Revista Científica Interdisciplinaria Investigación y Saberes
2024, Vol. 14, No. 1 e-ISSN: 1390-8146
Published by: Universidad Técnica Luis Vargas Torres
How to cite this article (APA):
Dias, S., López, S., Maliza, D., Vargas, C. (2024) Impact of Marjory
Gordon's model on nursing care of CKD patients undergoing hemodialysis: A cross-sectional study,
Revista Científica Interdisciplinaria Investigación y Saberes, 14(1) 82-100
Impact of Marjory Gordon's model on nursing care of CKD patients
undergoing hemodialysis: A cross-sectional study
Impacto del modelo de Marjory Gordon en la atención de Enfermería de pacientes con
insuficiencia Renal Crónica sometidos a Hemodiálisis: Un estudio transversal
Stefanny Karolina Dias Ledesma
Licenciada en Ciencias de la Enfermería. Magíster en Gestión del cuidado en mención en Unidades de
emergencia y unidad de cuidados intensivos. Universidad Estatal de Bolívar.
tefitakaro@gmail.com, https://orcid.org/0000-0003-4176-1300
Silvana Ximena López Paredes
Licenciada en Ciencias de la Enfermería. Doctora en Ciencias de la Salud. Universidad Estatal de Bolívar.
silvhana@hotmail.es, https://orcid.org/0000-0001-9289-8089
Daysi Alexandra Maliza Asitumbay
Licenciada en Ciencias de la Enfermería. Universidad Estatal de Bolívar. alexandramaliza24@gmail.com,
https://orcid.org/0009-0000-6180-2881
Cindy Mariuxi Vargas Armijo
Licenciada en Ciencias de la Enfermería. Universidad Estatal de Bolívar. cindyvargasarmijo@gmail.com
https://orcid.org/0009-0002-5510-001X
This article focuses on how the Marjory Gordon model improves
nursing care in patients with chronic renal failure undergoing
hemodialysis. The study, conducted over 5 months at Mount Sinai
Hospital, explores the efficacy of this model in identifying and treating
prevalent health problems in this patient group. The Marjory Gordon
model, known for its holistic and systematic approach to nursing care,
was implemented to assess dysfunctional patterns in patients with
chronic renal failure. A quantitative, descriptive, cross-sectional
research design was used, applying surveys to a sample of 67
patients, ranging in age from 30 to 75 years, both outpatients and
inpatients. The results revealed significant improvements in several
Abstract
Received 2023-10-14
Revised 2023-12-20
Published 2024-01-05
Corresponding Author
Stefanny Karolina Dias Ledesma
tefitakaro@gmail.com
Pages: 82-100
https://creativecommons.org/licens
es/by-nc-sa/4.0/
Distributed under
Copyright: © The Author(s)
Impact of Marjory Gordon's model on nursing care of CKD patients undergoing hemodialysis: A
cross-sectional study
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aspects of patient care, including nutrition, metabolism, elimination,
activity, exercise, sleep, rest, and stress management. These findings
underscore the importance of adopting a structured, patient-centered
approach to nursing care, especially in complex clinical settings such
as hemodialysis. The study concludes the need to integrate and
socialize care plans based on this model among nursing staff, which
could significantly improve the quality of care provided. In addition,
it is recommended that nursing staff reinforce and formally adopt
these care plans, ensuring more effective and patient-centered care.
Keywords:
nursing process, chronic renal failure, hemodialysis,
Marjory Gordon, care.
