8\nth<\/sup> \u2013 11\nth<\/sup> paragraph \nComment 10 : <\/i>Subtheme, physical impact.  End of page 6. Incongruent narrative in relation to the data provided. The pain of swabs is not as significant as the pain of fluid build-up. \u201cThe subsequent physical impact is pain. The mandatory (p. 6) and, \u201cswab obligations carried out by participants are a cause of pain, which is necessary for them to continue undergoing the hemodialysis process\u201d (p. 7) \nAnswer 10 : <\/i>Explanations have been added to clarify what participants stated (P6 and P7). \nGeneral writing concerns:<\/b> \nComment 11 : <\/i>The paper requires an edit for English spelling, grammar, and structure. The following are the suggestions I can offer. \nAnswer 11 : <\/i>Thank you so much for your kind suggestion & guidance, we've tried to revise the manuscript according to your suggestions. Hope the quality of spelling, grammar, and structure will be much improved and hope you agree \nComment 12: <\/i>\u201caims\u201d (p. 1) aimed \u2013 the study is done Repetitive sentence twice in a row. \u201cAs a risk group, hemodialysis patients have a fear of not being able to face COVID-19 if they are exposed. As a high-risk group, hemodialysis patients fear they may not be able to cope with COVID-19 if exposed (WHO, 2020a).\u201d (p. 3) \nAnswer 12 : <\/i>Those repetitive sentences have been deleted \nComment 13 : <\/i>Quite a few occurrences where words, sentences, or concepts are repeated multiple times in a sentence or paragraph. For conciseness, please reword. : \u201cHemodialysis patients must go to the unit hemodialysis 2-3 times per week and undergo 4-5 hour hemodialysis process, further increasing the patient\u2019s risk of being exposed to COVID-19\u201d (p. 3) \nAnswer 13 : <\/i>Repetitive words, sentences or concepts have been removed and adjusted. \nComment 14 : <\/i>\u201cIn addition, some patients\u2019 schedules have been modified as a result of the hemodialysis unit\u2019s efforts to optimize the hemodialysis schedule.\u201d (p. 6) \nAnswer 14 : <\/i>Repetitive words have been removed and adjusted. \nComment 15 : <\/i>\u201cThe majority of participants reported experiencing disturbances in their sleep patterns during the pandemic. However, during the current pandemic, these disturbances have been exacerbated due to concerns about the results of the swab.\u201d (p. 7) \nAnswer 15 : <\/i>Repetitive words have been removed and adjusted. \nComment 16 : <\/i>\u201cA reduction in social interaction and a sense of ostracism were among the social impacts experienced by participants. A reduction in social interaction has been observed among fellow hemodialysis patients in the hemodialysis unit. Other social impacts include instances of ostracism. Some participants were ostracised by their families and neighbours during the pandemic due to the assumption that they had contracted the COVID-19 virus from the hospital.\u201d (p. 8) \nAnswer 16 : <\/i>Repetitive sentences have been removed and adjusted.­­­­­ \nComment 17 : <\/i>\u201calso a physical\u201d (p. 6) This sentence requires rewriting or a supporting reference. Is there evidence that BP increases in end-stage renal clients ONLY in relation to anxiety about COVID? Statements such as these need to be well-cited \nAnswer 17 : <\/i>The sentence adjusted into \u201c\nAn increase in blood pressure was found as a physical impact<\/b> experienced by hemodialysis patients during COVID-19 pandemic due to anxiety about swab results<\/i>\u201d referred to participant's statement (P2), below : \u201c\nThe swab test is what scares me, and it causes my blood pressure to rise<\/b>. It is always on my mind, especially when waiting for the results\u2014my results are coming out tomorrow, and I am so anxious"(P2)\u201d and already stated in page 7.<\/i> \nConfusing wording or edits :<\/b> We apologize for the confusion. All the revisions are stated below: \nComment 18 : <\/i>\u201cface patients\u201d (p. 3). Clarify. \nAnswer 18 : <\/i>This sentence \u201c\nTransportation to the hospital is also a challenge, as many hemodialysis patients have to face patients who depend on public transportation<\/i>\u201d have already changed into \u201c\nTransportation to the hospital is also a challenge, as many hemodialysis patients have to face the reality that they depend on public transportation<\/i>\u201d \nComment 19 : <\/i>\u201caimsto\u201d (p. 3) aimed? \nAnswer 19 : <\/i>The word \u201c\nAimsto<\/i>\u201d was replaced with \u201c\nAimed<\/i>\u201d \nComment 20 : <\/i>\u201cand proficient\u201d (p. 3) missing a word \nAnswer 20 : <\/i>This sentence in page 3 was deleted due to its part of rigour, and rewritten in the discussion as part of rigour. \nComment 21 : <\/i>\u201cand telephone\u201d (p. 4) This sentence is unclear. \nAnswer 21 : <\/i>This sentence \u201c\nResearchers conducted face-to-face interviews three times