SURVIVAL FROM STRESSOR: COPING STRATEGIES OF PATIENTS HAVING DIAGNOSED OF KIDNEY FAILURE

By: DOMINIQUE EXCELSIS J. DEGAMO, R.N.

ARELLANO UNIVERSITY Florentino Cayco Memorial School of Graduate Studies Manila, Philippines

March 2013

ACKNOWLEWDEGEMENT

Research in Nursing is a Scientific inquiry on problem and issues related to nursing practice. This develops the sincere desire of the researcher to contribute to the universal effort of improving the delivery of health care to preserve human life. Words are not enough to express the deepest gratitude and sincere appreciation to the following significant people who have contributed a lot to the realization of this study: Engr. Joseph Paul J. Juanich for providing the researcher the inspiration and strength to complete this study; The respondents of this study without whose response, this study would not have been realized. His cousins, colleagues, aunties and his mother for serving as her inspiration and for lovingly standing by his side in the completion of this study. And above all, to God Almighty for giving him strength, infinite guidance and wisdom to complete this research.

D.E.D.

DEDICATION

To God Almighty, my Lord and Savior To my Mother To my Brothers and Sisters To my future my Wife To my Niece and Nephew My Aunties and Uncles This work is lovingly dedicated

TABLE OF CONTENTS TITLE PAGE ACKNOWLEDGEMENT DEDICATION TABLE OF CONTENTS APPENDICES CHAPTER I. THE PROBLEM AND ITS BACKGROUND Introduction Background of the Study Theoretical Framework Conceptual Paradigm ... Paradigm of the Study .. Statement of the Problem Hypothesis ... Scope and Limitation of the Study Definition of Terms i ii iii iv

Page

II.

REVIEW OF RELATED LITERATURE AND STUDIES Related Local Studies .. Related Foreign Studies .. Related Local Literature .. Related Foreign Literature ..

III.

METHOD OF PROCEDURE AND SOURCES OF DATA Research Method .. Research Instrument The Sample and Sampling Method .. Statistical Treatment of Data ..

CHAPTER I THE PROBLEM AND ITS BACKGROUND

Introduction Nursing is a most noble profession. It is a calling and privilege to lift the quality of life of our fellowmen and to assist God in making this world better. Those who select nursing as a course, and career, generally want to make a difference in peoples lives. These patients are subjected to stress of everyday life. Stress is a part of every patients having diagnosed with kidney failure. When a disease is introduced to ones life, it interferes with whatever balanced one has adjusted to. The most common response to such a disease is to adapt lifestyle that will keep the balance undistributed or controlled. There is a feeling of safety as there is a control ove r the equilibrium of ones life. Most day-to-day stressors are balanced successfully, because human beings have a large capacity to control the numerous variables. For example, taking an alternate route may reduce the stress of a traffic jam, or the stress of an examination may be reduced by adequate preparations. A sense of control is very important to ones sense of wellbeing. Stress is a universal phenomenon; stress requires change or adaptation so that the person can maintain equilibrium. Stress can be Internal or External. Nature of stressor involves Intensity, Scope, Duration and other stressors derive from their number and nature. Categories of Stressors and their examples are Physical - drugs or alcohol, Psychological - such as adolescent emotional upheaval, or unexpressed anger, Social - isolation, interpersonal loss, Cultural - ideal body image and Microbiologic

such as infection. The greater the stressor, the greater the stress response Stress response involves both localized and general adaptation. People use coping mechanisms, also called ego defense mechanisms, to relieve anxiety. They are usually unconscious; that is, the client is not aware of their use. Watch for excessive use of these mechanisms. Too much use of these mechanisms may be harmful to patients, instead to help the patient it will turn an additional stressor to them. This study focus on Coping Strategies on Patients Having diagnosed of Kidney Failure. Having diagnosed with this disease may be stressful to patients and may affect their activities of daily living. Due to many reports of kidney failure in our country the researcher utilized it as his basis of interest to conduct a study. In this study the researcher is trying to learn about and understand what are the coping strategies of patients having diagnosed of kidney failure. The overall goal of the researcher in this study is to recognize the coping strategies of patients having diagnosed and kidney failure and realize the cause of their problem why they acquire that disease.

