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1
بسم هللا الرحمن الرحيم
AN-Najah National University
Faculty of Nursing
in Quality of life for patient undergoing hemodialysisNorth of West Bank
Prepared by :
Ata Al-Shareef Ayman Qaisiya Sameh yahya
Supervised by:
Miss Fatimah Hersalah (RN. MSN. CNS.)
2011-First semester 2010
2
Table of Contents:
No. Content Page
I. Acknowledgement 4
II. List of Abbreviations 5
III. List of Tables 6
IX. Study Abstract 7
Chapter one
1. Introduction 8
1.1 Study background 11
1.2 Significance of study 12
1.3 Aims of Study 12
1.5 Demography 12
Chapter two
2 Literature Review 13
3
Chapter Three
3 Methodology 15
3.2 Study population 15
3.3 Study design 15
3.4 Sampling 16
3.5 Instrument of the study 16
3.6 setting of the study 17
3.7 Inclusion criteria and exclusive criteria 17
3.8 Data collection 18
3.9 Ethical consideration: 18
3.10 Statistical analysis 18
Chapter Four
5 Study Results 19
Chapter Five
6 Discussion 26
7 Conclusion 30
8 Study limitations 30
4
9 Recommendations 31
10 References 31
Acknowledgement
To our fathers and mothers who were the kind embrace for their
sons, who supported their sons financially and emotionally to the last day
of their study. To the University to which we belong “AN-NAJAH
NATIONAL UNIVERSITY” represented by Dr.RAMI HEMDALLAH
who always support us and our faculty. To the dean of our faculty which
we appreciate her support Dr Aidah Alqaissi the person who was
the kindhearted there for all of her students , the person who taught us
the principles of research , the person who taught us this material from
Whose experience we were benefited, and for Miss Fatima Hersalah who
supervised our work and was the best supervisor, who supported us by
her experience to finish this work perfectly. To the ministry of health
which accepted us in its hospitals as guests. To all of our colleagues from
whom we were benefited in our working the project, the students who were friends
and brothers. To all of these people we present this work.
5
List of Abbreviations
QOL : Quality of life
HD : hemodialysis
ESRD :End Stage Renal Disease
Pt : patient
SPSS : Statistical Package for Social Science.
No. : Number.
WB : West Bank
6
List of Tables:
Table Content
Table (1) The distribution of the study sample on the question number 1
Table (2 ) The distribution of the study sample on the question number 2
Table ( 3 ) The distribution of the study sample on the question number 11
Table (4 ) The distribution of the study sample on the question number 9
Table (5) The distribution of the study sample on the question number 3
Table (6) The distribution of the study sample on the question number 4
Table (7) The distribution of the study sample on the question number 5
Table (8) The distribution of the study sample on the question number 5
Table (9) The distribution of the study sample on the question number 8
Table 10) The distribution of the study sample on the question number 6
Table (11) The distribution of the study sample on the question number 10
7
Abstract:
Background: Quality of life (QOL) in end-stage renal disease patients
has become an important focus of attention in evaluating hemodialysis. Patients’ adaptation to a chronic disease is determined by their beliefs about ESRD and HD.
Aim: of this study is to evaluate the quality of life in hemodialysis patents and to
research the influence of various factors related to HD and ESRD .
Method: Cross-sectional design of 100 hemodialysis patients, was recruited from
four governmental hospitals from four cities distributed in north of the west bank .participant age range from (20-65 year), chosen by convenience sample. They completed the Short-Form Health Survey (SF-36).
Result: in our study we found that in general health for (HD) pts was good, also
(60% -70%) of them have disturbances in their social function and activity
daily living related to their physical and psychological limitation .
Conclusion: as conclusion hemodialysis patients have low quality of life as
consequence of (ESRD) and (HD). There is disturbance in their function and well being status.
Key words: Quality of life (QOL), Hemodailysis (HD), End Sage Renal Disease
(ESRD).