and telephone<\/b> due to the COVID-19 pandemic situation<\/i>\u201d have already change into \u201c\nResearchers conducted three times contact, either face-to-face interviews or telephone calls<\/b> due to the COVID-19 pandemic situation<\/i>\u201d \nComment 22 : <\/i>\u201cin relation to\u201d (p. 5) because of? Anxiety requires a cause\/effect wording \nAnswer 22 : <\/i>This sentence \u201cSome participants indicated that they experienced feelings of anxiety\n in relation to both fellow hemodialysis patients and hemodialysis nurses<\/b>\u201d have already change into \u201cSome participants indicated that they experienced feelings of anxiety \nbecause of being suspected by other patients or the nurses<\/b>, that they may be carrying the SARS-CoV-2 virus\u201d \nComment 23 : <\/i>\u201carises\u201d (p. 5) arose \u2013 past tense \nAnswer 23 : <\/i>The word \u201c\nArise<\/i>\u201d was replaced into \u201c\nArose<\/i>\u201d \nComment 24 : <\/i>\u201cIt should be noted that swab results were not available.\u201d (p. 6) This sequence of sentences, the one before and after, do not relate to this one. Please describe whether swab results, when not ready on time, affected schedules. This is a set of confusing statements in relation to the sequence of swabbing that seemed to be regularly scheduled at every two to three weeks. This translation within a participant quote requires clarification. Not sure a patient would say, expressing dissatisfaction. \u201cexpressing dissatisfaction\u201d (p. 8) \nAnswer 24 : <\/i>This sentence \u201c\nAs a consequence of the pandemic, the patient's hemodialysis schedule was postponed. It should be noted that swab results were not available<\/b><\/i>\u201d has already been adjusted and given the reason, so it was changed into \u201c\nAs a consequence of the pandemic, the patient's hemodialysis schedules was postponed if<\/b><\/i>\n their swab results were not available. In some cases, it was found that the results of the swab were received 1-2 days after swabbing process, due to limitations in resources<\/i><\/b>\u201d \nComment 25 : <\/i>Curious how maladaptive coping mechanisms is described since it has not been defined in the methods nor described in the discussion. \u201cothers resorted to maladaptive coping mechanisms to deal with the pandemic\u2019s multifaceted impacts.\u201d (p. 9) \nAnswer 25 : <\/i>The word \u201cmultifaceted impacts\u201d have been deleted. Genuinely, maladaptive coping mechanisms are described by the participant (P3 and P6) by treating themselves without having a consultation with the doctor or using a mask while sleeping even he\/she didn\u2019t suffer from COVID-19. \nComment 26 : <\/i>\u201cinclude\u201d (p. 9) missing wording \nAnswer 26 : <\/i>The sentence \u201c\nStress during an infectious disease outbreak includes<\/b> fear and worry about health problems and worsening chronic health problems (CDC, 2020)<\/i>\u201d was changed into \u201c\nStress during an infectious disease outbreak such as<\/b> fear and concern about health problems and the worsening of chronic conditions, can significantly impact individuals (CDC, 2020)<\/i>\u201d \nComment 27 : <\/i>\u201cEntire\u201d (p. 9) all? \nAnswer 27 : <\/i>The word \u201c\nEntire<\/i>\u201d was replaced with \u201c\nAll participants<\/i>\u201d \nComment 28 : <\/i>\u201cwhich\u201d (p. 9) delete? \nAnswer 28 : <\/i>The word "which" on page 9 had already been deleted \nComment 29 : <\/i>\u201cHemodialysis schedule were overcrowding\u201d (p. 10) reword this sentence \nAnswer 29 : <\/i>This sentence \u201c\nHemodialysis schedule were overcrowding<\/i><\/b>\n and limited health personnel in hemodialysis units which made this situation more challenging to prepare many special machines for hemodialysis patients with COVID-19 at the start of this pandemic<\/i>\u201d was changed into \u201c\nThe hemodialysis schedule was often full<\/i><\/b>\n, and the limited number of healthcare personnel made it challenging to prepare the necessary machines for COVID-19-positive hemodialysis patients<\/i>\u201d \nComment 30 : <\/i>\u201cnegative behavior\u201d (p. 10) What is negative behaviour? This needs rewording. Risky? Emotional responses are protective so it\u2019s difficult to put a qualifier to how it is expressed without knowing the demographics and context. \nAnswer 30 : <\/i>Negative behaviour was explained in the added sentence "\nExcessive emotional responses can lead to negative behaviours. COVID-19, as a new infectious disease, has triggered heightened anxiety and fear, which can result in dangerous behaviours (Ho et al (2020)\u201d Comment 31 : <\/i>\u201cThey done it t\u201d (p. 10). Not grammatically correct \nAnswer 31 : <\/i>This sentence \u201c\nParticipants chose to <\/i>\nhide their health status, mainly if they got symptoms that were similar to the main symptoms of COVID-19 or had a history of contact with families who have COVID-19 symptoms. They did it<\/b> to avoid referrals to an isolation room and carrying out COVID-19 screening which could later have an impact on delay\u2026<\/i>\u201d changed into \n\u201cParticipants chose to hide their health status, particularly when they exhibited symptoms similar to those of COVID-19 or had a history of contact with infected family members. This was done to avoid<\/b> being referred to isolation rooms or undergoing COVID-19 screenings, which could cause delays in their hemodialysis schedules\u201d Comment 32 : <\/i>\u201cTherefore, if participants already have symptoms such as fever, cough, and shortness of breath, participants will chose to treat themselves.