CHAPTER the case when it advances into stage

CHAPTER
I

INTRODUCTION

Background
and Rationale of the Study

Kidneys are significant
organs that facilitate numerous processes in our body. Their main function is
to remove wastes or excess fluid from the blood. However, when they operate at
only below 10–15% of their normal capacity, they tend to malfunction. This
consequently leads to the development of kidney diseases such as chronic kidney
disease (CKD) 55. Chronic kidney disease is
progressive. In the case when it advances into stage five or end stage renal
disease (ESRD), dialysis or kidney transplant is deemed necessary to survive 76. In 2013, approximately 23,000 Filipino went
through dialysis Department of Health (DOH) 72.
This is nearly four times higher than the 4,000 documented cases in 2004, or a
10-15% increase a year. In fact, CKD is the 7th leading cause of death in the Philippines
(National Kidney and Transplant Institute (NKTI)).

Typically, kidney diseases
develop without any symptoms. A person then starts to feel tired, lose
appetite, and sense irritation 14. In some
instances, swollen ankles and high blood pressure develop 14. Frequent urination might also be experienced 14. Conservative medical treatment that involves
drugs, diet, and exercise is enough in the early stages. However, when the
condition becomes unmanageable and the level of waste products turns out of
control (determined from blood test), renal replacement therapy needs to be carried
out as advised 14. This should be performed as
soon as possible, hence the need of advanced planning and proper
decision-making.

Furthermore, the compliance
of patients to treatment is vital in the whole process. Dialysis has a number
of restrictions and modifications that significantly influences various aspects
of the life of a patient; from social and economic status to professional and
psychological well-being.  For instance,
in efforts to develop defense mechanisms, a patient refuses treatment and shows
signs of psychiatric disorders and disruption of interpersonal and family
relationships (Health Science Journal, volume 8, 2014). A patient may also find
dilemma in actively participating in work, social, and leisure activities. These
negatively affect the feeling of autonomy and self-worth of the patient that
may consequently develop into depression (Health Science Journal, volume 8,
2014). It has been shown that depression is correlated to the reduced
compliance to treatment of patients (Kimmel et al. 5).
Depressed patients (20–30% of ESRD patients 5)
are found to be three times as likely to be non-compliant with treatment
recommendations as non-depressed patients (ISRN Nephrology, Volume 2013, 2013).
Moreover, depressed patients establish a new identity through becoming mindful
of the uncertain future and dependent on medication, machinery, and healthcare
providers (Gregory et al. 5 ISRN Nephrology, Volume
2013, 2013). Therefore, the family should play the key role in
alleviating the burden of the patient. This could be through attending to the
meals and medication of the patient, to providing moral and financial support.

Statement
of the Research Problem

                    This study aims to describe the life experiences
of ESRD patients undergoing dialysis in Aklan. The influences of the treatment
process to the physical, social, emotional, and spiritual aspects of life of
the patients are looked into. Specifically, it seeks to answer the following
questions:

What
experiences have the ESRD patients encountered?How
did the diagnosis affect their psychological behavior?How
did they manage the whole treatment process?  

Description
of Research Tradition in Phenomenon of Interest

            Descriptive phenomenological approach is utilized as the
research tradition. Such method is used to describe a particular phenomenon or
the occurrence of things, as a lived experience 31.
Its objective is to directly investigate and describe a phenomenon as
consciously experienced, without theories about their causal explanations or
objective reality (Van Manen
M.,1990).
Furthermore, it intensifies perception on lived experiences while laying
emphasis on the breadth, depth, and richness of those experiences (spiegelberg, 1975, p.70).

            The approach involves a three-step process: (1)
intuiting, (2) analyzing, (3) describing (Streubert and
Carpenter,2010). Intuiting requires the researcher to be completely
immersed in the phenomenon under examination. At this point, information about
the phenomenon (as described by the participants) are beginning to be
recognized. Evaluation, criticism, and opinion are avoided so as to have a
focus on the phenomenon being described (Spiegelberg,
1965,1975). (Streubert and Carpenter,2010). In analyzing, the essence of the phenomenon begins to emerge based
on the data collected (Spiegelberg, 1965,1975). Attention
is given to the data and how they are presented to ensure an accurate
description (Streubert and Carpenter,2010). In
the final step, describing, critical elements of
the phenomenon are communicated and brought to written and verbal descriptions (Spiegelberg, 1965,1975). It includes the classification
of common critical elements on the lived experiences and describing them in
detail (Streubert and Carpenter,2010).
Additionally, bracketing (setting aside of own perceptions of the researcher
regarding the phenomenon) is employed to maintain impartiality (Streubert and Carpenter,2010).

Philosophical
Underpinnings of Philosophical Frame of Interest

During the 1950s, an
American psychologist named Julian B. Rotter formulated the social learning
theory, which he used to explain motive and behavior. Rotter believed, as most
social learning theorists do, that if there is an observed link between behaviors
and reinforcers, then behaviors are affected by the reinforcers 15. If there seems to be no connection, there would
be less predictable reactions to reinforcers (and learning is not as likely to happen).
This belief on the dependency of outcome towards behavior is referred to as
locus of control 15. Locus of control regards
the tendency of people to think that control resides internally within them
(outcomes are a product of personal characteristics and behaviors) or externally,
with others or the situation (outcomes are governed by luck, chance, or fate) 15. That is, people with high internal locus
become more confident when they are able to change things and situations so as
to achieve their own success. Then again, in taking responsibility, they have
to accept blame for failures as well. On the other hand, people with high
external locus think that others have power over them and they can do nothing
about it. They lean towards becoming fatalistic, yet passive and accepting 15. Success is ascribed to fate rather than effort. They
hesitate to actively participate in activities, believing that they cannot deliver.
Therefore, locus of control has profound significance as it strongly influences
how people behave.

Significance
of the Study

Patients with ESRD
undergoing dialysis are mostly confronted with different difficulties that can
affect their way of life and functioning. This study may benefit the following:

            Persons with ESRD
undergoing dialysis. This study may be used as a basis for them to explore,
cope, and identify negative and positive emotions based on their experiences.

            Family and Support Group. This may help the family or
support group of ESRD patients undergoing dialysis to deeply understand the
experiences of the patients. In that way, they could provide sufficient and
proper emotional, psychological, medical, and financial support to the patient.

            Health Care Providers. The study may help the
health care providers understand the experiences of the ESRD patients
undergoing dialysis. This may serve as a guide for them on how to take care of
the patients.

            Future Researchers. Future researchers may use
this study as a reference to conduct extensive studies about ESRD and explore
other issues concerning the disease.

Scope
and Limitations of the Study

            The participants in this study are ESRD patients
undergoing dialysis in Aklan, ages 18 years old and above. This study focuses
on exploring the experiences of persons with ESRD undergoing dialysis. The data
are gathered through a face-to-face interview by documenting their narrative
statements through recording.