Expressive Writing Therapy (EWT) dan Pendampingan Perawat untuk Mengurangi Kesepian pada Pasien Hemodialisis Usia Dewasa Muda: Studi Kasus

https://doi.org/10.22146/jkkk.113032

Vijna Putri Sukma Wahyudi(1), Ispriyatiningsih Ispriyatiningsih(2), Melyza Perdana(3), Christantie Effendy(4*)

(1) Prodi Profesi Ners Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(2) Unit Hemodialisa Rumah Sakit Umum Dr. Sardjito
(3) Departemen Keperawatan Medikal Bedah, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(4) Departemen Keperawatan Medikal Bedah, Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Background: Loneliness is a common psychosocial issue among young adult hemodialysis patients, hence it may affect emotional well-being and treatment adherence. Evidence on simple nurse-facilitated interventions, such as Expressive Writing Therapy (EWT) combined with supportive accompaniment, remains limited in this population.
Objective: To describe the changes in loneliness level following the implementation of Expressive Writing Therapy (EWT) combined with nurse-led accompaniment.
Case report: A 21-year-old female who had undergone hemodialysis for six years participated in a six-day expressive writing program and seven accompaniment sessions. The initial UCLA-Loneliness Scale Version 3 score was 42, indicating the middle threshold of mild loneliness.
Outcome: After the intervention, the score decreased to 33 (non-lonely category). The UCLA instrument was analyzed across three dimensions: intimate loneliness, relational loneliness, and collective loneliness. The greatest improvement was observed in the intimate dimension, followed by partial improvement in the relational dimension, while the collective dimension remained stable. Subjectively, patient reported emotional relief, greater social connectedness, and renewed motivation.
Conclusion: The combination of EWT and nurse accompaniment may help reduce loneliness and improve emotional experiences related to loneliness in young adult hemodialysis patients. This approach may be considered a holistic nursing strategy for chronic conditions.

INTISARI

Latar belakang: Kesepian merupakan masalah psikososial yang sering dialami pasien hemodialisis dewasa muda dan dapat memengaruhi kesejahteraan emosional serta kepatuhan terhadap terapi. Namun, bukti penelitian mengenai pemberian intervensi sederhana yang dapat difasilitasi perawat, seperti Expressive Writing Therapy (EWT) yang dikombinasikan dengan pendampingan, pada kelompok ini masih terbatas.
Tujuan: Studi kasus ini bertujuan mendeskripsikan perubahan tingkat kesepian dan pengalaman subjektif pasien setelah penerapan Expressive Writing Therapy (EWT) dan pendampingan perawat.
Laporan kasus: Seorang pasien perempuan berusia 21 tahun yang telah menjalani hemodialisis selama enam tahun mendapatkan intervensi berupa program penulisan jurnal ekspresif selama enam hari dan tujuh sesi pendampingan. Skor awal UCLA-Loneliness Scale Version 3 pada pasien tercatat 42 yang menandakan di posisi pertengahan kategori kesepian tingkat ringan.
Hasil: Setelah intervensi, skor turun menjadi 33 yang termasuk kategori tidak kesepian. Kesepian yang diukur instrumen UCLA memiliki tiga dimensi, yaitu kesepian intim, kesepian relasional, dan kesepian kolektif. Perbaikan terbesar terlihat pada dimensi kesepian intim, diikuti oleh peningkatan parsial pada dimensi kesepian relasional, sementara dimensi kesepian kolektif menunjukkan skor stabil. Secara subjektif, pasien melaporkan pelepasan emosional, peningkatan keterhubungan sosial, dan munculnya motivasi baru.
Simpulan: Dalam kasus ini, kombinasi EWT dan pendampingan perawat berpotensi membantu menurunkan kesepian dan memperbaiki pengalaman emosional terkait kesepian pada pasien hemodialisis dewasa muda. Pendekatan ini dapat dipertimbangkan sebagai strategi keperawatan holistik pada kondisi penyakit kronis.


Keywords


dewasa muda; expressive writing therapy; hemodialisis; kesepian; pendampingan perawat

Full Text:

PDF


References

  1. Pallone JM, Santos DGM dos, Oliveira Dias AL, Ferreira LGS, Costa da Silva C, Orlandi F de S. Loneliness Level and Its Associated Factors in Patients with Hemodialysis. Clin Nurs Res. 2022;31(6):1164–1171. https://pubmed.ncbi.nlm.nih.gov/34955033/.