8
Chapter One
1. Introduction:
1. A Normal kidneys and their function:
The kidneys are a pair of bean-shaped organs that lie on either side of spine in the lower middle of back. Each kidney weighs about ¼ pound and contains approximately one million filtering units called nephron. Each nephron is made of a glomerulus and a tubule. The kidneys are connected to the urinary bladder, it receive urine from kidneys . Urine is stored in the urinary bladder until empted by the bladder. The bladder connected to the outside through urethra.
Figure 1.1 Anatomy of the kidney
There are many function for kidneys the major one removing waste products that result from metabolism ,tissue damage and other substance and remove excess water from blood.
9
Kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood. Kidneys also produce certain hormones that have important functions in the body ,such as Active form of vitamin D ,Erythropoietin and Renin (Smeltezer C. et al . 2007) .
1. B Kidney failure and kidney disease: Kidney failure occurs when the kidneys partly or completely lose their
ability do normal functions. Total loss of kidney function known as End Stage
Renal Disease, ESRD is one type of kidney disease is chronic disease. (Smeltzer C et
al .2007).
1. C Causes of ESRD: Although ESRD caused by a multitude of kidney diseases, the majority of ESRD populations were either diabetic or suffering from hypertension disease. (Smeltezer C. et al . 2007). Reports from Western European and Asian Pacific region, including Australia and New Zealand showed that diabetic nephropathy as the main cause of ESRD. Data showed an increase in both incidence and prevalence of diabetic nephropathy between 1998 and 2000 (Lee, 2003). Studies from the USA showed that hypertension was the second major causative of ESRD. Glomerulonephritis considered as a third major cause of ESRD (Anderson, Brenner, 1988).
10
1. D ESRD Treatment: There are two treatment choices for (ESRD): The first one is dialysis, The second one is Kidney transplantation for survival. Hemodialysis: Hemodailysis is one of the treatment options in renal replacement therapy (
Ko.B, Et al ,2007) . Hemodialysis removes waste and excess fluid from the blood
when the kidneys can't do so sufficiently. The blood drawn intravenously, sent to a
dialyzer, and returned to the body through a blood vessel. During that blood is exposed to extracorporeal semi permeable membrane and on the other side of which a dialysate solution is flowing (Tong M, et al .2001). Two major mechanisms govern the movement of molecules (diffusion and ultra filtration). Diffusion refers to the movement of a solute across a semi permeable membrane from a region of higher concentration to a region of lower concentration this transport is dependent on the physical size of the molecule relative to the size of the pores in the membrane. Ultrafiltration refers to plasma water removal by applying a negative transmembrane pressure across the dialysis membrane. This hydrostatic pressure forces plasma water from the patient out into a dialysate (Tong M, et al .2001) . The blood circulated and diffused numerous times during a dialysis session; each circulation through the machine removes more waste and excess fluid (Smeltezer C. et al . 2007).
The aim of hemodialysis treatment is to save patient life and prevent complication
that occur as a result of ESRD (Stojanovic.M. , et al ,2007) . Hemodialysis usually
performed three or more times a week for 4 hours or more. There are two major goals
11
for HD the first one is to increase patient survival on other hand to prompt QOL for
them (Moreno,F,1996).
1. E Quality of life QOL and HD:
Quality of life (QOL), an individual's perception of his or her life and sense of
well-being in relation to his or her goals, expectations, standards, and concerns,
(Sloan JA .2002) . As defined by the World Health Organization, "QOL is an
individual’s perception of their position in life in the context of the culture and value
systems in which they live with the patient survival and concerns" (WHO.1993).
QOL may be profoundly altered by chronic disease. A recent prospective
evaluation of health-related QOL in a cohort of patients with chronic kidney disease
showed decreasing scores with advancing chronic kidney disease ( Mujais SK,
2009).Several studies of dialysis patients have shown that measures of QOL and
depression are correlated with mortality and hospitalization.( Kalantar-Zadeh K ,
2001).For many dialysis patients, the quality of their lives is more important than
hospitalization or mortality rates. Quality of life continues to be a significant problem
for patients receiving hemodialysis (HD) as a result of treatment HD complication and
ESRD consequences.( Kathy P 2003 ).A host of physical and psychological
symptoms occur in patients on chronic hemodialysis. (Steven D. et al . 1998).