\u201d (p. 10). This statement is not supported by evidence, nor is it explained well in the ensuing sentences. What does this mean in relation to hemodialysis treatment and\/or COVID? \nAnswer 32 : <\/i>The sentences adjusted into \u201c\nAs a result, participants with symptoms like fever, cough, and shortness of breath chose to self-medicate<\/i>\u201d was a statement spoken by participants number 3 (P3). This condition is stated on page 9 \u201c\nWhen I got fever, cough or shortness of breath, I took vitamin C,  folic acid and played sports despite the rain. I also drank honey and boiled ginger, which is high in potassium, but I do not care. The main thing is that it is clear: do not be exposed to COVID-19\u201d (P3)\u201d Comment 33 : <\/i>\u201cWhen\u201d (p. 10). This word delineates the start of a new paragraph and new set of commentary on misinformation. \nAnswer 33 : <\/i>This word "\nwhen<\/i><\/b>" was changed into \n" At the onset of a crisis or pandemic<\/b>, individuals and communities typically seek information about the situation. However, when official sources or trusted news are lacking, people often turn to social media or other unreliable sources, which can fuel negative emotional responses and amplify fear, uncertainty, and distorted risk perceptions (Torales et al., 2020)\u201d Comment 34 : <\/i>\u201cChronic, especially those requiring routine or long-term treatment.\u201d (p. 10). Not a sentence \nAnswer 34 : <\/i>The sentence "\nChronic,<\/i><\/b>\n especially those requiring routine or long-term treatment<\/i>" paraphrased to \n"<\/i>\nAn especially ironic situation arose<\/i><\/b>\n for hemodialysis patients, who require routine or long-term treatment. This study found that the COVID-19 pandemic negatively impacted the physical health of kidney failure patients undergoing hemodialysis, primarily due to delays and changes in their treatment schedules. In addition to the physical health impacts, the pandemic has also had significant mental health consequences (Pfefferbaum & North, 2020)\u201d Comment 35 : <\/i>\u201cthey infected\u201d (p. 10) sentence structure \nAnswer 35 : the s<\/i>entence "\nthey infected<\/i>" replaced with "\nexposed to<\/i>" \nComment 36 : <\/i>\u201cThe World Health Organization (WHO)\u201d (p. 10). The acronym was used in a previous paragraph. \nAnswer 36 : <\/i>The abbreviation of WHO is deleted to avoid repetition \nComment 37 : <\/i>This both does not apply and does not reflect the evidence from the pandemic. This is an example where references need to be updated to acknowledge when the data was collected, but how the paper impacts current reality. \u201cactively trying to control and reduce the impact of this pandemic by identifying, testing, and treating infected patients and developing drugs, vaccines, and treatment protocols (WHO, 2020b). \nAnswer 37 : <\/i>The sentence was changed into \n\u201cCurrently, By the time of initial outbreak, the World Health Organization is actively trying to control and reduce the impact of this pandemic by identifying, testing, and treating infected patients and developing drugs, vaccines, and treatment protocols. However, success in overcoming this pandemic could not be guaranteed at that time due to the unpredictability of the situation (Kumar & Nayar, 2020)\u201d.<\/i> This was\n <\/i>to highlight that the action happened at the start of the pandemic situation, not currently as stated before. \nComment 38 : <\/i>Purpose of this statement? \u201cHowever, success in overcoming the pandemic cannot be confirmed (Kumar & Nayar, 2020).\u201d (p. 11) \nAnswer 38 : <\/i>The sentence already rewrote into \n"However, success in overcoming this pandemic could not be guaranteed at that time due to the unpredictability of the situation (Kumar & Nayar, 2020)\u201d Comment 39 : <\/i>This is a random intervention that is not written within other options or within its own section. Provide an evidentiary citation that this is an option. \u201cTherefore, hemodialysis nurses can create chat groups that are innovative, engaging, and easily accessible to hemodialysis patients and families.