Coping Mechanism in Hemodialysis Patients at Dr. Zainoel Abidin

Regional Public Hospital Banda Aceh: Study in Moeslim Community

Bebby Balqis, Maimun Syukri, Dedy Syahrizal

Faculty of Medicine, Universitas Syiah Kuala, Aceh, Indonesia

Keywords: Chronic Kidney Disease/CKD, Coping Mechanism, Hemodialysis.

Abstract: The Patients with chronic kidney disease are required to undergo hemodialysis for their life survival. This

situation is a stressor experienced in the long term. The ability of the patient in dealing with stressors uses

different coping mechanisms. Coping mechanism in patients with chronic kidney disease consists of

Problem Focused Coping, Emotion Focused Coping and Disfuntional Coping. The aspect of religiosityis

one that influences the coping mechanism of patients who undergoing hemodialysis. This aspect of

religiosity also include as a part of Emotion Focused Coping mechanism. The aim of this study was to

analyze the coping mechanism in Moeslem hemodialysis patients in dr. Zainoel Abidin Banda Aceh.

Methods: A total of 46 participants were the Moslem patients which is diagnosed with chronic kidney

disease who undergoes hemodialysis in Dialysis Installation RSUD dr. Zainoel Abidin Banda Aceh since

September-October 2017 formed a convenient sample for this descriptive, cross-sectional hospital-based

study. The Coping Mechanism of patiens were measured using The Carver Brief Cope questionnaire. This

research uses univariates analysis to know the frequency distribution of each variable. Results: Based on the

datas found that all of the Moslem patients under going hemodialysis mostly use Emotion Focused Coping

(abaout71,7%) as Coping mechanism than Problem Focused Coping (about 28,3%) and no patients using

Disfungtional Coping to overcome their problems. Conclusion: This study revealed significant findings

regarding the importance of religiosity as coping mechanism in Moeslem hemodialysis patients. All

Moslem patients under going hemodialysis were not found using disfunctional coping to overcome their

problems. Therefore, it has been highly recommended to integrate religiosity into the health-care process for

such patients to facilitate the achievement of overall optimum health levels.

1 INTRODUCTION

Patients with chronic kidney disease (CKD) will

undergo some therapies. There are hemodialysis,

renal transplantation and Continous Ambulatory

Peritoneal Dialysis (CAPD). One of the supportive

therapy that becomes a must for people with CKD is

hemodialysis. Long-term hemodialysis process is

becoming a stressor for patients with CKD. Based

on the fact, patients with CKD need the proper

coping mechanism for facing their stressor.

It will affect the psychological, quality of life

and cause some problems in the personal life of the

patient. The Problems are not only in physical and

social, but also in psychological aspect that makes

the patient feel depressed with the disease. The

psychological pressure of the patient will be a

problem if they does not have a good coping

mechanism.

Coping mechanism of patients with CKD is one

of the things that must be considered. Based on the

research, most of the patients who takes

hemodialysis and Continous Ambulatory Peritoneal

Dialysis (CAPD) in the diagnosis of psychiatric

disorders. Patients with hemodialysis tend to have

severe psychological distress due to the length of

time of undergoing hemodialysis, the high cost of

hemodialysis, and the fear of death. It cause a higher

use of dysfunctional coping mechanism in HD

patients than CAPD patients. Dysfunctional coping

mechanism is a non-problem-oriented mechanism

that tends to cause distress conditions for patients

with hemodialysis (Baykan et al, 2012). This is

reinforced by the other study which states that

almost all of the patients with HD have severe

psychological distress and the others use coping

mechanism with emotional focused and problems

focused(Shinde et al, 2014).Another study also

Balqis, B., Syukri, M. and Syahrizal, D.

Coping Mechanism in Hemodialysis Patients at Dr. Zainoel Abidin Regional Public Hospital Banda Aceh: Study in Moeslim Community.

DOI: 10.5220/0009447302490253

In Proceedings of the 1st International Conference on Psychology (ICPsy 2019), pages 249-253

ISBN: 978-989-758-448-0

 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reser ved

249

states patients with CKD mostly use the coping

strategies that convert to a religious, active coping,

and coping that focuses on the emphasis of

activity(Cinar et al, 2009 ;Kohlsdorf et al, 2015).

Religiosity is thought to affect the coping

mechanism of a patient. The factors of religiosity

consist of social aspects, experiences, needs and

thoughts that will affect the coping mechanism. The

level of religiosity can help the patient controls the

emotion that affect physical and mental health. The

degree of religiosity has an important effect on

medical decision-making related to successful

coping, faster recovery and higher quality of life.

Many patients may expect help with the giving of

meaning, hope and overcoming fear(Taheri-

kharameh, 2016).

