Assessing Family Communication Patterns in Patients of

Hemodialysal Therapy with the Pattern of Kidney Failure

Rr Dinar Soelistyowati and Silvia Nurlaila

Department of Communication Art, University of Bhayangkara Jakarta Raya, Bekasi, Indonesia

Keywords: Kidney Failure Patients, Hemodialysis Therapy, Family Communication, Health Communication.

Abstract: This study aims to examine the pattern of family communication carried out by a husband or wife if their

partner suffers from kidney failure and must do hemodialysis or dialysis and discuss how communication

efforts made by the hospital to be able to make patients feel happy and calm. This study covers how the

interaction of family communication carried out by a husband or wife to their partner who is a patient with

kidney failure before and during hemodialysis therapy and communication efforts made by doctors and

nurses as the hospital in providing information about the development and results obtained to patients. This

research is qualitative by using a combination of Peplau's Interpersonal Relations Theory with the Theory of

Health Belief Models and Behavior Change. The results of this study are expected to be able to bring

behavioral changes and cultural changes between husband or wife to their partners so that the results of this

communication can be socialized and become a reference for families of patients with similar diseases and

as standard operational procedures for doctors and nurses in assisting hemodialysis patients.

1 INTRODUCTION

As a creature that always lives together,

communication is an ability inherent in humans.

Through communication, we can express what is in

our minds. With communication as well, we can

build relationships with many people, be it forming a

network of professional relationships where we

work, building social relationships with people in

the environment where we live, to establish

relationships that are affective and personal like love

and affection with the people we choose as life

partners in creating a happy and prosperous family

both physically and mentally.

Within social boundaries, the family is explained

as an element of a larger kinship network that

connects one's ancestors and descendants (Nam,

2004, p. 2). Whereas from a medical point of view,

the family is defined as a group of people related to

blood or marriage or strong mutual ties, such as

those from the same ancestor, or a husband, wife,

and their children (Miller, Keane, & O'Toole, 2003).

If considered together, these two understandings

have a similarity in which these people can be

considered as families if there is a relationship

between family members, both those from the core

members or from outside parties who have joined to

become part of the family. This means, in the

process of its formation, every member in the family

needs communication activities to channel what will

be discussed in the family.

As in the formation of other communication

networks, the formation of family networks requires

several aspects that are at least worthy of attention

so that the family can be considered a prosperous

family. One important aspect is health. Health itself

has become one of the most important things in

human survival. Various ways have been done by

humans, both in terms of innovation or findings on

drugs, methods, and other medical efforts to

maintain human health both physiologically and

psychologically. However, in a dynamic era like

now, maintaining health seems to be a complex

endeavor for the community, especially in people

with high mobility levels. The density of daily

activities combined with a fluctuating lifestyle

makes it difficult to implement healthy food

consumption patterns. As a result, people are more

likely to turn to fast food that has the potential to

cause various diseases, ranging from external

diseases such as allergies to internal diseases

involving important organs such as stroke and

kidney failure.

The existence of kidney failure in Indonesia is

slowly increasing. Through her seminar, Nila F.

Soelistyowati, R. and Nurlaila, S.

Assessing Family Communication Patterns in Patients of Hemodialysal Therapy with the Pattern of Kidney Failure.

DOI: 10.5220/0009593502850293

In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 285-293

ISBN: 978-989-758-454-1

285

Moeloek (2018) also believes that diseases caused

by kidney such as Diabetes Mellitus and its

complications ranks 8th out of 10 causes of death in

Indonesia with a prevalence of 6.7 percent, also

ranks 3rd out of 4 on a national scale of 41,590

deaths in Indonesia with a total of 2,786 people.