Background of the Study The Department of Health (DOH) is the principal health agency in the Philippines. It is responsible for ensuring access to basic health services to all Filipinos through the provision of quality healthcare and regulation of providers of health goods and services. DOH administration is composed of about 17 central and regional offices, 16 center of Health Development located in various regions, 70 hospitals and 4 attached agencies. Government hospitals provide hospital-based care, specialized in general services. Some conduct research on clinical priorities while some are training hospitals for medical specialization.

Metro Manila hospitals have three levels of health care services available, namely, the primary, secondary and tertiary care. Highly technological and highly sophisticated tertiary care level of services is provided by Medical Centers and large hospitals. With respect to ownership and control, the hospitals are classified as to whether they are operated by the government (public) or non-government (private). The researcher focuses on the study on Coping Strategies on Patients Having Diagnosed of Kidney Failure. With this, the researcher selected government sponsored Metro Manila hospitals for his study because major respondents of his study are in government hospitals. It is important to know and understand the coping strategies of the patients in order for us to further enhance and utilize and to be apply if applicable to future with the same cases.

Conceptual Framework This study utilized the Adaptation Theory of Sister Callista Roy where according to her, When push comes to a shove, we will seldom disappoint ourselves. We all harbour greater stores of strength than we think. Adversity brings the opportunity to test our mettle and discover for ourselves the stuff of which we are made. Do not underestimate the power of a person to cope. He may be dependent now but deep within him lies the energy to adapt. I remember a particular a particular patient when I was still an ICU nurse. He was a pastor afflicted with a serious liver problem. Specialists come and go at his ICU bed but they cannot seem to diagnose the problem. Time is running out and the pastor is slipping fast. Hes bleeding and God knows how many units of blood have been transfused to him. He went into coma. Doctors were giving up, and so were we. Weve

primed the family but they just wont give upyet. The wife is always there at his side during visiting hours, always cheerful and full of hope. So is the daughter who even lets her dad listen to praise songs as if he is not comatose. Many days passed and to our amazement, the pastor woke up from coma. Its been uphill from there. Everything just fell into the right place. He was transferred to a regular room and eventually discharged with a clean bill of health. Amazing? What could it be? A miracle? Or could it be the medications working, or the transfusion? Or the familys fervent prayers? We couldnt tell but one thing is certain: human beings are made to persist. And that is what Sister Callista Roy believed, too. This study is highly related to Sister Callista Roys Adaptation Theory for it has common goals and interrelated to each other. Healthful coping management strategies include balanced diet, adequate rest, regular physical exercise, Relaxation techniques such as: Breathing exercises, Meditation, Progressive relaxation, Prayer, Guided imagery, Relaxation response, Yoga, Biofeedback, Hypnosis or self-hypnosis and Humor may also help, Therapeutic touch or massage, Social support, Spirituality, Crisis intervention and Cognitive restructuring: Nurse and client analyze client's appraisal of stressors. Emphasis is on restructuring client's unrealistic or negative thinking.

Paradigm of the Study Johnsons nursing model was the impetus for the development of Roys Adaptation Model. Roy also incorporated concepts from Helsons adaptation theory, von Bertalanffys system model, Rapoports system definition, the stress and adaptation theories of Dohrenrend and Selye, and the coping model of Lazarus (Philips, 2002).