Resumen
El presente artículo se centra en cómo el modelo de Marjory Gordon
mejora la atención de enfermería en pacientes con insuficiencia renal
crónica sometidos a hemodiálisis. El estudio, realizado durante 5
meses en el Hospital Monte Sinaí, explora la eficacia de este modelo
en identificar y tratar problemas de salud prevalentes en este grupo
de pacientes. El modelo de Marjory Gordon, conocido por su
enfoque holístico y sistemático en la atención de enfermería, se
implementó para evaluar patrones disfuncionales en pacientes con
insuficiencia renal crónica. Se utilizó un diseño de investigación
cuantitativo, descriptivo y transversal, aplicando encuestas a una
muestra de 67 pacientes, con edades de 30 a 75 años, tanto
ambulatorios como hospitalizados. Los resultados revelaron mejoras
significativas en varios aspectos del cuidado del paciente, incluyendo
la nutrición, metabolismo, eliminación, actividad, ejercicio, sueño,
descanso, y en la gestión del estrés. Estos hallazgos subrayan la
importancia de adoptar un enfoque estructurado y centrado en el
paciente en el cuidado de enfermería, especialmente en contextos
clínicos complejos como la hemodiálisis. El estudio concluye la
necesidad de integrar y socializar planes de cuidado basados en este
modelo entre el personal de enfermería, lo que podría mejorar
significativamente la calidad del cuidado brindado. Además, se
Impact of Marjory Gordon's model on nursing care of CKD patients undergoing hemodialysis: A
cross-sectional study
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recomienda que el personal de enfermería refuerce y adopte
oficialmente estos planes de atención, asegurando una atención más
efectiva y centrada en el paciente.
Palbras clave:
proceso enfermero, insuficiencia renal crónica,
hemodiálisis, Marjory Gordon, cuidado.
Introduction
In the context of chronic renal failure (CRF), especially when
accompanied by hemodialysis treatments, there is a complexity of
care needs, which go beyond the physical aspects and encompass
psychological and social dimensions of patient care. In the field of
nursing, there is a growing need for holistic approaches that address
the diverse needs of these patients(Suárez Oropesa et al., 2020).
This study arises from the identification of a gap in current nursing
care methodologies for CKD patients on hemodialysis. Traditional
approaches often focus primarily on physical symptoms and
treatment adherence, neglecting the holistic needs of the patient
(Araya et al., 2023).. This gap underscores the need for a more
integrated and patient-centered approach to nursing, a role that the
Marjory Gordon Model is uniquely qualified to play, thanks to its
holistic and systematic methodology.
The main objective of this study is to evaluate the effectiveness of the
Marjory Gordon Model in improving nursing care for CKD patients on
hemodialysis. Specifically, it seeks to determine how this model can
contribute to improving overall patient outcomes, including aspects
such as symptom management, adherence to treatment, and patient
satisfaction with the care received(Martin, 2014)
It is hypothesized that implementation of the Marjory Gordon Model
of nursing care will lead to significant improvements in the
management of CKD patients on hemodialysis. By focusing on
comprehensive patient assessment and care planning, it is expected
that the model will address both the physiological and psychosocial
needs of these patients, thereby improving their overall well-being
and treatment experience.
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cross-sectional study
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The importance of this study lies in its potential to influence nursing
practices on a larger scale, both nationally and internationally. The
findings could provide empirical evidence on the efficacy of the
model in a specific clinical context, offering valuable insights for
health policies and administrative decisions in care centers for CKD
patients.
From this perspective, and prior to discussing the subject, it is
important to present a brief theoretical review, which allows us to
place ourselves within a favorable conceptual framework.
Chronic renal failure (CKD) represents a significant medical and public
health challenge. Characterized by a progressive decline in kidney
function, CKD leads to the accumulation of wastes and fluids in the
body, negatively impacting the patient's overall health and quality of
life. As the disease progresses to the terminal stage, known as end-
stage renal disease (ESRD), it becomes imperative to resort to renal
replacement treatments such as hemodialysis(de Sequera et al.,
2023).
Hemodialysis is a blood filtering process that mimics some kidney
functions, including removing waste, excess salt and water, and
maintaining nutrient balance. This treatment is generally performed
three times a week, with each session lasting between three and five
hours. During hemodialysis, blood is removed, cleaned through a
dialyzer and then returned to the body. To facilitate this process,
vascular access is required, either through an arteriovenous fistula, a
graft, or a catheter(de Sequera et al., 2023; González-Robledo et al.,
2020).
The management of CKD on hemodialysis is complex and goes
beyond mere medical treatment. It involves substantial patient
engagement, including adherence to a rigorous treatment schedule,
dietary and fluid restrictions, and management of side effects such as
hypotension, cramping, and fatigue. In addition, nursing care plays a
vital role, not only in the administration of hemodialysis, but also in
the ongoing education and support of the patient and family. Nurses
provide guidance on disease management, diet, medication, and
strategies for coping with treatment challenges(Hernandez et al.,
2018).