\u201d (p. 11) \nAnswer 39 : <\/i>The sentence rewrote into \n\u201cTherefore, hemodialysis nurses could consider creating innovative, engaging, and easily accessible chat groups for hemodialysis patients and their families\u201d<\/i> The purpose of creating chat group by nurses for hemodialysis patients during the pandemic was intended to enabled hemodialysis patients to continue communicating, share stories or provide support to each other through the group chat. Apart from that, families of hemodialysis patients can also share stories and support each other on how to deal with and care for hemodialysis patients during the COVID-19 pandemic. \nComment 40 : <\/i>Some of the expenses suggested by the authors are minimized in statements such as this. Economic impacts certainly included PPE, swabs, and transportation, but probably also included changes to wages, benefits, ability to access appropriate diets\u2026 \u201cmainly by supplying funds for purchasing personal protective equipment. Apart from that, swabs and other examinations are mandatory.\u201d (p. 11) \nAnswer 40 : <\/i>The additional costs that had to be borne were mainly personal protective equipment, because hospitals had to implement protection protocols during hemodialysis services. Meanwhile, wages, benefits, and the ability to access appropriate diets could have been an additional burden for patients, but were not a concern for researchers. \nComment 41 : <\/i>The spiritual connection was a surprise under stressors. This phrase in particular is colloquial. \u201cget used to it\u201d (p. 11) \nAnswer 41 : <\/i>Paraphrased this sentence into "\nDuring the pandemic, the majority of participants employed adaptive coping strategies such as spiritual strengthening, positive thinking, and efforts to accept and acclimatize to their circumstances.<\/i>" \nComment 42 : <\/i>What is like? \u201cIt is like\u201d (p. 11) \nAnswer 42 : <\/i>Word "it's like" was replaced with "Some of the examples were" \nComment 43 : <\/i>Not sure that parenting should be presented as a burden. \u201cand the burden of being parents\u201d (p. 11) \nAnswer 43 : <\/i>\u201cSeveral previous studies identified factors of demographics as a potential risk of implementing maladaptive coping strategies in dealing with the COVID-19 pandemic, such as age, gender, race, socioeconomic status, and the burden of being parents.\u201d This sentence is quoted from Atchison et al (2020) and also Clay & Parker (2020) and is not the opinion of the researcher. \nComment 44 : <\/i>Starting with the sentence \u201cUnderstanding\u201d (p. 11) what is strategy coping? \nAnswer 44 : <\/i>This sentence "Understanding of strategy coping" needs more explanation, so we changed into "\nEfforts by trying to understand strategies in managing coping mechanisms is very important to support the patient's coping efforts " Comment 45 : <\/i>\u201cconsist\u201d (p. 12) that consist of? \nAnswer 45 : <\/i>This sentence \u201c\nResults of research on end-stage renal disease patients undergoing hemodialysis in the era of the COVID-19 pandemic illustrate three main themes, consist of\u2026<\/i>\u201d already changed into "\nResults of research on end-stage renal disease patients undergoing hemodialysis in the era of the COVID-19 pandemic illustrate three main themes, namely..<\/i>" \nComment 46 : <\/i>\u201cunderwent\u201d (p. 12) Who underwent? \nAnswer 46 : <\/i>This sentences \u201c\nThese findings showed that end-stage renal disease patients underwent hemodialysis in the COVID-19 pandemic era\u2026.<\/i>\u201d is clearly written into "\nThese findings demonstrated in patients with end-stage renal disease who underwent hemodialysis during the pandemic era<\/i>" We have conveyed all our answers above, and hope you can provide further feedback, we thank you for your attention\n <\/b>and look forward to receiving your further communications. Yours sincerely, Dewiyanti Toding","URL":"https:\/\/f1000research.com\/articles\/13-1404\/v2#referee-comment-13262","order":1,"name":"referee-comment-13262","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.188121.r416416, Mehtap Kavurmaci, Nursing Faculty, Department of Internal Medicine Nursing, Atat\u00fcrk University, Erzurum, 24 Sep 2025, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-1404\/v2#referee-response-416416","order":2,"name":"referee-response-416416","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.188121.r436381, Yafi Sabila Rosyad, Mental health nursing, Putrajaya, 02 Jan 2026, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-1404\/v2#referee-response-436381","order":3,"name":"referee-response-436381","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"We would like to express our sincere gratitude to The Center for Higher Education (BPPT) and The Indonesia Endowment Funds for Education (LPDP) for their support through scholarship programs that enabled us to conduct this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}