Life Satisfaction and Subjective Well-being Chronic Renal Failure

Patient with Hemodialysis in Medan

Cholina Trisa Siregar

, Siti Zahara Nasution

, Zulkarnaen

Faculty of Nursing, Universitas Sumatera Utara, Jalan Prof. Maas No. 3, Medan, Indonesia

Faculty of Psychology, Universitas Sumatera Utara, Jalan dr. Mansyur No. 5, Medan, Indonesia

Keywords: Subjective Well-being, Life Satisfaction, Health Status, Quality of Life.

Abstract: Chronic Kidney Disease (CKD) patients have psychosocial problems that affect their lives such as

personality changes and despair. CKD changes their lives and decreases the happiness of the sufferer. This

study was aimed to identify the subjective well-being CKD patients with hemodialysis in Medan, Sumatera

Utara, Indonesia. The sample of this research consists of 360 CKD patients with hemodialysis. Subjective

well-being patients were measured by Satisfaction with Life Scale (SWLS) at the scale I and II. The Scale II

consists of Scale Positive and Negative Experience (SPANE). The result of the research shows that life

satisfaction 109 (30,3%) patients are in the average category feel satisfied with the current condition and

subjective well-being 282 (78,4%) patients are in the medium category. Acceptance of patients on their

condition of the disease can improve health status, quality of life and do the activity daily living.

1 INTRODUCTION

The result data Report of the Indonesian Renal

Registry (IRR) (2015) that new patients with HD

consist of 4,977 patients in 2007 increased to 21,050

patients in 2015 and active HD patients in 2007

consist of 1,885 patients increased to 30,554 patients

by 2015 (Nazly, 2013). The prevalence of chronic

kidney disease also increased in Medan, Sumatera

Utara. The number of new patients and active

patients in 2013 consists of 847 people increased to

957 people by 2014 in Sumatera Utara (Becker,

2005). Chronic Kidney Disease (CKD) patients who

obtain hemodialysis have various problems in life.

Fatigue, immobility, hypotension, muscle cramps,

nausea, vomiting, and behavior impose limitations

into physiological disorders and provide

psychological effects on the sufferer (Diener, 2000)

Karabulutlu, Bilici, Cayir, Tekin and Kantarci

(2010) explain that chronic diseases such as chronic

kidney disease does not only invade the physical but

also give negative psychosocial effects. Individuals

with chronic kidney function disorder usually

experience feelings of helplessness, no hope, and no

strength. These signs are seen when the person

experiences a change of personality, fear, anger,

more sensitivity, anxiety, and despair (Diener, 2002.

Diener & Diener (2009) reveals that negative

affects such as unhappy circumstances will affect the

mental burden of the patient and then will affect his

health (Diener, 2004). If patients with CKD

undergoing hemodialysis experience unhappiness,

then the patient will experience a decrease in health

conditions, while patients with high self-acceptance

will experience significant health improvements The

above matter makes acceptance of self as a general

concept to describe the level of well-being

experienced by individuals according to evaluation

subjective of his life. This concept can evaluate the

concept of individual life satisfaction, pleasant and

unpleasant emotions, fulfillment, and satisfaction in

areas such as marriage and work (Diener, 2005).

2 METHOD

The research used descriptive analysis design. The

population in this study were patients with chronic

kidney disease who were undergoing hemodialysis

in the hemodialysis unit of Central General Hospital

H. Adam Malik, Dr. Pirngadi, and Kidney Special

Hospital Rasyida Medan. The hospital became the

largest hemodialysis service unit in Medan,

Indonesia. The number of samples of 360 patients

with conscious awareness of compos mentis being

694

Siregar, C., Nasution, S. and Zulkarnaen, .

Life Satisfaction and Subjective Well-being Chronic Renal Failure Patient with Hemodialysis in Medan.

DOI: 10.5220/0010084206940698

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

694-698

ISBN: 978-989-758-449-7

hospitalized and outpatient. The sampling technique

used is simple random sampling. The research

instrument used in the form of demographic data and

two separate psychological scales compiled by

Diener et. al (2009), namely Satisfaction with Life

Scale (SWLS) on the scale I and Scale Positive and

Negative Experience (SPANE) on a scale of II.

Instrument validated by a lecturer of the Faculty of

the Nursing University of North Sumatra who expert

in the field with V = 0.93 and reliability value

Cronbach alpha = 0.823 means the instrument in this

study valid and reliable for use.

Life satisfaction is evaluated by using

Satisfaction with Life Scale (SWLS). There are

seven categories of agreements which are individual

responses or responses to the statements provided

and given scores for each option. The lowest score

of the total SWLS score is 5 and the highest score of

the total SWLS score is 35. After obtaining the total

SWLS score, then the categorization will be done.

