Grieving as an Internal Factor of Nurse-Patient Interaction in a Dialysis Unit

Ika Yuni Widyawati, Nursalam Nursalam, Kusnanto Kusnanto, Rachmat Hargono, Pei-Lun Hsieh

Abstract views = 2041 times | downloads = 905 times


Introduction: The quality of the nurse-patient interaction is one factor that affects the patient adherence, but a study that provides an overview of factors in the nurse-patient interaction in improving or maintaining dialysis patient adherence has not been found. The aim of this study was to provide an overview of the various factors involved in the interaction process between nurses and patients undergoing dialysis in relation to their adherence to fluid and dietary restrictions.

Methods: A qualitative research design with an interpretive phenomenology approach was used in this study. The researcher intends to interpret the findings of the research, in this case the activity of the dialysis patients, in order to get a picture of the various factors involved in the process of interaction between nurse and dialysis patient. The unit of analysis used in this study was the disclosure or exposure of the internal factors of the nurse-patient interaction process, especially in relation to fluid and dietary restrictions. There were 15 participants who were selected based on the inclusion criteria. In-depth interviews, with field notes, were used in this study as the data collection method.

Results: The analysis of the theme based on the goal of the research includes grieving, needs and values/morals, but in this article, the researchers only describe one theme - grieving.

Conclusion: This result provides an overview of the findings on nurse-patient interaction factors that can serve as baseline data for the development of nursing care, both in nursing assessments and interventions aimed at improving dietary adherence and the fluid restriction of dialysis patients.


dialysis patient; grieving; nurse-patient interactions

Full Text:



Addo, E. (2015). Chronic Care Model Staff Education and Adherence with End-Stage Renal Disease Patients. Walden University. Retrieved from 27, 2018).

Al-Khattabi, G. H. (2014). Prevalence of Treatment Adherence among Attendance at Hemodialysis in Makah. International Journal of Medical Science and Public Health, 3(5), 592–598. (Accessed:March 27, 2018).

Al-Orabi, M. Q., Alshalawi, N. N., Alotaibi, M. M., Abdallah, M. A. A., Yousif, & Elbur, A. I. (2015). Prevalence and Predictors of Non-Adherence to Medication among Patients on Hemodialysis in a Tertiary Care Hospital, Taif, Kingdom of Saudi Arabia. European Journal of Pharmaceutical and Medical Research, 2(6), 18–23.

Alikari, V., Matziou, V., Tsironi, M., Theofilou, P., & Zyga, S. (2015). The Effect of Nursing Counseling on Improving Knowledge, Adherence to Treatment and Quality of Life of Patients Undergoing Hemodialysis. International Journal of Caring Sciences, 8(2), 514–518.

Bradbury, B. D., Fissell, R. B., Albert, J. M., Anthony, M. S., Critchlow, C. W., Pisoni, R. L., … Gillespie, B. W. (2007). Predictors of Early Mortality among Incident US Hemodialysis Patients in The Dialysis Outcomes and Practice Patterns Study (DOPPS). Clinical Journal of the American Society of Nephrology, 2(1), 89–99.

Bruce, C. A. (2002). The Grief Process for Patient, Family, and Physician. Journal of the American Osteopathic Association, 102(9 Suppl 3), S28–S32.

Bruce, C. A. (2007). Helping Patients, Families, Caregivers, and Physicians in the Grieving Process. Journal of American Osteopathic Association, 107(7), 33–40.

Chatwin, J. (2008). Hidden Dimensions: The Analysis of Interaction in Nurse – Patient Encounters. Quality in Primary Care, 16, 109–115.

Chow, S. K. Y., & Wong, F. K. Y. (2010). Health-related Quality of Life in Patients Undergoing Peritoneal Dialysis: Effects of A Nurse-led Case Management Programme. Journal of Advanced Nursing, 66(8), 1780–1792.

Cleary, M., Edwards, C., & Meehan, T. (1999). Factors Influencing Nurse-Patient Interaction in The Acute Psychiatric Setting: An Exploratory Investigation. The Australian and New Zealand Journal of Mental Health Nursing, 8(3), 109–116.

da Silva, R. A. R., de Souza, V. L., de Oliveira, G. J. N., da Silva, B. C. O., Rocha, C. C. T., & Holanda, J. R. R. (2016). Coping Strategies used by Chronic Renal Failure Patients on Hemodialysis. Escola Anna Nery, 20(1), 147–154.

