The results of this study showed nutrition as the highest among all the domains under self-care management. The result implies that patients are moderately self-reliant. In study, nutritional management is defined as adhering to appropriate dietary restrictions and recommendations as prescribed by the healthcare providers. It entails following a specific diet such food items low in sodium, potassium and phosphorus, maintaining adequate protein intake, and limiting daily fluid intake. (Smith, Coston, Glock, Elasy, Wallston, Alp Ikizler, Cavanaugh, 2010). According to Balaga (2012), patients who are undergoing hemodialysis adhere to their prescribed diet because it helps them to enhance their self-esteem and self-satisfaction as a result of fulfilling adherence. His study also states that HD patients verbalize that they are being cautious about what they eat and drink since it affects their weigh between dialysis session. Further, it is generally believed that people will be compliant with regard to healthy behavior if they believe that the anticipated barriers are outweighed by the benefits (Janz et al., 2002 as cited by Yokoyama, et. al, 2009). Also, Yokoyama et al. (2009) that fluid control adherence is correlated with dialysis staff encouragement and other HBM components (such as self-efficacy, health locus of control, and psychological burden). However, patients with chronic renal failure often fail to comply with their diet therapy (Balaga, 2012). Patients undergoing hemodialysis experience food cravings especially on the foods that were restricted by their physician in which some patients completely deprive themselves of that food however some allows themselves to eat some small portions to take away their focus on that particular food. (Balaga, 2012). Also, the study of Stark, Sneetselar, Hall, et. Al (2011), suggests that due to the need to accommodate lengthy treatments and the fatigue often experienced after dialysis, HD patients often rely on higher sodium fast foods and convenience foods. In addition, compliance with fluid restriction is particularly difficult during hot periods of year, when patients have an increased thirst (Gabriel R., (1990). Lack of compliance to dietary recommendations may lead to accumulation of metabolic by products and excess fluid in the circulatory system, leading to increased morbidity and mortality for renal failure patients.(Ahrari S, Moshki M, Bahrami M, 2014).It also reduces the benefits of routine treatments, exacerbates symptoms, reduces the quality of life of the patient, as well as increasing costs to both the patient and the health system. ( Ikizler, Franch, Kalantar-Zadeh, ter Wee, Wanner, 2014; Hansen, Seifeldin, Noe, 2007 as cited by Nerbass, Corea, dos Santos, Kruger, Sczip,Vieira, Morais, 2017 ).
In this study, spirituality refers to the personal understanding of life and death, its meaning, relationship to the sacredness and practices of their belief as a way to find relief. Spirituality refers to the personal understanding of life and death, its meaning, relationship to the sacredness and practices of their belief as a way to find relief. According to Fradelos et. al , 2015, patients who suffers from chronic renal disease face problems in many aspects of their life. This includes physical as well as mental such as stress, anxiety, depression. It was also mentioned that, they exhibits an amount of spiritual needs, which relate and influence the physiological adaptation to the illness. Spirituality and religiosity plays an important role for dialysis patient (Lucchetti et. Al 2010). Having the meaning and knowing the purpose helps with the relief of anxiety and tension, spirituality also helps in overcoming fears and anxieties (Shrivastava, 2012). Furthermore, according to Nash et. Al (2009), spirituality helps in addressing individuals' understanding of illness and change. Spiritual perspectives and practices can provide a context wherein anxieties about physical and mental functioning may be faced, felt, and understood. In this study spiritual tasks are frequently done but not all the time (x=3.02). According to Ferra, 2016 , there are 9 ways to achieve spirituality enlightenment, 1.) be honest to yourself , 2.) kill your ego , 3.) forgive other people and yourself, 3.) embrace your fears, 4.) embrace your feers , 5.) meditation, 6.) prayers and pilgrimage , 7.) detach yourself from worldly things, 8.) learn yoga, and 9.) taking psychedelics. However, if a person has low spirituality, they can have a negative outcome on their health and in vice versa. . According to Jansen et. Al (2010), in comparison to healthy people, patients with chronic kidney disease face many difficulties in participating in various fields of life, such as paid work, sports and social activities, this may be due to the signs and symptoms brought about by CKD. Furthermore, According to the National Kidney Foundation, like fatigue and having less energy, trouble concentrating, poor appetite, and trouble sleeping are some of the symptoms that contribute to their decrease participation to activities which may decrease spirituality of the patients undergoing dialysis. Reason such as physical constraints due to CKD decreases the respondent’s ability to adhere to their spirituality activities like attending spiritual gatherings like going to the church or attending bible studies. Also, people diagnosed with chronic illnesses usually cannot expect to regain their health in the near future. This fact makes the illness difficult to cope with psychologically so this contributes to anger, bitterness, and the resulting loss of hope can serve as emotional pitfalls for the chronically ill (InnerWisdom , 2015).
