Renal Health Advocacy For Nurses in La Union 1325915359

E-International Scientific Research Journal
ISSN: 2094-1749 Volume: 3 Issue: 1, 2011
Renal Health Advocacy for Nurses in La Union:

A Prototype
Holly Lou E. Mangaoang, RN,MAN
Instructor
Don Mariano Marcos Memorial State University
Agoo, La Union, Philippines
Abstract
This study aimed to determine the renal health practices of nurses in La Union. It was conducted
in the calendar year 2009-2010. One hundred seventeen (117) regular staff nurses in five (5)
tertiary hospitals were selected using stratified random sampling.
Descriptive survey method and a questionnaire were used in gathering data which were treated
using Weighted Mean, Average Weighted Mean, t-test and Analysis of Variance.
Results show that most nurses are young adults, females, employed in private hospitals with
incidence of UTI. Hygiene is always implemented while the rest are often implemented. The
extent of implementation of renal health practices differs as to gender. All the renal health
practices are strengths of the respondents and a renal health advocacy for nurses in La Union is
proposed.
Keywords: Continuing Education Activities, Nurse Educators
Introduction
The heart of nursing is in the promotion of health and prevention of diseases. And with the
advancement of the profession nowadays, nurses continuously face a lot of demands. Nurses
may spend considerable time walking and standing. They need emotional stability to cope with
human suffering, emergencies, and other stresses. Because patients in hospitals require 24-hour
care, nurses in these institutions may work nights, weekends, and holidays. They may also be oncall; available to work on short notice. Most nurses now work 12-hour days at the bedside, two
on and two off, and on weekends, Friday, Saturday and Sunday, with Friday being an eight-hour
day. And even though hospitals post staffing plans that state that each nurse will be responsible
for only so many patients of a particular type, many hospitals regularly violate their own plans
by forcing nurses to work overtime and care for extra charges during a shift (Guerra,2008)
Nurses are at a particularly high risk for illness, emotional exhaustion and musculoskeletal
injuries. In 2005, 16,500 publicly employed nurse supervisors and registered nurses were absent
each week due to illness and injury. While this is slightly less than in 2002 (17,100 per week), it
is significantly greater than the 9,400 absences per week in 1987. (Greensdale, 2007) In 1991,
A.L Bendtsen, MD, coined the terms, nurses bladder when his research revealed that seventy
34

(70) percent of nurses in a Danish study suppressed the desire to void during working hours.
Ignoring the bladder's need to empty can lead to overdistension, urinary incontinence and urinary
tract infections. Since most nurses, regardless of work setting, experience high patient loads,
heavy demands, and long workdays that may interfere with regular bathroom breaks, new
behaviors focusing on bladder health must occur. With this study, main reasons for suppression
of desire to void were busy work, poor toilet facilities and indolence. The frequency of
micturition was higher during evening and night shifts than in the day shift.
Moreover, a study was also conducted by LIAO Yuan-Mei , et .al which was published in 2009
in the International journal of nursing studies. Three medical centers and five regional hospitals
in Taipei were selected where 1065 female nurses were chosen randomly. Based on 907 usable
surveys, 590 (65.0%) experienced at least one type of lower urinary tract symptom (LUTS). The
prevalence for different LUTS ranged from 8.0% to 46.5%. It was also found out that most
nurses bladder habits were poor or very poor.
With these situations, nurses renal health practices must be assessed in order for them not only
to promote health to others but also to themselves and also decrease the incidence of renal health
problems. And despite the nurses working conditions, nurses must still be good examples and be
the advocates and promoters of health.
With this study, it would determine
results of the study would be a great
This would then eventually enhance
consequently decrease the incidence
management is costly.
the renal health practices of nurses in La Union and the

basis on how to prevent such and to promote their health.
the Renal Disease Prevention Program in the region and
of UTI and its complications more so that renal disease
Statement of the Problem

This study aimed to determine the renal health practices of nurses in La Union as a basis in the
formulation of a Renal Health Advocacy for nurses in La Union. Specifically, it tried to answer
the following problems:
1. What is the profile of the respondents as to
a. age
b. gender
c. classification of hospital where nurses are employed
d. incidence of Urinary Tract Infection?
2. What is the extent of implementation of renal health practices of nurses in La Union in terms
of
a. hygiene
b. fluid intake
c. elimination habits
d. lifestyle?
3. Is there a significant difference in the extent of implementation of renal health practices of
nurses in La Union when grouped according to
a. age
b. gender
35

c. classification of hospital where nurses are employed
d. incidence of Urinary Tract Infection?
4. What are the strengths and weaknesses of renal health practices of nurses in La Union?
Materials and Methods

