CHAPTER 1

INTRODUCTION

“I am tired, I want to end this”. This is one of the most common line we heard to people

suffering from a chronic disease like the End-Stage Renal Disease (ESRD) is the end result of a

gradual, progressive loss of kidney function. The loss of function may be so slow that you do not

have symptoms until your kidneys have almost stopped working and it is the final stage of

chronic kidney disease. At this stage, the kidneys are no longer able to remove enough wastes

and excess fluids from the body. At this point, you would need dialysis or a kidney transplant.

Hemodialysis is as fast and efficient method of removing urea and other toxic products.

Affecting 10 percent of the global population and responsible for more than a million deaths

each year, chronic kidney disease (CKD) has become a major public health issue. (Chronic

Kidney Disease: A Global Crisis, 2018). According to (National Kidney and Transplant

Institute, n.d.) ESRD is the 7th leading cause of death among the Filipinos. One Filipino develops

chronic renal failure every hour or about 120 Filipinos per million population per year. In which

the patient must undergo a kidney transplant or hemodialysis. According to the report of Jerome

Paunan (Paunan, 2018) when he interview the nephrologist Dr. Russel Villanueva that they saw

an increase of 10 to 12 percent per year in the number of new patients undergoing dialysis.

However most patients that underwent this treatment are physically and emotionally exhausted to

the point they want to give up their life.

It is very important to determine the quality of life they are living as we are here to

support them, to make them feel that there still someone to back them up, for us to understand

what they are going through. As World Health Organization defines Quality of Life as an

individual's perception of their position in life in the context of the culture and value systems in

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which they live and in relation to their goals, expectations, standards and concerns. It is a broad

ranging concept affected in a complex way by the person's physical health, psychological state,

personal beliefs, social relationships and their relationship to salient features of their

environment. (World Health Organization, 2019)

Thinking that you had a grave illness will make you feel depressed, what more if you are

now on the end-stage of the disease that nobody knows when you will be perish here on earth,

going through this ordeal will made you lose hope. So as a researchers, we want to focus on

providing relief from their symptoms, pain, physical stress, and mental stress, so that we can

study their lived experiences to impart our research to our readers the facts, knowledge and skills

to care for a hemodialysis patients. Hoping that our study may bring hope to a hemodialysis

patients.

(remove the unessarry )The aim of this study is to (a) to explore factors apparently

associated with long-term tenure on hemodialysis based the answers to reamain the patient in the

hemodialysis and (b) to explore and identify characteristics, attitudes, beliefs, and behaviors

among patients in HD that exempt their interpretation and enactment of self-management of the

variety of “Lived Experiences of Patients with End-Stage Renal Disease Undergoing

Hemodialysis Treatment at Caraga Regional Hospital” patients that are diagnosed with End-

Stage Renal Disease on routine of hemodialysis treatments from their own perspectives in terms

of socio-demographic characteristics that a hemodialysis patients have in Caraga Regional

Hospital.

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REVIEW OF RELATED LITERATURE

Kidney failure, also called end-stage renal disease (ESRD), is the last stage of chronic

kidney disease. When your kidneys fail, it means they have stopped working well enough for

you to survive without dialysis or a kidney transplant.

In most cases, kidney failure is caused by other health problems that have done

permanent damage (harm) to your kidneys little by little, over time. When your kidneys are

damaged, they may not work as well as they should. If the damage to your kidneys continues to

get worse and your kidneys are less and less able to do their job, you have chronic kidney

disease. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why

kidney failure is also called end-stage renal disease, or ESRD for short. (American Kidney Fund,

2019)

Diabetes is the most common cause of ESRD. High blood pressure is the second most

common cause of ESRD. Other problems that can cause kidney failure include: autoimmune

diseases, such as lupus and IgA nephropathy, genetic diseases (diseases you are born with), such

as polycystic kidney disease, nephrotic syndrome, urinary tract problems. (American Kidney

Fund, 2019)

Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear

until your kidneys are badly damaged. In the late stages of CKD, as you are nearing kidney

failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up

in your body such as itching, muscle cramps, nausea and vomiting, not feeling hungry, swelling

in your feet and ankles, too much urine (pee) or not enough urine, trouble catching your breath,

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trouble sleeping. If you have kidney failure (end-stage renal disease or ESRD), you will need

dialysis or a kidney transplant to live. There is no cure for ESRD, but many people live long

lives while on dialysis or after having a kidney transplant. Learning that you have kidney failure

can come as a shock, even if you have known for a long time that your kidneys were not working

well. Having to change your lifestyle to make time for your treatments can make coping with this

new reality even harder. You may have to stop working or find new ways to exercise. You may

feel sad or nervous. All is not lost. You can get help to feel better and have a fulfilling life. Your

kidneys do many jobs to keep you healthy. Cleaning your blood is only one of their jobs. They

also control chemicals and fluids in your body, help control your blood pressure and help make

red blood cells. Dialysis can do only some, not all, of the jobs that healthy kidneys do. Therefore,

even when you are being treated for kidney failure, you may have some problems that come

from having kidneys that don’t work well. (American Kidney Fund, 2019)

Hemodialysis is the most common method of dialysis. Maintenance hemodialysis

guarantees survival, and controls patient's uremic symptoms. It is routinely applied in three

sessions per week, lasting at least 3–4 hours. However, there are other timeframes for

hemodialysis based on patient's clinical and metabolic status. There are limitations for these

people concerning their lifestyle, regiment, and liquid intake. Patients undergoing hemodialysis

have a strict regime of dialysis, dietary and fluid restrictions, and medications. Moreover, there

are numerous physical, psychological, and social problems associated with the treatment, which

make it difficult to accept. The onset of illness may render the individual, being a believer or

nonbeliever, to realize the lack of control over his/her life. Starting hemodialysis is a critical

transition that is associated with many changes. (Hassani et. al, 2017). Hemodialysis separates

solutes by differential diffusion through a cellophane membrane placed between the blood and

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dialysate solution, in an external receptacle. Blood is shunted through an artificial kidney

(dialyzer) for the removal of excess fluid and toxins and then returned to the venous circulation.

Beacause the blood must actually pass out of the body into a dialysis machine, hemodialysis

requires an access route to the blood supply by an artriovenous fistula or cannula or by a bovine

or synthetic graft.

Brief History of Hemodialysis

The history of dialysis dates back to the 1940s. The first type of dialyzer, then called the

artificial kidney, was built in 1943 by Dutch physician Willem Kolff. Kolff had first gotten the

idea of developing a machine to clean the blood after watching a patient suffer from kidney

failure. When his invention was completed, he attempted to treat over a dozen patients with acute

kidney failure over the next two years. Although only one treatment turned out successful, he

continued to experiment in improving his design. Kolff came to the United States in the late

1940s and went to work at Mount Sinai hospital, trying to get kidney treatment to become a

health service. Because of the hospital’s opposition to the type of therapy at the time, he and his

colleagues conducted treatment issues at a separate site. More experimentation lead to the

manufacturing of an improved design in the early 1950s. However, Kolff’s device only treated

acute kidney failure and not end stage renal disease (ESRD). (A Brief History of Dialysis, 2016)

Dr. Belding Scribner, a professor of medicine at the University of Washington, developed

a way for ESRD patients to received treatment through an access point in their arm. In 1962,

Scribner opened the first official dialysis clinic for patients. He eventually developed a portable

dialysis machine that allowed patients to receive dialysis treatment at home. By 1973, 40 percent

of dialysis patients were doing their treatments at home. Nowadays, over 90 percent of dialysis

patients receive treatment at dialysis centers. Many more treatment option have become

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available, including peritoneal dialysis, home hemodialysis and nocturnal in-center treatment. (A

Brief History of Dialysis, 2016)

The objectives of hemodialysis are to extract toxic nitrogenous substances from the blood

and to remove excess water. In hemodialysis, the blood, laden with toxins and nitrogenous

wastes, is diverted from the patient to a machine, a dialyzer, in which the blood is cleansed and

then returned to the patient. (Cheever, Kerry H.; Hinkle, Janice L.;, 2014)

Palliative approach to dialysis care as a transition from a conventional disease-oriented

focus on dialysis as rehabilitative treatment to an approach prioritizing comfort and alignment

with patient preferences and goals of care to improve quality of life and reduce symptom burden

for maintenance dialysis patients in their final year of life. This transition aligns with palliative

care in general as well as with the current demographic of the United States dialysis population.

The Centers for Medicare & Medicaid Services (CMS) recognize palliative care as “patient- and

family-centered care that optimizes quality of life by anticipating, preventing and treating

suffering”. Provision of palliative care is appropriate at any age and at any stage in serious illness

and it is not exclusively reserved for patients who have exhausted or decided to forgo life-

prolonging therapies. CMS further states that “as age or illness progress, and cure or

rehabilitation are no longer realistic expectations, care focuses increasingly on palliation”..ESRD

is a unique illness in that while there is no cure and it portends a higher mortality rate than do

some cancers, some patients with ESRD survive decades while receiving dialysis or following

transplantation. Therefore, a one-size-fits-all approach to dialysis care cannot be expected to

meet the needs of such a heterogeneous demographic. This heterogeneity reflects a dramatic

change in the ESRD patient population over the past 4 decades. A similar shift in how we

approach dialysis care should follow suit. (Grubbs et. al., 2014)

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 Effects of Hemodialysis to ESRD Patients

Emotional Aspect - Because of numerous dialysis sessions, the participants spent a lot of

time with healthcare staff including nurses and doctors. As such, they expected the medical staff

to support them psychologically and emphasized their empathy: “ Whene nurses listen to me, I’m

sure they care for me. (Participant 5). “When I was hospitalized for my heart condition, “I’d like

to visit the staff of my own ward (hemodialysis); I was very alone.” (Participant 7) Emotional

support of the family was another extrracted concept and participants stated that emotional

support of family memebers is an integral part of care: “I’d like my wife and my children to listen

to me and spend more time with me; when they are with me, I’m not afraid of the disease.”

(Participant 3). What the statement of the participants implied was that the empathy of the health

staff, especially the nurses, and the emotional support of the family members made the patients

feel secure and less worried and, thus, they considered empathy as a concept of care.

(Shahgholian & Yousefi, 2018)

Financial Aspect - Providing job oppurtunities and financing were the sub-themes

emphasized by the participants. Because of frequent dialysis sessions, job loss, insufficient

ability to work hard and continuosly, medical expenses, transportation costs and disproportion

between income and treatment of life costs, the patients had economic problems. As such, they

believed that having a suitable job and being secured financially is a kind of care. "I lost my job

because of dialysis; charity doesn’t help much; I wish the association helped more and the

insurance covered the cost of all the drugs; or at least we could have a good job.” (Participant 3)

Participants’ remarks implied that the society has to change its attitude towards the condition of

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theses patients. As the lack of an organized program to support patients has led to a lot of

economic problems for them., providing a job in proportion with the physical condition and

dialysis time of theses patients can help them benifit from a systemic economic support.

(Shahgholian & Yousefi 2018)

Mental Aspect - Participants discussed a mental fatigue that affected their ability to

remember conversations, names of people they had known for years, and where they were

driving in the car. This fatigue specifically accompanied the physical exhaustion that came after

dialysis sessions. Stated one man in his late 50's who was disabled due to ESRD, lived with his

father, and was a partial amputee: "I can't think of people's names, people I've known." At times,

participants wondered if this fatigue was due to the process of aging but seemed to discount this

as they could pinpoint times in the day and on specific days when they were not as mentally

sharp as usual and were able to related these times to their dialysis sessions. (Horigan et. al.,

2013)

Physical Aspect - Participants described a lack of physical strength and energy that

made them feel lifeless, washed out, weak, and drained. It was an overpowering, bodily feeling.

Often participants experienced a sensation of being lightheaded and dizzy in conjunction with

extreme fatigue, particularly immediately after dialysis. As one participant, a 69-year old woman

on hemodialysis for eight years, who worked part-time cleaning office buildings and was a

primary caregiver for her grandson stated: "It feels just like your life has just went out of you."

