Dynamics of Hope in Hemodialysis Patients in Rsudza Banda Aceh

Khairatun Nisak

, Lely Safrina

and Marty Mawarpury

Department of Psychology, Medicine Faculty, Universitas Syiah Kuala

Keywords: Hope, Chronic Kidney Disease Patients, Hemodialysis Therapy.

Abstract: Chronic kidney disease (CKD) is a permanent progressive loss of kidney function, transpiring over a long

period of time and irreversible, however the psychological consequence commonly experienced by CKD

patients may impact their treatment. Hope is a purpose-related unit of cognition that that can help patients

cope with psychological effects so they can undergo maximum treatment. This study aimed to understand

hope concept in hemodialysis patients. This study was a qualitative study with a case study approach.

Sampling technique was purposive sampling with 4 respondents undergoing hemodialysis therapy and data

was collected through interview and observation. The result showde that all four of the respondents had low

hope. On the other hand, in terms of the quality of hope, which are pathways and agency, each respondent

had differences of perseverence in facing their illness. In this research, family and partner support, self-

efficacy, and acquiescence in God’s will were factors affecting hope.

1 INTRODUCTION

One of chronic diseases becoming major health

problem in the world today is chronic kidney failure

(Riset Kesehatan Dasar [Risksdas], 2013). The

disease has high prevalence every year (Himmelfarb

& Sayegh in Asti, Hamid & Putri, 2014). Prevalence

of chronic kidney failure patients in Indonesia is at

0,2 %, it reaches 475.282 people, and prevalence of

chronic kidney failure in Aceh is the second highest

in Indonesia at 0,4 %, it reaches 17.977 people. The

prevalence keeps increasing as age grows (Riskesdas,

2013).

Chronic kidney failure disease (so-called CKD) is

gradual loss of kidney function (progressive), which

is incurable (irreversible), and happens for long time

and permanent (The Indonesian Society of Internal

Medicine, 2009). CKD occurs gradually, which can

be monthly or even yearly, and cannot be cured

(Nurani & Mariyanti, 2013). Damage of kidney

function may be inhibited if patients undergo

treatment regularly. Two methods to manage kidney

failure are a kidney transplant and a hemodialysis.

The kidney transplant is defined as the most ideal way

to manage end-stage kidney failure, because it may

overcome all kinds of kidney function degradations

(The Indonesian Society of Internal Medicine, 2009).

Another management for degradation of kidney

function which is frequently applied for CKD patients

is hemodialysis, because the former therapy, kidney

transplant, remains limited due to many obstacles like

availability of kidney donor, operation technique and

post-operation treatment (Nurani & Mariyanti, 2013).

Hemodialysis is defined as cleaning blood therapy

conducted routinely and largerly to keep life quality

and prolong survival of acute and chronic kidney

disease patient by cleaning blood from excessive

concentration of substances inside body with a

machine in form of artificial kidney called dialyzer

(Schiffl, Lang & Fischer, 2002). Hemodialysis

therapy has to be undertaken for 12-15 hours every

week, or at least 3-4 hours per-therapy (Nurani &

Mariyanti, 2013).

Hemodialysis therapy has effects on patients i.e. it

may improve life quality, reduce stress of patients

(Rodrigue, Mendelbrot & Pavlakis, 2011).

Hemodialysis has physical and psychological effects

on patients. The physical effects are hypotension,

chest pain, nausea, vomiting, and dialysis stability

disruptions like convulsion, pain and muscles cramp

(Suzanne & Brenda, 2001). Psychological effects are

anxiety, sleep problem, and considering to suicide

(Theofilou, 2011).

Hemodialysis therapy which must be undertaken

by patients for 12-15 hours every week requires failure

kidney patients to undergo therapy routinely and

regularly as schedule. It may make patients physically

exhausted like being sick during therapy, or

Nisak, K., Safrina, L. and Mawarpury, M.

Dynamics of Hope in Hemodialysis Patients in Rsudza Banda Aceh.

DOI: 10.5220/0008791702650270

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 265-270

ISBN: 978-989-758-438-1

265

psychologically exhausted. However, hemodialysis

therapy does not make CKD disappear or cured. The

condition often makes patients lose their hope.