  2. Margono HM. Dealing with Loneliness in Hemodialysis Patients: How to Prevent The Detrimental Effects of Loneliness. Jurnal Psikiatri Surabaya. 2024;13(S1):62–67. https://e-journal.unair.ac.id/JPS/article/view/62657.

  3. Nagilanga KL, Munro Wild H, Pattison N. Improving Interaction and Reducing Social Isolation in Young Adults with kidney Disease Requiring Hemodialysis. - University of Hertfordshire (Research Profiles) [Homepage on The Internet]. c.2025 [Updated 2025; Cited 2025 Jun 25]. Available from https://researchprofiles.herts.ac.uk/en/projects/improving-interaction-and-reducing-social-isolation-in-young-adult.

  4. Vork DL, Schneekloth TD, Bartley AC, et al. Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated with Higher Health Care Utilization. Mayo Clin Proc. 2018;93(3):321. https://pmc.ncbi.nlm.nih.gov/articles/PMC5854145/.

  5. Fleck A. Chart: One in Four Young People in The World Feels Lonely | Statista [Homepage on The Internet]. c.2025 [Updated 2025; Cited 2025 Nov 9]. Available from https://www.statista.com/chart/31243/respondents-who-feel-fairly-or-very-lonely/.

  6. Widya Pangestika V, Nugroho Jati S, Muhammadiyah Pontianak U. Comparative Study of Loneliness in Indonesian and Malaysian Students. Psikoislamedia: Jurnal Psikologi. 2024;9(1):16–26. https://jurnal.ar-raniry.ac.id/index.php/Psikoislam/article/view/22743.

  7. Detore NR, Burke A, Nyer M, Holt DJ. A Brief Resilience-Enhancing Intervention and Loneliness in At-Risk Young Adults: A Secondary Analysis of A Randomized Clinical Trial. JAMA Netw Open. 2024;7(2):e2354728–e2354728. https://doi.org/10.1001/jamanetworkopen.2023.54728.

  8. Pennebaker JW. Writing about Emotional Experiences as A Therapeutic Process Special Section. Psychological Science. 1997;8(3):163-166. http://www.jstor.org/stable/40063169.

  9. Unggun Cahya Jalu Putra W, Yulianti S, Reza M. The Effect of Expressive Writing Therapy on Reducing Stress Levels in Chronic Kidney Disease Undergoing Hemodialysis at Undata Hospital. Journal of Health and Nutrition Research. 2023;2(1):48–53. https://doi.org/10.56303/JHNRESEARCH.V2I1.120.

  10. Slatcher RB, Pennebaker JW. How Do I Love Thee? Let Me Count The Words: The Social Effects of Expressive Writing. Psychol Sci. 2006;17(8):660–664. https://pubmed.ncbi.nlm.nih.gov/16913946/.

  11. Pennebaker JW, Chung CK. Expressive Writing: Connections to Physical and Mental Health. The Oxford Handbook of Health Psychology. 2011;417–437. https://psycnet.apa.org/record/2013-01232-018.

  12. Sloan DM, Marx BP. A Closer Examination of The Structured Written Disclosure Procedure. J Consult Clin Psychol. 2004;72(2):165–175. https://pubmed.ncbi.nlm.nih.gov/15065952/.

  13. Travagin G, Margola D, Revenson TA. How Effective are Expressive Writing Interventions for Adolescents? A Meta-Analytic Review. Clin Psychol Rev. 2015;36:42–55. https://doi.org/10.1016/j.cpr.2015.01.003.

  14. Kelly M. Psychosocial Approach in People with CKD: Psychosocial Implications. 2024;293–298. https://link.springer.com/chapter/10.1007/978-3-031-30320-3_19.

  15. Kogon AJ, Hooper SR. Mental Health and Social-Emotional Functioning in Children and Adolescents with Chronic Kidney Disease. 2024;39:2015–2031. https://doi.org/10.1007/s00467-023-06151-1.

  16. Torrisi LG, Zwieten A van, Guha C, et al. Patient and Caregiver Perspectives on Mental Health in Children and Adolescents with Chronic Kidney Disease. Clin Kidney J. 2025;18(4). https://dx.doi.org/10.1093/ckj/sfaf067.

  17. Russell DW. UCLA Loneliness Scale (Version 3): Reliability, Validity, and Factor Structure. J Pers Assess 1996;66(1):20–40. https://doi.org/10.1207/s15327752jpa6601_2.