While quoted from the results of the Basic Health

Research (Riskesdas) in 2018, the prevalence of

chronic kidney disease (PGK) occurred at 3.8

percent or an increase of 1.8 percent compared to

2013. According to the Director of Prevention and

Control of Non-communicable Diseases the Ministry

of Health of the Republic of Indonesia, Cut Putri

Arianie, an increase in the number of kidney patients

is caused by three factors. First, there is an extension

of the life expectancy of Indonesians to 71 years for

women and 68 for men. Secondly, the occurrence of

technological transition phenomena that makes

people less likely to move so that it can potentially

cause symptoms of diabetes and hypertension and

high blood pressure. Third, there is an economic

transition which has resulted in an increase in the

income of Indonesian people so that they tend to be

reluctant to make their own food and switch to fast

food whose ingredients have the potential to cause

obesity and other physical health disorders. These

diseases can be a major cause of chronic kidney

disease in Indonesia (Novita, 2019).

Responding to the situation, several efforts have

been socialized and carried out by the government to

the people of Indonesia as a form of preventive

measures in preventing chronic kidney disease, such

as diligently exercising, multiplying activities, and

implementing a drinking pattern of eight glasses of

water every day. However, when it is already

experiencing kidney disease, especially chronic

diseases such as renal failure undergoing

hemodialysis therapy or dialysis, special assistance

is needed, either from the family or from the

hospital, in which each of facilitation required a

strong and intense communication.

In his research related to social studies on health,

Armstrong (Liliweri, 2013, p. 33) states that health

problems and disease problems, and even the

definition of illness, experienced by humans is not

solely derived from individual neglect, family

negligence, negligence of groups or community,

even community neglect in maintaining individual

health. According to him, various social studies on

health actually reported that most of the illnesses

suffered by individuals as well as community

"illnesses" in general stem from ignorance and

misunderstanding of various health information that

they access. Therefore, we need to pay attention to

the flow of health information that is sent and

received by humans. This means we must study

health communication.

Communication at the family level itself also

needs to be considered, especially when

accompanying family members who have certain

diseases. They need to be given special enthusiasm

and motivation given verbally in order to persuade

patients when undergoing a medical process such as

a healing effort. In addition, family communication

also needs to be done to be able to make patients feel

happy and calm when undergoing each of these

medical processes.

Seeing the background picture above, researchers

are interested in reviewing research on family

communication interaction patterns as a form of

mentoring for kidney failure patients undergoing

hemodialysis therapy and communicating

communication efforts undertaken by doctors and

nurses towards patients specifically through the

work of science. Researchers hope the results of this

study can be used as a reference for families of

patients with similar diseases as well as standard

operational procedures for doctors and nurses in

assisting hemodialysis patients.

2 THEORETICAL STUDY

2.1 Communication

In his book entitled Mapping Health

Communication, Gangar defines communication as

the process of delivering and receiving messages

from someone who is shared with others.

Communicating here can be interpreted to help

convey the message to then be known and

understood together. Message in communication is

used in choosing and making decisions.

Communication is defined as such because it is

fundamental in daily life. We cannot live without

communicating. Therefore, communication means

conveying a message from the source of the message

(communicator) to one or more recipients of the

message (audience) using a set of rules or certain

methods. At the simplest level, communication

requires several elements in the form of the sender

of the message, the message itself, the recipient, and

the communication media. However, for each

complex event, the message sender also functions as

the recipient of the message, and other different

messages are sent through different media (2009, p.

4).

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2.2 Family

According to the WHO regional director for the

Southeast Asia region, Dr. Samlee Plianbangchang,

the family is a basic unit on a social level and

provides a basic physical and psychological

environment when children begin to grow and

develop. The family also plays a very important role

in caring for and socializing children as well as

influencing adolescent development (WHO, 2013, p.

3).

The word "family" itself is full of images. In

general, the term "family" refers to the motto or call

to the activities of family members, for example

hard working families, togetherness, or those who

prioritize the welfare of the group over the

individual. Another reason, the word "family"

embodies a set of values that distinguish normal

individuals from abnormal people and right people

from wrong people (Bahfiarti, 2016, p. 65).