Hope is essential to have and develop among

patient, because hope is psychological resource which

is able to assist patients cope their chronic disease

(Elliot & Olver in Duggleby dkk., 2012). Literally,

harapan is different from hope, which is defined as

desiring something to happen (Kamus Besar Bahasa

Indonesia [KBBI]), while hope is not only a desire

but also a process to reach the desire.

Snyder (2000;2007) defined hope as a cognition

unit related to a purpose consisting of pathways, the

ways to reach the purpose and the agency containing

the ability of individual along with motivation to

reach the purpose. Hope may be as protective factor

against psychological pressure in patients (Santos,

Sigulem, Areco, Gabbay, Dib, Bernardo, 2015).

Emmons (2004) stated the same thing as Snyder that

hope was future-oriented, which meant a form of

some good possibilities in the future with quite high

probability. However, in defining hope, Emmons did

not explain the process to realize the hope, because

according to him, hope is just future-oriented which

comes without process to realize it. Damon (2012)

defined hope similar to Snyder, that it was related to

importance of purpose, a reachable thing when an

individual got close to one’s life purpose. Difference

of the theory from Snyder’s is Damon does not

provide aspects to reach the purpose of the hope.

Hope could be beneficial for patients with chronic

diseases, it can reduce pain that is experienced by

patients (Berg, Snyder, & Hamilton, 2016), it may

improve motivation and self-efficacy of sick patients

(Berg, Snyder, & Hamilton, 2016), it may make

patients possible to consider their purposes and

achievement toward their diseases and arrange plan

first to cope with the obstacles. It may make patients

minimalize a stress which will be faced so that they

will not be too exhausted to face their diseases

(Hirsch & Sirois, 2016). One with high hope has an

ability to develop ways to reach desired purposes and

motivate oneself to reach the purposes (Snyder in

Selvam & Poulsom, 2012).

The researcher considers research about hope in

CKD important to do, the researcher is interested to

conduct the research about hope with aim to know an

image of hope in patient undergoing hemodialysis

therapy in dr. Zainoel Abidin General Hospital,

Banda Aceh, because the hospital is general hospital

of Aceh Province which has dialysis installation for

50 machines and is able to serve 400 patients every

week (Una, 2014).

In this research, the researcher will refer to hope

theory by Snyder, because the theory has been used

in 12 research found by the researcher during

literature study, an example of a research which used

Snyder theory is conducted by Hirsch & Sirois (2016)

about hope in patients with chronic diseases. In

addition, Snyder also has develop an instrument for

hope theory, either for qualitative research or for

quantitative research with good validity and

reliability. According to literature review, the theory

was mostly used in patients with chronic diseases.

However, research about hope is still limited in Asia.

According to Snyder (2000), there are two aspects

of hope, as follows:

a. Pathways, is a capacity to find a way in order to

be able to reach a purpose. The path into the

purpose is important in order to get success

opportunity from the hope. Pathways thoughts

will emerge in the first six month when patient is

diagnosed.

b. Agency, is motivational component which is

required to reach a purpose. Agency reflects one’s

judgment toward an ability to be persevering in

getting the purpose. Agency thoughts will emerge

in the next six month after pathways thoughts

develop.

Factors influencing Hope.

There are several factors that influence hope as

follows:

1. Emotion. Hope is emotion, although hope is

managed by cognition, environment may

influence the development and the damage of

hope (Lopez, Snyder & Pedrotti, 2007).

2. Cognition. Hope is often considered as emotion, a

feeling makes ones possible to defend their belief

in frightening condition. Hope is a thought or

belief that individual may keep moving toward the

purpose (Lopez, Snyder & Pedrotti, 2007).

3. Obedience. Depression patients usually suffer

from desperate feeling or lose hope on themselves

and sometimes they do not fully obey the

undergone medication to improve their health

(Simoni, Frick, Huang, 2006).

Patients will keep undergoing therapy repeatedly

based on their kidney condition and docter’s advice,

depression patients often have desperate feeling and

lose hope on themselves and sometimes they do not

fully obey the undergone medication to improve their

health (Simoni, Frick, Huang, 2006). Patients without

hope tend to not obey the medication (Simoni, Frick,

Huang, 2006).