1.2 Study background:
The quality of life (QOL) is an important predictor of outcome in end-stage renal
disease (ESRD) patients. Therefore, (QOL) in (ESRD) patients have become an
important focus of attention in evaluating hemodialysis. Patients adaptation to a
chronic disease is determined by their beliefs about (ESRD) and( HD) (Wasserfallen
J .2004) .many studies take risk factors for poor QOL for hemodialysis patient
(Seica1 A.2009) .
12
1.3 Significance of study:
According to our past experience from training in many hospitals,
we noticed that there were many complaints from Pts about their disease
(ESRD) and treatment (HD). Otherwise, we noticed that some patients refused
to regimen their necessary treatment and they refused cooperation with
health instructions that prescribed from health team.
So, we selected our topic to study it, and measure the (QOL) for (HD) Pts and to identify the effects of (ESRD) and (HD). As well as, we hope to give some
recommendations according to study result .
1.4 Aims of Study:
The aim of this study is to assess the quality of life for hemodialysis patient, by
using SF-36 instrument.
1.5 Hypothesis:
1- Quality of life (QOL) for patient undergoing hemodialysis (HD) is low.
1.6 Demography:
Our study conducted in north of the West bank of Palestine including the towns of: Nabulus, Tulkarem, Salfeet, Jenin. with population 320, 160, 65,220.
13
Chapter Two
Literature Review:
Quality of life affected by several factor, disease and treatment is some of
factor that also affect the quality of life. Pts with (ESRD) and who treated by
(HD) negatively affect quality of life. (Cleary.J, Drennan.J 2004). So that Social
support associated with improved physical health and the religious may serve as
coping mechanism for dealing with kidney disease (Rambod.M, Rafii.F, 2007)
.Another study conclude Self-care self-efficacy have great impact on outcomes of
QOL (Tsay.H, et al, 2001)
Anxiety and depression are considered as frequent disorders in end-stage renal disease patients (Untas A.2009) .Major depression is highly prevalent in the general population and is associated with grave consequences in terms of excessive mortality, disability, and secondary morbidity. Indeed, depression seems to affect people more frequently during their more productive years, tending to recur without appropriate recognition and management (Sartorius N, 2001). but when we compare the
subjective (QOL) of patients with major depression and subjects undergoing
hemodialysis, the pts with major depression significantly have lower (QOL) (Marcelo
T., et al, 2006). Patient on (HD) who understands their chronic disease they are able
to control their illness and have low emotional response (Covic.A, et al, 2004).
A Canadian study of 99 dialysis patients suggested that depression or anxiety associated with hemodialysis Pts (Graven JL .1987). Study that take a large proportion of 160 hemodialysis patients experience depressive mood (TsayS.2001). Another study concluded that Depression is associated with decreased health-related quality of life
14
and increased mortality in hemodialysis patients (Rebecca A. et al, 2006) .so that Caregiver were not always aware of this inducing a sense of emotional distance and a sense vulnerability in the patient (Hargen.B , 2004). There is many coping
mechanism that use to reduce of the affect of depression on (QOL). Hemodialysis
patients with strong spiritual beliefs had higher social function this will prevent
depression and improve quality of life than those with weak spiritual beliefs ( Kao.T
,2007)
However how pt receive his treatment it also effect (QOL) such higher dose
hemodialysis (3 times every week ) was associated with better physical health and
less bodily pain than who receive 2 time weekly (Hnruh.M , et al ,2003) . on other
hand, There was a tenancy for those who dialyzed at home to score higher on quality
of life self care ability and sense of coherence than those who dialyzed themselves in
Center ( Agoborg .M , 2005). The preparedness and training for patient to undergo
(HD) for long term reverse the poor clinical outcome by improving the nutritional
status and (QOL) in (HD) patients. (Furuta A, et al, 2007).
Finally (ESRD) Pts have many hormonal disturbances and higher disturbances
in (QOL) than the normal population ( SYang.H ,etal 2008) . so that (QOL) for
patients on (HD) is markedly impaired. Co morbid conditions and older age and poor
income substantially reduce (QOL) in (HD) patients (Stojanovi M, et al, 2007) .