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The approach to care is multidisciplinary, involving nephrologists,
nurses, dietitians, social workers and, on occasion, psychologists, to
provide comprehensive and personalized care. This team collaborates
closely to ensure that patients receive not only the necessary medical
treatment, but also the emotional and psychological support, crucial
to manage a chronic disease and its associated treatments(Suárez
Oropesa et al., 2020). .
The implementation of the Marjory Gordon Model of nursing care for
patients with chronic renal failure (CKD) undergoing hemodialysis
represents a significant evolution in health care. This model, with its
focus on eleven functional patterns, provides a comprehensive
framework for the assessment and management of care for these
patients(González-Parra et al., 2023; Martín, 2014).
CKD often culminates in the terminal stage where hemodialysis
becomes essential. However, this treatment imposes unique
challenges for both the patient and the nursing staff, including the
need to manage physical and emotional side effects and adhere to a
strict therapeutic regimen.
The person-centered Marjory Gordon Model addresses these
challenges by focusing on patterns such as health perception and
management, nutritional-metabolic, elimination, activity/exercise,
sleep/rest, cognitive-perceptual, self-perception/self-concept,
roles/relationships, sexuality/reproductive, adaptation/stress
tolerance, and values/beliefs. In the context of hemodialysis, this
model guides nurses to conduct a comprehensive assessment,
identify potential problems, and develop personalized care plans
(Aziz et al., 2015; Nuñez-Marrufo et al., 2017).
Application of the model begins with a detailed assessment of how
the patient perceives his or her disease and treatment. Understanding
the patient's perception of his or her health is crucial to developing
effective treatment management strategies and education.
Nutritional care is another critical aspect, given that hemodialysis
patients require a special diet to control fluid balance, electrolytes,
and prevent waste accumulation(Martínez-López et al., 2014).
Regarding the elimination pattern, it is critical to monitor residual
urinary function and manage the effects of anuria or oliguria. The
activity/exercise pattern encompasses assessment of the patient's
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cross-sectional study
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physical capacity and promotion of safe activities that improve
strength and general well-being. Sleep quality and rest are also vital,
as fatigue is a common symptom in these patients(Khan et al., 2023;
Martinez Lopez et al., 2014).
The cognitive-perceptual pattern focuses on the patient's ability to
understand and process information, crucial for the effective
management of their treatment. Self-image and self-concept are
often affected in patients undergoing intensive and prolonged
treatments such as hemodialysis, requiring emotional and
psychological support(Abad López & Abad López, 2021).
The patient's roles and relationships may change drastically due to his
or her disease, impacting his or her social and family life. In this sense,
Gordon's model helps to identify changes in these patterns and
provide the necessary support. Sexuality and reproduction may also
be affected, requiring a sensitive and respectful approach.
Stress management and coping are crucial, as CKD and hemodialysis
can be stressful experiences. Finally, understanding the patient's
values and beliefs allows for care that respects their individuality and
cultural preferences.
Methodology
This research adopted a quantitative approach, centered on
measurement and calculation(Sampieri et al., 2014). to identify
altered Marjory Gordon functional patterns in patients with chronic
renal failure (CKD) undergoing hemodialysis at Mount Sinai General
Hospital. A survey validated by three nursing experts was used: Dr.
Mery Rea, Mgtr. María Olalla and Mgtr. David Agualongo. The
quantified results of the survey made it possible to develop specific
care plans and socialize priority problems with the nursing
professionals.
The research design was non-experimental, descriptive and cross-
sectional cohort. No variables were manipulated and no participants
were randomly assigned. Instead, phenomena were described as they
occurred in their natural setting, particularly between January and
May 2023. The descriptive objective focused on specifying
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cross-sectional study
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properties, characteristics, and conditions of CKD patients, detailing
aspects related to their health status, treatment, and disease
management. The population studied included 67 outpatients and
inpatients of Internal Medicine and Emergency of the Mount Sinai
General Hospital, aged 30 to 75 years. This diverse population,
composed of men and women with different medical backgrounds,
shared the common diagnosis of CKD, a condition requiring regular
hemodialysis treatment. The sample was selected using a
nonprobability method by convenience. All patients with CKD who
were receiving in-center hemodialysis were included, following
inclusion criteria such as confirmed diagnosis of CKD, current
hemodialysis treatment, and willingness to give informed consent.