Activities as simple as sitting up in a chair or riding in a car became physically taxing. In a sense,

the fatigue dictated what patients could and could not do on a daily basis. The same participant

stated when speaking about holding the phone to her ear during a phone conversation she had

just had: "Just like holding the phone there, it just feels like all of my strength is just gone out of

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my arm." Another participant, a 52-year old woman on hemodialysis for one and a half years,

who continued to work part-time as a receptionist in a doctor's office and had adult children,

stated: "The whole day was shot because I couldn't really do anything…you know it does control

what I can and can't do." Participants described a lack of interest and energy for participating in

activities because they were so overwhelmingly fatigued. Added one participant, a 74 year old

man who lived with his wife and was retired from his job as a manager at the county department

of works, on hemodialysis for three years: "Well, I still feel lazy and I don’t feel like getting up

and do a lot of stuff, it doesn’t take long to realize the couch looks better, and the chair looks

better than what you doing." (Horigan et. al., 2013)

Psychosocial Aspect – Perception of Somatic and Psychological Disturbance of Disease:

A participant stated: “When I referred for a checkup to a clinic, the results horrified me. My

God! would be sick for the rest of my life. I saw my life ending. I felt fear and become

depressed”. (Aghakhani et. Al, 2014) . At the same time, participants underwent physiological

and psychosocial stressors, such as lifestyle changes, role disturbances, dialysis frequency,

withdrawal from social lives, uncertainty, hopelessness, and depression. A number of the

participants controlled their diet, demonstrating high treatment compliance; this practice was

associated with certain personality traits and family support. However, other young patients

ignored the pain of the disease and were completely dependent on dialysis. They believed that

assuming a new lifestyle and maintaining self-control were difficult to accomplish while

routinely having meals with family or friends, during which they were often encouraged to eat

more. As shown, family or friends may influence patients negatively and positively. These

results were familiar to those elucidated by (Al Nazly 2016).

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 Social Aspect - Increasing the society’s understanding of the condition of the patients was

another theme. The patients expressed their dislike of the pity of others and stated that they

wanted others to understand them. Thus, instead of pity that might annoy them, they expected

others to help and support them when necessary: ‘People don’t understand us; if they did, they

would, for example, give up their seat to us in the bus, or give us they turn in the pharmacy or

doctor’s office.’ (Participant 12) ‘Everyone is very busy and there is no support. Many people

pity us but I don’t like it.’ (Participant 10) (Shahgholian & Yousefi, 2018)

Spiritual Aspect – Following the perception of accessible resources for social support,

the patients try to accept difficulties based on their values and beliefs. A participant stated: “I

frequently pray to retain my health for my family’s sake. I accept everything God wills. Some

had tendency to admit their disease was a penalty for their sins and prayed to God for

forgiveness. I trust in God. This conditrion is intended for me to by God”. (Aghakhani et al,

2014)

Jean Watson’s Theory of Human Caring

Watson stated that the Theory of Human Caring could serve to guide clinical nursing

practice by enabling it to transcend the physical dimensions of the care recipient in order to grasp

the whole of the care situation as experienced by the person. More specifically, Watson defines

nursing care as helping people give meaning to their existence, suffering, and disharmony by

means of a caring relationship. The relationship that nurses cultivate with patients and their

families corresponds to a human process that Watson calls the “transpersonal caring

relationship”. This is a genuine relationship that requires nurses to base their practice on a system

of humanistic-altruistic values that allows patients and their families to grow in an environment

conducive to the development of potential . Caring rests on humanistic values that influence

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attitudes, which in turn guide behaviours. This results in a more humanistic professional practice.

According to Cara , the attitudes required for nurses to engage in such practice can be developed

and strengthened. These include authentic presence, compassion, active listening, understanding,

support, reciprocity, and collaboration. (Delmas et. al., 2018).

Watson devised 10 caring needs specific carative factors critical to the caring human

experience that need to be addressed by nurses with their patients when in a caring role. As

carative factors evolved within an expanding perspective, and as her ideas and values evolved,

Watson offered a translation of the original carative factors into clinical caritas processes that

suggested open ways in which they could be considered. The first three carative factors are the

“philosophical foundation” for the science of caring, while the remaining seven derive from that

foundation.

The three primary carative factors with their corresponding translation into clinical

caritas processes (1.)The formation of a humanistic-altruistic system of values. “Practice of

loving-kindness and equanimity within the context of caring consciousness”. (2.) The instillation

of faith-hope. “Being authentically present and enabling and sustaining the deep belief system

and subjective life-world of self and one being cared for” (3.) The cultivation of sensitivity to

one’s self and to others. “Cultivation of one’s own spiritual practices and transpersonal self

going beyond the ego self”. (Gil Wayne, 2017)

Medical Assistance for Hemodialysis Patient

The Philippine Health Insurance Corporation (PhilHealth) today announced that coverage

for hemodialysis is now expanded from 45 to 90 sessions per year in order to help lessen the

financial burden of its members undergoing the said treatment.“Based on a series of consultative

meetings and dialogues with our stakeholders, our current coverage of P 4,000 for hemodialysis

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is more than enough to cover the treatment cost per session, thus, we are adjusting the case rate

amount to P 2,500.00 per session but extending the number of sessions per year,” said

PhilHealth President and CEO Alexander A. Padilla. With this new development, PhilHealth

members including their qualified dependents undergoing dialysis treatment are ensured of

longer sessions in a year thereby reducing out-of-pocket expenses to achieve better health

outcomes. The adjusted PhilHealth coverage of P 2,500.00 per session includes payment for

facilities and professional fees of attending physicians. (PhilHealth Extends Dialysis Coverage to

90 Days, 2015)

The IMAP is the flagship program of the agency which was institutionalized in 1995 to

provide timely and responsive financial assistance to individuals with health-related problems.

With the Guarantee Letter as the medium used in providing such services addressed to health

facilities (Hospitals, Dialysis Centers, etc.), the PCSO assumes the obligation of a specific

amount due from the client for the services rendered. The amount of assistance is based on the

classification system established under the program. For Dialysis: the program covers 50-60% of

the total treatment cycle. For PhilHealth Members: Hemodialysis patient will be provide of 6

tranches for Epoietin syringe at Php11, 900.00 per tranche and additional 14 sessions for the HD

procedure at Php31, 500.00. For Non-PhilHealth Members Hemodialysis patient will receive Php

20,000.00 for six tranches (Php120,000.00). (Enrolment System for Chemotherapy and Dialysis ,

2017)

Statistics and Prevalence

The number of patients in Caraga Region who underwent dialysis has increased, said Dr.

Romina Rusillon, a nephrologist and resident partner of the Renal Disease Control Program

(REDCOP), an advocacy program of the government aimed to inform the public of renal health

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care and prevention. Speaking before the local media here during the conduct of ‘ Caraga in

Focus” a TV program of the Philippines Information Agency (PIA)-Caraga, Rusilllon said that as

of 2010, the number of patients who have undergone dialysis in the region is already 70

(Roperos, 2012). According to Caraga Regional Hospital-Hemodialysis Unit, In 2018 there are

140 patients that were undergone a hemodialysis treatment and 124 patients succumb in their

demise from the disease. Twice higher in the past 8 years.

One Filipino develops chronic renal failure every hour or about 120 Filipinos per million

population per year. More than 5,000 Filipino patients are presently undergoing dialysis and

approximately 1.1 million people worldwide are on renal replacement therapy. (Kidney Health

Plus)

Affecting 10 percent of the global population and responsible for more than a million

deaths each year, chronic kidney disease (CKD) has become a major public health issue. In the

U.S. alone 30 million people, or 15 percent of adults, are estimated to have chronic kidney

disease. Around the world, the number of people with chronic kidney disease continues to rise.

The impact is immense; patients with CKD face diminished quality of life, higher risk of other

health problems, and significant financial costs or death. (Chronic Kidney Disease: A Global

Crisis, 2018).

The GBD 2015 study also estimated that, in 2015, 1.2 million people died from kidney

failure, an increase of 32% since 2005. In 2010, an estimated 2.3–7.1 million people with end-

stage kidney disease died without access to chronic dialysis. Additionally, each year, around 1.7

million people are thought to die from acute kidney injury. Overall, therefore, an estimated 5–10

million people die annually from kidney disease. Given the limited epidemiological data, the

common lack of awareness and the frequently poor access to laboratory services, such numbers

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probably underestimate the true burden posed by kidney disease. It is therefore possible that,

each year, at least as many deaths are attributable to kidney disease as to cancer, diabetes or

respiratory diseases, three of the four main categories targeted by the 2013 action plan. In

addition, the estimated number of DALYS attributable to kidney disease globally increased from

19 million in 1990 to 33 million in 2013. In 2016, the DALYs associated with chronic kidney

disease, along with those associated with cardiovascular disease, cancers, diabetes and

neurological disorders, were found to have increased significantly between 1990 and 2015. A

report from the GBD 2016 study highlighted the important omission of focus on chronic kidney

disease and suggested that “the SDG agenda offers at best a minimal platform for drawing

attention to the health care and monitoring needs of [chronic kidney disease].” Kidney disease is

associated with a tremendous economic burden. High-income countries typically spend more

than 2–3% of their annual health-care budget on the treatment of end-stage kidney disease, even

though those receiving such treatment represent under 0.03% of the total population. In 2010,

2.62 million people received dialysis worldwide and the need for dialysis was projected to

double by 2030. Globally, the total cost of the treatment of the milder forms of chronic kidney

disease appears to be much greater than the total cost of treating end-stage kidney disease. In

2015, in the United States of America, for example, Medicare expenditures on chronic and end-

stage kidney disease were more than 64 billion and 34 billion United States dollars, respectively.

Much of the expenditure, morbidity and mortality previously attributed to diabetes and

hypertension are attributable to kidney disease and its complications. (Luyckx et. al., 2018)

Theoretical framework

Jean Watson‘s “Philosophy and Theory of Transpersonal Caring” mainly concerns

on how nurses care for their patients, and how that caring progresses into better plans to promote

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health and wellness, prevent illness and restore health. According to Watson’s theory, “Nursing

is concerned with promoting health, preventing illness, caring for the sick, and restoring

health.” It focuses on health promotion, as well as the treatment of diseases. The nursing model

also states that caring can be demonstrated and practiced by nurses. Caring for patients promotes

growth; a caring environment accepts a person as he or she is, and looks to what he or she may

become.

Watson’s theory is best understood as a moral and philosophical basis for nursing. The

scope of the framework encompasses broad aspects of health-illness phenomena. In addition, the

theory addresses aspects of health promotion, preventing illness and experiencing peaceful death,

thereby increasing its generality. The carative factors provide guidelines for nurse-patient

interactions, an important aspect of patient care. (Gil Wayne, 2017).

As Practicing of Loving Kindness caring is grounded on a set of universal humanistic

altruistic values. Humanistic values include kindness, empathy, concern, and love for self and

others. They derive from childhood experiences and are enhanced by beliefs, cultures and art.

Altruistic values arise from commitments to and satisfaction from receiving through giving.

They bring meaning to one’s life through one’s belief and relationships with other people.

Humanistic-altruistic feelings and acts provide the basis of human caring and promote the best

professional care, and as such, constitute the first and most basic factor for science and ethic of

caring. (Watson, 2006)

In practicing faith and hope of carative factor, patient’s beliefs are encouraged, honored

and respected as significant influences in promoting and maintaining health. Regardless of what

scientific regimen is required for medical care of a person, the nurse should nurture faith and

hope and the deep belief system of the one-being- cared for. Even when there is nothing left to

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do medically, the nurse nurtures a patient’s faith and hope in something or someone beyond his

or her self. (Watson, 2006)

Sensitivity to self and other be human is to feel. All too often people allow themselves to

think their thoughts, but not feel their feelings. The only way to develop sensitivity to one’s self

and to others is to recognize and feel one’s feelings. The development of self and the nurturing of

judgment, taste, values, and sensitivity in human relationships evolve from emotional states. The

development of feeling is encouraged by the humanities and compassionate life experiences.

Sensitivity to self is the recognition and acknowledgement of feelings – painful as well as happy

ones. It is cultivated by looking into oneself and a willingness to explore one’s own feelings.