15
Chapter three
Methodology:
3-1 Study population:
The population of the study is (HD) patients. It accounts 100 patients 25
from Tulkarem , 38 from Nablus , 25 from Jenin and 12 from Salfeet.
Patients are 60 male and 40 female, there ages range between (20-65) years.
3-2 Study Design:
This study was designed as descriptive, non experimental, cross sectional
health status survey of Quality of life for patient undergoing hemodialysis treatment
was carried out.
Cross-sectional designs involve the collection of data at one point in time ,the phenomena under study are captured during one period of data collection. Cross-sectional studies are appropriate for describing the
status of phenomena or for describing relationships among phenomena at
a fixed point in time.
Advantages of cross-sectional studies:
16
1-Relatively inexpensive and takes up little time to conduct;
2-Can estimate prevalence of outcome of interest because sample is
usually taken from the whole population;
3-Many outcomes and risk factors can be assessed;
4-Useful for public health planning, understanding disease etiology and
for the generation of hypotheses;
5-There is no loss to follow-up.
Disadvantages of cross-sectional studies:
1-Difficult to make causal inference;
2-Prevalence-incidence bias (also called Neyman bias). Especially in
the case of longer-lasting diseases, any risk factor that results in death
will be under-represented among those with the disease.
3-3 Sampling:
Convenience sample is a subset of individual chosen from a the
mentioned hospitals. We visited each center for two days and took all
patients who met inclusion criteria.
.
3-4 Instrument of the study:
Short form health questionnaire (SF-36) was used to measure Quality of life. The
questionnaire contained 36 questions covering eight scales divided into two
Physical function, edit containwhich Functional Scaleswas he first one groups: T
Role Function Physical causes, Role Function-Emotional factors, Social function and
Pain. The second one was Well-being Scales which in contained Psychological well-
17
being, Vitality and General Health. This form measured the individual's (QOL) in
general over the last four weeks. It took 5-10 minutes to complete ( Mingardi G et al
.1998).
Validity
SF-36 is international tool to test quality of life , we was take two form of SF-36
from the SF-36 free website (www.sf-36.com) one of them in English and the other in
Arabic language . Study tool was subjected for the test by experts who recommended
for its validity for the achieving of the study purposes.
Reliability:
Instrument was tested by pilot test. We was give 7(HD) Pts from AlWatanee
hospital SF-35 instrument and ask them to fill it, after 10 days we ask them to fill
other one after that we administer it to SPSS .Khronapach Alpha which was (0.87)
this result acceptable for the study purposes.
3-6 Setting of the study :
Our study conducted in Palestine Country especially in the north of WB
four governmental hospitals included ,This study was made in kidney department in
the mentioned hospitals.
Inclusion criteria and exclusive criteria: 3-7
Inclusion Criteria:
1- Hemodialysis patient in the mentioned center who receive (HD) for two times or
more weekly.
2- Patient who receive hemodialysis for period more than one year.
18
3- Who use Arteriovenous fistula for (HD).
4- Patient age range from 20-65 year.
Exclusion Criteria:
1- Patient who has hepatitis B and C.
2- Patient with amputations and congenital deformity.
3-8 Data collection:
We used the face to face method to collect the data. Pts were receive consent form that contain brief information about study. Pt was signature it if he
accepted to participate in study, pt was fill questionnaire alone if he need an
explanation ,ask us to help him .The place of the meeting was in the
Kidney department, beside the patient for period ranged from 10 to
15 minutes.
3-9 Ethical consideration:
Permission was obtained from the Palestinian ministry of health to conduct this
study and to use the facilities in the hospital. A signed consent was obtained from
each participant after discussing with each of them the purpose of the study and all
related matters to the research purpose , pts was given the right to withdrawn from
study any time without any consequences.
3-10 Statistical analysis:
We was use SPSS Statistical Package for Social Science (10 version) to analysis
19
data. Arabic form of SF-36 was inserted to SPSS program to analyses 100
questionnaire.
Chapter Four
Study Results:
The ages of study participants ranges and distributed according to this scale:
20‐30 year (n=20; 20%), 3‐‐50 year (n=52; 52%), 50‐65 year (n=28; 28%).