Figure 1 - Conceptual Paradigm In the Adaptation Model, assumptions are specified as scientific assumptions or philosophical assumptions. In Scientific Assumptions; Systems of matter and energy progress to higher levels of complex self- organization. Consciousness and meaning are constitutive of person and environment integration. Awareness of self and environment is rooted in thinking and feeling Humans by their decisions are accountable for the integration of creative processes. Thinking and feeling mediate human action. System relationships include acceptance, protection, and fostering of interdependence. Persons and the earth have common patterns and integral relationships. Persons and environment transformations are created in human consciousness. Integration of human and environment meanings results in adaptation (Roy&Andrew, 1999, p.35). In Philosophical Assumptions; Persons have mutual relationships with the world and God. Human meaning is rooted in the omega point convergence of the universe. God is intimately revealed in the diversity of creation and is the common destiny of creation. Persons use human creative abilities of awareness, enlightenment, and faith. Persons

are accountable for the processes of deriving, sustaining and transforming the universe (Roy & Andrew, 1999, p. 35).

The Four Modes of Adaptation are Physiologic-Physical Mode which Physical and chemical processes involved in the function and activities of living organisms; the underlying need is physiologic integrity as seen in the degree of wholeness achieved through adaptation to change in needs. Self-concept- Group Identity Mode which focuses on psychological and spiritual integrity and sense of unity, meaning, and purposefulness in the universe. Role Function Mode which individuals occupy in society, fulfilling the need for social integrity. It is knowing who one is in relation to others. Lastly, Interdependence Mode which the close relationships of people and their purpose, structure and development individually and in groups and the adaptation potential of these groups. The Conceptual Paradigm (Figure 1) used by the researcher derived from the theory of Sister Callista Roy served as a guide in conducting this study.

The first column contains the input of the study. These is the stimulus to the patients which is their kidney failure disease which affect their physical, emotional and mental capacity. It also validates the different documents, books, textbook and related studies and literature read by the researcher to get information needed in the study. The second column is the control process which reflects the coping mechanism regulator. In this column perceived the clients thinking on how or what coping mechanism they will utilize. The third column is the Effectors which are the physiologic function, self-concept, role function and interdependence perceived by the patient. These pertains to the client how they respond to stress and how they utilize their coping mechanisms. This is also the gathering of data through guided questioners. The fourth column is the output, which consist of the adaptive and ineffective response of the patient to stress utilizing their coping mechanism. This is also the interpretation and analysis of the data with regards to the coping mechanism they used. It measures the effectivity of the patients coping mechanisms.

Statement of the Problem The main purpose of the study was to determine the coping strategies of the patients having diagnosed of kidney failure. Specifically, the study sought to answer the following questions: 1. What is the demographic profile of the patients with regards to: 1.1. Age 1.2. Sex 1.3. Religion, and

1.4. Educational Attainment 2. How do respondents utilize coping strategies in their current condition? 3. How do respondents utilize coping strategies when it affect their: 3.1. Physical 3.2. Emotional 3.3. Mental, and 3.4. Spiritual 4. Is there any significant relationship between their profile and the coping strategies? 5. What recommendations do researchers offer to enhance the coping strategies of the patients having diagnosed of kidney failure?

Hypothesis The researcher comes up with a result that there is no significant relationship between the coping strategies of the patients according to their demographic profile.

Scope and Limitation of the Study The respondents of the study were composed of 10 patients in selected hospitals in metro manila. The focus of the study is to determine the coping strategies utilize by the patients having diagnosed of kidney failure. This study is limited to ten patients to minimize the workload and maximize the analyzation and interpretation time of the researcher for better outcome results. Furthermore, the researcher studied the relationship of each profile factor with the coping strategies applied by the patients. The outcome of the results was used as a

basis of an action plan to be presented by the researcher for development planning for the patient. The validity of the data is greatly dependent on the respondents honesty and sincerity in answering the questionnaires. Some patients have lesser anxieties every day, as compared to other patients who are included in this study, which may affect the response.