The descriptive survey method of research was used in the study. The respondents of this study
are composed of regular staff nurses working either in public or private tertiary hospitals in La
Union. Stratified random sampling was utilized to get the respondents. To ensure that the
respondents are well represented, the strata used are the five tertiary hospitals in La Union and
the different areas in the hospital where the respondents are assigned.
The questionnaire is the main tool that was used in gathering relevant data from the respondents.
The tool is composed of three parts: the cover letter, demographic characteristics, and the
questionnaire proper. The demographic characteristics are age, gender, classification hospitals
where nurses are employed and incidence of Urinary Tract Infection. A review of the
respondents medical records particularly the urinalysis result was also done except those
employed at Lorma Medical Center since the chief nurse refused the request of the researcher.
However, the chief nurse claimed that before the nurses were hired and annually, they conduct
physical exam and urinalysis and the nurses were informed about the results.
In the questionnaire proper, it is made up of topics pertaining to the four areas of renal health
practices namely hygiene, fluid intake, elimination habits and lifestyle. The validity of the tool
used in the study was determined and it was evaluated by three experts in the field of Research
and Medical Surgical Nursing. Furthermore, the reliability of the tool was also established
wherein thirty contractual staff nurses were chosen to be the respondents. They are working at
Ilocos Training and Regional Medical Center, which is a tertiary hospital. They were chosen
randomly and were asked to answer the questionnaire honestly. The cronbachs alpha formula
was used to measure the internal consistency reliability of the instrument.
Before the actual floating of the questionnaire, the researcher sent letters to the medical center
chiefs and chief nurses of the five tertiary hospitals in La Union. The total number of nurses
working in these hospitals was determined in order to know the sample population. After
determining the sample size for each hospital, the respondents were selected from the different
areas in the hospital using stratified random sampling.
The respondents were asked for their consent and they were also informed about the
confidentiality of the data gathered. Subsequently, copies of the questionnaire were distributed,
instruction was explained and they were retrieved immediately after they had answered the entire
questionnaire. Each retrieved questionnaire was checked that all items were answered.
A documentary analysis of the respondents medical records, specifically the urinalysis result,
was also done to validate their history of Urinary Tract Infection. Furthermore, a follow-up
interview was done to verify some of the respondents answers.
The data gathered was tabulated and converted into frequencies. Weighted Mean and Average
36

Weighted Mean were used to treat the data regarding the extent of implementation of renal
health practices of the respondents. To determine if there is a significant difference in extent of
implementation of renal health practices of nurses in La Union when grouped according to age,
the Analysis of Variance (ANOVA) was used
Results and Discussion

Distribution of the Respondents as to Profile
The respondents are regular staff nurses and they were grouped according to profile
which are age, gender, classification of hospitals where nurses are employed and incidence of
UTI.
21- 35
y/o
With
incidence
of UTI
Without
incidence
of UTI
Total
29
Table 1. Distribution of the Respondents as to Profile

Age
Gender
Classification of
Hospital
36- 55
56 y/o
y/o
and
M
F
Pu
Pri
above
36
3
68
4
64
68
33
35
68
41
49
18
31
49
19
30
49
70
43
117
22
95
117
52
65
117
Legend:
M Male
F - Female
Pu- Public
Pri- Private
As to age, the largest number of respondents belonged to 21-35 age group and the least number
belonged to 56 and above age group. It is also evident in the table that the number of respondents
with incidence of UTI under the 21-35 age group is less than 25% of the their total population
while those belonging to the 36-55 age group, the respondents with incidence of UTI is around
80% of their total population and lastly only one (1) out of three (3) respondents from the 56 y/o
and above age group had incidence of UTI. According to Smeltzer and Bare (2004), people
between the ages of twenty (20) and fifty (50), urinary tract infections (UTI) are about fifty (50)
times more common in women than in men. On the other hand, the incidence of bacteriuria in
elderly adults differs from those in younger adults.
Furthermore, the number of female respondents is more than four (4) times the number of males.
This is due to the fact that women are more interested to pursue nursing rather than men.
Traditionally, the nursing profession was viewed as a calling mainly for women. However, as
the profession advances, gradually, men are already considered and accepted to become nurses.
It is also evident in the table that there are more females with incidence of UTI than men. And
37