  18. Stickley A, Ueda M. Loneliness in Japan during The COVID-19 Pandemic: Prevalence, Correlates and Association with Mental Health. Psychiatry Res. 2022;307:114318. https://doi.org/10.1016/j.psychres.2021.114318.

  19. Pollet T V., Thompson A, Malcolm C, McCarty K, Saxton TK, Roberts SGB. Are We Measuring Loneliness in The Same Way in Men and Women in The General Population and in The Older Population? Two Studies of Measurement Equivalence. PloS. 2022;17(12):e0266167. https://doi.org/10.1371/journal.pone.0266167.

  20. Pennebaker JW, Beall SK. Confronting a Traumatic Event: toward An Understanding of Inhibition and Disease. J Abnorm Psychol. 1986;95(3):274–281. https://doi.org/10.1037//0021-843x.95.3.274.

  21. Birchall M, Nightingale S, Bray A, et al. Revisiting Expressive Writing: A Narrative Review of Its Therapeutic Applications [Homepage on The Internet]. c.2023. [Update 2023; Cited 2025] Available from https://www.researchgate.net/publication/370341234.

  22. Pennebaker JW, Smyth JM. Opening Up by Writing It Down: How Expressive Writing Improves Health and Eases Emotional Pain. New York; The Guilford Press: 2016.

  23. Kupeli N, Chatzitheodorou G, Troop NA, McInnerney D, Stone P, Candy B. Expressive Writing as A Therapeutic Intervention for People with Advanced Disease: A Systematic Review. BMC Palliat Care. 2019;18(1):1-12. https://doi.org/10.1186/s12904-019-0449-y.

  24. Frattaroli J. Experimental Disclosure and Its Moderators: A Meta-Analysis. Psychol Bull. 2006;132(6):823–865. https://pubmed.ncbi.nlm.nih.gov/17073523/.

  25. Camedda C, Bici G, Magi CE, Guzzon A, Longobucco Y. The Therapeutic Nurse–Patient Relationship in Hemodialysis: A Pilot Mixed-Method Study on The Perceived Quality of Nurses’ Attitudes and Caring Behaviors. Nurs Rep. 2023;13(3):990–1003. https://doi.org/10.3390/nursrep13030087.

  26. Cosentino C, D’apice C, Gaudio M Del, et al. Effectiveness of Expressive Writing Protocol in Palliative Care Healthworkers: A Quantitative Study. Acta Bio Medica: Atenei Parmensis. 2021;92(2):1-9. https://doi.org/10.23750/abm.v92iS2.11468.

  27. Forchuk C. Peplau and Therapeutic Relationships. In: Roles S, Kalia K. (eds) The Nurses’ Guide to Psychotherapy. Singapore; Springer: 2024.

  28. Taylor F, Combes G, Hare J. Improving Clinical Skills to Support The Emotional and Psychological Well-Being of Patients with End-Stage Renal Disease: A Qualitative Evaluation of Two Interventions. Clin Kidney J. 2016;9(3):516. https://doi.org/10.1093/ckj/sfw017.

  29. Jeong D, Choi YJ, Experience of Loneliness among Middle-Aged Hemodialysis Patients: Qualitative Study. J Nurs Manag 2025;2025(1).1-13. https://doi.org/10.1155/jonm/1013725.

  30. Pierro L, Pretagostini R, et al. Effectiveness of Expressive Writing in Kidney Transplanted Patients: A Randomized Controlled Trial Study. Healthcare. 2022;10(8):1559. https://doi.org/10.3390/healthcare10081559.

  31. Feroze U, Martin D, Kalantar-Zadeh K, Kim JC, Reina-Patton A, Kopple JD. Anxiety and Depression in Maintenance Dialysis Patients: Preliminary Data of A Cross-Sectional Study and Brief Literature Review. Journal of Renal Nutrition 2012;22(1):207–210. https://doi.org/10.1053/j.jrn.2011.10.009.



DOI: https://doi.org/10.22146/jkkk.113032

Article Metrics

Abstract views : 9 | views : 6

Refbacks

  • There are currently no refbacks.


Copyright (c) 2025 Vijna Putri Sukma Wahyudi, Christantie Effendy, Melyza Perdana, Ispriyatiningsih Ispriyatiningsih

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

Jurnal Keperawatan Klinis dan Komunitas (Clinical and Community Nursing Journal) 
collaborates with DPW PPNI DIY

Lisensi Creative Commons  

Jurnal Keperawatan Klinis dan Komunitas (Clinical and Community Nursing Journal) is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.