Definition of Terms Adaptation it refers to the response of a system to a stressor. Anxiety is a state of uneasiness and distress about future uncertainties. Coping successful adjustment of the individual to intrinsic and internal as well as extrinsic or external factors. Coping Mechanism adaptation to anxiety based on conscious

acknowledgement of a problem, the individual engages in reality oriented problemsolving activities designed to reduce tension. Coping Strategies refers to abilities or skills of nursing students in learning nursing concepts, skills and professional behavior. Department of Health (DOH) - is the executive department of the Philippine government responsible for ensuring access to basic public health services by all Filipinos through the provision of quality health care and the regulation of all health services and products. Stress a condition in which the human system responds to input that has disturbed its state of equilibrium as balance. It is the bodys response to any intense, physical, emotional or mental demand placed on it by oneself or others. It is neither negative nor positive but has negative or positive effects. Stressor any system input, which may have either positive or negative effect, depending on the way it is processed; may be classified as situational (untoward events) or developmental (anticipated events related to growth and development).

CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES This chapter presents related studies and literature, both local and foreign, on the coping strategies utilized by the patients having diagnosed of kidney failure, which provide the researcher an important insight in conducting the present study. Based on the review made by the researcher, this section served as a resource material for acquiring more information regarding the problem to be tackled.

Related Local Studies According to Manila Bulletin (2012), CITY OF SAN FERNANDO, Pampanga - At least 1,136 residents in Central Luzon are suffering from kidney failure and other severe kidney-related diseases that need dialysis treatment, the Philippine Renal Disease Registry (PRDR) of the Department of Health (DOH) reported yesterday. Pampanga topped the list in the region with 434; followed by Bulacan, 202; Nueva Ecija, 178; Tarlac, 140; Bataan, 100; Zambales, 81; and then Aurora with one. Most of the patients are male, numbering 607 while 529 are female. On the age bracket, the 51-to-60 bracket topped with 282 patients; followed by the 61-70 age group with 262; and the 7180 at 166. The report also said that at least 37 patients have undergone kidney transplant operation. Central Luzon has a total of 65 dialysis centers and two transplant centers which are Angeles University Foundation Medical Center located in Pampanga and Jecsons Medical Center in Tarlac. "To avoid dialysis, one must maintain a healthy lifestyle, regularly do check-ups, proper diet and exercise," said Central Luzon Organ Sharing Effort (CLOSE) Head Dr. Joy Mallari.

Dr. Sicat (2011), of his study Foreign students cultural adjustment and coping strategies. The study analyzed the cultural adjustment and coping strategies of Timorese, Nepalese and Indians, and Koreans enrolled at Tarlac State University (TSU) during the school year 2007-09 in Tarlac. The qualitative research design via case analysis was utilized as the method of investigating the problems encountered by these foreign students. The students were selected by purposive sampling. After thorough interview with the subjects, using an interview schedule as a tool, problems in the cultural adjustment were identified. The cultural adjustments that were dealt with by the students from East Timor, Nepal, and Korea were eating habits (these groups are fond of extremely spicy food), hygiene practices (like frequent bathing and changing of clothes). In their schooling, the most common problem was their inability to understand the lessons in language foreign to them or in accent different from theirs. In religion, the conflict was when they compromised their belief to their host countrys belief. Homesickness was so much of a source of sadness. The Timorese, Nepalese and Indians could hardly intermingle with other students because of their odor which Filipino students found hard to take. The Koreans found the hot climate in the Philippines a pressing problem. The coping strategies used by the students were: adaptation to the conditions at TSU (to include food, clothing, and lodging), compromise, prayerfulness, constant communication with family and friends, and intermingling with the students by sports activities. The Koreans used their economic advantage to enjoy their stay in the country, while the Timorese had better conditions here than at home.