the number of females with incidence of UTI is more than half of the population of females as
compared with males where only a few of the male population had incidence of UTI. This
implies that females are more prone to develop renal diseases.
Urinary tract infections may be caused by bacteria, viruses, fungi or a variety of parasites. More
than 85 percent of urinary tract infections are caused by bacteria from a person's own intestines
especially the large intestines, or vagina. The more common pathogens are Escherichia coli,
Staph saprophyticus, Proteus vulgaris and mirabilis, Klebsiella. The organisms that cause
infection usually enter the urinary tract by one of the two routes. The most common route by far
is through the lower end of the urinary tract - the opening at the tip of the man's penis or the
opening of a woman's vagina - resulting to an ascending type of infection that spreads up the
urethra. The other possible route is through the bloodstream, usually directly to the kidneys.
(Dumaguing, 2005)
From the five (5) tertiary hospitals in La Union, more respondents are employed in private
hospitals than public hospitals mainly because three (3) out of the five (5) tertiary hospitals are
private namely La Union Medical Diagnostic Center, Bethany Hospital and Lorma Medical
Center. It is also presented in the table that the number of respondents with incidence of UTI in
private hospitals is nearly the same that of the respondents employed in public hospitals.
It is also evident in the table that more than half of the respondents had incidence of UTI when
they were employed in the hospital where they are working; where sixty eight (68) had incidence
of UTI and only forty nine (49) has no incidence of UTI. This implies that nurses in general are
at risk of developing renal diseases.
It is also evident in the table that more than half of the respondents had incidence of UTI when
they were employed in the hospital where they are working; where sixty eight (68) had incidence
of UTI and only forty nine (49) has no incidence of UTI. This implies that nurses in general are
at risk of developing renal diseases.
Summary of the Extent of Implementation of Renal Health Practices of Nurses in La Union
In order for nurses to have good renal health, the four aspects of renal health practices must be
well implemented and these are hygiene, fluid intake, elimination habits and lifestyle. The
following table presents the summary of the extent of implementation of these four aspects.
It is illustrated in the table that hygiene gained the highest mean and the only renal health
practice which is always implemented while fluid intake had the least mean of all the renal health
practices. This shows that nurses who are trained to be promoters of good hygiene as advocated
by the mother of nursing became what they really are trained and educated of. The result
displays that Filipino nurses are not just excellent thinkers but also doers.
38

Table 2. Summary Table of the Extent of Implementation of Renal Health Practices of
Nurses in La Union
Renal Health Practices
A. Hygiene
B.Fluid Intake
C.Elimination Habits
D. Lifestyle
Legend:
Statistical
Range
4.20-5.00
3.40-4.19
AWx
DER
4.60
3.63
4.14
3.67
AI
OI
OI
OI
Descriptive
Equivalent Rating
Always Implemented
Often Implemented
DER
AI
OI
Accordin
g to Joseph
Bereger of the
New York Times (2008) Filipino nurses are highly prized here (US) because they speak English,
are trained in American-caliber medicine and enjoy a reputation for tender care the legacy of
a society in which families tend to their own sick and aging relatives.
On the other hand, fluid intake had the least mean mainly because of the nurses habits on
coffee, tea and cola drinking and the lack of cranberry juice consumption. Fluid intake,
elimination habits and lifestyle renal health practices need to be improved further in order to
uplift the health of the nurses and eventually the clients whom they are caring. As evident in the
table, the renal health practices which are hygiene, fluid intake, elimination habits and lifestyle
are well implemented. It is therefore necessary to sustain their implementation to further promote
renal health among nurses in La Union.
Differences in the Extent of Implementation of Renal Health Practices of Nurses in La
Union When Grouped According to Profile
There may be many factors that can affect the extent of implementation of renal health practices
of nurses in La Union and one of which is their profile. The succeeding table presents the
differences in the extent of implementation of renal health practices of nurses in La Union when
grouped according to profile which are age, gender, classification of hospital where the nurses
are employed and their incidence of Urinary Tract Infection. It is presented in table 8 that
according to age, the computed value of lifestyle (5.99) is greater than the tabular value (3.07).
Therefore, the result is significant and the rest of the renal health practices are not significant.
The values under age versus lifestyle was treated with t-test to determine the pair which has the
significant result (see appendices) and it was revealed that the respondents belonging to the 2135 age group versus the 36-55 age group has the significant result, meaning there is a significant
difference in the extent of implementation of the renal health practices. Specifically, it was found
39