Life satisfaction category starts from the very high

category, high, average, slightly below average,

dissatisfied and very dissatisfied. Scale Positive and

Negative Experience (SPANE) is a psychological

scale to evaluate positive affects and negative

affects. On this scale, respondents were asked to

think about what they experienced during the past

four weeks and then assess how often respondents

experienced the feelings expressed on the scale. The

lowest score of the total SPANE-Positive and

SPANE-Negative scores was 5 and the highest score

of SPANE-Positive and SPANE-Negative scores

was 25 each.

3 RESULT

The result showed that demographic data, the

majority of age 41-60 years old were 58,6% (211),

56,9% (205) male majority, the majority of Senior

high school education as much as 36,9% (133),

Occupational the majority was no work as much as

52,2% (188), the majority material status was

marriage as much as 85,6% (308), Frequency of

hemodialysis, Long diagnosed of CKG was more

than 1 years as much as 76,4% (275), Family

involvement as much as 67,5% (243), The majority

patients were Batak as much as 61,1% (220).

Description can be seen in the table below.

The result of the study showed the majority of

responden life satisfaction was average as much as

18.3% (109). Description can be seen on the table

below.

The result of the study showed the majority of

responden subjective well being was medium as

much as 78.4% (282). Description can be seen on

the table below.

Table 1. Characteristic Of Patient Demographic.

Karakteristik

Demografi

Sex

Male

Female

205

155

56.9

43.1

Age

18-40 Years old

41-60 Years Old

>60 Years Old

211

23.4

58.6

17.8

Education

Elementary School

Junior High School

Senior High School

Diploma

Bachelor

133

104

10.3

15.3

36.9

8.6

28.9

Occupational

No work

Entrepreneur

PublicCompany mployees

188

110

52.2

30.6

17.2

Marital Status

Single

Marriage

Widow/ Widower

308

10.3

85.6

4.2

The frequency of

hemodialysis/ weeks

Once

Twice

Three times

333

0.6

92.5

6.9

Long diagnosed

<1 Years

≥1 Years

275

23.6

76.4

Family Involvement/Closed

Friend

Yes

243

117

67.5

32.5

Culture

Batak

Jawa

Minang

Aceh

Melayu

Tionghoa

Nias

Sunda

NTT

220

61.1

20.8

4.7

1.4

5.3

2.5

1.1

2.8

0.3

Life Satisfaction and Subjective Well-being Chronic Renal Failure Patient with Hemodialysis in Medan

695

Table 2. Distribution of respondent's life satisfaction

frequency.

Life Satisfaction

(%)

Very High

High

Average

Under Average

Unsatisfied

Very Unsatisfied

109

11,1

26,1

30,3

18,3

13,3

0,8

Table 3. Distribution of self-acceptance of chronic kidney

disease patients undergoing hemodialysis in Medan.

Subjective Well-being

(%)

Low

Medium

High

282

10.8

78.4

10.8

4 DISCUSSION

The results of this study obtained data that the

majority of respondents male sex as many as 205

patients (56.9%) and the majority of respondents are

in the age group 41-60 years as many as 211 patients

(58.6%). Perez & Jeannie (2012) in his research in

the Philippines also adds that well-being women

tend to be higher than men in some aspects,

including in terms of spiritual experience, positive

relationships with others and purpose in life (Diener,

2013).

The results of this study obtained data that the

last education respondents as many as 133 people

(36.9%) is the high school level. education and self-

acceptance have small but significant relationships.

Education is associated with the well-being of

lower-income individuals as well as in poorer

countries (Eddington, 2005).

Revenue has a relationship consistent with self-

acceptance in analysis on a country scale but has

little effect on the individual scale. The results of

this study obtained the data that the majority of

respondents did not work as many as 188 patients

(52.2%). Diener, Oishi & Tay 2013) explains that

the relationship of income on a state scale with self-

acceptance is in a more prosperous country because

it has a better democracy and more respect for

equality among others while the income of each

individual in a certain time interval only give a small

effect on the acceptance self (IRR, 2014). This is

because most people who have higher incomes

should spend more time to work and have less time

to have fun and social relationships so with the

income and employment status does not really affect

individual self-acceptance (Diener, 2004).

Individuals who do not have a job will not

experience psychological experience from their

work, such as job demands, pressure from leaders

and colleagues. Past psychology experience presents

the strength and ability of an individual to deal with

new social experiences.