The distribution of the study sample according to the Academic qualification was
Primary ( n= 26;26%), Preparatory ( n= 26;26%), Secondary ( n= 30;30%), B.A( n=
14;14%), M.A ( n= 4;4%).The results of the study questions which are most of patient
in the secondary school.
A-The result of according well being scale:
1- General health:
Question (1): In general, would you say your health is.
Table (1): The distribution of the study sample on the question number 1:
20
Percentage No. In general , would you say your health is
14.0 14 Excellent
15.0 15 Very good
43.0 43 Good
14.0 14 Fair
14.0 14 Poor
100% 100 Total
It has been shown from the table (1) that (43%) of participants their general health
good status .
Question (2): Compare to one year ago, how would you rate your health in general
now?
Table (2): The distribution of the study sample on the question number 2;
Percentage No. In general , how would you rate your health
12.0 12 Much better now than a year ago
28.0 28 Somewhat better now than a year ago
36.0 36 About the same as one year ago
14.0 14 Somewhat worse now than a year ago
10.0 10 Much worse now than a year ago
100% 100 Total
It has been shown from the table (2) That the rate (36%) participants their general
health is the same as one year ago.
Question 11:
: The distribution of the study sample on the question number 11: Table (3)
Definitely false
Mostly false
Don't know
Mostly true
Definitely true
11. How TRUE or FALSE is each of the following statements for you?
21
4.016.030.026.024.0a. I seem to get sick a little easier than other people
18.020.024.028.0 10.0b. I am as healthy as anybody I know
6.018.040.016.020.0c. I expect my health to get worse 20.020.022.026.012.0d. My health is excellent
The table (3) Pts didn’t known the outcome of their disease and treatment. Such as they don’t know how they get their illness when they compare with other patients.
2- Vitality and Psychological well-being (MH)
Question (9):
The distribution of the study sample on the question number 9: : Table (4)
None of the time
A little of the time
Some of the time
A good bit of the time
Most of the time
All of the time
9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question,
10.0 12.0 22.0 24.0 16.0 16.0a. did you feel full of pep? 10.010.030.018.012.020.0b. have you been a very nervous person? 6.030.028.018.0 4.014.0c. have you felt so down in the dumps
nothing could cheer you up? 12.012.038.020.010.08.0d. have you felt calm and peaceful? 20.018.0 22.024.014.0 2.0e. did you have a lot of energy? 18.028.020.016.0 12.06.0f. have you felt downhearted and blue? 12.020.0 20.034.010.04.0g. did you feel worn out? 10.020.034.018.06.012.0h. have you been a happy person? 2.016.022.038.06.016.0i. did you feel tired?
The table (4) showed that the (HD) pts become nervously, depressed and worn out some times .on other hand they feel happy and more energy in some of times.
Functional scale : Results according B-
22
1- Physical function
Question 3:
Table (5): The distribution of the study sample on the question number 3
(HD) Pts have physical limitation .as a result of it they can't do vigorous activity
.they have some of limitation to do moderate activity . they are able to do light
activity and self care.
2- Role Function-Physical (RP)
Question 4:
The distribution of the study sample on the question number 4: : Table (6)
No Yes 4. During the past 4 weeks, have you had any of the following
not limited at all
limited a little
limited a lot. .
.
3-The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?
22,0 36,042,0a. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports.
28.0 54.0 18,0 b Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf?
34.0 44.0 22,0 c. Lifting or carrying groceries. 34.0 54.0 12.0 d. Climbing several flights of stairs. 58.0 34,0 8.0 e. Climbing one flight of stairs. 44.0 40.0 16.0 f. Bending, kneeling or stooping. 26.0 32.0 42.0 g. Walking more than one mile. 40.0 46.0 14.0 h. Walking several blocks. 58.0 28.0 14.0 i. Walking one block. 66.0 18.0 16.0 j. Bathing or dressing yourself.
23
problems with your work or other regular daily activities as a result of your physical health?
24.0 76.0 a. Cut down the amount of time you spent on work or other activities?
