Resilience of Chronic Renal Failure Patients Undergoing

Hemodialysis in Medan, Indonesia

Cholina Trisa Siregar

, Siti Zahara Nasution

, Reni Asmara Ariga

, M. Pahala Hanafi Harahap

and

Muhammad Taufik

Faculty of Nursing, Universitas Sumatera Utara, Medan, Indonesia

Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Faculty of Mathematic and Natural Science, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Elderly, Hopes, Family Support, Awards, Emotional, Information, Instrumental.

Abstract: Chronic renal failure (CRF) is a failure of kidney function that progresses slowly and can’t recover so the

body is unable to maintain the metabolic, fluid and electrolyte balance in the body. Haemodialysis therapy is

used as one of the renal replacement therapy in CRF patients to prevent dangerous complications that can lead

to death. Patients suffering from chronic renal failure who underwent haemodialysis will face psychological,

financial, physical and social suffering. The patient will experience a meaningless state in which this situation

will lead the patient to the process of seeking meaning in suffering so that there is a need for resilience in the

face of his illness. This study aims to identify the resilience of patients with chronic renal failure who

underwent haemodialysis in Medan. Methods: the population in this study were patients with chronic renal

failure with a sample of 117 people using accidental sampling technique. Data were collected using

questionnaires and analysed by frequency distribution. The result showed that 84 of 117 responders were in

medium resilience (71.8%). Based on the results of the study can be concluded that patients who experience

chronic renal failure in Medan have

1 INTRODUCTION

A hemodialysis is a form of replacement therapy in

patients with kidney failure, both acute and chronic.

Patients suffering from renal failure are assisted with

the aid of a haemodialysis machine that takes over the

kidney function. Patients with renal failure who

undergo haemodialysis therapy, take 12-15 hours to

dialysa each week, or at least 3-4 hours per treatment.

This activity will take place continuously throughout

his/her life (Asiah, 2005).

Charuwanno suggests that the continued use of

haemodialysis therapy throughout his/her life can

lead to feelings of discomfort to the sufferer, increase

stress and affect the quality of life, including

psychological health. (Charuwanno, 2005) Increased

levels of stress experienced by hemodialysis patients

are caused by financial problems due to a decrease in

health conditions, difficulties in maintaining work,

sexual ability to disappear and impotence,

relationships with spouses and fear of death

(Asiah,

2005).

The results of Hanim's study showed that 18 of

the 27 patients undergoing haemodialysis therapy

were in the category of severe stress while 9 patients

were able to adapt to changes in Rantauprapat

hospital. (Hadiningsih, 2014) The condition depends

on how far the ability of the patient in adaptation to

changes that occur. This condition is known as

resilience (Hanim, 2013).

The resilience of patients undergoing

hospitalization is a matter that needs to be assessed to

achieve a rebalance due to the changes that happened.

Feelings of despair and helplessness are often faced

by patients because various treatments cannot help

him/her recover from chronic illness. The state of

severe stress can also arise due to the unpreparedness

of the body to accept the changes and demands of life.

(Hurlock, 2007) Research conducted by Iliescu and

Cotoi said that medical diagnosis and hospital

environment can also affect the patient's

psychological form of depression, anxiety, worry or a

combination of all if the individual is not able to do

resilience (Iliescu, 2013).

132

Trisa Siregar, C., Zahara Nasution, S., Asmara Ariga, R., Pahala Hanaﬁ Harahap, M. and Tauﬁk, M.

Resilience of Chronic Renal Failure Patients Undergoing Hemodialysis in Medan, Indonesia.

DOI: 10.5220/0010137500002775

In Proceedings of the 1st International MIPAnet Conference on Science and Mathematics (IMC-SciMath 2019), pages 132-137

ISBN: 978-989-758-556-2

Failure of the resilience process will cause severe

stress for a long time. The response of the body in

response to stress causes the body's energy to increase.

The energy released by the stressor will create a state

of tension that causes discomfort for the patient. The

discomfort that protracted will cause fatigue in the

human body that can lead to death

(Hanim, 2013).

2 METHODS

The research design used in this study is descriptive

that aims to obtain a picture of the resilience of

patients with chronic renal failure who underwent

haemodialysis in Medan. The sample in this research

were 117 people where the sampling technique used

by accidental sampling. This research was conducted

in the haemodialysis installation ward of Dr. Pringadi

Hospital and H. Adam Malik General Hospital in

Medan. The research instrument used was

demographic data and resilience scale consisting of

25 statements adapted from the Resilience Scale (RS)

owned by Wagnild and Young which then modified

by the researchers. Instrument validated by Dr.

Wiwik Sulistyaningsih with V = 0.97 and reliability

value of Cronbach alpha = 0.810 (Morton, 2012).

Data collection was done after getting permission

from the related institution, researcher look for

prospective respondent then explain to prospective

respondents assisted by family about purpose,

benefit, and how to fill questionnaires. After getting

informed consent, respondents are welcome to fill out

questionnaires or read by the researcher and gave the

opportunity to the respondent if there was anything to

ask. After all the data on the questionnaire had been

collected, it is analyzed through several stages,

starting from checking the completeness of the data

(editing), coding, ensuring clean data, and measuring

each respondent's answer by looking for percentage (

tabulating) which is then presented in the form of

frequency distribution tables.