2.3 Family Communication

Family communication is important to learn. This is

due to the constitutive relationship between

communication with family. To know the

description of the activities of a family, a social

interaction is needed, in which in the process the

ability to communicate between family members is

needed. Quoted from Hurlock (1997, p. 198), family

communication is defined as the formation of family

life patterns in which there is an element of

education, the formation of attitudes, and behavior

of children that affect the child's development.

From different sources, family communication is

explained as an activity that must occur in family

life. This explanation is obtained because without

communication in the family, life in the family will

become lonely due to the loss of speaking, dialogue,

exchanging ideas so that it will cause vulnerability

between family members. An example of this

explanation is the communication held between

husband and wife, as well as communication

between parents and children need to be built in

harmony in order to build good relationships in the

family (Bahfiarti, 2016, p. 70).

2.4 Health Communication

As we all know, health communication is a scientific

field that is growing rapidly in recent decades. As a

scientific field, health communication is a field that

is rich in studies, amazing and relevant to the study

of communication between humans and media

communications relating to health efforts and health

promotion efforts (Junaedi & Sukmono, 2018, p. 2).

Based on the eight points set out in the Toronto

Consensus Statement, Rogers in Harrington (2015,

p. 8) defines health communication as a multi-aspect

and multi-disciplinary approach to reach different

audiences and share information related to health

with the aim of getting involved influence, and

support individuals, communities, health experts,

special groups, policy makers and the public to

defend, introduce, adjust, or maintain behavior,

practices, or policies that will ultimately improve

their health outcomes.

In addition to definitions from experts, the NCA

(National Communication Association) provides a

definition that health communication is the science

of communication related to experts and health

education, including the interaction science of

providing clients, as well as the diffusion of health

information through public health campaigns. While

the ICA (International Communication Association)

explains that health communication is

communication that is primarily involved with the

role of communication theory, practice, and research

in terms of health promotion and health care

(Mulyana, 2018, p. 38).

2.5 Cronic Kidney Disease

Chronic renal failure or what is commonly called

CKD (cronic kidney disease) is a fatal progressive

kidney damage in which the body's ability to

maintain metabolism and fluid and electrolyte

balance, causing azotemia (urea retention and other

nitrogenous waste in the blood). This disease is also

known as end stage renal disease (ESRD). Apart

from the continuation of acute kidney failure,

chronic kidney failure can be caused by several

conditions such as: (1) systemic diseases, especially

Diabetes Mellitus, hypertension, lepitopirosis; (2)

chronic kidney infections (glomerulonephritis,

pyelonephritis); (3) autonomal genetic makeup; (4)

obstruction (disturbance) in the urinary tract; (5)

drugs and nefrotoxic chemicals, and; (6)

environmental factors, such as the presence of

cadmium, mercury, and chrome exposure (Diyono &

Mulyanti, 2019, pp. 43-44).

2.6 Health Belief Model Theory

If interpreted language and separately, this theory

has three main words as concepts, namely health,

beliefs, and models. The word health (health) refers

to the perfect condition that is owned by a person, be

Assessing Family Communication Patterns in Patients of Hemodialysal Therapy with the Pattern of Kidney Failure

287

it physically, mentally, or socially, and is not in a

condition of having a disease or disability (WHO,

2017).

The word belief (belief) means to have a faith, so

that belief can be translated as one's belief in

something that can cause certain behaviors or

actions (Putri, 2016, p. 11). Meanwhile, according to

Hayden, belief (belief) is very closely related to

culture which is one's perception of the right thing

even though it is not a truth. From these two

explanations, it is concluded that belief is a belief in

something that is considered right or wrong that is

influenced by culture so that from that belief will

produce an action or behavior (2017, p. 67).

While the model is generally explained as a

representation (representation) of an object, object,

or ideas in a simplified form of conditions or natural

phenomena. While the model that refers to the

Health Belief Model is interpreted as a

representation of an idea into a condition.