The research question is how is hope in

hemodialysis patients ?

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

266

2 METHOD

This research was used qualitative method with study

case approach, a study involves a problem which is

explored through one or several cases in limited

system (Creswell, 2007). The researcher preferred

study case because wanting to understand an abstract

construct, by looking at image of hope in patient

undergoing hemodialysis therapy.

1. Respondent characteristics

a. Hemodialysis patient undergoing the

therapy for at last 18 month, because:

- in at least 12 bulan, aspects of hope, pathways

thoughts and agency thoughts, will have emerged

from an individual (Snyder, 2000).

- physical condition has experienced edema

(hands, legs, or stomache is swollen), in this

condition, patients tends to be stress and depressed

about changes in their body (Theofilou, 2011).

b. Ready to be respondent

2. procedures of respondent selection

The technique to select respondent was purposive

sampling. Purposive Sampling is a technique used by

the researcher if having certain considerations in

selecting the sample. Respondents were selected

based on certain criteria which had been set in

advance based on problem and purpose of the

research. Research location was in dialysis room in

The Zainoel Abidin General Hospital Banda Aceh. In

this research, the researcher interviewed four

respondents based on characteristics in this research.

The four respondents were interviewed in two steps

of interview which took place in 2 months 17 days.

The data analysis method which was used by the

researcher was modification model of The Stevick-

Colaizzi-Keen (Moustakas, 1994).

The respondents in this research was 4 (four)

patients who underwent hemodialysis therapy. The

table of the description of the respondents who were

involved in the research about hope in hemodialysis

is as follows.

Table 1.

Dimension

Age

42-year-old

37-year-old

37-yar-old

32-year-old

Occupation

Civil Servant

Housewife

Civil Servant

Working at

Private

Sector

Domicile

Banda Aceh

Marriage

Status

Married

Widow

Single

Length of

Therapy

3 years

7 years

Initial History

Nephrotic

Syndrome

Preeclampsia

Hypertension

Hypertensio

Hope experienced by the three respondents was

different. MS had the worst pathways and agency

among the other respondents, MS often broke

prohibition required by the doctor, had no motivation

and purpose, because he thought life was not special

and surrendered with what happened.

WF had different pathways and agency, WF

obeyed the hemodialysis therapy schedule as the

doctor required, WF never missed to attend the

therapy, however, WF said that she sometimes broke

the prohibitions like the requirement to drink enough

water, as the result she suffered from shortness of

breath. WF had good motivation to survive, her

children and husband supported her to keep

undergoing hemodialysis, but WF said that she was

not sure about gaining recovery by undergoing

hemodialysis.

FH also had different pathways and agency as

WF, she obeyed the schedule of hemodialysis, but FH

occasionally broke the recommendation by the doctor

like the prohibition to excessively drink water and do

excessive activity. FH explained that the only way to

keep healthy and make the children happy was by

keeping undergoing the hemodialysis therapy,

however she had no any plan for her life.

HA had the highest quality of pathways and

agency of the four respondents, HA never broke the

prohibitions which were required by the doctor and

always underwent the therapy routinely as the

schedule. HA really wanted to be recovered in order

that she could make her dream come true, but HA was

not sure that she could recover by undergoing

hemodialysis therapy

The result showed that the four respondents had

low hope, because they did not meet the indicators of

behavior from each aspect of hope, but if it is seen by

the quality of hope, each respondent had different

hope. HA was the only respondent who had good

quality of hope, because HA showed her obedience

toward the doctor’s recommendations, it could be

seen from her physical was healthier than the other

three respondents. Snyder (2000) stated that a

character of individual who had good hope was the

individual was able to mark one’s ability to be

persevering in getting one’s target.