People who are not sensitive to and repress their own feelings may be unable to allow others to

express and explore their feelings. Sensitivity to self not only leads to self-acceptance and

psychological growth, but to sensitivity and acceptance of others. Nurses who are sensitive to

others are better able to learn about another’s view of the world which, subsequently, increases

concern for others’ comfort, recovery, and wellness. Nurses who recognize and use their

sensitivity promote self-development and self-actualization, and are able to encourage the same

growth in others. Without this factor nursing care would fall. (Watson, 2006)

Caring Moment/Caring Occasion

Caring moments are quite simply human to human interactions. These interactions have

the potential to create a moment of transcendence (healing). On her Caring Science webpage,

Watson (2013) explains the importance of caring moments, a caring moment involves an action

and choice by both the nurse and the other. The moment of coming together presents them the

opportunity to decide how to be in the moment and in the relationship as well as what to do with

and during the moment. If the caring moment is transpersonal, each feels a connection with the

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other at the spirit level, thus it transcends time and space, opening up new possibilities for

healing and human connection at a deeper level than physical interaction. (para. 6). Caring

moments contain the "whole caring-healing-loving consciousness" (Watson, 2013, para.7). This

is a vital element within the Theory of Human Caring. The caring moment "transcends time,

space and physicality"(Watson,2013, para.7 ). Watson's theory is unique in its ability to address

the needs of both the patient and the nurse. Caring moments provide meaning to our work as

professional nurses. (Watson's Caring Theory, n.d.)

Transpersonal caring relationships and caring moments are created through the use of the

carative processes.

The relationship of Jean Watson’s Theory of Human Caring in our study is the

importance of supportive care setting for patients, so that we can determine the effect of

authentic caring on patients and the result of their health outcomes and also to alleviate the

quality of their daily living.

Figure 1 Theoretical Framework

Conceptual Framework

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 In Watson’s Theory the focus is the patient in which the view of nursing, person,

environment, and health affects how the provider interact with patients. This conceptual

framework will guide us through the nursing process in rendering care to an ESRD patient. To

help the patient and family adapt to their state of health and human-to-human interaction

consistent with nursing. This will also ensure to achieve and provide to heal, teach, discover and

serve to its patient. According to Watson, caring is central to nursing practice, and promotes

health better than a simple medical cure. The nursing model also states that caring can be

demonstrated and practiced by nurses. Caring for patients promotes growth; a caring

environment accepts a person as he or she is, and looks to what he or she may become.

As illustrated in the diagram, Figure 2 shows the interplay of the dependent and

independent variables. Box 1 represents the independent variables which shows how participants

variety according to its patient’s sociodemographic characteristics such as age, gender, religion,

marital status, educational attainment, employment status, monthly income, and membership on

health insurance. These are important variables used in determining our study.

These nine factors may influence the quality of life of the participants towards having

hemodialysis:

Age, study revealed that younger and elderly people on dialysis faced quite different

problems. Younger people in both RRT groups had statistically higher assessment of ESRD as

loss or challenge and they more frequently used distractive and emotional preoccupation coping

strategies. Depression, confusion, and bewilderment dominate the emotional status of both

patient populations, especially in the younger cohort. (Nowak, 2013)

Gender, Although Rostami and coworkers showed that men had better QoL than women,

other studies found that females had better or equal QoL when compared to males. There are

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some important subjects to note about gender effects on QoL which can help this matter higher

prevalence and severity of psychological disorders such as major depressive disorder and anxiety

disorder in females cause poorer HRQoL in women than men.

Religion, the importance of spiritual well-being for QoL of hemodialysis patients.

Religious wellbeing predicted better quality of life in patients with ERDS. Focus on spirituality

reinforcement in routine patients care could improve different aspects of QoL. As well, spiritual

support of family or charities could have a good impact in QoL of these patients.

Marital Status, Kao et al. (2009) evaluated the association between economic, social,

psychological factors, and health-related quality of life of 861 hemodialysis patient. Kao and

colleagues found that marital status was not associated with health related quality of life. Blue

(2013) also elaborated that the support of the spouse, family, and friends during crisis has long

been seen to have a positive social effect on people during stressful times.

Educational attainment, the results of the present study showed that participants of higher

education had better quality of life, possibly because education allows deep understanding of the

disease and compliance to the therapeutic regimen. Another alternative explanation is that higher

education may reflect higher income and consequently ability to afford treatment. Other relevant

studies have shown positive relationship between the level of education and quality of life.

(Gerasimoula 2015)

Length of Time in Hemodialysis - Long-term dialysis interferes and leads to an

unfavourable self-image, causing many negative emotions such as despondency, anger,

dissatisfaction and disappointment. A source of anxiety for the patients undergoing long-term

hemodialysis is undoubtedly their current health status and awareness of reduced control over

their own health. (Dziubek et. al, 2016)

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 Frequency of Treatment per Week- Patients undergoing hemodialysis generally undergo

three sessions of dialysis a week, each session lasting 4 h, and spend a great deal of time with

healthcare practitioners. However, they are mostly cared for physically, and in addition to

physical care, they stress their need for emotional and psychological support from healthcare

practitioners and communication with them. (Shahgholian & Yousefi 2018)

Employment Status, Employment status also influenced the QOL. There was a significant

difference between QOL scores in physical health, psychological health, and environmental

dimensions of hemodialysis patients with different employment status. Post hoc analysis showed

that hemodialysis subjects who were employed, scored statistically significant higher scores in

the physical, psychological, and environmental domains compared to hemodialysis subjects who

were not employed.

Monthly Income, Pearson's correlation showed a positive relationship between the annual

family income and the physical, psychological, and environmental QOL scores. A similar

observation was made between the education status of hemodialysis subjects and their

psychological and environmental QOL scores. A positive relationship was also documented

between the duration of dialysis and the psychological and environmental QOL scores. On the

other hand, a negative association was observed between the number of co-morbidities and

physical health.

Membership of Health Insurance, Hemodialysis patients who have a membership of

health insurance can receive discounted medical treatment and have several ways of getting

financial support from the government has better quality of life. It was also expected that the

other hemodialysis patients who have no membership of health insurance would have a poor

quality of life.

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 The second box shows the Caring Moment/ Caring Occassion rendered to the

hemodialysis patients. This is a vital element within the Theory of Human Caring. The caring

moment “transcends, time, space, and physicality”,

The third box shows dependent variables such as emotional aspect, financial aspect,

mental aspect, physical aspect, psychosocial aspect, social aspect, and spiritual aspect that may

influence the quality of life that a hemodialysis patient is living at Caraga Regional Hospital.

Respondents Socio-demographic Philosophy and Lived Experiences of

Profile as to: Theory of Hemodialysis Patient
Transpersonal Caring
 Age  Emotional Aspect
 Gender  Carative Factor  Financial Aspect
 Religion  Caring Occasion  Mental Aspect
 Marital Status  Physical Aspect
 Educational Attainment  Psychosocial Aspect
 Length of Time in Hemodialysis  Social Aspect
 Frequency of Treatment per Week  Spiritual Aspect
 Employment Status
 Monthly Income
 Membership on Health Insurance.

Figure 2 Schematic Diagram of the study

Statement of the Problem

The study aims to (a) to explore factors apparently associated with long term tenure(act) on

Hemodialysis; and (b) to explore and identify characteristics, attitudes, beliefs, and behaviors

among patients on HD that exempt(set apart) their interpretation and enactment of self-

management of the variety of “ Lived Experiences of Patients with End–Stage Renal Disease

Undergoing Hemodialysis Treatment at Caraga Regional Hospital” patients that were diagnosed

with End-Stage Renal Disease on routine of hemodialysis treatments from their own perspectives

in terms of socio-demographic characteristics that a hemodialysis patients had in Caraga

Regional Hospital.

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Specifically, this study sought to answer the following questions:

1. What is the demographic characteristics of the respondents in terms of:

1.0 Age

1.1 Gender

1.2 Religion

1.3 Marital Status

1.4 Educational Attainment

1.5 Length of Time in Hemodialysis Treatment (months)

1.6 Frequency of Treatment per Week

1.7 Employment Status

1.8 Monthly Income

1.9 Membership on Health Insurance

2. How does the transpersonal caring relationships affect the authentic presence of caring to

the hemodialysis patients?

2.0 Carative Factor

2.1 Caring Moment/ Caring Occasion

3. Based on Jean Watson’s Theory. What are the lived experiences of hemodialysis patient

at Caraga Regional Hospital in terms of the following aspects;

3.0 Emotional Aspect

3.1 Financial Aspect

3.2 Mental Aspect

3.3 Physical Aspect

3.4 Psychosocial Aspect

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 3.5 Social Aspect

3.6 Spiritual Aspect

Significance of the Study

The result of the study of “Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment at Caraga Regional Hospital” would be an additional pool

of knowledge in the program of providing holistic care to a hemodialysis patient. This specific

aims of this study: (a) to explore factors apparently associated with long-term tenure on

Hemodialysis; and (b) to explore and identify characteristics, attitudes, beliefs, and behaviors

among patients on HD that exempt their interpretation and enactment of self-management. For

phenomenological studies, Creswell (1998) recommends 5-25 and Morse (1994) suggests at least

six. (Complete Disseratation 2019). Thus, this research conducted the target participant was

known 10 patients that are diagnosed with End-Stage Renal Disease aged 15-80 years old, in

which they started at least 3 months up to 5 years on maintenance of hemodialysis treatment

requiring at least twice or thrice a week, who were undergoing their procedure in the

Hemodialysis Unit of Caraga Regional Hospital. The research will be conducted on the

Academic Year of 2019-2020.

This study is considered beneficial to the following:

Participants. This study will be a great help to the ESRD patients coping and support

systems because ESRD patients’ needs to be care physically, mentally, emotionally and

especially their quality of life, it is important that ESRD patients have someone to back

them up, to make them feel that life is beautiful in spite of challenges their facing

Page | 23
through, that they have someone to turn to in hardest times of their life, they have

someone that understands their feelings and what they going through, and they can still

feel confident in spite of their condition. This study also contributes to their knowledge

and insights about ESRD and Hemodialysis means in healthcare systems.

Support System of ESRD Patient: This study provide information that will help family,

friends, people who are waiting for a dialysis, spouse or significant other, mentors or co-

workers, social, religious and spiritual groups understands the pain, illness, difficult

feelings and challenges of ESRD patient going through. Make them understand and

realized that hemodialysis patient needs more care, love, affection, attention and

understanding to have better support and communication to others to express their

feelings and opinions in the difficulties of their condition.

Dialysis Care Team: This study gives information about importance of work, care and

level of satisfaction. It provides groundwork to be put in mind for them to know how

aspects affect the quality of care that they are given to the client. From this point they can

make interventions that help in increasing the level of satisfaction among nurses,

nephrologists, and client.

Nursing Students: As a nursing student and a future nurse this research gives us an

opportunity to help, to care and to share our knowledge and skills. It is important to know

the possible problems and interventions that we may encounter someday in our respective

field of course. This research open up our mind and heart that being a nurse is not only a

profession but a passion to care for the scars and pain that patient is suffering from and

no matter what happen we must give our therapeutic and good quality of care.

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 Future Researchers: This serves us guide for the future researchers as they choose to

tackle a related topic when they do a research.

Scope and Limitation of the Study

The participants of the study were the 10 Hemodialysis patients in Caraga Regional

Hospital on the purpose of exploring and understanding their lived experiences in aspects of their

emotional, financial, mental, physical, psychosocial, social, and spiritual while undergoing on

hemodialysis. This research study will be conducted on the 1st semester of school year 2019-

2020 from the months of August-November within the bounds of Caraga Regional Hospital,

Surigao City.

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Definition of Terms

For the purpose of clarity, the following terms are defined conceptually and some terms

are defined operationally.

 Azotemia - is a medical condition characterized by abnormally high levels of

nitrogen-containing compounds (such as urea, creatinine, various body waste

compounds, and other nitrogen-rich compounds) in the blood.

 Caritas - is a Latin word connecting authentic human caring with love and deeper

ethical meanings, honouring the preciousness and fragility of human caring. The 10

Caritas Processes of the theory are embedded in a framework of Caring Science as

sacred science.

 Dialyzer - is an artificial filter containing fine fibers. The fibers are hollow with

microscopic pores in the wall, also known as semi-permeable dialysis membrane.

 Emotional Aspect – refer to how one feels. Kinds of Emotions Pleasant Emotions

such as love, feelings, of accomplishment & affection; there are also unpleasant

emotions as fear, anxiety and anger.