Basically, the Health Belief Model is a

translation of the sociopsychological model. This

model describes four variables that are the size and

attitude of individuals towards health. The four

variables include: (1) understanding vulnerability to

disease, (2) overall understanding of disease, (3) the

benefits of taking action in dealing with disease, and

(4) readiness of individual actions against disease

(Notoatmodjo, 2010, p. 113 -115).

In its application, this model is used as an effort

to explain broadly how the failure of community

participation in the prevention and early detection of

a disease, is also used as the main framework in

behavior related to human health. This model can

also be said as a conceptual formulation to find out

the perceptions of individuals whether they accept or

not about their health, so to find out about individual

perceptions, can be assessed from variables that

include individual desires to avoid pain, their belief

that there is an effort to avoid the disease.

2.7 Behaviour Change Theory

Basically, this theory considers several main theories

about behavior and behavior change that can be a

problem for the development of effective

interventions in driving behavior, including theories

and concepts from the mainstream of psychology,

and branches of science related to health, pleasure,

recreation, physical activity and training in

psychology.

Prochaska and DiClemente explained that

behavioral changes occur in five stages, including:

a. Pre-contemplation: at this stage, the

individual has no desire to change his

behavior in a predictable future.

b. Contemplation: in this stage, the individual

begins to be aware that a problem has arisen

and to consider several actions in a serious

way to explain the problem. However, at this

stage, the individual has not made a

commitment to take the action.

c. Preparation: includes the desire to change and

some behaviors that are usually minor and

often experience limited success.

d. Action: In this stage, the individual actually

changes his behavior, experience, or

environment in order to get past his problems

or to achieve his goals.

e. Maintenance: individuals who have reached

this stage tend to try to prevent relapses and

strengthen the results obtained at the previous

stage of the action.

3 RESEARCH METHOD

This study uses descriptive qualitative methods, with

retirees aged 50 years and older as research objects

and case studies as research methods and purposive

sampling as data analysis techniques. These methods

and techniques were chosen to determine the type of

family communication patterns used between

husband or wife who are hemodialysis therapy

patients with their partners when mentoring patients

and implementing communication carried out both

with family members and with doctors and nurses.

In conducting its research, researchers used a

combination of theories between health belief model

theory and behavior change theory.

This study focuses on family interaction patterns

communicated through husband or wife to their

partners who are kidney failure patients undergoing

hemodialysis therapy and health communication

used by doctors and nurses to provide information

and persuasion to patients related to hemodialysis

therapy carried out by patients. In the process of

research, researchers collect data by non-

participatory observation and study of literature and

inquiry.

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4 DISCUSSION & RESULT

4.1 The Situation of Kidney Failure in

Indonesia

Based on the results of research conducted by the

Basic Health Research (Riskesdas) in 2013, there

was an increase in prevalence with age, with a sharp

increase in the age group of 35-44 years compared to

the age group of 25-34 years. Prevalence in men

(0.3%) is higher than women (0.2%), higher

prevalence occurs in rural communities (0.3%), not

going to school (0.4%), self employed, farmers /

fishermen / laborers (0.3%), and the lowest and

lower middle ownership index quintiles of 0.3%

respectively. Whereas the province with the highest

prevalence was Central Sulawesi at 0.5%, followed

by Aceh, Gorontalo and North Sulawesi at 0.4%

each.

Source: Basic Health Research (Riset Kesehatan

Dasar) 2013

Figure 1: Prevalence of Chronic Kidney Failure by

Characteristics in Indonesia in 2013.

Other data was also obtained from the

Indonesian Renal Registry (IRR) in 2017. In its

report, the number of new patients continues to

increase from year to year in line with the increasing

number of HD units, new patients are patients who

first had dialysis in 2017 while active patients are all

patients both new patients in 2017 and old patients

from the previous year who are still undergoing

routine HD therapy and are still alive until

December 31, 2017. In 2017 active patients

increased sharply this shows that more patients can

undergo longer hemodialysis, apparently a factor

JKN has a role in maintaining the continuity of this

therapy (Indonesian Renal Registry, 2017, p. 8).

