Lived Experiences and Coping Strategies of Patients with Renal Failure - Essay Example

Lived Experiences LIVED EXPERIENCES AND COPING STRATEGIES OF PATIENTS WITH RENAL FAILURE Introduction The road ahead of people experiencing serious illness is not straight nor smooth. At times, they may feel like simply quitting. On the other hand, restoring health is like a "moving forward process", in which the patients as well as their family may need to go through an emotional period. These experiences are often noted observed by people who suffered from some chronic illnesses such as diabetes, various type of cancer, arthritis and renal failure. An individual's diet, lifestyle and habits may contribute to acquiring various diseases. Countless studies have linked diet, lifestyle and habits to several forms of kidney Disease. Diet has been a strong linked to development of common adult ailments (Health and Home, 2002). According to International Federations of Kidney Foundations and International Society of Nephrology (Sun-Star, 2007), one (1) of every (10) adult may possibly suffer from renal disease. In United States, Chronic Kidney Disease prevalence has been continuously rising over the past years; researchers at John Hopkins Bloomberg School of Public Health (2008) say. In their investigation, it was explored in the overall prevalence of Chronic Kidney Disease (CKD), there have been around 10% increase of population suffering it during 1988-1994; while 13% during 1999-2004. Similarly, Chronic Kidney Disease is a common condition encompassing problems such as abnormal kidney function or structure, with an estimated 3.4 million Lived Experiences 2 people in the UK having moderate or severe CKD. Most individuals with this condition does not experience any symptoms and therefore may be unaware that they have it, but there are simple tests which can detect the condition. If CKD remains undetected, it can progress to established kidney failure requiring dialysis or transplantation, very poor health and in some cases early death (CDC, 2009). Aims This study aims to document the live experiences of patients who are suffering from renal failure, at the same time, design a health care plan for the patients. By doing so, the appropriate care of the health care team will be improved in such a way that it could assist patients and their loved ones recognize as well as cope with the challenges they confront in combating kidney failure. With positive outlook, determination and education, health care team will hopefully be one with the patient and family. Review of Related Literature Presented in this section are the various readings and findings of different authors in order to provide necessary background and framework of the study, most especially on methodology . According to the American family physician that chronic kidney disease are the major health problem that are increasingly throughout the world. In which this problem could lead to heart diseases if not treated earlier and because a lot of people don't know the real definition of kidney problem and do not enough facilities in the Lived Experiences 3 detection and evaluation of the disease (Johnson, et.al., 2004). Sometimes people are unaware that their kidneys are not functioning properly. This is because kidneys are very adaptable. Even when most of a kidney is not working the remaining portion will increase its activity to compensate for the loss, (Gerry, 2006). Some cases of renal disease has no symptoms which can lead to chronic complication or serious health problem; although there are guidelines for early identification of the disease that will help people save their lives in a way of early detection. The guidelines tend to offer some simple test for CKD if they have risk factors like diabetes mellitus, high blood pressure, cardiovascular disease, and a family history of kidney failure (NICE, 2008). Data from the United States Renal Data System (USRDS) indicated that there has been an increase of 104% in the prevalence of chronic renal failure (CRF) between the years 1990-2001. There is an even higher prevalence of the earlier stages of chronic kidney disease. There are over 250,000 Americans affected with Chronic Renal Failure annually, it may be caused by a number of diseases and inherited disorders (Edinburgh, 2006). Also, the Third National Health and Examination Survey (NHANES III) estimated that the prevalence of chronic kidney disease in adults in the United States was 11% (19.2 million): 3.3% (5.9 million) had stage 1, 3% (5.3 million) had stage 2, 4.3% (7.6 million) had stage 3, 0.2% (400,000) had stage 4, and 0.2% (300,000) had stage 5. Furthermore, the prevalence of chronic kidney disease stages 1-4 increased from 10% in 1988-1994 to 13.1% in 1999-2004, (Arora, 2008). Lived Experiences 4 The lived experiences of patients suffering from renal disease could be inconvenient and this fact may raise interest to potential nurse researchers. Any nurse researcher may find their journey interesting and the rest of the community will certainly learn from the life struggles starting from the onset of the illness until the progress. In investigating patients illness there several approaches in nursing. In fact, during the last three (3) decades, several theories have been developed and enhanced in many practical activities, that includes nursing. The reason for the said development is that, research and theories