 End-Stage Renal Disease – also known as Chronic Renal Failure is a progressive,

irreversible deterioration in renal function in which the body’s ability to maintain

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 metabolic and fluid and electrolyte balance fails, resulting in uremia or azotemia

(retention of urea and other nitrogenous wastes in the blood).

 Financial Aspect – of or relating to finance or finances; of or relating to persons who

manage money, capital or credit.

 Hemodialysis - simply dialysis, is a process of purifying the blood of a person whose

kidneys are not working normally.

 IgA nephropathy (nuh-FROP-uh-thee) - also known as Berger's disease, is a kidney

disease that occurs when an antibody called immunoglobulin A (IgA) builds up in

your kidneys. This results in local inflammation that, over time, can hamper your

kidneys' ability to filter waste from your blood.

 Mental Aspect - of or relating to the mind specifically: of or relating to the total

emotional and intellectual response of an individual to external reality. Of or relating

to intellectual as contrasted with emotional activity.

 Nephrotic syndrome - is a kidney disorder that causes your body to excrete too

much protein in your urine. Nephrotic syndrome is usually caused by damage to the

clusters of small blood vessels in your kidneys that filter waste and excess water from

your blood.

 Palliative Care - is an interdisciplinary approach to specialized medical and nursing

care for people with life-limiting illnesses. It focuses on providing relief from the

symptoms, pain, physical stress, and mental stress at any stage of illness.

 Peritoneal dialysis (PD) - is a treatment that uses the lining of your abdomen (belly

area), called your peritoneum, and a cleaning solution called dialysate to clean your

Page | 27
 blood. Dialysate absorbs waste and fluid from your blood, using your peritoneum as a

filter.

 Physical Aspect - characteristics are defining traits or features about your body. These

are aspects that are visually apparent, knowing nothing else about the person. The

first thing you see when you look at someone could be their hair, clothes, nose, or

figure.

 Polycystic kidney disease (PKD) - is an inherited kidney disorder. It causes fluid-

filled cysts to form in the kidneys. PKD may impair kidney function and eventually

cause kidney failure. People with PKD may also develop cysts in the liver and other

complications.

 Psychosocial Aspect - is relating to the combination of psychological and social

behaviour. An example of psychosocial is the nature of a study that examines the

relationship between a person’s fears and how he relates to others in a social setting.

 Quality of Life (QoL) as an individual's perception of their position in life in the

context of the culture and value systems in which they live and in relation to their

goals, expectations, standards and concerns. It is a broad ranging concept affected in a

complex way by the person's physical health, psychological state, personal beliefs,

social relationships and their relationship to salient features of their environment.

 Renal replacement therapy (RRT) is therapy that replaces the normal blood-

filtering function of the kidneys. It is used when the kidneys are not working well,

which is called renal failure and includes acute kidney injury and chronic kidney

disease.

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  Social Aspect - Social Relation any relationship between two or more individuals

mutual dealings or connections or communications among persons or groups.

 Spiritual Aspect - a relationship with God, a higher power or other mystical beings,

is reported to be a source of strength for people. It creates a belief in individuals that

they would be able to cope with any adversity in life.

 Uremia - is the condition of having high levels of urea in the blood. Urea is one of

the primary components of urine. It can be defined as an excess of amino acid and

protein metabolism end products, such as urea and creatinine, in the blood that would

be normally excreted in the urine.

CHAPTER 2

RESEARCH AND METHODOLOGY

This chapter deals with the method employed in this study. It includes the research

design, participants, instrument, data gathering procedure and the data analysis. According to a

psychologist Jonathan A. Smith 2014 a qualitative research method known as interpretative

phenomenological analysis has two parts first, that it is rooted in phenomenology, attempting to

understand the meaning that individuals ascribe to their experiences, and second that the

researcher must attempt to interpret this meaning in the context of the research.

Research Design

A phenomenological approach, a descriptive( describe) qualitative research method, was

used in this study. Phenomenological research allows the opportunity for further examination of

the meaning, description, and understanding of human experiences. Thus the researchers,

“results from phenomenological inquiry have the potential to expand understanding about the

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lived experiences of people and allow nurses and health care team to tailor their care to meet the

needs of the patient. Phenomenology provides answers to concerns and explanations of lived

experiences of patients with ESRD undergoing hemodialysis.

Research Setting

Participants that agreed to participated in the interview while dialysis treatment was

ongoing. Comfort and convenient to the participants was provided to ease boredom while they

were still on dialysis treatment. The researchers make sure that environment was clear enough

for both of them.

Ethical Consideration

There are a number of ethical principles that should be taken into account when

performing research. At the core, these ethical principles stress the need to (a) do good (known

as beneficence) and (b) do no harm (known as non-maleficence).

In practice, these ethical principles mean that as a researcher, we need

to: (a) obtain informed consent from potential research participants; (b) minimize the risk of

harm to participants; (c) protect their anonymity and confidentiality; (d) avoid using deceptive

practices; and (e) give participants the right to withdraw from our research.

It discusses the five ethical principles and their practical implications when carrying out a

research. Approval for the study was obtained through the patient’s informed consent, and

patient has the right to know and to receive information necessary for the research that the

patient can understand. Patient must receive a complete support and review and right to be

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treated with dignity, respect, and consideration with privacy during the interview. Patient’s

personal medical information will be kept confidential.

Population & Sampling

A purposive sampling technique in which we relied our own judgment when choosing the

participants that will participate in our study. A purposive sampling method utilized to select 10

participants. All participants’ ages 15-80 years old, in which they started at least 3 months up to

5 years on maintenance of hemodialysis treatment requiring at least twice or thrice a week, who

are undergoing their procedure in the Hemodialysis Unit of Caraga Regional Hospital that agreed

to participate in the interview.

Instrument

The main tool used in conducting the whole study was the researcher-made interview. It

is divided into two parts. Part I we will ask question which consists about the Socio-demographic

profile of the participants. Part II Consists of Philosophy and Theory of Transpersonal Caring, as

well as the Caring Moment and Occassion of the participants rendered by the healthcare staff in

the hospital institution. And lastly part III Consists about the lived experiences of the

hemodialysis patient with respect to their emotional aspect, financial aspect, physical aspect,

mental aspect, social aspect, psychosocial aspect, spiritual aspect. For content validation,

researchers presented the questionnaires to the experts.

Data Gathering Procedure

In conducting the study, the researchers sent a letter to the Dean of CAMS asking

permission to conduct the study outside the school. Another letter was sent to the Chief of

Page | 31
Caraga Regional Hospital thru the head of Caraga Renal Dialysis asking permission to conduct

the study. The researchers obtained an informed consent from the participants before the conduct

of the study and they will be given an opportunity to ask questions and clarifications regarding

the study. Participants were interviewed in their suggested place where the patient is comfortable

to the venue of interviewing and if they are permitted with their family, guardian, and significant

others. We gathered data during the one-on-one interview with each participant and utilized

field notes during the interview. Field notes allowed the researcher to maintain and comment

upon impressions, environmental contexts, behaviors, and nonverbal cues that may not be

adequately captured through the (trasfer to dictionary) audio-recording during the 30-45 minutes

interview of the patient. The notes contain sensitive information about the patient to secure the

privacy of the patient such notes need not be formal. Demographic data including the

participant’s age, length of time since ESRD diagnosis. Once initial demographic data obtained,

the researcher ask the participant research questions. Questions are open-ended and participants

were encouraged to express their feelings and experiences. Providing open-ended questions

during the interviews create as an opportunity for new concepts to emerge, and more insights to

be reveal.

Data Analysis

The researcher engaged with the data through listening to the recorded interviews,

reading and re-reading the written transcriptions, and deeply examining the transcribed data is

necessary in order for the researcher to become extremely familiar with the data (Priest 2002).

Thematic analysis, description analysis, and interpretation approach will be utilized for the data

analysis process of this study. One of the first steps in the data analysis process will be for the

researchers to transcribe the notes during the interviews, and then highlight distinct codes. Field

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notes compiled during interviews can be a useful complementary source of information to

facilitate this process, as the gap in time between interviews, transcribing, and coding can result

in memory bias regarding the nonverbal or environmental context issues that may affect

interpretation of data. Coding is a way of indexing or categorizing the text in order to establish a

framework of thematic ideas about it Gibbs (2007). The goal of coding is to synthesize the raw

data into distinct ideas or conceptual units in hopes of cleaning up the data. Next, utilizing

thematic analysis, the researcher will identify recurrent patterns and similarities among the

codes, and develop distinct themes or propositional statements for the groupings. The themes

identified in this qualitative research study will serve as the study’s results.

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 CHAPTER 3

PRESENTATION, ANALYSIS AND INTERPRETATION

This chapter deals with the presentation, analysis and interpretation of data based on the

sequence of the problems posed in Chapter 1.

PART I SOCIO-DEMOGRAPHIC PROFILE

Table 1: Profile of the respondents in terms of: age, gender, religion, marital status, educational

attainment, employment status, monthly income, membership on health insurance:

Variables Ranges f(n=10) Percentages (%)

15-25 years old 3 30%
26-36 years old 2 20%
37-47 years old 0 0%
Age
48-58 years old 1 10%
59-69 years old 2 20%
70-80 years old 2 20%
Male 5 50%
Gender
Female 5 50%
Roman Catholic 8 80%
Baptist 0 0%
Muslim 0 0%
Religion
Born-Again Christian 2 2%
Iglesia Ni Cristo 0 0%
Others 0 0%
Single 4 40%
Married 4 40%
Marital Status Widowed 1 10%
Separated 1 10%
Divorced 0 0%
Elementary 1 10%
Educational Attainment High School 3 30%
Use simple table simple College/University 5 50%
Masters/Doctors 0 0%

Page | 34

Length of time in Hemodialysis
Treatment (months)
Frequency of Treatment per
week
Full Time Employment
Part-Time Employment
Employment Status
Monthly Income
Membership on Health Insurance
Technical School 1 10%
Others 0 0%
3-12 months 3 30%
13-22 months 1 10%
23-32 months 2 20%
33-42 months 4 40%
43-52 months 0 0%
53-62 months 0 0%
Twice 8 80%
Thrice 2 20%
Student 1 10%
1 10%
0 0%
Unemployed 7 70%
Retired 1 10%
Others 0 0%
Below ₱ 10,000 5 50%
₱ 10,001 - ₱ 50,00 4 40%
₱ 50,001 - ₱ 100,000 0 0
Above ₱ 100,001 0 0
None 1 10%
Phil Health 7 70%
Sun Life Insurance 0 0%
PhilAm Life 0 0%
Kaiser International 0 0%
Health Group
None 3 30%
Others 0 0%

Table 1 Shows that by age, 3 (30%) are 15-25 years old; 2 (20%) are 26-36 years old; 2 (20%)

are 59-69 years old; 2 (20%) years old are 70-80 years old and 1 (10%) are 48-58 years old. As

to the gender, 5(50%) male and 5(50%) were female. In terms of religion, 8 (80%) were Roman

Catholic and 2 (20%) were Born-Again Christian. The question about marital status revealed that

4 (40%) were single, 4 (40%) were married, 1 (10%) were widowed and 1 (10%) were separated.

As to educational attainment, 5 (50%) were in College Graduate, 3 (30%) were high school

Page | 35
graduate, 1 (10%) were in elementary level and 1(10%) were finished in Technical School. For

the length of time in Hemodialysis Treatment, 4 (40%) respondents were 33rd months-42th

months, 3 (30%) respondents were 3rd months-12th months, 2 (20%) were 23-32 months, and 1

(10%) were 13th months-22th months. Participants were frequently on treatment per week on, 8

(80%) twice a week and 2 (20%) thrice a week. Data Analysis of the employment attainment

revealed that 7 (70%) were unemployed, 1 (10%) were full time employee, 1(10%) was retired,

and 1(10%) was student. As to the monthly income, 5(50%) were having below to ₱ 10,000,

4(40%) were having ₱10,000-₱50,000 and 1(10%) no income in which there family supported

them financially. As to their membership in health insurance, 7 (70%) respondents had

PhilHealth and 3 (30%) had no insurance.

