Chapter 1

THE PROBLEM AND ITS SCOPE

Introduction

Satisfaction from services is what every person wanted, knowing it is

vital for those who rendered services, like health care providers. Institutions

like hospitals, needed to know the satisfaction of their patient in order to meet

the patients needs. Hemodialysis unit, which treat patient with renal problems,

are just few of those patients who are in the hospital receiving care from

doctors, nurses, and other health care providers. Dealing with their level of

satisfaction towards the services they are receiving may aid in meeting their

needs, as well as, it may help the institution to render quality health care.

About 1.2 million Filipinos today are suffering from kidney diseases,

requiring either dialysis or a kidney transplant for them to live (Council for

Health and Health Development, 2009). According to the Department of

Health, Kidney disease is now one of the top ten cause of death among

Filipinos wherein 7,000 die annually due to kidney failure.

Kidney or renal failure has two types, the acute and chronic. Acute

renal failure (ARF) is worsening of renal function over hours to days, resulting
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in the retention of nitrogenous waste (such as urea nitrogen) and creatinine in

the blood (Mcphee, et. al. 2008). Acute Renal Failure loss fifty percent (50%)

of functioning nephron lasting for (2-4) weeks in less than three months. It can

return to its renal function with supportive care, and high in mortality in some

situations (Ignatavicius and Workman, 2006). Chronic renal failure (CRF) on

the other hand, is the result from abnormal loss of renal function over months

to years. According to Ignatavicius and Workman ( 2006) Chronic Renal

Failure has ninety-to-ninety five percent (90-95%) damaged nephrons, lasting

through the patients life; and fatal without a renal replacement therapy, such

as dialysis or kidney transplantation.

Injury, shock, exposure to toxins, infections, and other renal disorders

may cause damage to the nephrons, resulting in ARF (Cohen,2007). Causes

of CRF on the contrast involve primarily of diabetes and hypertension,

accounting for two-thirds of cases. In the Philippines, diabetes accounts for

forty one percent (41%), inflammation of the kidney is twenty four percent

(24%), and about twenty two percent for hypertension (Council for Health and

Development, 2009)

Treatment for renal failure, like hemodialysis, is very expensive and

draining to the pocket of the patient. In 2007, only seventy three percent

(73%) of the Filipino patient with renal failure were able to afford necessary
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treatment (Council for health and development, 2009).

The common complications during hemodialysis includes: hypotension,

cramps, nausea and vomiting, headache, chest pain, back pain, itching, and

fever and chills . Renal failure requires careful monitoring of the patient status

and administering medication (Daugridas, et. al. 2007).

In this study, the nursing and medical care, as well as the physical

structure of the hemodialysis unit of Mindanao Sanitarium Hospital (MSH) will

be evaluate using a questionnaire distributed to 30 patients in order to gather

the needed data that may help to reach for the concerns or their satisfaction.
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Theoretical Framework

This study is anchored on Roy’s Adaptation Model which is defined as

''the process and outcome whereby the thinking and feeling person uses

conscious awareness and choice to create human and environmental

integration''. This model focuses on the individual as a biopsychosocial

adaptive system that employs a feedback cycle of input (stimuli), throughput

(control processes), and output (behaviors or adaptive responses). Both the

individual and the environment are sources of stimuli that require modification

to promote adaptation, an ongoing purposive response. Adaptive responses

contribute to health, which she defines as the process of being and becoming

integrated; ineffective or maladaptive responses do not contribute to health.

Each person's adaptation level is unique and constantly changing (Daugridas,

et. al. 2007).

In the study, this model is focused on the patients output or responses

to the input and throughput, which represents the nursing and medical care

involved during hemodialysis, and the physical structure of the hemodialysis

unit (Council for health and development, 2009).

Another theory that supports the study is Neuman, its main focus is on

the interaction of the parts, subsystems within the system particularly views

individual as an open system, based on the individual's relationship to stress,

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the reaction to it, and reconstitution factors. In the study, this theory centers to

evaluate the responses or the effects of the nursing and medical care, and

the physical structure to the level of satisfaction among patients who undergo

hemodialysis (Council for health and development, 2009).

Hall proposed that nursing functions differ, using three interlocking

circles to present aspects of the patient. She labeled the circles as the body

(the care), the disease (the cure), and the person ( the core). She also believe

that professional nursing care hastened recovery and that as less medical

care was needed, more professional nursing care and teaching were

necessary (Council for health and development, 2009).