out that those belonging to the 36-55 age group has a higher extent of implementation of the
lifestyle renal health practices than the other age group.
Table 3. Differences in the Extent of Implementation of Renal Health Practices of Nurses
in La Union When Grouped According to Profile
Age
Gender
Classification
Incidence
of Hospital
of Urinary
Where Nurses
Tract
are Employed
Infection
Fc
Ft
Tc
tt
tc
tt
tc
tt
1.79
.002
3.07
28.2* 1.72
1.65
-1.3
1.65
A. Hygiene
*
1.95
3.07
-9.2
1.72
-.59
1.65
.004
1.65
B.Fluid Intake
*
.719
3.07
4.4
1.72
1.23
1.65
-.48
1.65
C.Elimination
*
Habits
1.72
-.51
1.65
-1.3
1.65
5.99*
3.07
-3.4
D. Lifestyle
*
Legend:
S
fc= anova computed value
tc= t-computed value
ft= anova tabulated value
tt= t- tabulated value
*= Significant
According to Erik Erickson, middle adulthood, those aging 36-55 years old, is the time when
people can take on greater responsibilities and control. Strength comes through care of others
and production of something that contributes to the betterment of society, which Erikson calls
generativity. This is one of the reasons to why those belonging to the middle age have higher
extent of implementation of the lifestyle renal health practices as compared to the young adults.
This means that the developmental stage of an individual can affect to how he will manage his
activities like implementing the renal health practices most especially lifestyle.
To determine more the difference between the age groups, a study was conducted to Chinese
adults. This study examined stereotype traits of Chinese young adults generated by sixty (60)
young, sixty (60) middle aged and sixty (60) older Chinese adults. Results indicated that Chinese
participants had multiple stereotypes and mixed perceptions of the young. While considerable
overlap was observed between stereotype traits generated by these Chinese participants and those
from earlier studies with Western participants (e.g energetic, ambitious, lazy, and reckless),
unique Chinese traits (e.g open-minded, filial, hedonistic, and individualistic) associated with
young adults were also identified. Whereas the middle-aged and older participants listed an equal
number of positive and negative traits, the young participants generated significantly more
negative traits than positive ones about their own age group. The traits or attitudes of the young
adults could affect to how they would carry out healthy behaviors.
It is also evident in the table that the computed values under gender are all higher than the
tabulated value therefore the result is significant and the research hypothesis is accepted.
40

Therefore there is a significant difference in the extent of implementation of renal health
practices when grouped according to gender. Specifically under hygiene and elimination, the
males have higher extent of implementation than the females. This is due to the results which are
both positive (28.2 and 4.4). On the other hand, under fluid intake and lifestyle, the females have
a higher extent of implementation as compared to the males since the values ar negative (-9.2
and -3.4).
The biological difference between a man and a woman greatly influenced the result of the study.
Specifically, the males have a higher extent of implementation on hygiene and elimination due to
anatomical factors of women. In women, the vulva has many major and minor anatomical
structures, including the labia majora, mons pubis, labia minora, clitoris, bulb of the vestibule,
vestibule of the vagina, greater and lesser vestibular glands, and vaginal orifice. The vulva is,
however, more susceptible to infections than the penis and testicles and it needs more cleaning
than the penis. The female needs more hygienic practices also especially during pregnancy and
menstruation which the males arent experiencing.
Furthermore, women tend to get UTI more often because their urethra is shorter and closer to the
anus than in men. Because of this, women are more likely to get an infection after sexual activity
or when using a diaphragm for birth control. Menopause also increases the risk of a UTI. In
addition, with the circumcision of the males, this is already a hygienic practice which can
prevent them from developing UTI. In a cohort study conducted by To, et al, it presents that a
decrease in risk of urinary-tract infection is one of the most commonly given reasons for
circumcision of newborn boys.
Strengths and Weaknesses of Renal Health Practices of Nurses in La Union
The Urinary system works with the other systems of the body to help maintain homeostasis. In
order for an individual to become well, he or she must execute regular healthy renal practices.
Renal health practices are habits or routines that an individual observes and exercises in order to
protect the urinary system which includes two kidneys, two ureters, the bladder and the urethra.
The Urinary System is a group of organs in the body concerned with filtering out excess fluid
and other substances from the bloodstream. The substances are filtered out from the body in the
form of urine.
The following table presents the strengths and weaknesses of renal health practices of nurses in
La Union which are hygiene, fluid intake, elimination habits and lifestyle.
Table 4. Strengths and Weaknesses of Renal Health Practices
of Nurses in La Union
AWx
DER
(Descriptive
(Average Weighted
Equivalent Rating)
Mean)
4.60
AI
Strength
A. Hygiene
3.63
OI
Strength
B.Fluid Intake
4.14
OI
Strength
C.Elimination
Habits
3.67
OI
Strength
D. Lifestyle
41