The difference of hope of the four respondents

could be caused by various factors, i.e. family support

and the length of therapy, from the beginning of the

diagnosis to the present time. WF and FH explained

that family support was very essential for them,

because it could strengthen them to keep undergoing

the hemodialysis therapy. The result above is in

accordance with the previous research conducted by

Rosland, Heisler, and Piette (2011) which stated that

Dynamics of Hope in Hemodialysis Patients in Rsudza Banda Aceh

267

family support was significantly able to affect

patient’s obedience toward the treatment, moreover,

obedience was the factor that affect hope.

HA was the respondent undergoing the longest

treatment of the four respondents, for 7 years. The

other three respondents had undergone the treatment

for 3 years. It made HA have the highest quality of

hope of the four respondents which can be seen from

her pathways and obedience behavioral indicators. It

is in accordance with previous research which stated

that patients who had endurance would show higher

obedience toward a therapy (Medeiros, Arantes,

Tajra, Santiago, Carvalho, Liborio, 2016).

The four respondents did not have good

qualification of hope, because they did not meet two

of three factors which affected hope, cognition and

obedience factor. The four respondents were not

certain that their recovery could be achieved by

hemodialysis therapy, because they thought that

hemodialysis therapy was not healing therapy, but the

therapy to make them still in well condition.

Basically, hemodialysis therapy may recover, it can

be seen from the development of URR (Urea

Reduction Ratio) which is checked every week, the

higher ratio, the less toxic inside blood and it means

that therapy goes effective. Several factors influence

the successful therapy, like age, nutritional intake and

the obedience level (The Indonesian Society of

Internal Medicine, 2009).

Three respondents, MS, WF, and FH said that

they broke the prohibition required by the doctor, like

drinking excessive water and consuming prohibited

food. It showed that they did not have obedience

which was one of the factors affecting hope, the more

individual obeys, the more hope improve

progressively (Simoni, Frick, Huang, 2006).

According to the result, there are other topics

arouses besides the aspects of hope, i.e. family

support, partner support, self-efficacy and

resignation. Two of four respondents stated that

family support was essential for them in undergoing

the hemodialysis therapy, like being accompanied by

the children during the therapy. It is in accordance

with previous research which showed that family was

the most essential supporting resource for patients

(Ahrari, Moshki, Bahrami, 2014). Furthermore, a

respondent, WF, said that partner support was

necessary for her, her partner accompanied and

waited for her during comma, cleaned her body when

she was unconscious, and took care of her until now.

So that, WF got encouraged to undergo the treatment

as required. It is in accordance with other research

about partner support which stated that partner

support significantly could decrease pain suffered by

patient with chronic disease (Williams & Cano,

2014).

The four respondents had low self-efficacy, they

told that they were not certain that the hemodialysis

therapy could recover their disease. They believed

that the therapy was only for making them keep

healthy. Low self-efficacy is as the result of low hope

of patients, as the research by Berg, Snyder, Hamilton

(2008) which stated that individual with good hope

was able to improve one’s self-efficacy. Therefore, it

is important to conduct clinical approach for

hemodialysis patients to improve their self-efficacy

(Tsay & Healstead, 2002).

Later on, the four respondents also mentioned

about their resignations on what they suffered. They

perceived the disease was the test by God and they

just resigned on what they suffered. It is in

accordance with previous research which found that

patients with chronic disease would give up with their

disease (Riva, Montali, Wirth, Curioni & Williams,

2016)

The research result is confirmed by several

previous researches finding that patients with was

caused by negative experience, death of family

member because of chronic disease or lack of social

support, no support from expected others (Davidson

& Simpson, 2006; Eliott & Olver, 2009; Buckley &

Herth, 2004). A research found that patients with

good hope possessed high social support, they were

encouraged to be able to achieve their target despite

difficult condition (Billington, Simpson, Unwin,

Bray, & Giles, 2008).

3 CONCLUSIONS

Hope is a unit of purpose-related cognition which

consists of ways to achieve a purpose and self-ability

along with motivation to achieve the purpose i.e.

pathways and agency. The result showed that the four

respondents had low hope, furthermore if it seen from

quality of hope, each respondent had different hope,

different perseverance in facing their disease.

Based on affecting factors, only one factor of

three factors was performed by the respondents,

emotion factor. Interestingly, there were other topics

emerged in this research, family support, partner

support, self-efficacy and resignation. Those topics

could influence hope in the four respondents, so that

the respondents could not achieve the target they want

The limitation of the research was limited time

with respondents because the respondents’ health

condition was unpredictable.