Looking in the data, it can be said that many of the respondents are already in their

adulthood age which did not support those in Nowak (2013), who found younger and older adult

perceived their quality life. And male and female were equal in seeking the medical treatment

unlike in Rostami’s study. More Roman Catholics were having a medical treatment. Single and

Married status dominated the study in which were equal in a medical treatment unlike in the

(rephrase)study of Kao and colleagues are not associated with health related quality of life. Most

respondents were college graduate the results of the present study showed that participants of

higher education had better quality of life, possibly because education allows deep understanding

of the disease and compliance to the therapeutic regimen that agreed in the study of Gerasimoula

(2015).

Page | 36
PART II PHILOSOPHY AND THEORY OF TRANSPERSONAL CARING

A. CARATIVE FACTORS

Table 2: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Practice of Loving Kindness.

Themes Coding
Genuine Care was felt by the patient

Caring Nurses Patient felt that nurses considered them a family

Concern also felt by the patient

Approachable to their patients

Attentive Nurses Act immediately to the needs of the patients

Nurses are skilled at their job

Keen observant to the needs of the patient

Understanding Nurses Interactive with their patient

Divert the attention of the patients

(single spacing)(summarize the word content focus)(APA sixth edition references not

bibliography)Because of numerous dialysis sessions, the participants spent a lot of time with

healthcare staff including nurses and doctors. Nurses promote a therapeutic alliance with the

patients. What the statements of the participants implied was that the empathy of the health staff,

especially the nurses, made the patients feel secure and less worried and, thus, they considered

empathy as a concept of care. Like Watson said, caring is central to nursing practice, and

promotes health better than a simple medical cure. The nursing model also states that caring can

Page | 37
be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring

environment accepts a person as he or she is.

TABLE 2.1 (REFER FROM THE APPENDIX) (DONT USE MOST USE OUT OF

10 PATIENT THERE ARE 3 PATIENT)

Participants No. Responses

“Oo grabe ila pag alaga nila sa amo ang mga nurse dire ug gituring nila kami ug
1 pamilya”

2 “Oo Makita na ko ila malasakit ug pag alaga. Oo gipasabot man”

“Oo, Mu-serve sila sa ako, mu-alaga sila.”

3

4 “Oo, buotan man sila. Oo, musabot sila.”

“OO mabati ug mutawag ko na mayaot ako tag bati naa man dayun sila
5 masampit, hatagan kag mga pain reliever ug dili na nimu maangot ang sakit, ing-
ana sila”

“Marajaw man sila maduolan man dayun sila ug mutabang maam maalaga man
6 sila denhi nga nurse mga maayu”.

“-mutabang man dayun sila maam, mga abtik man ang mga nurse deri ug maayu
7 pud mualaga saela mga pasyente ang ang doctor pud maam maayu kaayu

“OO maam uy pag mag bati nako mu tawag jud ko ug nurse uy d man gud ko shy
type na pasyente labi na ug musakit ako ulo mag pa BP dayun ko. Sila tanan ako
8 friends mu tabang jud na sila nako bisag kanang mga papelis nako ako epa lihog
okay kayo sa ila.”

“Oo maam tabang dayun sila maam labi na maam ug mag hypotension k, mag
9 BP dayun sila ug emonitor ko”

“ Oo maam permi kay mutabang jud sila kay mao may ila trabaho hehe, Oo
10 maam Makita man sad maam na palangga jud mi nila dri ila pa gani mi
storyahon permi para d mi ayahan”

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(difination dont bold)(DONT ATELIZE THE RESULTS)( PATIENT SHOULD BE

DEPENDENT TO GOD)

Table 3: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Authentically Practice Faith and Hope

Themes Coding
Hopes of Patients Family dependent

Reliance with God

Faith Acceptance of the outcome

Pray without ceasing

Respect the belief of the patient

Nurse Response
Nurse understands the beliefs of the patient

Based on Watson’s Theory patient’s beliefs are encouraged, honored and respected as

significant influences in promoting and maintaining health. Regardless of what scientific

regimen is required for medical care of a person, the nurse should nurture faith and hope and the

deep belief system of the one-being-cared for. Even when there is nothing left to do medically,

the nurse nurtures a patient’s faith and hope in something or someone beyond his or her self. So

as reflected in the results participants were dependent to God and to their family. There hope

and expectation comes from their family and to God. It is also a big help that most of the nurses

had a same belief with the patients.

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Participants No. Responses
“Sa Diyos. Ang Diyos ra ang pag asa sa amo sitwasyon , oo dako natabang ang
Diyos para sa ako ug tanggap naho kung kuhaon man niya ako kay sa iya ra ako
1
may pagtuo, tanan dre nurse may respeto sa amo mga pasyente”

“Sa pamilya ug sa Ginoo. Oo dako ang tabang sa Gino. Oo tanan sila naa
2 respeto”

“Sa Ginoo og sa akong pamilya. Oo, mag-ampo man ako, di raman mag-ampo
3 kun may paga-bati. May tigbati man kaw o waya mag-ampo kaw gajud. Oo, in-
respito man nila an ako pagtuo.”

“Medyo hinay na, wa nay kusog. An paglaum ko kutob ra lamang kun hain kutob.
4 Di man gayud kita maka buot. Oo nakatabang.”

5 “Sa Ginoo gajud ang tanan pag salig maam”

6 “Waya nay lain ma’am sa ginoo ra gyud”

“Kan lord ra gyud maam ug sa pamilya wala nay lain pa”

7
“ Sa Ginoo jud maam uy pag kapoyon nako ampo jud na tagaan pako ug kusog
maam na muanhi sa diaylisis. Wala man noon kuy na sugat na problema sa mga
8
nurse kay ksagaran catholic man sila”

“ Sa Ginoo maam wala nay lain pa, mag ampo lang ko always para may pag asa
9 permi”

“Sa Ginoo maam siya raman jud makaayo maam kay kaning ako sakit maam
10 Ginoo na lang maka aayo ani”

Page | 40
Table 3: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Sensitivity to One’s Self and Others.

Themes Coding
Rapport to everyone
Empathy
Family sticks and stays together

Distant kin-relationship

Close knit relationship

Cares
Comparison from then and now.

Moral imperative

In terms of family, it does not matter the distance nor the situation is, as long as the one

needed an assistance the other will be there to all out support, just as the relationship of the

participants based on the results of their current medical ordeal, it did not break them or

abandoned the other. Instead the bond between them makes them stronger as one. Just as

Watson’s said that sensitivity to self is the recognition and acknowledgement of feelings –

painful as well as happy ones. It is cultivated by looking into oneself and a willingness to explore

one’s own feelings.

Page | 41
Participants No. Responses
“Wala man dire ako mga anak kay layo man sila, ako maguwang ako iban dire”
1

2 “Okay naman”

3 “Ok ra, helping hands tun ako pamilya”

“Mga buotan sila. Ayang-ayang di nila atimanon na ila man ko nanay.”

4
Naa raman sila, nag tabang saako ,marajaw man sab ila pag areglar saako bisan
nag lisud na, ini ako maguyang amuy nag tabang-tabang saako kada dialysis
5
puli-puli sila saako nanay ug kinsa makalugar saela”

“Dia maam ako asawa waya may problema sap ag alaga ky ako mga anak naa
6 namay pamilya, busy man pud sila”

“Okay raman sila maam wala man ko nila pasagdi sa matag adlaw ug sap ag pa
7 dialysis naku”

“Okay kayo maam uy ako mga igsoun grabe na supporta sa ako ug mga
pagumangkon wala man koy lain madaganan kay single man ko. Labi na sa mga
8
pang adlaw-adlaw sila jud ang mag care nako.”

“ Lahi ra sa una maam mas tag alagaan ko ni mama, sa ila pag alaga maam ila
9 sa ko tag pa stop ug skwela para maka pahuway sa balay”

“ Ah lahi ra sa una maam uy mu atiman jud sila pero pag busy sad sabton na
lang nako kaya raman sad nako kay ang ako jud kanang pag anhi raman sad
10
dialysis okay raman sad na usahay ako lang sa gud”

Page | 42
B. CARING MOMENT/CARING OCCASSION

Table 4: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Caring Occasion.

Themes Coding
Blunt in a good way

Lenient to patient
Caring Moment
Attentive to patient’s situation

Hospitable

Patient was aware of the cause.

Mechanical Error Freightened reactions

No experience

The participants felt care and somehow relieved them from the stress of their situation

through how the nurse approached them and render their therapeutic care and communication.

They also appreciate the immediate action of the nurses when something is wrong on their

condition or when the mechanical error in the hemodialysis machine. Like what Watson (2013)

explains the importance of caring moments, a caring moment involves an action and choice by

both the nurse and the other. The moment of coming together presents them the opportunity to

decide how to be in the moment and in the relationship as well as what to do with and during

the moment.
Page | 43
Participants No. Responses
“Tarong ila trabaho dle sila strikto ug pilosopo storyahon nila kami dire ugsa
malingaw kami, kibali sila pamilya na namo ug naay problema storyahon kami.
1
Wala pa ko naka experience ug aberya”

“Syempre ang pagmahal mao na ang gipakita ng mga nurse sa ako. Oo naka ka
2 experience na ako na nagka aberya”

“Magreklamo man kaw unoy bation mo. Mo reklamo man kaw laong ta tugnaw,
sug-an man kaw. Automatic pag laong mo sug-an kaw. May diperensiya sa pag
3 sangon. Ayun-ayunan nila na para di mutingog. Aware ako na basin an dialyzer
ko may diperensya na”.

“Ganahan man ako sa ila. Buotan man sila. Lang on gani ko na jare na si nanay.
4 Oo sawanun kay uman adto. Mukari dayun sila.”

“Mao tung lagi maam ako laong gaena na dako jud tabang sa mga nurse denhi
mga abtik man sab sila ug mga buotan pag nagkayaot amo tagbati naa man
5 dajun sila mutambay. Waya man sab hinoon ko naka experience maam nga
nadaotan mig machine dere.”

“Mutabang sila largo ug masangpitan pagdali maam, wala man pud nag daot
6 ako machine samtang nag dialysis”

“Mabati man maam ky mga maayu man sila, wala man pud nadaot ako makina
7 samtang nag dialysis”

“Oo maam uy mao lage to okay kayo sila way problema mutabang jud pag mag
bati nako. Kalouy sa Ginoo maam wala man sad pa ko ka experience ug na
8
dautan ajaw sad tawon maam uy kahadlok sab.”

“Mutabang dayun sila maam labi na ug mutaas or mubaba ang BP, tas kung mag
9 lain ang tag bati maam or ang mag lain bout kay d man jud na malikayan kay
mag lain man amo lawas kung mag dialysis musabot ra sila maam.”

“ Wala man sad maam pero ang uban naka sulay ana pero ayaw sad tawon sa
ako hehe, pero d ra sad ko mahadlok ug mahitabo man uy kay naa may mga
10
nurse dayun mutabang sad.”

Page | 44
PART II LIVED EXPERIENCES OF HEMODIALYSIS PATIENTS

Table 5: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Emotional Aspect.

Themes Coding
Faith to God

Dependence to Nurse

(stable)Stability in Life Abstinence to the likes

Struggle to adjust

Spend quality time to love ones

Restrain actions
Remove the themes and
coding because based the Effects of the treatment
answers()Melancholy Fatigue

Everything goes through a good discussion

Say one’s prayers

Coping Mechanism
Understandig in a situation

Ease discomfort

(reflect the answers to SOP)As Shahgholian & Yousefi, 2018 statement in their study that

implied was the empathy of the health staff, especially the nurses, and the emotional support of

the family members made the patients feel secure and less worried and, thus, they considered

empathy as a concept of care. That also agreed on our study in which the study resulted that

Page | 45
participants also in the therapeutic care of the nurses, they also seek comfort from their love

ones, but most specially their relationship to God strengthen them to keep on fighting for their

lives and it was also one of the key element to deal the current health situation.

Participants No. Responses

- “Ang Diyos na siya na ang bahala, kay kung buhion niya ako edi Salamat ug
1 dapat tanggap mo gyud ang tanan”
- “Syempre mag pray yan ang pinaka powerful sa tanan“
- “Naglisod ko pag balance oo graben a pag antus”
2
- “Mag ampo ko”
- “Mag likay naman ko sa red meat.”
- “Happy all man ako permi. Ya may ako problema. Pero jaun lamang usahay
3 mag reklamo ako. Mo kuan ra ko musistorya, mo abide man sa ako ba. Usahay
jaun ako ako gusto supak man sa dialysis”.