3 RESULTS

The research design used in this study was descriptive

that aimed to obtain a picture of the resilience of

patients with chronic renal failure who underwent

hemodialysis in Medan. The sample in this research

was 117 people which the sampling technique by

using accidental sampling. This research was

conducted in the hemodialysis installation ward of

Dr. Pirngadi Hospital and H. Adam Malik General

Hospital in Medan. The research instrument used was

demographic data and resilience scale consisting of

25 statements adapted from the literature review.

Table 1. shows the majority of male respondents

as many as 64 people (54.7%), age range 41-60 years

as many as 66 people (56.4%), 53 senior high school

education (45.3%), 48 self-employed (41%), the

married status of 108 people (92.3%).

Table 1: Distribution of frequency based on the

characteristics of respondents in Dr. Pirngadi Hospital and

H. Adam Malik General Hospital in Medan (n = 117).

Characteristics of

Res

ondents

(f) (%)

Sex

Male 64 54,7

Female 53 45,3

20-40 years 31 26,5

41-60

ears 66 56,4

61-80 years 20 17,1

Education

Primary School 17 14,5

Secondar

School 21 17,9

High School 53 45,3

Bachelo

26 22,2

Occupation

Housewives 43 36,8

Student 3 2,6

Self-em

48 41,0

Civil Servant 9 7,7

Retire

14 12,0

Marital Status

Sin

le 9 7,7

Marrie

108 92,3

Figure 1: Resilience of respondents.

Figure 1 shows that patients resilient is in

moderate resilience 84 of 117 respondents (71.8%),

32 respondents (27.4%) with high resilience, and 1

respondent (9%) with low resilience.

Resilience of Chronic Renal Failure Patients Undergoing Hemodialysis in Medan, Indonesia

133

Figure 2: Sex of respondents.

Figure 2. shows that of 64 respondents of the male

sex, 1 respondent has low resilience, 40 respondents

have moderate resilience and 23 respondents have a

high resilience. Of the 53 respondents of the female

sex, there were no respondents had low resilience but

44 respondents had medium resilience and 9

respondents had a high resilience.

Figure 3: Sex of respondents.

Figure 3. showed that from 31 respondents aged

20-40 years there was 1 respondent with low

resilience, 17 respondents with medium resilience,

and 13 respondents with high resilience. A total of 66

respondents aged 41-60 had 14 respondents with

medium resilience, and 52 respondents with high

resilience. A total of 20 respondents aged 61-80 years

there were 15 respondents with medium resilience,

and 5 respondents with high resilience.

Figure 4: Education of respondents

Figure 4. shows that 17 respondents with primary

school education had 15 respondents who had

moderate resilience and 2 respondents had a high

resilience. A total of 21 respondents with secondary

school education had 16 respondents with medium

resilience and 5 respondents have a high resilience.

At the high school education there was 1 respondent

have low resilience, 34 respondents with medium

resilience and 18 respondents had a high resilience.

Bachelor education as many as 26 respondents there

were 19 respondents had moderate resilient and 7

respondents had a high resilience.

Figure 5: Occupation of respondents.

Figure 5 showed that of 43 housewives’

respondents, 34 respondents with moderate resilience

and 9 respondents with high resilience. A total of 3

respondents a college where 1 have low resilience and

2 respondents with high resilience. In the self-

employed work of 48 respondents, there were 37

respondents with a moderate resilience and 11

respondents with high resilience. A total of 9

respondents work as government employees there

were 6 respondents with medium resilience and 3

IMC-SciMath 2019 - The International MIPAnet Conference on Science and Mathematics (IMC-SciMath)

134

respondents with high resilience, while 14

respondents who had been pension there were 8

respondents with moderate resilience and 6

respondents with high resilience.

Figure 6: Married status of respondents.

Figure 6 Show that from 9 respondents with

unmarried status there are 1 respondent had low

resilience, 4 respondents with medium resilience and

4 respondents with high resilience. A total of 108

respondents with married status there were 80

respondents with medium resilience and 28

respondents with high resilience.

4 DISCUSSION

The results of this study showed that the resilience

among 84 of 117 respondents of chronic renal failure

who underwent haemodialysis in the city of Medan is

in moderate resilience category with a percentage of

71.8%. Nisa argues that individual in the moderate

resilience category shows that individuals have been

able to adapt and survive in the face of illness but they

have ups and downs and tend to be unstable in attitude

(Mailani, 2015).

Mailani adds that chronic disease patients always

try to use strategies to deal with the disease. They tend

to get closer to God, get attention from family and

spouse, have great hopes for recovery, and accept

sincerely illness as part of God's trial. This can

provide reinforcement and motivation for patients to

stay their life as it once was (Nisa, 2016).

