Application of pursed-lip breathing to reduce fatigue in hemodialysis patients: A nursing case study
https://doi.org/10.52235/lp.v7i1.630
Keywords:
chronic kidney disease, fatigue, hemodialysis, nursing care, pursed-lipAbstract
Background: Chronic Kidney Disease (CKD) is a serious global health problem with a rapidly increasing prevalence. The disease is characterized by a progressive and irreversible decline in kidney function. In advanced stages, patients require renal replacement therapy, such as hemodialysis. Fatigue is one of the most common and debilitating symptoms experienced by patients undergoing hemodialysis, negatively affecting daily functioning and quality of life.
Objective: This study aimed to describe nursing care for a patient with CKD through the application of pursed-lip breathing to reduce fatigue levels in the Hemodialysis Unit.
Methods: This study employed a nursing case study design based on the nursing process. The subject was Mrs. S, a patient with CKD undergoing routine hemodialysis. Fatigue was assessed using the Fatigue Severity Scale (FSS), with an initial score of 52, indicating fatigue. The nursing diagnosis was exhaustion related to physiological conditions (chronic disease: CKD) and long-term treatment (hemodialysis). The nursing intervention consisted of the application of pursed-lip breathing, implemented over four consecutive visits during hemodialysis sessions.
Results: The evaluation demonstrated a gradual reduction in fatigue levels. The FSS score decreased from 46 on the first day, to 40 on the second day, 36 on the third day, and reached 30 on the fourth day, indicating no fatigue. In addition, the patient verbalized improved energy recovery, increased strength, reduced feelings of fatigue and lethargy, and improved appetite, consistent with the expected nursing outcomes.
Conclusion: The application of pursed-lip breathing as a nursing intervention was associated with a reduction in fatigue levels in a patient undergoing hemodialysis. This technique may be incorporated into routine nursing care to help manage fatigue and support quality of life among patients with CKD. Patients are encouraged to practice pursed-lip breathing regularly, particularly when experiencing fatigue during hemodialysis.
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References
Aljassim, N., & Ostini, R. (2020). Health literacy in rural and urban populations: A systematic review. Patient Education and Counseling, 103(10), 2142–2154. https://doi.org/10.1016/j.pec.2020.06.007
Almayrs, S. D., Hasanah, U., & Inayati, A. (2024). Penerapan Slow Deep Breathing Terhadap Kelelahan (Fatigue) Pada Pasien Gagal Ginjal Kronik Yang Menjalani Hemodialisa Implementation of Slow Deep Breathing To Fatigue in Patients With Chronic Rental Failure Undergoing Hemodialysis. Jurnal Cendikia Muda, 4(4), 583–591.
Amalia, P. A., & Aini, D. N. (2024). Pengaruh Relaksasi Otot Progresif Terhadap Kelelahan Pada Pasien Gagal Ginjal Kronis Yang Menjalani Hemodialisis. Journal of Language and Health, 5(3), 1496–1502. http://jurnal.globalhealthsciencegroup.com/index.php/JLH
Azizah, R. A. U., Nataliswati, T., & Anantasari, R. (2018). Pengaruh latihan Pursed Lips Breathing terhadap perubahan RR Pasien Pneumonia di RSUD Lawang. Jurnal Ners Dan Kebidanan, 1–7. https://doi.org/10.26699/jnk.v5i3.ART.p188-194
Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21, 878–883. https://doi.org/10.1111/j.1525-1497.2006.00540.x
Boonstra, M. D., Reijneveld, S. A., Foitzik, E. M., Westerhuis, R., Navis, G., & de Winter, A. F. (2021a). How to tackle health literacy problems in chronic kidney disease patients? A systematic review to identify promising intervention targets and strategies. Nephrology Dialysis Transplantation, 36(7), 1207–1221. https://doi.org/10.1093/ndt/gfaa273
Boonstra, M. D., Reijneveld, S. A., Navis, G., Westerhuis, R., & de Winter, A. F. (2021b). Co-creation of a multi-component health literacy intervention targeting both patients with mild to severe chronic kidney disease and health care professionals. International Journal of Environmental Research and Public Health, 18(24), 13354. https://doi.org/10.3390/ijerph182413354
Boonstra, M. D., Reijneveld, S. A., Westerhuis, R., Tullius, J. M., Vervoort, J. P. M., Navis, G., & de Winter, A. F. (2022). A longitudinal qualitative study to explore and optimize self-management in mild to end-stage chronic kidney disease patients with limited health literacy. Patient Education and Counseling, 105(1), 88–104. https://doi.org/10.1016/j.pec.2021.05.016
Brach, C. (2024). AHRQ health literacy universal precautions toolkit (3rd ed.). Agency for Healthcare Research and Quality.