- “Maghanyo ako sa Ginoo na tagaan pa ko nan lawas na marajaw kay metras

na buhi pa ako mangalad man gihapon ko.”
4
- “Kalooy sa Diyos, di man ako mapungtanon. Mangayo dajun ako kun unoy ako
ganahan”.
- “Kuan maam maglikay ka ssa mga pagkaun na bawal saemu lawas arun
makalikay kag balatian sa lawas, kay ug mukaon kag bawal ikaw raman pud
mag antos”
5
- ”Ug dili mayo ako bation maam mag ampo raku kay unsaon taman mao naman
ning kinabuhi, dili man pud ka pewde mag reklamo sa pamilya kay kabalo man
ka na busy sila panginabuhi”.
- “Mag likay sa mga bawal nap ag kaun maam ug dili mag lihuk-lihuk ug bug-at
6 kay dili naman pwede”
- “Ampo ra sa taas maam sa ginoo
- “Mamati sa mga Nurse maam kung unsay buhaton ug maglikay sa pagkaun na
7 bawal”
- “Ampo maam kay mao nay makaluwas saako”
- “Daghan kabaguhan maam like d nako kaayo ka kaon ug parat mag likay nakay
para mu taas pa ang kinabuhi maam. D sad ko mag stress maam uy kay masakit
8 kug samut.”
- “ Matulog lang ko maam para maka pahuway kay epekto raman sad na s aka
kapoy sa lawas maong mag lain ang bout o ang lawas”
- “Mag likay sa mga bawal maam para mas mutaas pa ang kinabuhi”
9 - “ Matulog lang ko maam para maka pahuway kay epekto raman sad na s aka
kapoy sa lawas maong mag lain ang bout o ang lawas”
10 - “Mamati sa mga Nurse maam kung unsay buhaton ug maglikay sa pagkaun na

Page | 46
 bawal”
- “Ampo maam kay mao nay makaluwas saako”

Table 6: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Financial Aspect.

Themes Coding
Medical care costs a lot
Treatment Cost
Significant others undisclosed costs to patient

Financially dependent to the kin.

Financial Strategies
Rely on the charity

Based on the results participants cost them a large sum of money for their medical expenses,

some participant’s significant others hid the medical charges to them so that it won’t stressed

them out. Results also shown that most of them depends on the financial aid given by the

government and health insurance ADD THE MALASAKIT while on the study of Shahgholian

& Yousefi, frequent dialysis sessions, job loss, insufficient ability to work hard and continuosly,

medical expenses, transportation costs and disproportion between income and treatment of life

costs, the patients had economic problems. As such, they believed that having a suitable job and

being secured financially is a kind of care. As the lack of an organized program to support

patients has led to a lot of economic problems for them., providing a job in proportion with the

physical condition and dialysis time of theses patients can help them benifit from a systemic

economic support.

Page | 47
Participants No. Responses
- “Milyon na ug 3 years na ko nag hemodialysis, kabalo ka kinsay ako financer
kuman ang Diyos”
1 - “Ang Diyos gihapon way lain gajud dle ka mosalig sa imo anak or lumon kay
kung dle ka hatagan ma depressed raka”.
- “Dako na ang gasto namo”
2 - “Mga anak na ko ang nagtabang sa mga pinansyal”
- “Pinaka dako gajud na ako gusto sa private. Min agi man ko sa Medical, sa
Miranda. Kada dialysis sa una 1,980. Pag tingog ng dialyzer, pag- laong pa ato
hugasan kun madaya pa, na di naman madaya, puli ta. Jaun gamay barato, na
an dako kay mahal man dos-mil man kapin. Palit kaw gajud. Hamok pa, jauy pa
3 injection”.
- “Kon na consume na an 90 sessions (PhilHealth), dialyszer man jaun 90
sessions. Kay kuyangon man kaw nan iton.Jaoy abtan ka 3 times mag dialysis,
kuyangon gajud karajaw. Duha ra gayud jaun ako. Bayad Ako”.
- “Jaun an waya ko mahibayo. Kay jare ra man an nahibayo (granddaughter)”.
4 - “Waya ako kahibayo….Jaun sila magtago-tago sila. (di pahibaw on nan SO para
dili ma stress)”.
- “Ug wala gajud mi kwarta paduolun man mi sa mga nurse deri maam sa
Malasakit, ug kung asa mi makaaju ug tabang
5 - “Sa isa ka semana maam kaduha ko mag pa dialysis kung kwentahun tanan mga
6,000-7,000 ang magastu tanan apil na pamasahe”.
- “Kung kwentahun maam mga 6,000 ang magastu kada anhe namu sa caraga
arun mag pa dialysis”.
6 - “Saako retirement maam na kwarta ug saako mga anak ky may ila man trabaho,
ug kung wala gajud sa Malasakit ug sa PCSO”.
- “Naa sa mga 7000 maam tanan tmaam ing-ana kamahal ang dialysis maam pero
7 okay lang hinoon ky maayu man lagi ta ug maka dialysis”
- “Sa ako pamilya maam ug sa gobyerno mudoul”.
- “No problem maam uy kay naa may philhealth. Mamahalan ra jud ko sa mga
medications mga 10,000 jud tawon magasto maam”
8 - “Support man jud ako family maam, di man sad ko mag problema kay naa man
koy negosyo sa una karun ako na manghud nag manage maong naa ray maka
sustain sa ako hemodialysis”
- “Wala ko kabalo pila jud maam kay si mama raman man bayaran pero naa koy
PhilHealth nag sakay pako kang papa”
9 - “Sa ako ra papa tanan maam kay si mama wala man trabaho, karun maam ni agi
na mga bulan wala kasakay barko si papa mao wala sad klaro ako pag inom
tambal kay wala may kwarta pa”
- “ 8,000 guro maam kay philhealth man sad ko nay sa PCSO naa sad silay libre
10 na injection taga bulan naka avail man ko ana sad pero usahay mas dako pa sa

Page | 48
 8,000 maam pag mag ka emergency pariah anang mahospital ko”
- “Ako strategy jud maam kanang mu apil ug mga charity kay maka tabang jud na
uy”

Table 7: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Mental Aspect.

Themes Coding
Intravenous Cannulation

Mental Distress Accustom to their situation

Feeling being neglected

Relax oneself

Supplication to God
Coping Mechanism
Strengthen own’s mind

Be with the family

In Horingan 2013 study results that participants wondered that fatigue was due to the

process of aging but seemed to discount this as they could pinpoint times in the day and on

specific days when they were not as mentally sharp as usual and were able to related these times

to their dialysis sessions a mental fatigue that affected their ability to remember conversations,

names of people they had known for years, and where they were driving in the car. This fatigue

specifically accompanied the physical exhaustion that came after dialysis sessions. However, in

our study results that intravenous cannulation inflicts pain to participants, some also admitted

that it is normal for their situation this kind of fatigue and be neglected from kin may affect the

mental stability of the participant. Though this may come tough, participants also strengthem

Page | 49
themselves such as diverting their attention, spend quality time to familiy and most specially

praying earnestly to the Lord.

Participants No. Responses

“Oo usahay kaning mga gipangtusok sa amo sakit gayud. kay kung dle na ko
madajaw edi pahingaon rkan ko tapos ug magpahinga ako dapat dile ko mag
1
antos. Kung gikapoy na ko molaong ra ko Diyos ug ayaw na ko pa antosa kuhaa
na ako waya nman ko ni asa kung mag dugay ako kinabuhi ug dawat na ko ini”
2 “Oo usahay kapoy na. mag ampo lang ako mao na ako buhaton”
“Usahay maka experience ako jaun pero I strong ko ra an ako mind. I relax ko
3 ra, ampo ko sa Ginoo Lord kuhaa inin ako pagka I stress, kaw may gamhanan,
kaw may nagdaya ng kinabuhi, kuhaa ini Lord kay ini an makasagabal sa ako”.
4 “Oo, pahuway ra gajud. Kun jaoy ako kaistorya, mag-istoryahay”
“Oo maam normal raman na ang kasakit deri na amu mabati maam kabalo man
5 gyud mo ana mao ng ug ing-ana man gani, kalma nalang jud ako buhaton ug pag
ampo sa ginoo nga tabanagan ako nija”
6 “Nakasinati na maam mao nang mag ampo gjud sa Ginoo”.
7 “Dili man gyud na malikayan maam mao sa ginoo rata musangpit”.
“Oo maam sometimes pero ako e spend most sa ako time sa pamilya kay para
8
maka limut ko sa mga problema ug malingaw ko”
“ Oo maam uy maka depress sa ako kanang mafeel nako maleft out ko sa ako
9 mga cousin kay syempre d nako maka uban-uban nila kay may sakit lage, mag
inusara na lang sa maam tas mag facebook”
“ Oo maam ka nang maka huna-huna ko na d nako maayo uy. Ampo jud maam
10
na tagaan pa ug taas na kinabuhi maam”

Table 8: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Physical Aspect.

Themes Coding
Frailty condition

In denial of the situation

Physical Change
Lifestyle effect

Change in Physical Appearance

Page | 50
 Pray to God

Do oneself’s best
Handling Physical Change
Seek comfort to kin

Unwind

Based on our study participants felt great impact in physical change due to the treatment of

hemodialysis but some are still in denial of their situation. Participants primary key to soothen their

situation was to pray to God for strength at this time. While on Horigan’s study that participants described

a lack of physical strength and energy that made them feel lifeless, washed out, weak, and drained. It was

an overpowering, bodily feeling. Often participants experienced a sensation of being lightheaded and

dizzy in conjunction with extreme fatigue, particularly immediately after dialysis.

Participants No. Responses

- “Wala man”
1
- “Waya okay ra wala may kakulangan sa enerhiya”
- “Oo naa murag malumpo waya nay lakas ug mitumba ko
2
- “Mag ampo ra ko sa Ginoo nga untana hatagan ko nja ug kusog”
- “Ya man, normal man gihapon ako. Sagdahon man ako nan ini (misis) mag
3 bunot nan lubi.
- “Waya naman”.
- “Hinay na, ya nay kusog”
4
- “Maningkamot kaw gajud…Mentras may buhay pa”.
- “Daghan kaaju maam labi na sa kusog ug sa mga bawal sa adlaw-adlaw na
5 panginabuhi dili naka makalihuk ug sakto lahi ra sauna tung wala pay sakit
- “Ampo lang maam ug pagsalig mao rajud na”
- “Sa kusog maam labi na ug dili naka makatrabaho ug mga bug-at dako gyud na
6 kabag-ohan
- “Ampo ra maam”.
- “Sa panglawas na kusog maam ug sa adlaw-adlaw na kakapuy labi na ug mag
7
dialysis ka

Page | 51
 - “Duol sa pamilya ug sa Ginoo maam”
- “Dali na lang ko kapuyan lahi ra sa una na sige ko laag karun dli na maam tas
8 wala nakoy work kay nag focus ko sa ako health karun”
- “Mag ampo rakan maam para tagaan ug kusog pa sa Ginoo”
- “Dali ra kapuyon maam ta sang ako mga kamut ni dagko amo sad sa tiil nag
9 catheter sad ko ma’am”
- “Mag ampo sa Ginoo maam tas mag lingaw-lingaw ug youtube”
- “Kanang na ngitom ko maam ug ni dry ako panit, tas loyahon rako dali”
10
- “Mag relax maam para maka pahuway”

Table 9: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Psychosocial Aspect.

Themes Coding
No great concern

To keep on going
Priorities in Life
To support my medical finances

To pursue dreams

Distance makes no difference

Financial burden
Perspective in Relationship
Family forever

Considerate than before

SEEK A GRAMARTICIAN TO UNDERSTAND THE WORD PER WORD Based on

the conducted study participants had no particular priorities in life REPDRASE IN THE BASE

YOUR ANSWERS IN THE NOTES PRIORITIES TO LIVED 3 OUT OF TEN BUT THE

REST TO PRIORITIES TO KEEP STRONG, as long as they are still alive, it’s fine with them.