In the same report, referring to the age category

of patients, the highest proportion of patients was

still in the 45 to 64 years category. When seen in the

table above patients aged less than 25 years

contributed 2.64% to active patients, this shows that

it is time to pay attention to the young age group to

start paying attention to kidney health (Indonesian

Renal Registry, 2017, p. 11).

Source: 10th Report of Indonesian Renal Registry.

Figure 2: Age Distribution Chart for Hemodialysis

Patients in Percent of 2017.

This should be taken seriously, because until now

chronic kidney failure is still incurable, so it still relies

on treatment aimed at slowing the process of

developing kidney failure, reducing complications,

and controlling symptoms of the disease.

4.2 Hemodialysis Therapy as a Fluid

Replacement Treatment for Kidney

Failure Patients

As explained in the previous discussion point that

there is no medical method that can treat kidney

failure holistically (thoroughly). Therefore, if it is

not taken seriously, it will be fatal for patients

because they cannot remove metabolic waste

products and excess fluid that accumulates in the

body when they have entered the final stage of

kidney failure (capacity is only 10% to 15% of

normal kidney function) . In response to these

conditions, it is necessary to replace fluid that is

needed by the patient to survive. One form of

treatment in question is a dialysis method which is

medically better known as hemodialysis.

Practically, hemodialysis uses a dialiser

(artificial kidney) to remove excess fluid,

electrolytes, and metabolic waste products from the

blood. Blood is drawn from the patient's body

through access to blood vessels such as

arteriovenous fistulas (connections are made

between the arteries and veins in the lower arm) or a

venous catheter is inserted into the main vein in the

neck. Blood is circulated by a dialysis machine at a

speed of around 200cc / minute, passing through an

artificial kidney to filter metabolic waste products

and excess fluid. Blood that has been "cleaned" is

then returned to the patient's body. A patient may

Assessing Family Communication Patterns in Patients of Hemodialysal Therapy with the Pattern of Kidney Failure

289

require 2 to 3 times hemodialysis treatment per

week, and each treatment session will take 4 to 6

hours (Smart Patient, 2016).

4.3 Family Communication Patterns

Between Patients with

Hemodialysis Therapy and

Companions and Its Situation in

Implementing Hemodialysis

Therapy

The form of family communication applied between

one patient's family and another patient's family is

not the same. In general, there are four models of

family communication applied between therapeutic

patients (husband / wife) and their companions. The

four models are:

1. Equality Pattern, where each individual shares

the same rights in communication

opportunities. The role of each person is

carried out equally. Communication runs

honestly, openly, directly, and free from power

sharing. All people have the same rights in the

decision making process. Families get the

highest satisfaction when there is equality.

2. Balance Split Pattern, which is a pattern of

communication in which equality of relations

is maintained, but in this pattern each person

has a different area of authority than the others.

Each person is seen as an expert in a different

field. For example, in a normal / traditional

family, a husband is trusted in business or

political matters. The wife is trusted for

matters of child care and cooking. But the

division of roles based on gender is still

flexible. Conflicts that occur in families are not

seen as a threat because each individual has

their own area and their own expertise.

3. Unbalance Split Pattern, is a communication

pattern where one person dominates, one

person is considered an expert more than

another. One person is in control, this person

usually has higher intellectual intelligence,

wiser, or higher income. Other family

members compensate by submitting to the

person, allowing the dominating person to win

their own arguments and decision making.

4. Monopoly Pattern, which is a communication

pattern that is centered on one person who is

seen as the holder of power. One person is

more giving commands than communicating.

He has the full right to make decisions so

rarely or never ask or ask for opinions from

others. The power of attorney instructs others

what may and may not be done. Then other

family members ask for permission, ask for

opinions, and make decisions based on the

decisions of that person (Saputra, 2014).

Looking at diverse communication patterns like

this, of course there are also some verbal or nonverbal

behaviors that are applied both by the patient and by

the patient's family based on these patterns. The

following is a general description of the patient's

behavior in undergoing the process of hemodialysis

therapy.