Based on the studies and the facts above, it is

concluded that coping mechanism greatly affect the

mechanism of CKD patients who takes hemodialysis

to face their problems nevertheless the research that

explain about the relation of Coping Mechanism in

CKD patients has not been done before. Therefore,

we tried to make a research on Moslem patients who

take hemodialysis in Zainoel Abidin Hospital, Banda

Aceh.

2 LITERATURE REVIEW

This is an analytic observational research with cross-

sectional design, done in Dialysis Installation of

Zainoel Abidin Hospital, Banda Aceh on Sept-Oct

2017. The population of this research was Moslem

patients who undergoes hemodialysis in Dialysis

Installation of Zainoel Abidin Hospital, Banda Aceh.

It was taken in quota sampling determined by the

lameshow’s formula and included in the inclusion

criteria. Patients with loss of counciousness, stroke,

and Alzheimer’s were excluded in this study. It used

primary data and secondary data. The primary data

were obtained by interviewing CKD patients who

undergo hemodialysis with a coping questionnaire,

named Carver brief Cope Scale which the scales are

divided into (1) Problem Focused Coping (PFC);

active coping, planning, suppression of competing

activities, restraint coping, seeking social support for

instrumental reasons, (2) Emotion Focused Coping

(EFC); seeking social support for emosional reasons,

positive reinterpretation, acceptance, denial, turning

to religion (aspect of religiosity); and (3)

Disfunctional Coping (DC); focus on & venting of

emosions, behavioral disengagement, mental

disengagement, alcohol drug disengagement.

Questionnaire-guided 15–20-minute interviews were

conducted during the respondents HD unit scheduled

visits. The respondents were asked to respond based

on their best understanding of the question and

based on their experience. The interviewers will

filled in the patients’ responses in the questionnaire

as they interviewed them. The secondary data were

collected from Dialysis Installation’s medical record

to describe the demografic characteristic of

respondens (age, sex, duration of hemodialysis,

education). The data were analyzed using the SPSS

version 21. The respondents’ demographic

characteristics, and the coping mechanism

questionnaire result were analyzed using descriptive

statisticsto know the frequency distribution of each

variable.

3 RESEARCH METHOD

During this research it is found 46 respondents by

the characteristics as follows.

Table 1: Demographic Characteristic of Respondent.

Demografic characteristic n (46) %

Age

>60 years old 8 19,6

50-59 years old 16 34,8

40-49 years old 13 28,3

<40 years old 9 17,4

Sex

Man 31 67,4

Woman 15 32,6

Duration of Hemodialysis

>24 months 19 26,1

12-24 months 15 32,6

<12 months 12 41,3

Education

High 10 26,1

Moderate 24 52,2

Low 12 21,7

n: samples, %: persentage of total samples

Table 1 shown that the majority of CKD patients

undergoing hemodialysis were mostly aged 50-59

years (34.8%). According to sex,the number of men

is more than women with a percentage of men

67.4% and women 32.6%. The data also shows that

the respondents in this study mostly underwent

hemodialysis for more than 24 months (41.3%).

ICPsy 2019 - International Conference on Psychology

250

Moderate education is found to be the highest

number of respondent’s educational status who

underwent hemodyaylis.

Table 2: Distribution of Coping Mechanism Due to Carver

Brief Cope Scale

Coping Mechanism n (46) %

Problem Focused Co

13 28,3

Emotion Focused Co

33 71,7

Disfunctional Coping 0 0

Table 2 shown that the majority of CKD patients

who get hemodialysis mostly use a mechanism that

focuses on emotion (Emotion Focused Coping)

which were used by 33 patients (71,7%) , 13 patients

used Problem Focused Coping (28,3%), and none of

the patients use disfunctional coping to solve their

problems individually.

Table 3: The Classification of Coping Mechanisms

(Carver Brief Cope Scale).

Coping mechanism n (46) %

Problem

Focused

Coping

Active co

5 10,8

Plannin

3 6,5

Suppression of

com

etin

activities

- -

Restraint co

- -

Seeking social

support for

instrumental reasons

5 10,8

Emotion

Focused

Coping

Seeking social

support for

emosional reasons

8 17,3

Positive

reinter

retation

- -

Acce

tance 9 19,5

Turning to religion 15 32,6

Denial 1 2,1

Disfunctio

nal Coping

Focus on & venting

of emosions

- -

Behavioral

disen

ement

- -

Mental

disengagement

- -

Alkohol drug

disengagement

- -

Table 3 shown that among Emotion Focused

Coping methode, the majority of coping mechanism

that patient use is turning to religion, as much as 15

patients (32,6%). Problem Focused Coping on

majority of CKD patients who get hemodialysis

using active coping mechanism is as much as 5

patients (10,8%).And none of patients are found

using Disfunctional Coping.