Hall's theory will be reflected in this study as the relationship of the

nursing and medical care, and physical structure of the hemodialysis unit to

the level of health or satisfaction of the patient (Council for health and

development, 2009).
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Conceptual Framework

Figure 1 shows the interplay between the independent and dependent

variables. The independent variables include the respondent's age, gender,

educational attainment, and family monthly income. The dependent variables

pertain to the respondent's level of satisfaction in terms of nursing care,

medical care, and physical structure of the hemodialysis unit.

Independent Variables Dependent Variables

Age Level of Satisfaction:

Gender • Nursing Care

Educational • Medical Care

Attainment
• Physical
Family Monthly Structure
Income

Type of Renal
Failure

Figure 1

Schematic Diagram of the Study Showing the Relationship between the

Independent and Dependent Variables

Statement of the Problem

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This study aimed to evaluate the level of satisfaction of hemodialysis

patients on the quality of care at Mindanao Sanitarium and Hospital.

Specifically, this study sought answers to the following questions:

1. What is the demographic profile of the respondents in terms of:

1.1 Age;

1.2 Gender;

1.3 Educational Attainment; and

1.4 Family Monthly Income?

2. What is the level of satisfaction of the respondents in terms of:

2.1 Nursing Care;

2.2 Medical Care; and

2.3 Physical Structure?

3. Is there a significant relationship between the level of satisfaction on the

quality of care when grouped according to profile?

HYPOTHESES
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The null hypothesis was tested at 0.05 level of significance.

Ho1: There is no significant relationship between the level of satisfaction on

the quality of care when grouped according to profile?

Significance of the Study

This study is beneficial to the following individuals:

Nurses. With the aid of this study, nurses rendering care to patients

having hemodialysis at Mindanao Sanitarium and Hospital will be aware of

the possible complains of the patients which may help them to develop or

improve their nursing care.

Medical Practitioners. This study will help physicians and other

medical practitioners, who are involved in rendering medical care on patients

undergoing hemodialysis, to be aware of the needs of the patients.

Student Nurses. This study will aid them on evaluating the services

they offered to the patients.

Hospital Administration. The outcome of this study will help the

administrators to implement the needed improvements on the physical

structure of the unit.

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Future Researchers. This will help them conduct a similar study on

evaluating the level of satisfaction of the patients, in the other departments of

Mindanao Sanitarium Hospital

Scope and Delimitation

The study was conducted at the Hemodialysis unit of MSH, involving

the patients undergoing treatment in the unit. It involved 80 respondents only

regardless of their age, gender, educational attainment, and monthly family

income. The working phase of this study was on the third week of March and

ended on the third week of the same month. The researchers themselves

disseminated the questionnaires to the patient.

Definition of terms

The following are operationally defined for better understanding and

clarity.

Level of Satisfaction. It pertains to the degree of fulfillment of the patient

needs, measured by a rating scale (5-Strongly Agree; 4-Agree; 3-Good; 2-

Disagree; 1-Strongly Disagree)

Physical Structure. It refers to the appearance inside the hemodialysis unit,

such as the color of the paint, cleanliness, and the arrangement of the

equipments and beds inside.

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Care. It is the act of providing treatment, attending the needs, and managing

the discomfort felt by the patient.

Medical Care. Refers to the act of care render by the Physician

(Nephrologist), like prescribing medication

Nursing Care. Act of care given by the nurse, such as monitoring the

patient’s blood pressure.

Type of Renal Failure. It refers to the decline or inability of the kidney to do

its function, such as excreting the waste in the body and maintaining the fluid

balance inside the body.

Acute Renal Failure. Refers to the sudden loss of the ability of the kidneys to

remove waste and concentrate urine without losing electrolytes.

Chronic Renal Failure. It refers to the slow loss of kidney function over time.

Age. The age of the respondents in terms of years

Gender. It refers to the hereditary factors that may influence the occurrence

of allergies.

Educational Attainment. It refers to the course level finished or graduated

by the respondents.

Hemodialysis Unit. The area in which the respondents undergo

hemodialysis treatment.
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Hemodialysis. It refers to the dialysis of the blood to remove toxic

substances or metabolic wastes from the bloodstream; used in the case of

kidney failure.