Related Foreign Studies In a study by Cook fair (1998;593) from the National Institute of Occupational Safety and Health, it was revealed that occupational stress is a diffuse and complex phenomenon. It is often difficult, if not impossible, to identify and quantify exposure to stress. Frequently, studies approach stress from the workers perspective and these suggest that the attitudes and behaviors of the workers must change to decrease stress. A shift of emphasis from the worker to the workplace conditions may, in fact, be more beneficial to the mental health of the employees. Researchers have identified workplace stressors, and this is an important step toward designing modifications of the workplace so that these stressors can be reduced or eliminated. Randolfi, (2000), proposed stress management programming as an important component of any worksite health promotion program. One innovative approach to the delivery of stress management services entails the development of a stress management and relaxation center. Analogous to a fitness center, the purpose of this facility is to provide employees with an area, equipment and qualified staff to encourage learning about and practicing stress management and relaxation techniques. Johnson and Johnson (2000) stated that 50 to 60 percent of all health problems are stress related. Too much stress can literally make one sick. They recommended the following strategies to cope with stress: 1. Do not try to handle everything alone. Let the people who are involved in this situation, husband, kids, friends, or family member, know they are needed for assistance. They probably are not aware of it and may offer help of their own accord or one can assign them specific tasks.

2. Set priorities. Decide the best use of ones time at each particular moment a more important matter is thus becoming increasingly urgent, simply because its easy or fun. 3. Make a list. Its one of the best ways to get and stay organized and to gain a feeling of control. Do not list huge tasks; break the task down into small, easy to accomplish steps. Badger (1998), recommended that the best way to manage stress is to take control of managing stress. By using some strategies, one can keep on top of any situation without letting circumstances get the best of you, such as the following: take a few deep breaths, try some stretching exercise, pay attention to the messages youre givin g yourself, get help when you need it, alternate mental and physical tasks, tackle your most undesirable tasks easily, set realistic expectations for yourself, cluster activities so you can get several tasks done in a short period of time, make a habit of taking your breaks and meals, avoid stimulants, which exacerbate your stress, and review past crisis for future learning. Qiu-Li Zhang (2008), he performed a systematic review of available published data in MEDLINE. A combination of various keywords relevant to CKD was used in this research. Related data of included studies were extracted in a systematic way. A total of 26 studies were included in this review. The studies were conducted in different populations, and the number of study participants ranged from 237 to 65181. The median prevalence of CKD was 7.2% in persons aged 30 years or older. In persons aged 64 years or older prevalence of CKD varied from 23.4% to 35.8%. Importantly, the prevalence of CKD strongly depended on which estimating equations were used. The

Modification of Diet in Renal Disease Study (MDRD) equation was likely to be preferred in recent epidemiological studies compared to the adjusted Cockcroft-Gault (CG) equation. Worldwide, CKD is becoming a common disease in the general population. Accurately detecting CKD in special groups remains inadequate, particularly among elderly persons, females or other ethnic groups such as Asians.

Related Local Literature

In this chapter, coping strategies will be explored from theoretical and empirical perspectives. As defined by Lazarus and Folkman (1980), coping strategies are defined as methods employed by people to deal with situations that require a tremendous investment of their resources such as time and effort. The following discussion will first offer a brief overview of the perspectives of coping theorists, with a special focus on Frydenberg and Lewis' (1996) classification of the three different types of coping strategies. Furthermore, previous studies about the coping experiences of families of children with disabilities and autism will be presented.

Coping theorists have generally categorized coping strategies under three groups: a) strategies focused on resolving the problem; b) strategies used to alleviate the emotions triggered by the situation; and c) strategies involving social support (Dalton & Pakenham, 2002). Apart from these three categories, theorists such as Billings and Moos (1981), along with Pearlin and Schooler (1978), have constructed alternative models by classifying the coping strategies in accordance with the approachavoidance dichotomy.

At a more practical level, Frydenberg and Lewis' (1993, 1996) model offers an assessment of coping strategies by separating them into productive, nonproductive and reference to others groupings. Productive coping strategies entail "reflecting on and tackling.

