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  3. Investigating the effect of rehabilitation program implementation on the quality of life, hope and depression of hemodialysis patients

Investigating the effect of rehabilitation program implementation on the quality of life, hope and depression of hemodialysis patients

Number of pages: 191 File Format: word File Code: 32029
Year: 2014 University Degree: Master's degree Category: Paramedical
Tags/Keywords: Chronic kidney failure - depression - Depression of hemodialysis patients - Dialysis - hemodialysis - hope - nursing - quality of life - The program can be opened
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  • Summary of Investigating the effect of rehabilitation program implementation on the quality of life, hope and depression of hemodialysis patients

    Dissertation

    Special Care Nursing Master's Course

    Abstract

    Introduction and purpose: Hemodialysis leads to a change in a person's lifestyle and health status, which not only affects physical health but also other aspects of health. It risks that all these factors affect the patient's quality of life, so the present study was conducted with the aim of determining the effect of rehabilitation on the quality of life, the level of hope and depression of hemodialysis patients in the city of Javanrood.

    Materials and methods: This research is a semi-experimental study of the before and after type, which is based on the non-probability sampling method based on the entry criteria of 30 patients referred to the hemodialysis center of Hazrat Rasool Hospital in Javanrood in the year 2012 was done. The rehabilitation program was implemented for 8 weeks with the participation of experts in the fields of nursing, physiotherapy, and clinical psychology. Data collection tools included France and Powers quality of life questionnaires, Herth's hope index, Beck's depression and personal characteristics. After explaining the objectives of the research to the patients and obtaining written informed consent, the questionnaires were completed by the researcher's assistant during the interview with the patient. Then, the patients underwent physiotherapy, psychotherapy, nutritional therapy and self-care programs (8 sessions, one session per week) during 8 weeks. After the rehabilitation program, the questionnaires were completed again. Then the data was analyzed using spss20 software and descriptive statistics tests, paired t, one-way analysis of variance, Wilcoxon, Kruskal-Wallis, Mann-Whitney, Fisher's exact test and chi-square. Findings: The average age of the patients was 55.8±14.3 years, 60% were male and 93.3% were married. 70% of patients were illiterate, 83.3% were unemployed and the average duration of hemodialysis was 3±2.4 years. The average quality of life score of the patients after the intervention (19.7±2.3) showed a significant increase compared to the average score before the intervention (15.2±1.1) (P<0.0001). Also, the scores of the quality of life of all patients before the intervention were between 10-19, which were at an average or semi-optimal level, but after the intervention, the quality of life of 50% of the patients improved to a good level (P<0.0001). There was no statistically significant relationship between the level of quality of life and marital status, level of education, employment and duration of hemodialysis. Also, the average score of hope of the patients after the intervention (38.4±3.3) showed a significant increase compared to the average score before the intervention (26.6±4.8) (P<0.0001). Also, comparing the depression index before and after the intervention, the results showed that the average score of the patients after the intervention (10.5±3.1) was reduced compared to the average score before the intervention (36.4±10.9), which indicates the better condition of the patients in terms of depression after the rehabilitation interventions (P>0.0001).

    Discussion and conclusion: Implementation Rehabilitation is associated with improving the quality of life, increasing hope and reducing depression of hemodialysis patients, it is suggested that rehabilitation programs be implemented with the participation of experts from various fields of nursing, physiotherapy and clinical psychology in hemodialysis centers. Also, in the next researches, the impact of rehabilitation programs on the number of times of hemodialysis, blood indices, mental health and patient satisfaction should be studied with a larger sample size and in a longer period of time. Research and the necessity of choosing the topic will be explained.

     

