End-of-Life Acceptance in Hemodialysis Patients: A Conceptual Analysis

La Rakhmat Wabula; Krisna Yetti; Masfuri Masfuri; Widyatuti Widyatuti; Ika Yuni Widyawati; Cahyu Septiwi

doi:10.56303/jhnresearch.v4i3.561

Authors

La Rakhmat Wabula Postgraduate in Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
Krisna Yetti Department of Basic Science and Fundamental Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
Masfuri Masfuri Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
Widyatuti Widyatuti Department of Community Health Nursing, Faculty of Nursing, Universitas Indonesia, Indonesia
Ika Yuni Widyawati Department of Medical Surgical Nursing, Faculty of Nursing, Airlangga University, Indonesia
Cahyu Septiwi Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Muhammadiyah Gombong, Indonesia

Keywords:

Hemodialysis, chronic kidney disease, acceptance, end of life

Abstract

End-of-life (EOL) acceptance is a crucial but underexplored concept among patients with end-stage renal disease (ESRD) undergoing hemodialysis. This study aimed to analyze and clarify the concept of EOL acceptance in hemodialysis patients using Walker and Avant’s eight-step method. These patients often face progressive physical deterioration and limited life expectancy, making psychological, emotional, and spiritual readiness to confront death a fundamental component of care. However, the term “EOL acceptance” lacks conceptual clarity and consistency in nursing practice. A comprehensive literature review was conducted using PubMed, CINAHL, and Scopus databases, targeting studies published between 2014 and 2024. The keywords used included ‘end-of-life,’ ‘terminal care,’ ‘death acceptance,’ ‘dying acceptance,’ ‘hemodialysis,’ ‘end-stage renal disease,’ and ‘terminal care nursing’. The analysis identified three attributes of EOL acceptance: psychological readiness to face death, integration of existential and spiritual meaning, and proactive decision-making toward dignified dying. Supporting factors include awareness of terminal illness, therapeutic communication, and psychosocial-spiritual support. The identified consequences are emotional peace, enhanced family preparation, and improved quality of life. This analysis delineates a conceptual framework for EOL acceptance, enabling nurses to assess and support patients facing terminal illness effectively. It also provides a foundational framework for developing assessment tools and nursing interventions to improve person-centered EOL care for individuals with ERSD.

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