Judging from the status of respondents, as

many as 308 people (85.6%) are married. Diener,

Gohm, Suh, Oishi (in Diener, E., Lucas, R. E., and

Oishi, S, 2005) reveal that marital status on self-

acceptance is influenced by local culture. The results

show that married couples are known to feel happier

than unmarried couples but live together or someone

who does not have a partner. Family relationships,

family attention to offspring, and small involvement

in patient care affect the patient's healing (IRR,

2015).

The results of this study obtained data that the

majority of respondents as much as 333 patients

(92.5%) do HD 2x a week with the majority 275

patients (76.4%) have been diagnosed GGK ≥1

years ago. When a disease attacks a person, spiritual

power can help him toward healing or on the

development of spiritual needs and concerns. The

power of one's spirituality can be an important factor

in dealing with the changes caused by his illness

(IRR, 2015).

This study also shows that the majority of

respondents are treated by the family or the nearest

person in the face of the disease, which is as many

as 243 people (67.5%). Taylor et. al, (2009) also

revealed the presence of people who provide social

support will increase the ability of individuals in the

face of stress so that can produce higher levels of

self-acceptance (Karahbulutlu, 2010).

The results of this study indicate that the

majority of respondents are Batak culture that is as

much as 220 people (61.1%). Kim, Y., Evangelista,

L.S., Phillips, L.R., Pavlish, C., & Kopple, J.D.

(2012) culture also affects the health status of

patients with chronic diseases. Their results show

that the average African-American tribe has a

negative perception of its condition and the lack of

confidence in treatment measures that affects self-

control during illness (Huppert, 2009). Cultural

norms are more affecting positive affects than

negative affects. In a culture that considers the

expression of positive things as bad, individuals tend

to report lower levels of positive affective effects

than individuals who grow up in a culture that

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

696

considers the expression of positive things as

something natural (Diener, 2004).

Positive affects are more influenced by the

environment because they are more social. Becker

and Newsom (2005) add that culture can emphasize

the independence, spirituality, and survival of

patients so that it will improve the ability to adapt to

the illness experienced. North Sumatra has a very

heterogeneous culture, has a lot of diversity and high

tolerance. The people of North Sumatra reflect the

diverse citizenship of the archipelago but still have a

high degree of integrity and sense of togetherness

that raises the patient's expectation to heal (Perez,

2012).

Table 2. Shows the majority of respondents' life

satisfaction is in the average category that is, as

many as 109 of 360 respondents (30.3%).

Individuals who are at this level want to increase

their life satisfaction to a higher level. Individuals

who are satisfied with their lives are individuals who

judge that their life is not perfect but everything

works well and always has a desire to grow and love

challenges (Simatupang, 2015). Diener, Lucas &

Oishi, (2002) says that the influence of demographic

factors, such as income, sex, age, education, marital

status, and religion on self-acceptance is usually

small. The extent to which demographic factors can

increase self-acceptance depends on one's own

values and goals, personality and culture (Diener,

2009).

The majority of the respondents in this study

were Batak tribes, where the Batak tribe had a habit

when a family member was sick, the other family

members would roll around to visit the patient. This

activity aims to improve the patient's spirit to

recover Patients who have support from their

families and spouses show improved care than those

without family support. Many researchers believe

marriage deals with self-acceptance because of

marriage as a force against the hardships of life.

Marriage provides emotional and financial support

that results in a positive state of self-acceptance

(Eddington, 2005).

Diener (2009) explains that social support is a

predictor of self-acceptance. With social support,

they are more often happy and less sad. This is

because the patient feels they have a place to tell

when they need it so that the patient feels

comfortable and this will contribute to the positive

affects that the patient feels. The high positive

affects perceived by individuals indicate the high

self-acceptance possessed by the individual

(Eddington, 2005). Simatupang, Nurmaini and

Siregar (2015) also added that in Batak tribe there

are also some rituals for sick family members, such

as giving ulos and making special food to the patient

as a symbol of attention and affection from all

family members to the sick. This is what gives

reinforcement so that patients tend to have good

positive affects (Potter, 2016). Situmorang said

(2015) Family support is a life spirit that is needed

by patients especially those undergoing

hemodialysis, family support can increase the

positive affect felt by patients. Increasing positive

affect makes psychosocial improvement and as a

source of evaluation to improve positive self-

acceptance (Situmorang, 2015)

Table 3. shows that the majority of respondents'

self-acceptance is in the moderate category, that is,

282 of 360 respondents (78.3%), and 39 respondents

(10.8%) with low self-acceptance, and 39

respondents (10.8% ) with high self-acceptance.

Self-acceptance in patients with chronic kidney

disease who underwent hemodialysis was in the

moderate category, ie as many as 282 out of 360

patients (78.3%) in Medan. Diener, (2000) adds

individuals with high self-acceptance levels

generally have some amazing qualities. These

individuals will be better able to control their

emotions and deal better with events in life (Diener,

2005).