are very essential components in a professional education that aims to improve the science of nursing so that he nursing practice (Benner, 1994) can be enhanced. Qualitative and Quantitative methods are two (2) fundamental methods may be used by health researchers. Along with considerations of the research method and approaches to use, the possible research questions for the chosen topic are: 1. What is the lived experience for people who are diagnosed with renal failure; 2. What coping strategies are used by renal failure patients and their families And 3. How can the care provided to renal failure patients be improved Th above mentioned sub-questions may be correlated with the patients' lifestyle choices, such as good nutrition and adequate physical activity, lead to good health and help to maintain a healthy weight and reduced the risk of having such problem like dietary intervention which is necessary with deterioration of renal function; and includes careful regulation of protein intake, fluid intake to balance fluid losses, sodium intake to balance sodium losses, and some restriction to potassium. Lived Experiences 5 Also, adequate caloric intake and vitamin supplementation must be ensured. Protein is restricted because urea, uric acid and organic acids the breakdown products of dietary and tissue proteins accumulate rapidly in the blood when there is impaired renal clearance. The allowed protein must be of high biologic value (dairy products, egg, meats). High biologic value proteins may be measured as well particularly with those foods taken by patients that are complete proteins and supply the essential amino acids necessary for growth and cell repair (Bernhard, 2001). If nurses are interested to explore patients' with renal failure conditions, they may employ the qualitative research approach. In this topic, the use of qualitative research may be decided. Descriptive research as defined by Best (1970), is concerned with: relationships or conditions that exist; prevailing practices; points of views, beliefs, and attitudes which are held; processes which are going on; effects that are felt; or the developing trends. At times, descriptive research may be concerned about how, what it is or what presently exists and is related to some proceeding phenomenon that has influenced or may have affected a present condition or event. The research may be reinforced by using exploratory informal interview method to arrive on the data that are necessary for the study. Typically, combination in research scores a move away on or after seeing human subjects as merely manipulable and information as somehow peripheral to individuals, and towards concerning knowledge as generated involving humans, often all the way through conversations (Kvale, 1996:11). Interview, an exchange of views between two Lived Experiences 6 or other people on an issue of mutual interest and emphasizes the social positions of research data. It is not completely either subjective or objective, but it is inter subjective. It enable participants - whether interviewers or interviewees, to share their interpretations of the kind of world that they live, and to articulate how they regard circumstances from their own positions (Cohen, Manion and Morrison, 2000). As mentioned, both methods above can be combined (Oppenheim, 1992:65), it may potentially seeks to cover emotionally loaded topics and would require skill on the side of the interviewer who will handle the interview situation, enabling participants to talk freely and emotionally. Richness, depth, honesty and authenticity, about their Experiences will be then be relayed. The interview finds qualitative knowledge shared in normal language and not aiming on quantification. Qualitative research involves the study of phenomenon from various aspects and from various viewpoints. According to Asperas (2002), this method involved the nature of prevailing condition, personal situational environment and intellectual factors and practices, which enabled the researchers to seek accurate information. It was in this light the method can be used. Furthermore, Seaman (1987) emphasized that a qualitative design fundamentally measures the size, magnitude, or extent of certain phenomenon. It may also use statistics to count, measure as well as analyze the data. Holloway (2002) added that qualitative design is accurate if and when it is the researcher's plan to describe, observe, discover, compare and analyze data. Qualitative paradigm also allows the use of various approaches such as phenomenology, grounded theory, Lived Experiences 7 action research, historical methods, collaborative evaluation research, feminist critical approaches, basic interpretations, ethnography, narrative analysis, postmodern and the post culture studies, case studies and other form of critical and additional approaches. Parse, Coyne and Smith (1985) underscored that qualitative research is employed to determine as well as to describe further the characteristics and the relevance of human experiences by the participants and at different levels of abstraction, is interpreted by the researcher. It becomes a more human approach due to the fact that it considered people not as an object but as a subject. It considered people's stories as valuable because they tell of inner journeys, processes that point to the unfolding of levels of reality seen in their connectedness. In this way, it