    1-1.  Statement of the problem

    Chronic kidney failure is the result of damage and destruction of more than 75% of kidney nephrons. At this stage, the body's ability to maintain the metabolism and balance of water and electrolytes is lost, which is accompanied by clinical symptoms such as anorexia, nausea, vomiting, bleeding, impaired senses and consciousness, and at the same time, an increase in blood potassium, an increase in blood pressure, an increase in fluid volume and congestive heart failure, anemia and bone diseases, metastatic calcification as a result of phosphorus retention, a decrease in serum calcium, abnormal vitamin D metabolism, and an increase in albumin levels occur [2,1]. .Available treatment methods for patients with chronic kidney failure include hemodialysis, peritoneal dialysis, and kidney transplantation [3]. The most common treatment method is hemodialysis [4]. It is predicted that by 2030, more than 70% of these patients will be in developing countries, whose total economy is less than 15% of the world economy [5]. The total number of patients with end-stage renal failure (ESRD)[1] under treatment in the world until 2012 was about 3010000, which had an annual growth of 7%, and this rate is high compared to the world population (100 to 2000 patients per million people), of the above number, 2106000 people are under hemodialysis and 252000 are under peritoneal dialysis, and about 652000 people They have also had a kidney transplant. Most of these patients are in Taiwan. Of the 2,358,000 patients undergoing treatment (blood and peritoneal dialysis), 19% are in America, 14% are in Europe, 13% are in Japan, and 54% are in other countries, in fact, about 50% of hemodialysis patients are in America, Japan, China, Brazil, and Germany [6]. The chairman of the board of directors of the association for the support of kidney patients has announced that 30-40 people are added to the kidney patients of Iran every day [7]. In Iran, according to the report of the Society for the Support of Kidney Patients in 2018, out of a total of 40,000 kidney patients, more than 15,000 people were on hemodialysis, of which about 1,500 people die due to the complications of this disease every year [8]. The head of the Iranian Nephrology Association announced that in 2012, the number of hemodialysis patients increased to 29,500 [9], on the other hand, the growth rate of these patients is eight times the growth rate of the country's population [10]. In general, the occurrence of chronic renal failure and performing hemodialysis leads to a change in a person's lifestyle and health status, which endangers not only physical health but also other dimensions of health [11] and causes stressful restrictions in life, each of which in turn can disrupt their psyche and personality so that a large number of these patients do not adapt to problems and tensions, and suffer behavioral changes such as anxiety, depression, isolation, delusions and hallucinations. [12, 13, 14] and they feel insecure about their future [15] On the other hand, healthcare service providers have realized that in the treatment of patients, it is not possible to pay attention only to the physical aspects of the patient, and to help the patients to achieve a normal life, different aspects of the patients' lives should be taken into consideration, so the quality of life in hemodialysis patients is an important issue that can be investigated. The results of clinical trials have shown that the quality of life can be considered as a sign of the quality of health care and a part of the patient's treatment plan, and its measurement in chronic diseases is a useful guide to improve the quality of care [16]. Quality of life has a multidimensional and complex concept that includes objective and subjective factors. Quality of life is often defined as a specific understanding of satisfaction in life, social and family health, hope, social etiquette and mental health of the patient [17], so it is necessary to include quality of life as a part of the care plan for chronic kidney failure patients [18]. In today's world, improving the quality of life is of particular importance, so that it can be said that the quality of life is the distance between people's expectations and experiences because usually patients with the same conditions report different quality of life [19]. Therefore, the evaluation of patients' quality of life helps the medical staff to understand how patients perceive their health, their ability to function, and their sense of well-being, and to pay attention to treatment methods to improve patients' quality of life [20]. In this regard, although alternative treatments help to save the lives of these patients, improving the quality of life is the main goal of the hemodialysis program [20], so that caring for patients is not the only goal of their treatment, but improving the quality of life with maximum performance and a sense of well-being, the ability to perform various daily activities and reducing the factors affecting the quality of life of this disease [13]. The reduction in the quality of life in patients undergoing hemodialysis may affect different aspects of a person's life, so that the reduction in the quality of life in the physical dimension can to change the person's performance status in such a way that his daily activity is disrupted and his ability to perform daily activities is reduced [21]

  • Contents & References of Investigating the effect of rehabilitation program implementation on the quality of life, hope and depression of hemodialysis patients

    List:

     

    Chapter One

    1-1. Introduction and statement of the problem.. 2

    Chapter Two

    Bremton's four ideas and overview. 8

    2-1. Definition of chronic kidney failure. 9

    2-1-1. Epidemiology..11

    2-1-2. Disease diagnosis..12

    2-1-3. Pathophysiology of chronic kidney failure disease. 12

    2-1-4. Stages of CKD and identifying the population at risk. 13

    2-1-5. Uremia biochemistry..14

    2-1-6. Clinical and laboratory manifestations of chronic kidney failure. 15

    2-1-7. Evaluation and treatment of patients with CKD.16

    2-1-7-1. History and physical examination. 16

    2-1-7-2. Laboratory investigations. 16

    2-1-7-3. Imaging studies. 17

    2-1-7-4. Kidney biopsy..17

    2-1-8. Proof of diagnosis and etiology of CKD. 18

    2-1-9. Reducing the progression of CKD.19

    2-1-9-1. Protein restriction. 19

    2-1-9-2. Slowing down diabetic kidney disease. 19

    2-1-9-3. Blood glucose control. 20

    2-1-9-4. Control of blood pressure and proteinuria. 20

    2-1-9-5. Treatment of other complications of kidney failure (adjusting the dosage of drugs). 21