Campbell, Z. C., Dawson, J. K., Kirkendall, S. M., McCaffery, K. J., Jansen, J., Campbell, K. L., Lee, V. W. S., & Webster, A. C. (2022). Interventions for improving health literacy in people with chronic kidney disease. Cochrane Database of Systematic Reviews, 2022(12), CD012026. https://doi.org/10.1002/14651858.CD012026.pub2
Candemir, B., Yıldırım, F., Yaşar, E., Erten, Y., & Göker, B. (2023). Relationship between health literacy and frailty in older adults with chronic kidney disease. Experimental Aging Research, 49(3), 201–213. https://doi.org/10.1080/0361073X.2022.2068326
Centers for Disease Control and Prevention. (2024). About body mass index (BMI). https://www.cdc.gov/bmi/about
Chadban, S., Arıcı, M., Power, A., Wu, M.-S., Mennini, F. S., Álvarez, J. J. A., Sanchez, J. J. G., Barone, S., Card-Gowers, J., & Martin, A. (2024). Projecting the economic burden of chronic kidney disease at the patient level (Inside CKD). EClinicalMedicine, 72, 102615. https://doi.org/10.1016/j.eclinm.2024.102615
Chen, N.-J., Huang, C.-M., Fan, C.-C., Lu, L.-T., Lin, F.-H., Liao, J.-Y., & Guo, J.-L. (2023). User evaluation of a chat-based instant messaging support health education program for patients with chronic kidney disease. JMIR Formative Research, 7(1), e45484. https://doi.org/10.2196/45484
Conley, M. M., McFarlane, C. M., Johnson, D. W., Kelly, J. T., Campbell, K. L., & MacLaughlin, H. L. (2021). Interventions for weight loss in people with chronic kidney disease. Cochrane Database of Systematic Reviews, 2021(3), CD013119. https://doi.org/10.1002/14651858.CD013119.pub2
Crisanto, E. Y., Djamaludin, D., Yulendasari, R., Rita Purnama, Triyono, T., & Umsani, U. (2022). Penyuluhan Kesehatan Tentang Perilaku Sehat Pasien Gagal Ginjal Kronik (GGK). JOURNAL OF Public Health Concerns, 2(2), 65–69. https://doi.org/10.56922/phc.v2i2.187
Davey, C. H., Webel, A. R., Sehgal, A. R., Voss, J. G., & Huml, A. (2019). Fatigue in Individuals with End Stage Renal Disease. Nephrology Nursing Journal : Journal of the American Nephrology Nurses’ Association, 46(5), 497–508.
Dawson, J., Hoffman, A., Josland, E., Smyth, A., Brennan, F., & Brown, M. (2020). Evaluation of health literacy in end-stage kidney disease using a multi-dimensional tool. Renal Society of Australasia Journal, 16(2), 36–43. https://doi.org/10.33235/rsaj.16.2.36-43
Gurgel do Amaral, M. S., Reijneveld, S. A., Meems, L. M. G., Almansa, J., Navis, G. J., & de Winter, A. F. (2022). Multimorbidity and health literacy among CKD patients. Journal of Nephrology, 35(6), 1709–1719. https://doi.org/10.1007/s40620-021-01229-1
Hinkhaw, C., Hanprasitkam, K., & Jianvitayakij, S. (2019). Effects of self-management and motivational interviewing program in diabetic nephropathy. Journal of Phrapokklao Nursing College, 30(2), 186–202.