It is shown in the table that all the renal health practices which are hygiene, fluid intake,
elimination habits and lifestyle are the strengths of the respondents. This shows that nurses are
educated and trained to be promoters of health and the renal health practices were included in the
course of their study. In addition, these renal health practices are included in the respondents
health teachings to their clients most especially those having renal problems such as End Stage
Renal Disease, Urinary Tract Infection, Nephritis, etc.
Hygiene garnered the highest mean and the only renal health practice which is always
implemented. This shows a positive implication that nurses perform good personal hygiene most
especially hand hygiene which is the most important practice to prevent infections.
This positive finding is supported by a study conducted by Flores, et al in 2007 which took place
in a large acute hospital trust serving South-West London and Surrey in United Kingdom. The
study found out that the overall hand-hygiene compliance rate of nurses was 64% which was
higher than the average baseline rates for hand-hygiene compliance of 40%. This proves that
compliance to performing hand hygiene is improving.
Summary, Conclusions, and Recommendations

Summary
This study aimed to determine the renal health practices of nurses in La Union as a basis in the
formulation of a Renal Health Advocacy for nurses in La Union. The study was conducted in the
calendar year 2009-2010. The respondents are regular staff nurses in 5 tertiary hospitals in La
Union.
Descriptive survey method was used and a questionnaire is the main tool in gathering data. A
review of the respondents medical records particularly the urinalysis result was also done except
those employed at Lorma Medical Center. The data gathered were treated using Weighted Mean
and Average Weighted Mean and t-test and Analysis of Variance through SPSS.
The following are the salient findings of the study:
1. Most of the respondents are 21-35 years old, female, employed in private hospitals
and with incidence of UTI.
2. The extent of implementation of renal health practices as to hygiene is always
implemented while fluid intake, elimination habits, and lifestyle are often
implemented.
3. The extent of implementation of renal health practices differs as to gender. Moreover,
the extent of implementation of hygiene differs as to classification of hospital where
nurses are employed and lifestyle differs as to the age.
4. All of the renal health practices are the strengths of the respondents.
5. A Renal Health Advocacy for nurses in La Union is proposed.
Conclusion
Based from the analysis and interpretation of the research findings, the following conclusions
were derived:
42

1. Nurses in La Union are dominated by female, actively and privately employed young adults
who had an experience of Urinary Tract Infection during their employment.
2. Nurses in La Union are knowledgeable about sound renal health practices.
3. Gender affects the implementation of renal health practices.
4. Nurses in La Union efficiently apply their knowledge on sound renal health practices.
5. The renal health advocacy for nurses in La Union is beneficial in the sustenance of
renal health among nurses and the public.
Recommendation
With the results established by this study, the following are recommended:
1. The Renal Health Advocacy for Nurses in La Union should be instituted in the tertiary
hospitals in La Union and other institutions where nurses are working like those
employed in primary and secondary hospitals and other agencies advocating renal health
such as Local Government Units (LGUs), Department of Health and others by
disseminating the IEC materials.
2. Administrators in hospitals should monitor the incidence of renal problems among
nurses by annually recording the morbidity cases among nurses.
3. Administrators in hospitals must provide an environment conducive to renal health.
4. Nurses should sustain the implementation of renal health practices to be good
examples for renal health promotion and prevention of renal problems by always
implementing the Renal Health Advocacy.
5. Student nurses, other health care providers and clients can use the advocacy to sustain
good renal health.
6. Researchers can further study the renal health practices of nurses considering
respondents who are also working in secondary and primary level of hospitals and clinics
in La Union. Researchers may also include other variables such as the number of years
that the nurses are employed and area of assignment of the respondents.
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ISSN: 2094-1749 Volume: 3 Issue: 1, 2011