The results of this study obtained data that male

respondents as much as 64 people (54.7%) more

resilient than women as many as 53 people (45.2%).

Purnomo argues that men tend to use problem-

focused coping because men usually use ratio or

logic, otherwise men are sometimes less emotional so

they prefer to directly solve the problems and directly

face the source of stress (Reivich & Shatte, 2002).

Women are more likely to use emotion-focused

coping because they are more emotionally or

emotionally used, so they rarely use logic or ratios

that make women more likely to regulate emotions in

coping with sources of stress or religious settlement

where women feel closer to God than men. Rinaldi

argues that men often use a problem-solving approach

and have an optimistic attitude than women, while

women use patterns of helplessness than men. Men

have confidence in solving problems and believe in

their ability (competence) to master difficult tasks or

situations, more positive than women (Rinaldi, 2010).

High resilient individuals (males) are able to adapt

to a variety of conditions to change circumstances and

are flexible in solving problems, whereas low

resilient individuals (women) have little adaptive

flexibility, are unable to react to changing

circumstances, tend to be stubborn or chaotic when

faced with change or pressure, as well as having

difficulty adjusting after experiencing traumatic

experiences (Rinaldi, 2010).

In this study, the most resilient group was in the

41-60 years age range of 66 people (56.4%). Hurlock

argues that individuals between a 41-60 years age

range are referred to as middle adulthood where at

this time there will be a decline in physical and

psychological ability, but individuals in this period

have been able to determine their problems

adequately both so stable enough and mature

emotionally in the face of life problems, especially

the diseases he suffered. Individuals who have

reached emotional maturity will be able to control

their emotions, can think well by looking at the

problem objectively and able to take attitude and

decision

(Septiyan, 2013). According to Hurlock this

period is a period of financial and social success

including power and prestige. This is also a happy

time for some couples, although at this time the

children do not live with parents anymore, but

actually feel happier because they feel free to reach a

career and spend more free time with a partner than

young adult so that tend to respond to an illness with

an open attitude towards their partner (Septiyan,

2013).

The results of this study obtained data that the

respondent’s education at high school level has more

resilient as many as 53 people (45.2%). According to

Entjang (1985 in Asiah, 2005) argues that the level of

education influences the individual mindset where

high levels of education will broaden his way of

thinking. (Setiasih, 2012) The higher the level of

education the tolerance and control of the stressor will

Resilience of Chronic Renal Failure Patients Undergoing Hemodialysis in Medan, Indonesia

135

be better, other than that individuals who have a

higher education will be better cognitive development

than a lower education so that will have a more

realistic assessment and make the disease is

something that must be faced (Sarafino, 2006).

Widakdo and Besral argue that higher-educated

patients have better skills and knowledge that tend to

be able to overcome life problems, whereas low

education will have low knowledge and ability so that

it has limited in coping pattern to the problems

experienced (Siburian & Wahyuni, 2012).

Reivich & Shatte also add that individuals who

have a broad mindset will have good cognitive

flexibility so that individuals with good cognitive

flexibility will have good resilience as well (Smeltzer

& Bare, 2002).

Work is also very influential on mental health.

The results of this study obtained data that the

majority of respondents who work as self-employed

more resilient as many as 48 people (41%). Setiasih

argues that work is one of the most important aspects

of life for the individual. Work also serves as a source

of identity, a source of autonomy, giving

opportunities to develop skills and creativity, a source

of purpose in life, a source of income and a sense of

security, and the source of other activities, such as

recreation. Individuals who have jobs have a positive

effect on mental health, where the subjective well

being of individuals who have a job is better than

subjective wellbeing individuals who do not have a

job. Individuals who do not have a job indicate that

there is no experience to gain employment benefits

that make individual subjective wellbeing low. If they

do not have a job, they have no income and no access

to psychological experience, whereas by having a job

the individual will have a good psychological

experience

(Tama, 2009).

Judging from the marital status of respondents, as

many as 108 people (92.3%) married status are more

resilient than unmarried. Taylor and Francis argue

that the support of spouse and family is very

influential on the mental health of family members.

Family social support can provide positive results on

health and wellbeing in patients with chronic diseases

(Wagnild & Young, 1993).

Couples 'and families' social support have a

positive or significant influence with high resilience.

Social support is one factor that can make a person

survive in any situation or in psychology is

categorized as a manifestation of resilience. The

higher the social support of spouses and families to

sick family members, the higher the resilience

(Widakdo & Besral, 2013).

5 CONCLUSION

The resilience of chronic renal failure patients

undergoing hemodialysis in Medan City is in

moderate resilience category, meaning that

individuals have been able to adapt and survive in the

face of illness but they have ups and downs and tend

to be unstable in their attitude. The mental health of

the patient facing his illness is also influenced by

several factors which will affect the ability of the

individual to adapt and face the psychosocial effects

he/she experienced, including the factors of gender,

age, education, occupation, and status.

ACKNOWLEDGEMENTS

The author would like to thank the Ministry of

Research and Technology Higher Education of the

Republic of Indonesia. This research is financed by

TALENTA Year 2017.

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