Manila Bulletin (2012), MANILA, Philippines - Kidney failure, also called renal failure, occurs in one of three forms. Acute renal failure is an illness in which your kidneys suddenly stop functioning, sometimes within a few days or even hours. Chronic renal failure, which is also called chronic renal insufficiency, develops over many years and insidiously interferes with your health. In end-stage renal failure, your kidneys function so poorly that they can no longer sustain life without the assistance of an artificial kidney machine or a kidney transplant. If you have acute kidney failure, you urgently need hospital treatment, preferably in a special unit to treat kidney diseases. If the cause is not obvious, you will probably have to undergo an intensive series of diagnostic tests, possibly including a needle biopsy of the kidney, in which a small piece of kidney is removed for examination. When the cause of acute kidney failure is heavy bleeding or a heart attack, treatment of the accompanying shock is required. If the cause of failure is a urinary tract obstruction, you will probably need an operation to relieve the blockage. If the underlying cause is kidney disease, or if the kidneys remain severely affected even though the cause of failure is successfully treated, treatment procedures vary. If shock or severe fluid loss (from hemorrhage, vomiting, or diarrhea) has led to acute kidney failure, an intravenous solution of saline, plasma, or blood, sometimes with an adrenaline-like substance, helps restore your blood pressure to normal levels. A diuretic occasionally is useful in

reestablishing urine flow, but only after your fluid loss is restored to the bloodstream by intravenous solutions. Kidneys will usually recover most or all the loss function within days to several weeks. But when little or no urine is being formed and the kidney damage appears massive, your physician may have to use an artificial device that performs the functions of your kidneys until they recover. This type of treatment is called dialysis. While you are under treatment, you may need a special diet that is high in calories but low in protein. This provides you with the energy you need but not overload your kidneys with waste products from the metabolism of protein. If you have chronic kidney disease, symptoms appear gradually and you may not have any for years. In fact, your kidney function can decrease 25 percent with no outward signs or symptoms of failure. Then you may notice that you are urinating more often than you used to. This is because your kidneys can no longer concentrate the urine as efficiently, so you pass urine at night and more frequently during the day. You may also feel progressively tired and lethargic. If your chronic kidney failure continues to get worse, you will have the symptoms of end-stage kidney failure. Self-help: Follow your physician's advice about the diet. Do not take medication without consulting your physician about any possible danger resulting from over-accumulation of the drug, which will be excreted more slowly by the less efficient functioning of the kidney. Professional help: there is no treatment available that can reverse the course of chronic kidney failure, but close medical supervision can sometimes help slow down the disease and counteract your symptoms. With active participation with the management of your disease like regular check-ups, a diet carefully planned with your physician's advice, and appropriate medication, you should be able to lead an active life despite

your kidney problem. Unfortunately, some patients with end-stage kidney failure are too ill for treatment by either dialysis or transplantation.

Related Foreign Literature According to Manfreda (Psychiatric Nursing, 1995 p.256), before a person can choose which coping method would be appropriate to him, he/she should first accept the fact that the ability to cope with stress and to relieve the anxiety which it produces varies person to person. Leish (2013), Coping strategies for are important, so that teasing does not escalate into bullying. That even makes me wonder: What is the difference between teasing and bullying and how do we stop both of them? Because of having my own speech and visual disabilities (challenges), I know too well what it means to grow up being "different" from other children. When I was 10 months old I had a head injury as a result of a car accident caused by a drunken driver. As a result, I've dealt with speech, visual, coordination challenges and depression most of my life. The speech is a little slow and slurred; my left eye is a lazy eye and only has a little peripheral vision. The right eye does fortunately see well enough to drive. As for coordination, the right side of my body is stronger than the left side. Depression has followed me most of my life. I have struggled most of my life with my challenges, and teasing and bullying have been a big part of that. Fortunately, I have learned some coping strategies that have helped me in difficult situations.

According to Torchbox (2009), using alternatives to self-harm will help you get through an intense moment when you may feel a strong urge to hurt yourself. But it's

never going to be easy, especially when you're trying to break the cycle for the first time. Doing something like squeezing ice won't cure the roots of your distress, but it may help you to use a more productive coping mechanism and show you that you can cope with stress in a less harmful way. You'll have to make a conscious effort not to hurt yourself, but the important thing is that if you do decide to use an alternative, you've made that choice yourself.