In their point of view in life, some of them felt burden in the family because of lots sum of

money to spend on their medical treatment but some appreciated their family because of

Page | 52
overwhemlming love and care they received and they still supported them despite of financial

dilemma. However in Al Nazly study said that a number of the participants controlled their diet,

demonstrating high treatment compliance; this practice was associated with certain personality

traits and family support. However, other young patients ignored the pain of the disease and were

completely dependent on dialysis. They believed that assuming a new lifestyle and maintaining

self-control were difficult to accomplish while routinely having meals with family or friends,

during which they were often encouraged to eat more. As shown, family or friends may

influence patients negatively and positively. participants underwent physiological and

psychosocial stressors, such as lifestyle changes, role disturbances, dialysis frequency,

withdrawal from social lives, uncertainty, hopelessness, and depression.

Participants No. Responses

- “Ang ako priority wala nman kay masakiton nman ako unsa pa may e priority
ang Diyos na ang bahala. Ang goals na ko jaun ako mga lupa ipang ibaligya
1 - “Waya man kay ako pamilya kay lagyo man sila ug naa nay lahi-lahi- pamilya
ako mga anak mag text ra or tawag sila ako tagaan na ko ug moral support dile
kung ako”.
- “Wala man ko prioridad kay nag stambay lang man ko”.
2
- “Oo dako epekto sa ako pamilya kay mga gastos”
- “Waya naman hurot naman sila tapos (children). Mo-us-us gayod an ako crea,
kay mo undang gyud ko”.
3
- “ Mentin raman an amo relasyon, ya may problema. Di man ko mag-angay sa
lalis”.
- “Mag lig-on ako kay para ako maka-panaw-panaw”.
4
- “Ya man, Buotan sila sa ako, naman ako buotan sab sa ila”.
- “Kuan rakan maam ang maka survived sa adlaw-adlaw ug makapatambal”
5
- “Okay raman sila maam okay man ang ako relasyon saela”
- “Ang naay kwarta dajun maam kung magpa dialysis kay kwarta man gyud ang
6 problenahan dayun para maka patambal”
- “ Wala silay labad maam”
- “Ang madajaw maam kung naay bation ug makalampus sa kasakit na bation
7 maka survive ba!”
- “ Support ra sila maam ug way ila problem”.
- “Ang mas mabuhi pa maam uy haha sa una maam ang maka tapos ako mga pag
8 umangkon ma’am”
- “Lahi ra sa una maam mas ni caring sila nako kay syempre may sakit man maam

Page | 53
 hehe”
- “ Ang maayo jud maam ug maka balik ug skwela maam para mapadayun ako
9 mga pangandoy”
- “Nalahi na sa una maam kay naa may sakit na”
- “ Ang mabuhi maam uy mao raman jud na maam kay naa may sakit”
10
- “Nalahi na karun maam kay mag huna-huna jud sila permi sa ako bation”

Table 10: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Social Aspect.

Themes Coding
Let God takes it course.

Acceptance of current Trust to the healthcare staff.

situation.
Care for one’s self

My family alone.

Acquired something to Moral support from others

someone.
None receive from friends.

We can see in the results that participantants are more independent to God, they also felt

assured in care of medicalstaff and also be extra careful to themselves because they are aware of

their own situation. Most of the participants support system came from their family, some to

their friends but few of them recieve nothing from their friends.While on Shahgholian &

Yousefi study that it is increasing the society’s understanding of the condition of the patients was

another theme. The patients expressed their dislike of the pity of others and stated that they

Page | 54
wanted others to understand them. Thus, instead of pity that might annoy them, they expected

others to help and support them when necessary.

Participants No. Responses

- “Ang Diyos nman ang bahala sa ako”.
- “Ah wala siguro maka laong raka jaun mga amigo usahay lumon ug anak kay
1
kung mangajo ra ko sa ginoo naa may moabot pero dle man ko mangajo moabot
lang jud”.
- “Mag ampo lang ko pirmi”.
2
- “Wala man karajaw ma’am kay wala man pud sila mahimo.”
- “Normal da sa ako. Kay normal raman ma sakit man ta. Kay kuan daan pa ko
nahibayo na mutaas an ato pressure, amo baja. Ya may bation inom-inom ra.
3 Kay kun nahibayo pa ko na amo jaun, nag inom ko nan pampaus-us sa
pressure”.
- “Aw mutabang man sila pag ampo na mo ubos an ako crea”.
- “Mag huna huna rakan na musangpit ako sa Ginoo na Lord unhon ko man na
madajaw gajud ako, na waya namn Lord. Ikaw ra gajud an makahatag sa ako
4 nan karajawan”.
- “ Waya gayud ako sa ako mga amigo. Sa pamilya ko ra gajud… Ako pa gani an
ayuan”.
- “Dawatun ra nimu maam ug salig ra gjud sa ginoo tanan mutuman raka sa
storya sa doctor nimu arun maka survive kay sila man maam ang nakahibayu ug
5
makatabang saako.
- “Oo unsahay maam makatabang man sila sa penansyal ug sa kusog”.
- “Ampo ra gyud kanunay”
6
- “ Oo ug mudoul ka saela ila man ka suportahan”
- “Sa ginoo sa lig arun tabangan sa bation na mayaot.”
7
- “ Tabangan man maam ug mudoul ka saela”.
- “Mas nag amping ko sa ako pag kaon maam ug maminaw jud sa doctor ug
8 nurses. Ug dli ko mag stress kay para taas pa ang kinabuhi”
- “Oo maam tanan ako friends ug family support jud sa ako, ako friends gina

Page | 55
 bisita ko nila”
- “Ampo maam para d mawad.an pag laom sa kinabuhi”
9 - “ Wala nakoy amega ron maam lahi ra sa una mga cousin na lang. Sila mama ug
papa maam support sa mga gastuhon sa ako pag dialysis”
- “ Dawaton rakan tas sundon tanan mga tag ingon sa doctor para mutaas pa ang
10 kinabuhi”
- “Mas mu tabang jud sila maam uy labi na sa mga gastuhon”

Table 11: Responses on the Lived Experiences of Patients with End-Stage Renal Disease

Undergoing Hemodialysis Treatment as to Spiritual Aspect.

Themes Coding
Salient in Life

Importance of Spirituality Source of strength

Hope in turmoil.

Pray without ceasing

Faith
Confidence in belief

As stated from the participants that spirituality has a great influence in life, it is hope in

their situation, a comfort in distress. As for participants perspectives, in order to strengthen their

faith, they must have a great relationship with God in which to pray and always attend prayer

service because this is their way to face rough times. Same as in the study of Aghakhani et al in

which following the perception of accessible resources for social support, the patients try to

accept difficulties based on their values and beliefs. Some had tendency to admit their disease

was a penalty for their sins and prayed to God for forgiveness.

Page | 56
Participants No. Responses
- “Maniwala lang gajud sa Diyos amo gajud jaun, ang Diyos gjud kay didto man
1 ta gjud pasingud tanan”.
- “Ang Diyos na ang bahala kay gihatagan ko nija ug chance”.
- “Oo grabe ka importante ug mag ampo lang pirmi ka sa ginoo.”
2
- “Oo padayon gihapon usahay ra makasimba, ug ampo lang gyud”
- “Importante karajaw kay sa Ginoo man, ya may lain dangpan an Ginoo man.”
- “Simba gihapon ko maski ya ako gibati. Mag-ampo sa Ginoo na kuhaon an ako
3
tigbalatian sa ako lawas, para smooth an ako pag pangalagad sa imo. Daan pa
na ulitawo ako, hinimbahon ako.”
- “Importante gayud an ato pagtoo”.
4
- “Mag sige ampo lamang…og simba. Ganahan gani ko labi na magkanta-kanta”.
- “Arang gyud ka importante maam, sa pagtuo ko nagkuha ug kusog ug sa
pamilya”
5
- “Ampo ra gajud maam sa ginoo na hatagan paku niya ug kusog labi na sa
kalisud”.
- “Sa poagtuo ug pagsalig ko naluwas maam ing-ana ka importante”.
6
- “Ampo ug ihatag sa ginoo tanan kabalaka ug kasakit maam”.
- “Tungod sa pagtuo maam makalampus sap ag dialysis”.
7 - “Dili man ka biyaan sa Ginoo maam ug muduol ug musalig kaw niya siya ra
gyud ang makatabang saako sakit”.
- “Arang gyud ka importante maam, sa pagtuo ko nagkuha ug kusog ug sa
pamilya”
8
- “Ampo ra gajud maam sa ginoo na hatagan paku niya ug kusog labi na sa
kalisud”
- “Imporatante kayo maam kay maoy na lang nag hatag nako ug pag laum”
9
- “Ampo maam ug mag salig maam”
- “Importante kayo maam kay mao may nag hatag nako ug kusog maam aside sa
10 ako pamilya”
- “Ampo maam ug mag simba kay ang Ginoo maam sige nag hatag meraglo sa

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 ako kinabuhi”

CHAPTER 4

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

This chapter the brief discussion of the contents in the proceeding chapters in summary

with the corresponding conclusions and recommendations.

SUMMARY

This study determined the lived experiences of patients with end-stage renal disease

undergoing hemodialysis treatment as to emotional aspect, financial aspect, physical aspect,

mental aspect, social aspect, psychosocial aspect, spiritual aspect. The study utilized the

descriptive qualitative type of research. The participants were 10 end-satge renal disease patients

undergoing a hemodialysis treatment in Caraga Regional Hospital. The main instrument

researchers-made questionnaire.

FINDINGS

The salient findings are summarized as follows:

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 The responses of the participants in the carative factor of Watson’s theory that nurses

provides a holistic care in them and satisfied of their work in which the attitudes was manifested

as authentic human caring, participants also felt love and empathy they receive from the staff that

shows a great influence in their current status. It is also evident that nurses honor the

preciousness and fragility of their patients because of positive feedback from the participants.

In caring moments / caring occassion, participants responded that the therapeutic

approach of the nurses were effective because it made their situations lighter. That participants

depends most to the nurses in terms of their health condition. The empathy of the medical staff

was one of the concepts of care and the participants emphasized the effectiveness of the

relationship with the nurses and doctors and remarked that this relationship can be soothing and

reassuring for them. The source of relief and hope for the health and well-being of the patients

came from there faith to the Lord, support from their family and nurse’s speaking to the patients

about their situation.

. The responses of the participants determined the lived experiences of the hemodialysis

patients that seems in the present study emphasized in mental and spiritual aspects more than

physical aspects. The results of the study conducted by our group showed that most hemodialysis

patients full dependency to their family were shown. And also despite of strong and optimistic

facade lies a fearful heart of the uncertainties in the situation, that everything was predestined

from above, so as for them to ease the tension they submitted all their fear, worries, concerns and

situation to God. That no matter what happens, they fully entrust everything to God.

Therefore, it can be concluded that although hemodialysis patients are exposed to mental

stressors, faith to the Lord, empathy and psychological support can help them against mental

distress. Faith to the Lord calms them somehow about there situation that as long as there faith is

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burning, the stronger they are in terms of emotional, financial, physical, mental, social,

psychosocial and spiritual. These prove an effective therapeutic care given by the nurses as

holistic approach. Empathy from different sources such as family and health care staff can

reduce the physical and psychological problems of these patients, thereby helping the patients to

cope with the illness more easily, keep away from isolation and gain more vitality and energy.

(support with the recommedations) ( this findings can ease the recoomendations)

Conclusions

Based on the results of the study, the following conclusions are drawn:

1. Hemodialysis patients at Caraga Regional Hospital were coming from adulthood stage,

two church denomination with Roman Catholic being dominant, both male and female

seek medical treatment.

2. Spiritual aspects appeared to have been the main theme of the study because of their

belief that faith keeps them going and God is the source of their strength in their

situation.

3. Most of the patients rely on their family regarding of support morally, physically and

financially because most of them are unemployed and dependent to them due to their

situation.

4. Based on data the help of the medical insurance and financial aid from the government

comes a big help for them on paying their medical treatment and can somehow lessen

their things to think about.

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 RECOMMENDATIONS

In the light of the findings and conclusion of the study, the following recommendations are

given:

1. Health care provider from Caraga Regional Hospital is one of the element that can relieve

the distress and support of health teaching to the patients increase the motivation of the

patients.