Those on peritoneal dialysis, under 18 years of age or with acute renal
failure were excluded.
For data collection, a structured survey of 50 closed-ended questions
with a 3-level Likert scale was used. This survey allowed detailed
identification of the alteration of the Marjory Gordon functional
patterns in the patients. Each participant gave informed consent prior
to the application of the survey.
Finally, the information collected was analyzed using SPSS V.25
software, which allowed the generation of tables and frequency
graphs for each question applied to the patients. This analysis
facilitated the understanding of the alterations in the functional
patterns and the development of appropriate nursing care plans.
Results
Table 1.
Distribution of vital signs in patients with CKD.
NO.
Vital Signs
Definition
Percentage
of Patients
1
Normal Blood Pressure
120/80 mmHg
23.9%
2
High Normal Blood Pressure
130/89 mmHg
10.4%
3
Hypertension Grade 1
140/99 mmHg
29.9%
4
Hypertension Grade 2
160/104 mmHg
23.9%
5
Hypertension Grade 3
≥ 180/110 mmHg
6.0%
6
Hypotension
90/60 mmHg
6.0%
7
Bradycardia
< 60 beats/min
11.9%
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8
Normocardia
60-100 beats/min
67.2%
9
Tachycardia
> 100 beats/min
20.9%
10
Eupnea
16-22 breaths/min
94.0%
11
Tachypnea
> 22 breaths/min
6.0%
12
Afebrile
36-37.5 ºC
97.0%
13
Fever
> 38 ºC
3.0%
14
Normal Oxygen Saturation
> 95%
77.6%
15
Mild Hypoxia
93-95%
22.4%
Note: Vital signs of patients diagnosed with CKD. WHO (2023).
In the population of patients with chronic renal failure undergoing
hemodialysis, the table shows a varied distribution of vital signs. Some
23.9% had normal blood pressure, while 60.7% had varying degrees
of hypertension, indicating an elevated cardiovascular risk. In
addition, 6.0% experienced hypotension. In terms of heart rate, the
majority (67.2%) had normocardia, although 20.9% presented
tachycardia and 11.9% bradycardia, suggesting the need for detailed
evaluation for these groups. Regarding respiratory rate, the majority
(94.0%) showed a normal rate (eupnea), reflecting good respiratory
control. These data reflect the complexity of health management in
these patients, highlighting the importance of personalized
monitoring and care to address these varied vital signs and their
potential clinical implications.
Table 2.
Marjory Gordon's Functional Patterns of Health
Items evaluated
%
A/v
%
Never
%
Total
Compliance with
recommendations
85%
7
10%
3
5%
67
Adherence to
medication schedule
81%
9
13%
4
6%
67
Consumption of
psychotropic
substances
13%
14
21%
44
66%
67
Skin problems due
to hemodialysis
19%
43
64%
11
16%
67
Nursing assessment
of vital signs
90%
7
10%
0
0%
67
Fistula cleaning by
nursing
100%
0
0%
0
0%
67
Explanation of the
97%
2
3%
0
0%
67
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procedure by the
nurse
Note: Description of the health perception-management pattern. By
authorship (2023).
Table 2 shows the Marjory Gordon functional health patterns in
patients with chronic renal failure undergoing hemodialysis, the
results reflect a high level of compliance and adherence to medical
recommendations and medication schedules, with 85% and 81%
respectively, indicating a significant commitment to treatment.
Although 13% of patients always consumed psychotropic substances,
the majority (66%) never did, suggesting a generally adequate
management of psychological conditions. Skin problems were
experienced by 19% of the patients consistently, but the majority
faced them only occasionally. Nursing care was outstanding, with
constant assessment of vital signs (90%), fistula cleaning (100%) and
explanation of the procedure (97%) always performed, demonstrating
exceptional care practice and effective communication with patients.
These findings underscore the importance of a comprehensive and
personalized care approach in the management of hemodialysis and
chronic renal failure treatment.