Table 1: Overview of Implementation of Patient

Communication Patterns.

Focus Point Informan Implementation

The

Communication

between

Patient and

Doctor

Mr. Y

Patients tend to have an

element of openness with the

doctor, especially regarding

information on the

development of patient

hemodialysis therapy. In

addition, patients have a

stable level of emotions,

high patience and always

have positive thoughts so

that it is easy for doctors to

provide advice and

motivation to patients.

Mrs. H

Patients tend to have an

element of openness with the

doctor, especially regarding

information on the

development of patient

hemodialysis therapy. Have

a slightly more emotional

level so that it needs a little

detailed communication to

avoid miscommunication

with the doctor /. Even so,

patients have a sense of

tolerance and patience that

is good enough so that it is

easy to reduce emotions and

motivate patients regularly.

Mr. P

The patient has an

intermediate level of

emotion so a gradual

explanation of information

is needed from the doctor.

Patients are also proactive

in carrying out therapy so

they can still be able to do

their daily routine.

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Table 1: Overview of Implementation of Patient

Communication Patterns (cont.).

Focus Point Informan Implementation

The

Communication

between

Patient and

Doctor

Mr. W

Have a high level of emotion

and passive activities so that

different communication

approaches are needed and

are carried out in stages in

order to achieve an

interpretation in accordance

with patient expectations.

The

Companion’s

Attempt in

Assisting the

Patient

Mr. Y

In providing assistance to

patients, couples tend to be

faithful to accompany

patients. Couples also

communicate proactively,

both with patients, doctors,

and with other patients'

families.

Mrs. H

Companion tends to actively

accompany the patient when

doing therapy. In addition,

the companion also actively

communicates routinely to

remind and motivate

patients and be selective in

communicating to avoid

conversations that can

discourage the patient.

Mr. P

Companion has a dominant

role in providing assistance

to patients. Almost all

activities related to patient

assistance and routine

patient activities are carried

out independently by the

companion.

Mr. W

In providing assistance to

patients, the companion

tends to communicate

minimally. There are not

many activities that can be

done by the companion

when accompanying the

patient.

The

Companion’s

Skills in

Assisting The

Patient

Mr. Y

The companion carries out

a detailed scheduling to be

adjusted to the patient's

activities in the hospital.

The companion also actively

checks the patient's

condition, especially when

the patient feels

uncomfortable after doing

therapy.

Mrs. H

The companion does leave

to be able to focus on

assisting the patient during

the therapy period.

Although communication

between the companion and

patient is fairly minimal, the

companion is always there

to meet the patient's needs

especially if the patient feels

unwell due to therapy or

starts to think negatively.

Mr. P

The companion is flexible in

accompanying the patient.

In addition, no obstacles

were found between the

chaperone and the patient.

Mr. W

To be able to accompany the

patient, the companion

conducts a shift system with

his assistants. In addition,

although the interaction

between the chaperone and

the patient is fairly passive

and minimal, the chaperone

is proactive in seeking and

broadening his horizons by

talking with the doctor and

other patients' families.

4.4 Health Communication Strategies

Performed by Doctors in

Communicating the Process and

Results of the Development of

Patient Hemodialysis Therapy

As in other fields of science, communication is also

an essential part of health services, especially in

patient safety. Depending on how the health worker

- be it a doctor or nurse - communicates with the

patient, the results of that communication can

threaten the patient's safety but can also prevent the

patient from a health threat. In addition,

communication for health services is often used as a

basis to be able to provide certainty that patients get

the best treatment process, explain the purpose of

treatment and discuss the patient care process with

other professionals involved.

Basically, establishing a relationship with a

patient is very important. Doctors are always

required to be friendly, polite, and show a desire to

help patients by letting patients express what is the

problem for patients. This is done so that the doctor

is able to understand what medical obstacles are

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291

being experienced by the patient so that he is able to

make an agreement with the patient regarding the

treatment plan that will be given to the patient. In

addition, it is important to ensure that the patient

understands and agrees with the treatment plan and

offers the opportunity to ask questions, confirm a

repeat visit, and provide an emergency contact

number if something unexpected happens before the

consultation time ends. To increase understanding

between doctors and patients, active involvement of

the patient and the patient's family is needed in the

therapy process by giving an informed consent

process.