2. Caraga Regional Hospital in hemodialysis unit may somehow invite a speaker to conduct

a seminar and counselling to the hemodialysis patients, to increase the knowledge of the

patients and also it will add great motivation to them. ( they need speaker because in the

conclusions they are lack of knowledge) ( needed in the conclusions should be answered

to recommendations) (don’t use vague statements like most large.)

3. Caraga Regional Hospital must seek a chaplain for the patients in which integrates a

focus on the spiritual aspect of the patients that may deliver them away from unpleasant

thoughts such as mental fatigue and depression and these may increase the quality of life

of the patients.

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 4. It will also great opportunity for the local government can conduct a small livelihood

seminar that will suit in their situation for them so that to add a sense of being still

capable to lead a normal life.

5. A therapeutic care and communication from the health staff is a big key in providing a

holistic care of approach to the patients. We encouraged the health staff to enhance in this

area to provide a more quality of services.

6. We also encourage that the significant others must participate also in treatment journey of

the patients that it also strengthen and enhance the support to the patients.

(relate the conclusions and recommendations)

(focus on the specific to guide the patients)

(Grammarian)

Appendix the answers

Inside the chapter 3 is the summarry of the answers and support with RRL

Dont italize the citations

Bibliography

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Education Center: http://www.dpcedcenter.org/news-events/news/a-brief-history-of-

dialysis/

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Aghakhani et. al. (2014). Content Analysis and Qualitative Study of Hemodialysis Patients,

Family Experience and Perceived Social Support. Iranian Red Crescent Medical Journal,

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http://www.kidneyfund.org/kidney-disease/kidney-failure/

Bragazzi, Nicola Luigi; Del Puente, Giovanni;. (2013). Chronic Kidney Disease, Spirituality and

Religiosity: A Systematic Overview with the List of Eligible Studies. Health Psychology

Research, 2.

Cheever, Kerry H.; Hinkle, Janice L.;. (2014). Brunner & Suddarth’s Textbook of Medical-

Surgical Nursing. Philadelphia: Wolters Kluwer Health | Lippincott Williams & Wilkins.

Chronic Kidney Disease: A Global Crisis. (2018, March 08). Retrieved from Siemens

Healthnieers: https://www.healthcare.siemens.se/news/chronic-kidney-disease.html

Dąbrowska-Bender , M; Dykowska , G; Żuk , W; Milewska , M; Staniszewska , A;. (2018). The

Impact on Quality of Life of Dialysis Patients with Renal Insufficiency. Patient

Preference and Adherence, 577—583 .

Delmas et. al. (2018, July 31). Effects on nurses’ quality of working life and on patients’ quality

of life of an educational intervention to strengthen humanistic practice among

hemodialysis nurses in Switzerland: a protocol for a mixed-methods cluster randomized

controlled trial. BMC Nursing, 11. Retrieved from National Canter for Biotechnology

Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249714/

Enrolment System for Chemotherapy and Dialysis . (2017). Retrieved from Philippine Charity

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 https://www.pcso.gov.ph/ProgramsAndServices/CAD/EnrolmentSystemForChemotherap

yAndDialysis.aspx

Gil Wayne, B. R. (2017, January 19). Jean Watson’s Theory of Human Caring. Retrieved from

Nurseslabs: https://nurseslabs.com/jean-watsons-philosophy-theory-transpersonal-caring/

Grubbs et. al. (2014, December). A Palliative Approach to Dialysis Care: A Patient-Centered

Transition to the End of Life. Retrieved from Clinical Journal of American Society of

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Patients. Nephrology Nursing Journal, 113–123.

Kidney Health Plus. (n.d.). Retrieved from National Kidney and Transplant Instititute:

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National Kidney and Transplant Institute. (n.d.). Retrieved from National Kidney and Transplant

Institute: http://nkti.gov.ph/patients-and-visitors/kidney-health-plus

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https://www.philhealth.gov.ph/news/2015/extends_dialysis.html

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Valsaraj, Blessy; Bhat, Shripathy M.; Prabhu, Ravindra; Dinesh, N.;. (2014). A Qualitative

Research on the Experience of Haemodialysis in South Karnataka:. Journal of Krishna

Institute of Medical Sciences University, 90-100.

Vera, M. B. (2018, December 07). Hemodialysis Nursing Care Plans. Retrieved from

Nurseslabs: https://nurseslabs.com/3-hemodialysis-nursing-care-plans/

Watson's Caring Theory. (n.d.). Retrieved from Google Site:

https://sites.google.com/site/watsonscaringtheory/watson-s-theory-of-human-caring-the-

history-and-development/caring-moment-caring-occasion

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https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

APPENDIX A

Letter to the College Dean

Mrs. Teresita P. Adobas RN,MN

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Dean, CAMS
Surigao Education Center
Km. 2, 8400 Surigao City
August 22, 2019

Dear Ma’am,

Greetings of Peace and Well-being!

The undersigned are presently undertaking a study entitled “Lived Experiences of Patients with End-
Stage Renal Disease Undergoing Hemodialysis Treatment at Caraga Regional Hospital”.

In this connection, the researchers would like to request from your good office the permission to
conduct our study outside the school campus.

The researchers fervently hope for your affirmative response regarding this matter. Thank you
very much and God bless!

Respectfully,
Escuyos, Amor L.
Ocon, Gladys Joy P.
Siega, Devorah O.
Villasor, Megan Juliet R.

Noted by:

Rocelyn S. Dawsan, RN
Research Adviser

Approved by:

Teresita P. Adobas, RN, MN

Dean, CAMS

APPENDIX B

Letter to the Caraga Regional Hospital Chief

Dr. Cheryl A. Gotinga, MD, FPPS

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Medical Center Chief I-OIC
Caraga Regional Hospital, Surigao City
August 23, 2019

Thru:
Dr. Romina L. Rusillon-Sajulga, MD, FPCP, DPSN, FPSN
Internal Medicine-Adult Nephrology
Dialysis Unit
Caraga Regional Hospital, Surigao City

Dear Dr. Cheryl A. Gotinga:

Good Day!

The undersigned are conducting a study entitled “Lived Experiences of Patients with End-
Stage Renal Disease Undergoing Hemodialysis Treatment at Caraga Regional Hospital” from
Surigao Education Center, College of Allied Medical Sciences, Nursing Department in Surigao
City. In this regard, we would like to ask your permission to allow us to conduct our study to
some of the Hemodialysis patients in Caraga Regional Hospital. Rest assured their answers will
be kept with utmost confidentiality.

Looking forward for your kind consideration regarding this request. Thank you and God
Bless!

Respectfully,
Escuyos, Amor L.
Ocon, Gladys Joy P.
Siega, Devorah O.
Villasor, Megan Juliet R.

Noted by:

Rocelyn S. Dawsan, RN Teresita P. Adobas, RN, MN

Research Adviser Dean, CAMS

Recommending Approval:

Dr. Cheryl A. Gotinga, MD, FPPS Dr. Romina L. Rusillon-Sajulga, MD, FPCP, DPSN,
FPSN
Medical Center Chief I-OIC Internal Medicine-Adult Nephrology
INTERVIEW QUESTIONNAIRES:

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PART I SOCIO-DEMOGRAPHIC PROFILE
Direction: Please check appropriate space that corresponds to your choice
Name (optional)

Age Gender Female Male

Religion
Roman Catholic Born-Again Christian Muslim
Baptist Iglesia ni Cristo Others, please specify ___________
Marital Status
Single Married Widowed Separated Divorced
Educational Attainment
Elementary High School College / University
Masters/Doctors Technical school Others

Length of Time in Hemodialysis Treatment (months)

3rd months-12th months 23rd months-32th months 43rd months-52th months
13th month-22th months 33rd months-42th months 53rd months - Above

Frequency of Treatment Per Week

Twice a week Thrice a week

Employment Status
Full time employment Retired Part time employment
Unemployed Student Other, please specify ________________
Monthly income
Below ₱ 10,000 ₱ 50,100- ₱ 100,000
₱ 10,100 - ₱ 50,000 Above ₱ 100,100
Membership on Health Insurance
Philhealth S
Sun Life Financial Philippines PhilAm LIfe
u
Kaiser International Health Group None Other, please specify___________
S
n
u
n
L
PART II PHILOSOPHY AND THEORY OF TRANSPERSOxxxxxxxxxxxNAL
i
L
CARING f
i
e
f
e
F Page | 68
i
F
n
i
a
n
A. CARATIVE FACTOR

I. Practice of Loving Kindness

 Did you feel care and help to your nurse while you are in treatment? Did your

nurse showed you care and understanding while you are in treatment?

Mabati ba nimu ang malasakit ug pag-alaga sa nurse nga nagatabang saemu

maam kada magdialysis ka? Mapakita ba sa nurse ang pag hatag ug alaga ug

pagsabot saemu?

II. Authentically Practice Faith and Hope

 What are your source of your hopes in everyday living? Did your faith in God help

in you in your physical strength?

Asa man ka magkuha ug kusog ug pag laum maam sa matag-adlaw? Nakatabang

ba ang imo pagtuo sa Ginoo sa imo panglawas na kusog?

III. Sensitivity to Soft and Others

 How was your family taking care of you?

Kumusta man ang imo pamilya maam sa pag alaga saemu?

B. CARING OCCASION

 How did your nurse do something to make you feel that she cares for you? While

you are in the dialysis treatment did you experience mechanical error in the

machine?

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 Unsa may ginabuhat sa nurse Ma’am/Sir para saemu na napabati niya ang pag

alaga saemu? Samtang nag dialysis ka maam naka experiensya baka nga nagka

aberya ang makina sa taggamit?

PART III THE LIVED EXPERIENCES OF HEMODIALYSIS PATIENT AT

CARAGA REGIONAL HOSPITAL

a. EMOTIONAL ASPECT

 How could you create more balance in your life, now that you are undergoing a

hemodialysis treatment?

Giunsa nimo paghimo ang dugang nga pag balanse sa imong kinabuhi, nga karon nag-

antus ka sa pagtambal sa hemodialysis?

 What are your coping strategies when you are having a bad day?

Unsa man ang imong mga stratehiya sa pagsagup kung naa kay dili maayo nga adlaw?

b. FINANCIAL ASPECT

A. How much does a hemodialysis treatment cost?

Pila ang gasto sa pagtambal sa hemodialysis?

B. What are your financial strategies on paying for your treatment?

Unsa imo mga stratehiya sa pinansyal sa pagbayd alang sa imong pagtambal?

c. MENTAL ASPECT

 Did you experience mental fatigue? How did you handle your mental fatigue?

Nakasinati ba ka nan kakapoy sa kaisipan? Paga unsa man nimo pagdaya?

d. PHYSICAL ASPECT

 What physical change did you experience during your hemodialysis treatment?

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 Unsang pisikal nga pag bag-o ang imong naagihan sa imong pag-agi pagpatambal sa
hemodialysis?
 How did you deal with the lack of physical strength and energy?
Gi unsa nimo pag atubang ang kakulang sa pisikal nga kusog ug enerhiya?
e. PSYCHOSOCIAL ASPECT
 What are your priorities in your life? What goals are most important to you currently?
Unsa man imo mga prioridad sa imo kinabuhi karun maam? Imong mga goals maam
karun?
 How do you think your health condition has impacted your relationships and your
perception to your family?
Ma’am/Sir unsa man an imo pagtan-awa bahin sa imong kondisyon karun sa epekto og
paglantaw nan imo relasyon sa imo pamilya?
f. SOCIAL ASPECT
C. How do you deal with having ESRD?
Giunsa man nimo maam pag deal sa imo sakit maam?
D. Did your friends and family in the community support and help you during your
hemodialysis treatment? How?
Ma’am/Sir nakakuha ba ka nan suporta gikan sa imo amigo o sa ijo komunidad? Unsa
man?
g. SPIRITUAL ASPECT
E. How important is spirituality to your life now?
Gaunsa ka-importante an imong pagka-ispirutuhanong bahin sa imong kinabuhi karun?
F. How do you keep your faith strong in tough times?
Paga-unsa nimo pagpadayun sa imong pagtoo sa panahon nan kalisdanan?

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