De los Ríos Castillo, J. L., & Sánchez-Sosa, J. J. (2002). Well-Being and Medical Recovery in The Critical Care Unit: The Role of The Nurse-Patient Interaction. Salud Mental, 25(2), 21–31.

Denhaerynck, K., Manhaeve, D., Dobbels, F., Garzoni, D., Nolte, C., & De Geest, S. (2007). Prevalence and Consequences of Nonadherence to Hemodialysis Regimens. American Journal of Critical Care, 16(3), 222–236. Retrieved from

Elliott, B. A., Gessert, C. E., Larson, P. M., & Russ, T. E. (2014). Shifting Responses in Quality of Life: People Living with Dialysis. Quality of LIfe Research, 23, 1497–1504.

Ginieri-Coccossis, M., Theofilou, P., Synodinou, C., Tomaras, V., & Soldatos, C. (2008). Quality of Life, Mental Health and Health Beliefs in Haemodialysis and Peritoneal Dialysis Patients: Investigating Differences in Early and Later Years of Current Treatment. BMC Nephrology, 9(1), 14.

Hagerty, B. M., & Patusky, K. L. (2003). Reconceptualizing The Nurse-Patient Relationship. Journal of Nursing Scholarship, 35(2), 145–150.

Kamaluddin, R. (2009). Analisis Faktor yang Mempengaruhi Kepatuhan Asupan Cairan pada Pasien Gagal Ginjal Kronik dengan Hemodialisis. Jurnal Keperawatan Soedirman, 4, 20–25.

Kimmel, P. L. (2000). Psychosocial Factors in Adult End-Stage Renal Disease Patients Treated with Hemodialysis: Correlates and Outcomes. American Journal of Kidney Diseases, 35(4), 132–140.

Kimmel, P. L. (2001). Psychosocial Factors in Dialysis Patients. Kidney International, 59(4), 1599–1613.

King, I. M. (2007). King’s Conceptual System, Theory of Goal Attainment, and Transaction Process in the 21st Century. Nursing Science Quarterly, 20(2), 109–111.

Klarenbach, S. W., Tonelli, M., Chui, B., & Manns, B. J. (2014). Economic Evaluation of Dialysis Therapies. Nature Reviews Nephrology, 10(11), 644–652.

Loghmani, L., Borhani, F., & Abbaszadeh, A. (2014). Factors Affecting the Nurse- Patients ’ Family Communication in Intensive Care Unit of Kerman: a Qualitative Study. Journal of Caring Sciences, 3(1), 67–82.

Martin, L. R., Williams, S. L., Haskard, K. B., & Dimatteo, M. R. (2005). The Challenge of Patient Adherence. Therapeutics and Clinical RRsk Management, 1(3), 189–199. Retrieved from

Millard, L., Hallett, C., & Luker, K. (2006). Nurse-Patient Interaction and Decision-Making in Care: Patient Involvement in Community Nursing. Journal of Advanced Nursing, 55(2), 142–150.

National Kidney Foundation. (2017). Coping Effectively: A Guide for Patients and their Families. Retrieved November 1, 2017, from

Ningsih, E. S. P., Rachmadi, A., & Hammad. (2012). Tingkat Kepatuhan Pasien Gagal Ginjal Kronik dalam Pembatasan Cairan pada Terapi Hemodialisa. Media Jurnal Ners, 7(1).

Nordby, H. (2007). Meaning and Normativity in Nurse-Patient Interaction. Nursing Philosophy, 8(1), 16–27.

Park, H., Rascati, K. L., Lawson, K. A., Barner, J. C., Richards, K. M., & Malone, D. C. (2014). Adherence and Persistence to Prescribed Medication Therapy among Medicare Part D beneficiaries on dialysis: comparisons of benefit type and benefit phase. Journal of Managed Care & Specialty Pharmacy, 20(8), 862–876.