38.0 62.0 b. Accomplished less than you would like? 30.0 70.0 c. Were limited in the kind of work or other activities 36.0 64.0 d. Had difficulty performing the work or other activities (for
example, it took extra time)
The table (6) shown that the large distribution of pts their disease interfere with daily activity because pain and time that spent in treatment and physical limitation.
3- Role Function-Emotional factors (RE)
Question 5:
Table (7): The distribution of the study sample on the question number 5:
No Yes 5. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as result of any emotional problems (such as feeling depressed or anxious)?
22.0 78.0 a. Cut down the amount of time you spent on work or other activities?
34.0 66.0 b. Accomplished less than you would like 34.0 66.0 c. Didn't do work or other activities as carefully as usual
The large distribution of pts have limitation in time , achievement, performance , doing their works according to psychological status.
4- Bodily Pain (BP):
Question (7):
How many bodily pain have you had during the past 4 weeks ?
Table (8): The distribution of the responds of the study sample on the question
number 7:
Percentage No. How many bodily pain have you had during the past 4
24
weeks ?
18.0 18 Not at all
18.0 18 Slightly too much
18.0 18 Slightly
14.0 14 Moderately
26.0 26 Quite a bit
6.0 6 Extremely
100% 100 Total
It has been shown from the table (8) that (26%) they have quite a bit of pain.
Question (8)
During the past 4 weeks, how much did pain interfere with your normal work
(including work outside the home and house work)?
Table (9): The distribution of the responds of the study sample on the question
number 8:
Percentage No. During the past 4 weeks , how much did pain interfere with
your normal work ( including work outside the home and
house work)
18.0 18 Not at all
28.0 28 Slightly
20.0 20 Moderately
22.0 22 Quite a bit
12.0 12 Extremely
100% 100 Total
It has been shown from the table (12) that (28%) of participant their pain slightly
interfere with normal work.
5-Social function (SF)
Question (6):
25
During the past 4 weeks, to what extent has your physical health or emotional
problems interfered with your normal social activities with friends, neighbors or
groups?
Table (10): The distribution of the responds of the study sample on the question
number 6:
Percentage No. During the past 4 weeks, to what extent has your physical
health or emotional problems interfered with your normal
social activities with friends, neighbors or groups ?
30.0 30 Not at all
32.0 32 Slightly
20.0 20 Moderately
8.0 8 Quite a bit
10.0 10 Extremely
100% 100 Total
It has been shown from the table (10) that social relationship slightly limited.
Question (10):
During the past 4 weeks, how much of the time has your physical health or emotional
problems interfered with your social activities (like visiting friends, relatives , etc..)??
Table (11): The distribution of the responds of the study sample on the question
number 10:
Percentage No. During the past 4 weeks, how much of the time has your
physical health or emotional problems interfered with your
social activities ( like visiting friends, relatives , etc..)?
10.0 10 All the time
26
22.0 22 Most of the time
30.0 30 Some of the time
24.0 24 A little of the time
14.0 14 None of the time
100% 100 Total
It has been shown from the table (11) that social activities are limited in some times.
Chapter five
Discussion:
The aim of our study is to to assess the quality of life (QOL) for patient
undergoing hemodialysis (HD) .
Method discussion:
The sample was chosen by convenience method controlled by inclusion and
exclusion criteria, we were face some obstacles, because there are many patients have
problems like amputation ,hepatitis which we considered as exclusion criteria ,so
that we can't take participant by simple random because it not enough to give us
large number that need to achieve aims of our study.
discussion:Results
Well-being Scales: A-
27
General Health (GH): I.
That present from table (1) that (43% of total population) have good health status,
and it is the same as one year ago. because they follow up care program, regimen in
their diet and medication, continuous routine of care, and availability of treatment.
Another finding about health it is the perception of illness, (30% of total
population) don't know if they get sick a little easier than other people or not, the get
of sickness it deferent according personal believe, culture, and spiritual state . (HD)
pts they see themselves as health as anybody they know, because they are know
people with the same disease and receive same treatment ,all of them come to center
three time weakly ,receive same care . Large distribution of (HD) pts didn’t know the
consequences of their disease .(26% of total population ) answer mostly true their
health excellent because they are regimen for treatment ,they are free of complication
Pt s didn’t known the outcome of their disease and treatment .the self perception
about illness different according people cognitive
II -Vitality (VT):
The large distribution ( 24% of total population) a good bit of a time they feel full
of pep because they able to deal with their illness. (24% of total population) a good
bit of a time have energy, because there disease and treatment interfere how they will
use this energy. (34% of total population) some time feel happy, when they forget
their disease and treatment.( 38% of total population) answer a good bit of a time they
feel tired because of the effort they paid to receive treatment and the influence of
28
disease.