Coping mechanism is another important dimension of overall self-management. In this study, coping mechanism is defined as coping with consequences and learning to live with effects of pathologic conditions is about accepting the chronic illness with pain, unintentional weight loss, muscle weakness, fatigue or exhaustion, low physical activity, and slow walking speed, cognitive dysfunction, and uncertain future. The results of this study shows a moderate self-relience in the domain of coping mechanism. Kidney failure has a serious impact on the lives of patients specially that they have to deal with long-term physical, psychological, and financial, stresses. (Suramanian, Quinn, Zhao, LAchance, Zee, Tentori, 2017). In view of this, CKD patients are forced to develop individual coping strategies to navigate the changes that the disease demands to them(Subramanian, Quiin, Zhao, Laurie, Lanchance, Zee, Tentori, 2017). These strategies enables them to face and get along better with the disease.(da Dilva, de Souza, de Oliveira, da Silva, Rocha, Holanda, 2015). Also, hemodialysis patients adapt coping startegies to interpret, comment and modity stressful situation and result in the suffer relief of situation.(Dehkordi, et al, 2013). However, Chronic illnesses (such as CKD) leave sufferers powerless, and decreased self-esteem which leads to inability to use normal coping resources such as physical strength and psychological stamina.(Scharloo, Kaptein, Hazes, Willems, Bergman, Roojmans, 1998). Also, decreased coping may be attributed to physical signs and symptoms brought by CKD such as fatigue, having less energy, having trouble concentrating, having trouble sleeping, having muscle cramping at night, having dry, itchy skin, and the need to urinate more often, especially at night. Failure in coping with this symptom of CKD may lead patient to view their condition as more uncontrollable and severe that may contribute on patient's deprived sense of control and non-adherence to self-management (Clarke et al., 2016).
In this study, medical management is defined as taking medicines correctly and self-monitoring of symptoms.In this study, the data gathered shows that respondents are moderately self- reliant indoinhg their medical management (X=2.66) . The costs can affect their adherence to medical management (Pascucci, Leasure, Belknap, Kodumthra). Many hemodialysis patients fails to adhere to their prescribed treatment (Morgan, 2001). However, reduced compliance due to some psychosocial factors like poverty, long periodic dialysis, family dysfunction, frequent hospitalizations and lifelong medication (Tijerina MS, 2006). The adequate cost of dialysis per month ranges from P25,000 to P46,000 or P300,000 to P552,000 annually (Danguilan 2008). Treatment for renal disease is burdensome for ordinary patients as majority cannot afford the high cost of treatment. Chronic kidney disease (CKD) patients belong to the group of subjects with one of the highest burdens of daily pill intake with up to >20 pills per day depending on the severity of their disease (Burnieret. Al ,2014).The result of the study implies that despite of the costly medical treatment, patients still adhere to medical treatment.
In this study, physical activity is difined as the ability of CKD patients to do activities of daily living. Compared to healthy people, patients with chronic kidney disease face many difficulties in participating in various fields, such as paid work, sports and social activities (Jansen L.D. et al., 2010). This has a negative impact on feelings of autonomy and self- worth and their psychological mood (Ryan, R. M. et al., 2003).The impairment of physical strength is also caused by physical pain experienced in each dialysis session and the day after dialysis (Gerogianni, 2014). In addition, According to National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), anemia occurs very common to people with chronic kidney disease( CKD) and some of the effects of anemia are body weakness and fatigue or feeling of tiredness. Another reason why people with CKD don’t always exercise is due to their lower exercise tolerance and functional capacity and more muscle wasting which means that they would need assistance to do this task (Pascucci, Leasure, Belknap, Kodumthra). People on hemodialysis require certain level of mobility and physical fitness. Emphasis of actual physical fitness of an individual in performing self-care activities is important for people with CKD. Moreover, sexual dysfunction is a frequent, common and multifactorial problem in patients with Chronic Renal failure (Barroso L.V.S. et al., 2008) which can significantly affect the quality of life of men and their partners, while they have a negative impact not only on their self-esteem but also on their interpersonal relationship (Barroso et al).