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

268

REFERENCES

Ahrari, S., Moshki, M., Bahrami, M. (2014). The

Relationship Between Social Support and Adherence of

Dietary and Fluids Restrictions among Hemodialysis

Patients in Iran. Journal of Caring Sciences. 3(1), 11-

19.

Asti, D.A., Hamid, A.Y.S., Putri, Y.S.E. (2014). Gambaran

Perubahan Hidup Klien Gagal Ginjal Kronis Yang

Menjalani Hemodialisa. Jurnal Kebidanan Dan

Keperawatan, 10 (2), 172-185.

Berg, C. J., Snyder, C. R., & Hamilton, N. (2016). The

Effectiveness of a Hope Intervention in Coping with

Cold Pressor Pain. Journal of Health Psychology. 13(6),

804-809.

Billington, E., Simpson, J., Unwin, J., Bray, D., & Giles, D.

(2008). Does hope predict adjustment to end-stage renal

failure and consequent dialysis ? Journal of Health

Psychology. 13, 683-699.

Brannon, L., Feist, J., & Updegraff, J. (2013). Health

Psychology Eight Edition: An Introduction To

Behavior And Health. USA: Wadsworth.

Buckley, J & Herth, K. (2004). Fostering Hope in

Terminally ill Patients. Nursing Standard. 19(10), 33-

41.

Creswell, J.W. (2007). Qualitative Inquiry & Research

Design Second Edition: Choosing Among Five

Approach. Lincoln: Sage Publication.

Damon, W. (2012). Age of Purpose. diakses pada tanggal 6

Juni 2017 dari

http://www.williamdamon.com/2009/10/the-age-of-

purpose>

Davidson, S.N & Simpson, C. (2006). Hope and Advance

Care Planning in Patients with End Stage Renal

Disease: Qualitative Interview Study, BMJ.

doi:10.1136/bmj.38965.626250.55.

Duggleby, W., Hicks, D., Nekolaichuk, C., Holtslander, L.,

Williams, A., & Eby, J. (2012). Hope, Older Adults,

And Chronic Illness: A Metasynthesis Of Qualitative

Research, Journal of Advanced Nursing. 68(6), 1211-

1223.

Eliott, J.A & Olver, I.N. (2009). Hope, Life, and Death: A

Qualitative Analysis Of Dying Cancer Patients Talk

About Hope, Death Studies. 33, 609-638.

Emmons, R.A., McCullough, M.E. (2004). The Psychology

og Gratitude. New York: Oxford University Press.

Gilman, R., & Dooley, J. (2006). Relative Levels Of Hope

And Their Relationship With Academic And

Psychological Indicators Among Adolescents, Journal

of Social and Clinical Psychology. 25(2). 166-178.

Hirsch, J. K., & Sirois, F. M. (2016). Hope And Fatigue In

Chronic Illness : The Role Of Perceived Stress, Journal

of Health Psychology. 21(4). 451-456.

Idrus, M. (2009). Metode Penelitian Kualitatif 2nd edition.

Jakarta: Erlangga.

Lopez, S J & Snyder, C. R. (2004). Positive Psychological

Assessment: A Handbook of Models and Measures.

US: American Psychological Association.

Madan, S., Pakenham, K.I. (2015). The Stress-Buffering

Effects of Hope on Changes in adjustment to

Caregiving in Multiple Sclerosis. Journal of Health

Psychology. 20(9). 1207-1221.

Medeiros, C.M.M.F., Arantes, E.P., Tajra, R.D.P.,

Santiago, H.R., Carvalho, A.F., Liborio, A.B. (2016).

Resilience, Religiosity and Treatment Adherence in

Hemodialysis Patients: A Prospective Study.

Psychology Health and Medicine.

doi.10.1080/13548506.2016.1191658

Moustakas, C. (1994). Phenomenological Reasearch

Methods. USA: Sage Publication.