According to NIH (National Institute of Diabetes and Digestive and Kidney Diseases) 2012, Healthy kidneys clean your blood by removing excess fluid, minerals and wastes. They also make hormones that keep your bones strong and your blood healthy. But if the kidneys are damaged, they don't work properly. Harmful wastes can build up in your body. Your blood pressure may rise. Your body may retain excess fluid and not make enough red blood cells. This is called kidney failure. If your kidneys fail, you need treatment to replace the work they normally do. The treatment options are dialysis or a kidney transplant. Each treatment has benefits and drawbacks. No matter which treatment you choose, you'll need to make some changes in your life, including how you eat and plan your activities. But with the help of healthcare providers, family and friends, most people with kidney failure can lead full and active lives.

CHAPTER III METHOD OF PROCEDURE AND SOURCES OF DATA

This chapter contains the procedural operation of how the research problems are to be answered. It includes the research design and instruments used in gathering data, the respondents of the study, analysis of the study and the statistical treatment that was used in interpreting the data gathered which provided a scientific framework in answering the problems of the study. Research Method The researcher used the descriptive method of research with questionnaires as the main data-gathering instrument. The descriptive method was utilized in determining the coping strategies and related coping procedures of respondents having diagnosed of kidney failure. The descriptive method describes the nature of the situation as it hints at the time of the study. This involves collection of data in order to test the hypothesis or to answer questions concerning the current status of the study. Research Instrument The main instrument used was the researchers prepared questionnaire on the coping strategies of patients having diagnosed of kidney failure in selected hospital in Metro Manila. The questionnaires consisted of three (3) parts: Part 1: - Dealt on the respondents demographic profile which sought to determine the age, sex, religion, and educational attainment. Part 2: - Dealt on degree to utilization of coping strategies when it affects their physical, emotional, spiritual and mental status. Part 3: - Dealt on the coping strategies usually used by the patients having diagnosed of kidney failure.

The Sample and Sampling Procedures This study involved 10 patients having diagnosed of kidney failure in selected hospitals in Metro Manila, chosen by random sampling. Random sampling is a method of selecting a sample size from a universe such that each member of the population has an equal chance of being selected as a sample. TABLE I DISTRIBUTION OF RESPONDENTS ACCORDING TO HOSPITAL HOSPITAL Arellano University Hospital 1 Arellano University Hospital 2 Arellano University Hospital 3 Arellano University Hospital 4 TOTAL NUMBER 2 2 2 2 10 PERCENT 20% 20% 20% 20% 100%

Statistical treatment of Data Obtained data were analyzed and treated statistically employing the simple frequency count percentage responses as shown by the formula:

Where: P = percentage f = frequency N = summation of respondents

The researcher applied the weighted frequency for each item by multiplying the frequency for each item by the weight of said item in the Likert 5-pointed numerical scale as shown below. The summation of the weighted frequency was computed by adding all the weighted frequencies for each item in the questionnaire. The descriptive equivalents of the resultant weight are the following:

TABLE II DESCRIPTIVE EQUIVALENTS Scale 5 4 3 2 1 Description Always/Strongly Agree Often/Agree Sometimes/Uncertain Seldom/Disagree Never/Strongly Disagree PERCENT 4.51 -- 5.00 3.50 -- 4.50 2.51 -- 3.49 1.50 -- 2.50 1.40 -- 1.49

Accordingly, the weighted mean of the weighted frequencies was computed using the formula:

Where:

WM = weighted mean, the summation of weighted frequencies divided by summation of frequency wf = summation of weighted frequencies f = summation of frequency

To answer specifically question No. 4, to determine if there is significant relationship between the demographic profile and coping strategies utilized by the patients having diagnosed of kidney failure, the researcher used the Chi-square test of Independence. The formula is shown below: ( )

Where:

O E

= observed cell frequency = expected (theoretical) frequency

NW = Downie and R.W. Health Basic Statistical method, 4th ed. (New York: Harper and Row, 1974), p.277.

Appendix