Payne, M. E., Eaton, C. K., Mee, L. L., & Blount, R. L. (2013). Promoting Medication Adherence and Regimen Responsibility in Two Adolescents on Hemodialysis for End-Stage Renal Disease: A Case Study. Clinical Case Studies, 12(2), 95–110.

Perkumpulan Nefrologi Indonesia [PERNEFRI]. (2014). 7th Report Of Indonesian Renal Registry 2014. Retrieved from (Accessed:March 27, 2018).

Potter, P. A., & Perry, A. G. (2006). Buku Ajar Fundamental Keperawatan. Konsep, Proses, dan Praktik. (D. Yulianti & M. Ester, Eds.) (4th ed.). Jakarta: Penerbit EGC.

Rogers, S. R. (2002). Nurse-Patient Interactions: What Do Patients Have to Say? The University of Texas.

Royani, Z., Rayyani, M., Behnampour, N., Arab, M., & Goleij, J. (2013). The Effect of Empowerment Program on Empowerment Level and Self-Care Self-Efficacy of Patients on Hemodialysis Treatment. Iranian Journal of Nursing and Midwifery Research, 18(1), 84–87.Retrieved from (Accessed:March 27, 2018).

Saran, R., Bragg-Gresham, J. L., Rayner, H. C., Goodkin, D. A., Keen, M. L., Van Dijk, P. C., … Port, F. K. (2003). Nonadherence in Hemodialysis: Associations with Mortality, Hospitalization and Practice in The DOPPS. Kidney International, 64(1), 254–262.

Sharac, J., McCrone, P., Sabes-Figuera, R., Csipke, E., Wood, A., & Wykes, T. (2010). Nurse and Patient Activities and Interaction on Psychiatric Inpatients Wards: A Literature Review. International Journal of Nursing Studies, 47(7), 909–917.

Shattell, M. (2004). Nurse-Patient Interaction: A Review of The Literature. Journal of Clinical Nursing, 13(6), 714–722.

Smeltzer, S., & Bare, B. (2008). Brunner and Suddarth’s Textbook of Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.

Smith, J. A., & Osborn, M. (2015). Interpretative Phenomenological Analysis as A Useful Methodology for Research on The Lived Experience of Pain. British Journal of Pain, 9(1),41–42.

Stoddart, K. M., Shattel, M., Chatwin, J., Williams, A., Irurita, V., Seiger, M., … Svensson, R. (2012). Social Meanings and Understandings in Patient-Nurse Interaction in The Community Practice Setting: A Grounded Theory Study. BMC Nursing, 11(1), 14.

Vardanjani, L. R., Parvin, N., & Shan, G. M. (2015). The Effects of an Individual, Multistep Intervention on Adherence to Treatment in Hemodialysis Patients. Disability and Rehabilitation, 38(8), 1–5.

Warrior, A. M. (2015). The Emotional Experience of American Indians receiving Hemodialysis and How It relates to Treatment Adherence. University of Nebraska.

Wijaya, A. (2005). Kualitas Hidup Pasien Penyakit Ginjal Kronik yang menjalani Hemodialisis dan mengalami Depresi. Universitas Indonesia.

Williams, A. M., & Irurita, V. F. (2004). Therapeutic and Non-Therapeutic Interpersonal Interactions: The Patient’s Perspective. Journal of Clinical Nursing, 13(7), 806–815.

Wortman, C. B., & Dunkel-Schetter, C. (1979). Interpersonal Relationships and Cancer: A Theoretical Analysis. Journal of Social Issues, 35(1), 35.

Zhang, Z. X., Luk, W., Arthur, D., & Wong, T. (2001). Nursing Competencies: Personal Characteristics Contributing to Effective Nursing Performance. Journal of Advanced Nursing, 33(4), 467–474.


  • There are currently no refbacks.

Copyright (c) 2018 Jurnal Ners

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This journal is indexed by:





This journal is published by:


          Faculty of Nursing Universitas Airlangga in Collaboration with Indonesian National Nurses Association


Creative Commons License

This journal (p-ISSN:1858-3598; e-ISSN:2502-5791) is licensed under a Creative Commons Attribution 4.0 International License


Current Stats

Previous Stats