4 DISCUSSION

This study found that all patients undergoing

hemodialysis using coping problems, Problem

Focused Coping (PFC) and Emotion Focused

Coping (EFC) which all patients undergoing

hemodialysis were able to control emotions well and

there were no patients using dysfunctional coping

(DC). If we see further methode of coping

mechanism so it is found that patients who use PFC

are divided into active coping about 5 patients

(10.8%), planning about 3 patients (6.5), suppression

of competing activities, restraint coping, seeking

social support instrumental reasons about 5 patients

(10.8%). Actually, most of the patients use active

coping to solve their problems. The patients who use

EFC coping mechanism were divided into seeking

social support for emotional reasons about 8 patients

(17.3%), positive reinterpretation acceptance about 9

patients (19.5%), denial only 1 patient (2,1%), and

the mostly use methode is turning to religion about

15 patients (32.6%) to solve the problems. Most

EFC patients are using a coping condition that

returns to religion (aspect of religiosity).

This is accordance with a research that was

conduct, reporting religiosity may help reducing

emotional pressure. Patel et al found that religion

may function as a treatment overcoming CKD

patients to improve the quality of their health. Such

relationships have been used in studies involving

HD patients. The current research results show that

religiosity, particularly religious handling and

organized religiosity, have important roles in life

quality and health status on HD patients. Religiosity

organizations are included in other services and

socializations. These may treat disease and improve

health quality (Saffari et al, 2013).

Many studies have found the role of spirituality

and religiosity in the health of patients with chronic

diseases. In the world, Muslims organize almost a

quarter of the population. The relationship between

religion and health can be very different in Muslim

countries compared to non-Muslim countries.

Several studies among patients with non-Muslim

religions have not found a significant relationship

between religion and health(Valcanti et al, 2012).

Patients who use coping strategies that turn to

religion as their goal to conquer problems that they

face. Coping strategy is a process that is not realized,

meaning someone lives everyday life by facing

Coping Mechanism in Hemodialysis Patients at Dr. Zainoel Abidin Regional Public Hospital Banda Aceh: Study in Moeslim Community

251

problems. However, patients have different traits

regarding to the problems and are not all the same.

Spirituality is claimed as important source in

overcoming chronic diseases. Spirituality enhances a

patient's ability to be out of illness and shorten

medication period. In the several study showed that

the patients’ quality of life are increased by using

spiritual and religious handling strategies.

Emphasizes that religion and spirituality provide a

powerful coping strategy to deal with stress in

patients with CKD (Valcanti et al, 2012, Saffari et

al, 2013, Taheri-kharameh, 2016).

Religious copingrefers to how a patient makes

use of his or her system of religious beliefs and

practices to understand and adapt to stress.

Patientswho use religion to cope with their illness

most often rely on positive religious coping, which

is characterized by a constructive reliance on faith to

promote healthy adaptation (e.g., through “seeking

God's loveand care”). (Susana et al, 2012)

Regardless there are facts related to the

effectiveness and usefulness of spirituality in the

process of patients’ responsibility, religious and

spiritual issues are not regarded as a major

component of current medication care. According to

the holistic model, the biological, psychological,

social, and spiritual dimensions and visual care must

address them all. Therefore, CKD patients should

not only adapt with illness and treatment, but also to

many physiological, psychosocial and spiritual

problems. In this context, many people adhere to

faith and religion as a way to find and help for their

problems(Mutoharoh, 2009; Shinde et al, 2014).

Religion and spirituality are deepening in health

care, as it can be used as a way to discover the

meaning of life, make hope and reconcile in the

middle, describe the weight of such a chronic illness.

The experts who conducted the study said the effects

of spirituality and religion in the field of health have

shown a positive relationship between various

aspects of physical and mental health, as well as

these things can help in supporting the patients, and

also in this case, either spirituality and religion can

be understood as an important disease prevention

strategy. Thus, the five main functions of religion

can be identified: seeking the meaning, controlling,

spiritual comfort, intimacy with God and with others

and the quest for life changes. Based on these five

basic functions, religious methods or strategies can

be identified. It is important for health workers to be

continuously on the patient’s side, to control the

meaning of spirituality and religion for them and

how significant events such as CKD can affect the

way they deal with the problem, so that this

phenomenon can occur(Valcanti et al, 2012, Saffari

et al, 2013, Taheri-kharameh, 2016).

Thus, religious/spiritual control methods can be a

significant supporting factor in dealing with CKD

patients and hemodialysis so that it can be an

important factor in the patient's spiritual assessment

and at the same time effective to help them using the

available resources.

5 CONCLUSION

The results show that the level of spirituality in

patients with CKD is very influential on their

healing therapy.This study revealed significant

findings regarding the importance of religiosity as

coping mechanism in Moeslem hemodialysis

patients.All Moslem patients undergoing

hemodialysis were not found using disfunctional

coping to overcome their problems.It is because of

the patients in RSUD dr. ZainoelAbidin are

moslems, and mostly they use coping mechanism

which returns to religious teaching to solve their

problems.Therefore, it has been highly

recommended to integrate religiosity into the health-

care process for such patients to facilitate the

achievement of overall optimum health levels.

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