Nurani, V.M. & Mariyanti, S. (2013). Gambaran Makna

Hidup Pasien Gagal Ginjal Kronik Yang Menjalani

Hemodialisa. Jurnal Psikologi, 11(1), 1–13.

O’Callaghan, C. A. (2009). At A Glance Sistem Ginjal.

Jakarta: Erlangga.

The Indonesian Society of Internal Medicine. (2009). Buku

Ajar Penyakit Dalam Jilid II (5th ed.). Jakarta: Internal

Publisihing.

RISKESDAS. (2013). Riset Kesehatan Dasar. Kementerian

Kesehatan

Rodrigue, J.R., Mandelbrot, D.A., Palvakis, M. (2010). A

Psychological Intervention to Improve Quality of Life

and Reduce Psychological Distress in Adults Awaiting

Kidney Transplantation. Nephrol Dial Trasplant. 26,

709-715.

Rosland, A.M., Heisler, M., Piette, J.D. (2012). The Impact

of Family Behaviors and Communication Patterns on

Chronic Illness Outcomes: a systematic review, J

Behav Med. 35. 221-239.

Sandra., Dewi, W N., D. Y. I. (2012). Gambaran Stres Pada

Pasien Gagal Ginjal Terminal Yang Menjalani Terapi

Hemodialisa Di Rumah Sakit Umum Daerah Arifin

Achmad Pekanbaru. Jurnal Ners Indonesia, 2(2), 99–

108.

Santos, F. R. M., Sigulem, D., Areco, K. C. N., Gabbay, M.

A. L., Dib, S. A., & Bernardo, V. (2016). Hope Matters

To The Glycemic Control Of Adolescents And Young

Adults With Type 1 Diabetes. Journal of Health

Psychology. 20(5). 681-689.

Schiffl H, Lang sM, Fischer R. (2002). Daily Hemodialysis

and The Outcome of Acute Renal Failure. The New

England Journa of Medicine. 346(5). 305-310.

Selvam, S. G., & Poulsom, M. (2012). The Psychology of

Hope from the Perspective of Religion. Journal of

Dharma. 37(4). 393-410.

Simoni, J.M., Frick, P.A., Huang, B. (2006). A

Longitudinal Evaluation of a Social Support Model of

Medication Adherence Among HIV-Positive Men and

Women on Antiretroviral Therapy. Health Psychology.

25(1). 74-81.

Snyder, C.R. (2000). Handbook of Hope Theory, Measures

and Application. Lawrence: Academic Press.

Snyder, C R & Lopez, S. J. (2007). Positive Psychology:

The Scientific and Practical Exploration of Human

Strengths. Lawrence: Sage Publication.

Suzanne, S.C. & Brenda, B.G. (2001). Buku Ajar

Keperawatan Medikal Bedag Brunner Dan Suddarths.

In: Penerbit Buku Kedokteran EGC

Dynamics of Hope in Hemodialysis Patients in Rsudza Banda Aceh

269

Theofilou, P. (2011). Quality of Life in Patients

Undergoing Hemodialysis or Peritoneal Dialysis

Treatment. J Clin Med Res. 3(3). 132-138.

Tsay, S.L. & Healstead, M. (2002). Self-care Self-efficacy,

Depression, and Quality of Life among patients

receiving hemodialysis in Taiwan. International Jounal

of NursingStudies. 39. 245-251.

Williams, A.M. & Cano, A. (2014). Spousal Mindfulness

and Social Support in Couples With Chronic Pain. Clin

J Pain. 30(6). 528-535.

Wlodarczyk, D. (2015). Optimism and Hope as Predictors

of Subjective Health in Post-Myocardinal Infraction

Patients: A Comparison of The Role of Coping

Strategies. Journal of Health Psychology. 1-11.

APPENDIX

Table 2: Table of the difference of hope among the

respondents.

Aspects

Behavioral

Indicators

Pathways

1. Obey the therapy

2. Have solutions

3. Keep obeying the

prohibition

√

Agency

1. Have motivation

2. encouraged

3. have life plan

4. Optimistic (sure to

recover)

√

Tema lain

1. Family support

2. Partner support

3. Low Self-efficacy

4. Resignation

√

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

270