is more holistic and not a fragmented approach. Phenomenology is a research that investigates people's life experiences and how they interpret those experiences. (Asperas, 2002) Note that the first research question mentioned earlier can be treated using phenomenological approach. Phenomenological nursing research can be described as "the exploration as well as the description of the meaning of certain part of an individual's health illness experience". Added to this, it focuses on the person's subjective experience in order to understand human life; and it does not merely focus on the objective nature of things (Donalek, 2004). Furthermore, as cited by Speziale and Carpenter (2007), phenomenology is explained by Herbert Spiegelberg as one "movement rather than a uniform method". He further elaborated that it primary objective is to direct investigation as well as description of phenomena based on Lived Experiences 8 conscious experience, in the absence of theories on causal explanation; free as possible from preconceptions that are unexamined and presuppositions (p.76-77). The second research question will require the grounded theory method to arrive at accurate results. Grounded theory is another form of qualitative method that is used to discover the social process which exists surrounding human interactions. Speziale and Carpenter (2007) states that grounded theory was introduced initially by Glaser and Strauss and can also be read in their book entitled "The Discovery of Grounded Theory", published in 1967. This theory, like any other qualitative methods, guides nurses to present, collect, collate, organize and analyze data from the nursing body of knowledge and nursing practice (Chenitz & Swanson, 1986). Perhaps the most relevant sub-question which is the question three (3) of the problem statement will require a design of a health care plan (action plan) that may be solicited from the ideas of health care administrators, health care practitioners and patients' family; so that would turn out to be a collaborative or consultative type. According to Tetley and Hanson (2001), an action research is known by several related terms including action inquiry, participatory action research, cooperative inquiry, collaborative research, community-based action research, and participative inquiry. There are three (3) types of action research. First is the technical collaboration, second type is mutual collaboration, and third type is enhancement research. Action research aims to improve or enhance all dimensions of nursing practice and Lived Experiences 9 education. Furthermore, it provides the researcher a direct access to specific area of investigation that enables the researcher stronger as far as the depth of the research is concerned (Speziale, & Carpenter, 2007). Remember that an action research is participatory, which means it gives all nursing researchers the opportunity to work openly and cooperate with their patients so that they will find out the difference in their lives, experiences, and ways to improve it. The analysis of data in qualitative research may start by immediate debriefing after each participant with the respective families, with the observer and debriefing notes will be made. Debriefing notes included comments about the focus group process and the significance of data. Listening to the tape and transcribing the content of the tape should be made. Checking the content of the tape with the observer noting and considering any non-verbal behavior. The benefit of transcription and checking the contents with the observer was in picking up the following: a. Parts of words, b. Non-verbal communication, gestures and behavior. The researcher normally facilitate the participants. The observer will be a public health graduate will attend all conversations and will help the researcher by taking notes and observing participant' on non-verbal behavior during the sessions. Observer will not be known to respondents and researchers (Asperas, 2002). These procedures in a qualitative study can be employed to code and categorize data will be adapted from approaches and means to qualitative content analysis. For coding the transcript it will be as important to go through the terms or Lived Experiences 10 transcripts line by line; and paragraph by paragraph, looking for important statements and codes based on the topics which will be addressed. The researcher will then compare the various codes based on the differences and similarities; and will sort them into categories. Finally the categories will be formulated into themes. REFERENCES Asperas,C.M., (2002) Basic Nursing Research: Trends, Methods, and Application Baker, N., & Seager, R. (1991). A comparison of psychological needs of hospice patients with AIDS. Hospice Journal , 7 (1/2), 61-69. Barbara, C et.al. (2005) Contemporary Nursing. Issues, Trends, and Management. 3rd edition.Elsver Mosby. Benner, P. (1994). Interpretive Phenomenology. Thousand Oaks, London, New Delhi: Sage Publications. Bleck, J.M & Hawk, J.H., (2004). Medical-surgical Nursing, Clinical Managements for positive outcomes. 7th ed. Vol.1, 961-963, by Elsevier Saunders. Curtin, R.B., & Mapes, D.L.(2001). Health Care Management Strategies of long-term dialysis survivor. Nephrology Nursing Journals, 28,385-394. Gennari, F.J., (2001). Medical Management of Kidney & Electrolytes Disorders. 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