Table 3.
Nutritional-metabolic pattern according to Marjory Gordon
Items evaluated
Always
%
A/v
%
%
Total
Lack of
appetite after
diagnosis
20
30%
26
39%
31%
67
Post-
hemodialysis
weight gain
1
1.5%
21
31%
67.5%
67
Post-
hemodialysis
weight loss
59
88%
7
10.5%
1.5%
67
Consumption
of a balanced
and healthy
diet
44
66%
19
28%
6%
67
Note: Scrutiny of dietary habits linked to kidney disease and its
hemodialysis treatment. Authored by the author (2023).
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Table 3 presents the analysis of the nutritional-metabolic pattern in
patients with chronic renal failure undergoing hemodialysis,
according to Marjory Gordon, reveals crucial aspects about the eating
habits affected by the disease and its treatment. Thirty percent of
patients experienced lack of appetite after diagnosis, and a similar
percentage (39%) experienced it occasionally, which can significantly
influence their nutritional status. Regarding post-hemodialysis body
weight, 88% of patients reported weight loss, which could reflect
metabolic problems or inadequate nutrient intake. Conversely, only
1.5% experienced weight gain, while 31% did so occasionally,
suggesting individual variations in metabolic response to treatment.
Positively, 66% of patients consumed a balanced and healthy diet, an
essential factor in the management of CKD. These findings highlight
the importance of personalized nutritional care in the treatment of
CKD, focusing on addressing poor appetite and ensuring a balanced
diet to optimize patients' well-being and quality of life.
Table 4.
Elimination pattern according to Marjory Gordon
Items
evaluated
Always
%
A/v
%
%
Total
Difficulty
urinating
post-
hemodialysis
25
37%
10
15%
48%
67
Post-
hemodialysis
stool
problems
35
52%
26
39%
9%
67
Post-
hemodialysis
burning, pain
or bleeding
4
6%
21
31%
63%
67
Note: The table reflects elimination problems faced by renal patients
after hemodialysis treatment. Authored by author (2023).
Table 4, which evaluates the elimination pattern in patients with
chronic renal failure undergoing hemodialysis according to Marjory
Gordon, reveals significant information on the difficulties faced by
these patients. Thirty-seven percent reported always having difficulty
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cross-sectional study
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urinating after hemodialysis, while 48% never experienced this
problem, suggesting that most do not face this specific challenge.
Regarding post-hemodialysis stool problems, 52% of patients
experienced them always and 39% sometimes, indicating that these
problems are common and could be related to the dialysis process
and changes in diet and hydration. Only 9% never had stool
problems. On the other hand, post-hemodialysis burning, pain or
bleeding was less common, with only 6% experiencing it always, while
63% never faced these symptoms. These results highlight the
importance of proper elimination management and the need for
specific interventions for those patients who face difficulties, thus
improving their quality of life and comfort during hemodialysis
treatment.
Table 5.
Activity-exercise pattern according to Marjory Gordon
Items evaluated
Always
%
A/v
%
%
Total
Shortness of
breath in daily
activities
14
21%
28
42%
37%
67
Incapacity for
fear of
damaging the
fistula
32
48%
28
42%
10%
67
Use of assistive
mobility
devices
28
42%
15
22%
36%
67
Note: Specification of the functional capacity of the renal patient to
perform daily activities in relation to the disease and treatment.
Authored by author (2023).
Table 5, focusing on the Marjory Gordon activity-exercise pattern in
patients with chronic renal failure undergoing hemodialysis, provides
valuable information on the functional capacity of these patients in
relation to their disease and treatment. Twenty-one percent of
patients always experienced shortness of breath in daily activities,
while 42% experienced it occasionally and 37% never had this
problem, indicating that, although it is a concern for some, it does not
affect most on a consistent basis.
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cross-sectional study
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Concern about damaging the fistula is notable, with 48% feeling
unable always for fear of damaging it and another 42% occasionally
concerned about this, reflecting the significant impact that
hemodialysis treatment has on lifestyle and perception of safety in
daily activities. In addition, 42% always required the use of assistive
devices to mobilize and 22% did so sometimes, suggesting that
mobility is a considerable challenge for many of these patients. These
results underscore the importance of providing adequate support and
resources to renal patients to improve their mobility and reduce the
fear of fistula damage, thereby improving their independence and
quality of life.