The consent process is a barometer used to

determine the extent of patient involvement in the

therapy process. Informed consent is not only

limited to giving signatures by patients and their

families, but also a process to provide opportunities

for patients and their families to consider all the

options and risks associated with patient treatment.

Viewed from the professional aspect, doctors are

also encouraged to use evidence-based medicine,

where information that contains the possibility and

failure of a treatment or therapy must be conveyed to

patients to help make decisions. Information that

must be given to patients includes:

1. Diagnosis: includes the diagnostic procedure

and results of the examination. If medical

measures are taken to make a diagnosis, the

diagnostic procedure must be explained.

2. The degree of certainty of diagnosis: Medical

science is a science that has a high degree of

uncertainty, with more symptoms appearing,

the diagnosis can change or can be more

certain.

3. Therapeutic risks: patients need to know the

side effects of therapy, complications due to

therapy or medical treatment, outcomes that

may affect the mental health of patients, the

background of the risk of therapy, the

consequences if not done therapy. Patients

also need to know the available therapeutic

options, not just the type of therapy the doctor

chooses. Patients also need to know the type

of therapy chosen, the expected results, when

therapy should be started, the duration of

therapy and the costs involved.

4. Benefits of therapy and risks if no treatment

is done: some of the treatment prognosis is

poor, so the choice not to provide therapy will

be better.

5. Estimated recovery time: the type of therapy

or medical treatment chosen may affect the

patient's life, such as work, the distance of the

place of treatment from the patient's home if

he must frequently control.

6. Name, position, qualifications, and

experience of health workers who provide

therapy and care: patients need to know

whether the health personnel who will

provide therapy or perform medical treatment

are experienced enough. If not, supervision is

needed from the senior and information about

this supervision must also be given to the

patient.

7. Availability and cost of care after discharge

from the hospital: patients may still need

treatment at home after discharge from the

hospital. Then the information on the

availability of health workers around his

home and the estimated cost of treatment to

recover must also be submitted.

5 CONCLUSIONS

Based on the results of the study found, the

researchers draw the following conclusions:

1. In creating communication interactions

between facilitators and patients in assisting,

there are four communication patterns, namely

equality communication patterns, balanced

split communication patterns, unbalanced split

communication patterns, and monopolistic

communication patterns (monopoly).

2. In relation to the husband / wife's efforts in

assisting patients, referring to the communica-

tion patterns of each informant, there are several

methods pursued by each of the assistants. This

variation in approach between assistants and

patients arises because of several factors such

as: a) division of tasks within the family, b)

gender issues, and c) the ratio of the internal

status ratio of each family member.

3. With regard to the special skills of the

companion in accompanying the patient, the

intensity of communication is a key factor in

the application of verbal interactions, both

internally (between the companion and patient)

and externally (between the patient's family

and the hospital including the doctor, nurse,

OB, and the family of fellow HD therapy

patients.

ICOH 2019 - 1st International Conference on Health

292

Referring to the conclusions that have been

concluded previously, the authors provide some

constructive suggestions as follows:

1. With regard to the many family

communication patterns that are formed from

each patient's family, it helps them try each

type of each of the existing communication

patterns so that they then compare and choose

the best communication pattern to be applied

in their respective families.

2. For each companion who wants to provide

assistance to their partners, it should be noted

that they must use consideration when and

where they must communicate based on the

portion of their duties in the family, how they

communicate based on their gender, and for

what communication is used if based on

status position in the family. In addition, to be

able to increase the intensity of

communication, the selection of the right

words needs to be considered so that the

companion can create good quality

communication in order to maintain the hearts

and minds of patients undergoing

hemodialysis therapy.