Ho, H.-K., Koh, E. Y.-L., Abdullah, A., & Tan, N.-C. (2024). Health literacy and self-care among CKD patients. Singapore Medical Journal. https://doi.org/10.4103/singaporemedj.SMJ-2023-068
Huang, H.-L., Hsu, Y.-H., Yeh, C.-W., Hsu, M.-F., & Chung, Y.-C. (2024). Effects of a health literacy education program on renal function. Journal of Nursing Research, 32(1), e310. https://doi.org/10.1097/jnr.0000000000000595
ISN-GKHA. (2023). Global Kidney Health Atlas. ISN: Internacional Society of Nephrology, 192. www.theisn.org/global-atlas
Kementerian Kesehatan RI. (2019). Riset Kesehatan Dasar Tahun 2018.
Lilia, I. H., & Supadmi, W. (2020). Faktor Risiko Gagal Ginjal Kronik Pada Unit Hemodialisis Rumah Sakit Swasta di Yogyakarta. Majalah Farmasetika., 4(Suppl 1), 60–65. https://doi.org/10.24198/mfarmasetika.v4i0.25860
Musniati. (2024). Fatigue Pada Penderita CKD yang Menjalani Hemodaliasa (HD) (Guepedia (ed.)). Guepedia.
Putri, D. M. (2024). Asuhan Keperawatan Pada Pasien Ny. A Dengan Chronic Kidney Disease Yang Menjalani Hemodialisa Dalam Penerapan Terapi Pursed Lips Breathing Untuk Penurunan Fatigue Di Ruangan Interne Wanita Rsup Dr. M. Djamil Padang. Universitas Andalas.
Rifa, A., Ayu, I., Satiti, D., Sagala, I. M., & Setyabudhi, V. (2024). Validity and Reliability of the Fatigue Severity Scale in Patients with Chronic Kidney Disease on Dialysis in Indonesia. 5(2), 140–143.
RISKESDAS Provinsi Kepulauan Riau. (2019). Riset Kesehatan Dasar Tahun 2018. Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan (PLB).
Riyana, A., & Nurhalimah, W. S. (2023). Pengaruh Progressive Muscle Relaxation Terhadap Tingkat Fatigue pada Pasien Gagal Ginjal Kronis yang Menjalani Hemodialisis. Jurnal Keperawatan Galuh, 5(1), 23. https://doi.org/10.25157/jkg.v5i1.9583
Salamah, N. A., Hasanah, U., & Dewi, N. R. (2022). Penerapan Pursed Lips Breathing Terhadap Fatigue Pada Pasien Gagal Ginjal Kronik. Jurnal Cendikia Muda, 2(4), 479–486.
Santoso, D., Sawiji, S., Oktantri, H., & Septiwi, C. (2022). Faktor-Faktor Yang Berhubungan Dengan Fatigue Pada Pasien Gagal Ginjal Kronik Yang Menjalani Hemodialisa Di Rsud Dr. Soedirman Kebumen. Jurnal Ilmiah Kesehatan Keperawatan, 18(1), 11. https://doi.org/10.26753/jikk.v18i1.799
Sari, A. P., Fitri, N. Ll., & Inayati, A. (2025). Implementasi Pursed Lips Breathing Terhadap Fatigue (Kelelahan) Pada Pasien Gagal Ginjal Kronik. Jurnal Cendikia Muda, 5(1), 56–62.
Septiwi, C. (2023). Pengaruh Breathing Exercise Terhadap Level Fatigue Pasien Hemodialisis Di Rspad Gatot Subroto Jakarta. Jurnal Keperawatan Soedirman (The Soedirman Journal of Nursing), 8(1), 14–21.
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