Table 6.
Sleep-rest pattern according to Marjory Gordon
Items evaluated
Always
%
A/v
%
Never
%
Total
Maintains 8 hours of
sleep
17
25%
41
61%
9
13%
67
Comfortable sleep
15
22%
43
64%
9
13%
67
Use of sleep
medications
2
3%
12
18%
53
79%
67
Problems resting
due to fistula
11
16%
33
49%
23
34%
67
Note: Characterization of sleep quality, relaxation perceived by
patients in relation to the diagnosis of chronic renal failure. Authored
by author (2023).
Table 6 shows the quality of sleep in patients with chronic renal failure
undergoing hemodialysis varies. Twenty-five percent maintain 8 hours
of sleep and 22% always sleep comfortably, which is positive.
However, 61% and 64% achieve it only sometimes, respectively,
suggesting sleep problems in a significant proportion. The use of
sleep medication is low (3% always), indicating that it is not a
commonly adopted solution. In addition, 16% always have problems
resting due to the fistula, highlighting a specific aspect of the
treatment that affects rest.
Table 7.
Cognitive-perceptual pattern according to Marjory Gordon
Items evaluated
Always
%
A/v
%
Never
%
Total
Hearing
difficulties
10
15%
27
40%
30
45%
67
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Vision problems
27
40%
20
30%
20
30%
67
Changes in
concentration or
memory
12
18%
36
54%
19
28%
67
Difficulty with
hemodialysis
treatment
9
13%
31
46%
27
40%
67
Note: Changes in cognitive abilities experienced by respondents after
undergoing hemodialysis. Authorship (2023).
Patients face varied cognitive and perceptual challenges, according
to Table 7 15% always have difficulty hearing and 40% sometimes,
while vision problems are more common (40% always). Concentration
and memory are also affected, with 18% always and 54% sometimes
experiencing changes. In addition, 13% always encounter difficulty
with hemodialysis treatment, which could affect their ability to
manage their care effectively.
Table 8.
Self-perception-self-concept pattern according to Marjory
Gordon
Items evaluated
Always
%
A/v
%
%
Total
Self-satisfaction
44
66%
14
21%
13%
67
Well-being with
body image
after fistula
45
67%
13
19%
13%
67
Mood changes
due to illness
10
15%
46
69%
16%
67
Fear, anxiety,
depression in
the face of
disease
22
33%
32
48%
19%
67
Emotional
support from
nursing staff
61
91%
6
9%
0%
67
Note: Manifestation of the mood and communication state of the
patient with chronic renal failure. Authored by author (2023).
Self-esteem and body image are generally positive, as shown in Table
8, with 66% satisfied with themselves and 67% always well with their
body image after fistula. However, mood change due to the disease
is common (69% sometimes), and 33% always experience fear, anxiety
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or depression. Notably, 91% always receive emotional support from
the nursing staff, highlighting the importance of emotional support in
their treatment.
Table 9.
Role-relationship pattern according to Marjory Gordon
Items
evaluated
Always
%
A/v
%
Never
%
Total
Considered
sociable
61
91%
5
7.5%
1
1.5%
67
Belongs to a
social group
32
48%
22
33%
13
19%
67
Social
exclusion due
to illness
3
4.5%
17
25%
47
70%
67
Income for
health needs
20
30%
31
46%
16
24%
67
Feeling part of
the
community
where you live
42
63%
24
36%
1
1.5%
67
Illness-related
violence
(physical,
psychological,
emotional)
4
6%
15
22.5%
48
71.5%
67
Coexistence:
- Alone
3
4.5%
-
-
-
-
67
- Family
62
93%
-
-
-
-
67
- Caregivers
2
3%
-
-
-
-
67
- Residence
0
0%
-
-
-
-
67
Note: Family and social relationships of the patient with chronic renal
failure. Authored by author (2023).
Table 9 shows that patients maintain an active social life, with 91%
considering themselves always sociable. Membership in social groups
is less common (48% always). Social exclusion due to the disease is
low (4.5% always), but 30% always need income for health needs.