3. For doctors, especially those who work

directly in handling patient hemodialysis

therapy, it is better to inform patients and

their families of the process and results of

routine therapy. This is needed in ensuring

that patients feel prioritized so as to be able to

bring up motivation for patients to recover.

REFERENCES

Bahfiarti, T. (2016). Komunikasi Keluarga (Suatu

Pendekatan Berkelanjutan Regenerasi Anak Petani

Kakao di Provinsi Sulawesi Selatan). Makassar: Kedai

Buku Jenny.

Diyono, & Mulyanti, S. (2019). Keperawatan Medikal

Bedah: Sistem Urologi. Yogyakarta: Andi Offset.

Gangar, A. (2009). Memetakan Komunikasi Kesehatan.

Bandung: BP2Ki.

Harrington, N. G. (2015). Helath Communication: Theory,

Method, and Application. New York: Routledge.

Hayden, J. A. (2017). Introduction To Health Behaviour

Theory. Burlington: Jones and Bartlett.

Hurlock, E. B. (1997). Psikologi Perkembangan: Suatu

Pendekatan Sepanjang Rentan Kehidupan. Jakarta:

Erlangga.

Indonesian Renal Registry. (2017). 10th Report of

Indonesian Renal Registry. Retrieved from indonesian

renalregistry.or: https://www.indonesianrenalregistry.

org/data/IRR%202017%20.pdf

Junaedi, F., & Sukmono, F. G. (2018). Komunikasi

Kesehatan - Sebuah engantar Komprehensif. Jakarta:

Prenadamedia Group.

Liliweri, A. (2013). Dasar-Dasar Komunikasi Kesehatan.

Yogyakarta: Pustaka Belajar.

Miller, B. F., Keane, C. B., & O'Toole, M. (2003). Miller-

Keane Encyclopedia & Dictionary of Medicine,

Nursing, and Allied Health (7th ed.). Philadelphia:

Saunders.

Moeloek, N. F. (2018). Air Bagi Kesehatan: Upaya

Peningkatan Promotif Preventif Bagi Kesehatan Ginjal

di Indonesia. Jakarta: Menteri Kesehatan RI.

Mulyana, D. (2018). Komunikasi Kesehatan: Pemikiran

dan Penelitian. Bandung: Remaja Rosdakarya.

Nam, C. B. (2004). The Concept of Family: Demographic

and Genealogical Perspective. Sociation Today, 2.

Notoatmodjo, S. (2010). Metodologi Penelitian Kesehatan

Edisi Revisi. Jakarta: Bhineka Cipta.

Novita, M. (2019, March 13). Ini Penyebab Pasien

Penyakit Ginjal di Indonesia Meningkat. Retrieved

from Tempo: gaya.tempo.co/read/1184925/ini-penye

bab-pasien-penyakit-ginjal-di-indonesia-meningkat/

full&view=ok

Putri, D. (2016). Gambaran Health Belief Model Pada

Penderita Kanker yang Memilih dan Menjalani

Pengobatan Alternatif. Surabaya: UIN Sunan Ampel.

Rogers, E. M. (1996). The Field of Health Communication

Today: An Up-To-Date Report. Journal of Health

Communication, 15-16.

Saputra, H. (2014, May 14). Pola Komunikasi dalam

Keluarga. Retrieved from https://lumalila

research.com: https://lumalilaresearch.com/2014/05/

14/pola-komunikasi-dalam-keluarga/

Smart Patient. (2016). Gagal Ginjal Kronis. Retrieved

from ha.org.hk: https://www21.ha.org.hk/smartpatient/

EM/MediaLibraries/EM/EMMedia/Chronic-Renal-

Failure-Indonesian.pdf?ext=.pdf

WHO. (2013). Family as Centre of Health Development -

Report of A Regional Meeting. Bangkok: World

Health Organization - Regional Office of South East.

WHO. (2017). Constitution. Retrieved June 20, 2019,

from WHO: https://www.who.int/about/who-we-

are/constitution

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