The results of this study obtained data of

patients diagnosed with chronic renal failure for

more than one year. Patients who underwent

hemodialysis for more than one year can adapt and

accept the condition of the disease. Acceptance of

conditions for diseases increases because the patient

does not feel alone as a person with chronic kidney

failure after meeting other people with hemodialysis.

Patients who have the acceptance of life and social

support from the family and community

environment, the patient tends to have a more

positive strategy and problem management so that

eventually will foster self-acceptance of the

condition of the disease (Safitri, 2013). Huppert

(2009) states painful experiences such as

disappointment, failure and sorrow are normal parts

of life, the ability to regulate these negative

emotions is important to be able to accept the

conditions that occur. Subjective well being can

change when extreme negative emotions or very

long lasting affect someone to function normally in

their daily lives (Taylor, 2006).

5 CONCLUSIONS

Based on the results of data analysis and discussion,

researchers can conclude that patients with chronic

Life Satisfaction and Subjective Well-being Chronic Renal Failure Patient with Hemodialysis in Medan

697

kidney diseaseexperience problems in life, not just

physical problems but also psychological problems.

Psychological problems will make the condition

more severe disease. Preventing the occurrence of

complications due to psychological impacts is

necessary to increase the ability of individuals to

accept the illness experienced. Description Self-

acceptance in patients with chronic kidney disease in

the city of Medan in accordance with the above data,

is in the moderate category where patients feel

began to reach satisfaction in life and positive

affects, then negative affects experienced can be

resolved due to the large attention and support from

family members in undergoing his life. Families, the

environment, and health workers have a very

important role in improving the patient's acceptance

of his illness.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research is supported by Ministry of Research and

Technology and Higher Education Republic of

Indonesia. The support is under the research grant

TALENTA Year of 2017.

REFERENCES

Al Nazly E, Ahmad M, Musil C, Nabolsi M 2013

Nephrology Nursing Journal, 40(4), 321.

Becker G, Newsom E 2005 The Journals of Gerontology

Series B: Psychological Sciences and Social Sciences,

60(4), S214-S223.

Diener E 2000 American psychologist, 55(1), 34.

Diener E, Lucas RE, Oishi S 2002 Oxford University

Press, 81-84.

Diener E, Lucas RE, Oishi S 2004 Dobrostan psychiczny.

The science of happiness and satisfaction with life, W:

Czapiński J.(ed.), 33-5.

Diener E, Lucas RE, Oishi S 2005 New York: Oxford

University Press, 63-73.

Diener E, Diener M 2009 Cross-cultural correlates of life

satisfaction and self-esteem In Culture and well-being,

71-91.

Diener E, Tay L, Oishi S 2013 Journal of personality and

social psychology, 104(2), 267.

Eddington N, Shuman R 2005 Penerimaan diri

(happiness). continuing psychology education.

IRR (Indonesian Renal Registry) 2014 7th Report Of

Indonesian Renal Registry.

IRR (Indonesian Renal Registry) 2015 8th Report Of

Indonesian Renal Registry.

Kim Y, Pavlish C, Evangelista LS, Kopple JD, Phillips LR

2012 Nephrology Nursing Journal, 39(1), 39.

Karabulutlu, E, Y., Bilici, M., Cayir, K., Tekin, S. B.,

Kantarci, R. (2010). Coping, Anxiety, And Depression

in Turkish Patients with Cancer. Eur J Gen Med

2010;7(3): 296-302

Huppert, F. A. (2009). Psychological well-being: evidence

regarding its causes and consequences. Applied

Psychology: Health and Well-Being, 1(2),137-164.

Perez, Jeannie A 2012 International Journal of

Humanities and Social Science, 2(13), 84-93.

Potter P, Perry A, Stockert P, Hall A 2017 Elsevier Public

Health, 9

Simatupang L.L., Nurmaini, Siregar CT 2015 Idea

Nursing Journal,6(3), 19-26

Situmorang, H. E. (2015). Hubungan dukungan keluarga

dengan kualitas hidup pasien gagal ginjal kronis yang

menjalani hemodialisa di rsud dok II Jayapura. Jurnal

Ilmu Pendidikan Indonesia, Vol. 3, No. 3, 23-30.

Safitri, R.P, & Sadif, R. S. (2013) . Spiritual Emotional

Freedom Technique (SEFT) to Reduce Depression for

Chronic Renal Failure Patients in Cilacap Hospital to

Undergo Hemodialysis. International Journal of Social

Science and Humanity, 3 (3),300-302.

Taylor& Francais, (2006). Resiliensce in the Chronic

Illness Experince. Vol. 14 Issue 2 pg. 187-201

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

698