Most feel part of their community (63% always), and disease-related
violence is low (6% always).
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Table 10
. Sexuality-reproduction pattern according to Marjory
Gordon
Items
evaluated
Always
%
A/v
%
%
Total
Sexually
active
7
10.5%
21
31%
58.5%
67
Satisfactory
sexual
relations
8
12%
19
28.5%
60%
67
Changes in
sexual health
due to
disease
15
22.5%
19
28.5%
49%
67
Note: Describes the satisfaction or dysfunction of the patient with
CKD in sexual and reproductive health in relation to the disease and
treatment. Authorship (2023).
According to Table 10, sexual activity in these patients is limited, with
only 10.5% always being sexually active and 12% always having
satisfactory sexual relations. Changes in sexual health due to the
disease are reported by 22.5% always, suggesting that CKD and
treatment significantly affect this area of their lives.
Table 11. Adaptation-stress tolerance pattern according to Marjory
Gordon
Items evaluated
Always
%
A/v
%
%
Total
Perform activities to
reduce anxiety or
depression
14
20.9%
25
37.3%
41.8%
67
Tenseness during
hemodialysis
22
32.8%
36
53.7%
13.4%
67
Crisis or major
problems in the last
year
13
19.4%
27
40.3%
40.3%
67
Note: The table reflects stressful situations that patients with CKD feel
in relation to the disease and treatment. Authored by author (2023).
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According to Table 11, stress management varies, with 20.9% always
performing activities to reduce anxiety or depression. Stress during
hemodialysis is common (32.8% always), and 19.4% have had crises
or major problems in the last year, reflecting the emotional impact of
their condition and treatment.
Table 12 .
Values-beliefs pattern according to Marjory Gordon
Items evaluated
Always
%
A/v
%
%
Total
Considers it
important to
belong to a
religious group
43
64.2%
15
22.4%
13.4%
67
His religion
prevents him
from carrying
out his
treatment
4
6%
5
7.5%
86.5%
67
Plans for the
future
35
52.2%
15
22.4%
25.4%
67
Religious group
to which you
belong
-
-
-
-
-
-
a) Catholic
39
58.2%
-
-
-
39
b) Evangelical
24
35.8%
-
-
-
24
c) Jehovah's
Witness
4
6%
-
-
-
4
d) Others
0
0%
-
-
-
0
Note: Emphasizes spiritual and religious beliefs that influence the
health of CKD patients. Authored by author (2023).
Table 12 establishes that most consider it important to belong to a
religious group (64.2% always), and few see their religion as an
impediment to treatment (6% always). More than half have plans for
the future (52.2% always), and most belong to Catholic or evangelical
religious groups. These results indicate that religious and spiritual
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beliefs play an important role in their perspective and management
of the disease.
Conclusions
The adoption of Gordon's model has facilitated a more
comprehensive and detailed assessment of patients' needs, allowing
nurses to address critical aspects of care that go beyond immediate
physical needs.
One of the key findings is improved self-care and adherence to
treatment. The model has proven effective in educating patients
about the importance of following medical recommendations and
medication schedules, which is crucial to the successful management
of chronic renal failure. This increased adherence is a testament to the
model's effectiveness in empowering patients and encouraging their
active participation in their own care.
In terms of nutrition and metabolism, the study highlights the
usefulness of the model in identifying and treating specific nutritional
problems associated with chronic renal failure and hemodialysis.
Personalized attention in this area has led to more effective nutritional
interventions, improving the overall health and well-being of patients.
Mobility and daily functional ability have also benefited. The model
has helped to recognize and address patient concerns related to
mobility, especially regarding fear of damaging the fistula and the
need for assistive devices. This comprehensive approach has
improved patients' independence and quality of life.
In addition, the model has provided valuable insights into sleep and
rest challenges, allowing nurses to develop strategies to improve
sleep quality and provide adequate rest, crucial aspects for patients'
recovery and overall well-being.
Taken together, these findings emphasize the importance of the
Marjory Gordon Model in nursing practice for hemodialysis patients.
By providing more holistic, patient-centered care, the model not only
improves the quality of nursing care, but also comprehensively
supports patients in their treatment and management of chronic renal
failure.
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