Psychological well-being (MH):
There are many disturbances in psychological state for (HD) pts. Such as, some times they become very nervous, feel so down in the dumps nothing could cheer they up , feel downhearted and blue, feel worn out , it is the same with what Untane find that anxiety and depression are considered as frequent disorders in end-stage renal disease patients( Untane et al .2009) . This emotional reaction result from many dimension. The first of all, all people hope continue high quality of life but this difficult for (HD) pts. The second one (HD) pts lose of many interests, finally as we notice that many of them think negatively about consequence of ( HD) and (ESRD). On other hand, (38 % of total population ) some of the time they feel calm and peaceful , because they understand treatment for their disease it is agree with Covic finding that (HD) pts who understand their chronic disease they are able to control their illness and have low emotional response (Covic.A, et al, 2004) B-Functional Scales:
I-Physical function (PF):
(HD) pts have limited a lot to do vigorous activity, and limited a little to do
moderate activity, but they were able to do self care like bathing and dressing without
any limitation. Fatigue, fluid and diet restriction, electrolyte imbalance, anemia, and
weakness all of this factors produce physical limitation. Luckily, physical limitation
can reduced by adherence to treatment it is the same with Mok E 2001 finding
29
II-Role Function-Physical (RP):
The large distribution of (HD) pts their disease interfere with their daily activities
like limited of time ,achievement, performance ,and doing works according to their
physical health , because they feel tiered and fatigue during the work, it was agree
with Welch and his colleague 2001 large number of hemodialysis patients have high
scale of fatigue and physical limitation.
III-Bodily Pain (BP)
Pain has highly relevance to patient outcomes. (HD) pts (26% of total population) feels quite a bit of Pain it is the significant problem it is similar with Davison SN at 2003 finding. Pain result from consequence of treatment and complication of illness like metabolic acidosis, electrolyte disturbance, and bone disease. The presence of pain slightly interfere with normal work activity (including work outside the home and house work) , pts age above 20 year of age they able to tolerate pain and can live with pain .
IV-Role Function-Emotional factors (RE)
The large distribution of pt (66%- 78% of total population) have limitation in their
time, achievement, performance , doing their works according to psychological
status, because they have pain ,stress, complication of illness , and fear
from unknown outcome.
V-Social function (SF)
Physical health or emotional problems slightly limit (HD) pts social relationship
30
and interfere sometimes with their social activities , but coping with illness and
treatment reduce it effect ,on other hand culture invite good relationship between
people and provide social support for them .
Finally (HD) patients have disturbance in their physical health, social function,
role function, general health, and have badly pain. So that, (QOL) negatively affected
by (ESRD) and (HD), it is the same with study that was done by Cleary.J, and his
colleague 2004. These results prove our hypothesis Quality of life (QOL) for patients
undergoing hemodialysis (HD) is low.
Conclusion:
As a conclusion, we found that participant's disease (ESRD) and treatment (HD)
has negatively affected their quality of life. Such as, they have physical limitation,
emotional problems, bodily pain, and social limitations. All of these factors interfere
with (QOL).
We notice that (HD) pts receive just medical treatment; there isn’t psychological
treatment to promote their psychological state, or specific training to decrease their
physical limitation .So that, hemodialysis (HD) patients have low quality of life.
Study limitations:
1- Their insufficient time and budget to take all centers in Palestine.
2- There is large number of patients not met criteria to enter this study.
Recommendations:
1- There is need to provide psychosocial support for patient.
2- Provide them with effective training program to reduce physical limitation.
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3- Provide patient with effective health education about their disease and
treatment.
4- Make some of social activities in centers to increase patient social function.
5- Use of palliative therapy to reduce patient pain.
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