    2-1-10. Hemodialysis in the treatment of kidney failure. 21

    2-1-10-1. Hemodialysis..22

    2-1-10-1-1. dialyzer..23

    2-1-10-1-2. dialysis fluid..23

    2-1-10-1-3. Blood transport system. 23

    2-1-10-1-4. vascular access.23

    2-1-10-2. The goals of hemodialysis..25

    2-1-10-3. Complications during hemodialysis. 25

    2-1-10-3-1. Hypotension..25

    2-1-10-3-2. Treatment of hypotension. 26

    2-1-10-3-3. Muscle cramps. 26

    2-1-10-3-4. Prevention of muscle cramps. 27

    2-1-10-3-5. Nausea and vomiting. 27

    2-1-10-3-6. Treatment of nausea and vomiting. 27

    2-1-10-3-7. Headache..27

    2-1-10-3-8. Headache treatment..27

    2-1-10-3-9. Prevention of headache. 27

    2-1-10-3-10. Chest pain and back pain. 28

    2-1-10-3-11. Treatment of chest pain and back pain. 28

    2-1-10-3-12. itching..28

    2-1-10-3-13. Treatment of itching. 28

    2-1-10-3-14. Fever and chills..29

    2-1-10-3-15. Treatment of fever and chills. 29

    2-1-10-3-16. Complications of fever and chills. 29

    2-1-10-3-17. Imbalance syndrome. 29

    2-1-10-3-18. Treatment of imbalance syndrome. 29

    2-1-10-3-19. Prevention of imbalance syndrome. 30

    2-1-10-3-20. Anaphylaxis-like reactions. 30

    2-1-10-3-21. Arrhythmia..30

    2-1-10-3-22. Arrhythmia treatment. 31

    2-1-10-3-23. Hemolysis..31

    2-1-10-3-24. Treatment of hemolysis. 31

    2-1-10-3-25. Air embolism..31

    2-1-10-3-26. Treatment of air embolism. 32

    2-1-11. Future vision..32

    2-1-12. Problems of hemodialysis patients and nursing measures. 33

    2-1-13. Adaptation stages in ESRD patients. 34

    2-1-14. Rehabilitation of kidney patients. 35

    2-1-14-1. Encouraging patients.. 37

    2-1-14-2. Physiotherapy..39

    2-1-14-2-1. Evaluation of functional capacity. 41

    2-1-14-2-2. Sports..43

    2-1-14-2-3.  Exercise methods in hemodialysis patients. 44

    2-1-14-2-3-1. Low-intensity intradialytic sports. 44

    2-1-14-2-3-2. Flexible and strengthening sports. 45

    2-1-14-2-3-3. Resistance sports. 45

    2-1-14-2-4. Sports program..46

    2-1-14-2-5. The effect of exercise training programs in CKD patients. 47

    2-1-14-2-6. Reasons for non-participation of patients in the exercise program. 48

    2-1-14-2-7.  Health examination related to physical fitness and fitness. 50

    2-1-14-3. Education and empowerment of CKD patients. 52

    2-1-14-3-1. Orem's self-care theory. 52

    2-1-14-3-2. The role of nurses in training and empowering hemodialysis patients. 54

    2-1-14-4. Psychotherapy..57

    2-2. Bremton review..61

    Chapter three..72

    3-1. Objectives..73

    3-1-1. General purpose..73

    3-1-2. Minor goals..73

    3-1-3. research assumptions..74

    3-1-4. Defaults..74

    3-1-5. Theoretical definition of words..75

    3-1-6. Practical definition of words..76

    3-1-7. Type of study..78

    3-1-8. The studied community..78

    3-1-9. Sampling..78

    3-1-10. Sample volume..78

    3-1-11. Admission criteria of patients. 78

    3-1-12. Exit criteria..79

    3-1-13. method79

    3-1-14. Data collection tools. 79

    3-1-14-1. Quality of life questionnaire. 80

    3-1-14-2. Hurth's hope index questionnaire. 80

    3-1-14-3. Beck depression questionnaire. 81

    3-1-15. Information analysis method. 84

    3-1-16. Limitations. 84

    3-1-17. Moral considerations. 85

    Chapter 4. 86

    4-1. Findings. 87

    The fifth chapter. 115

    5-1. Discussion and review of findings. 116

    5-2. Conclusion. 128

    5-3. Application in nursing. 129

    5-4. Suggestions for future research. 130

    List of sources. 131

    Appendices. 158

    Appendix A (France and Powers Quality of Life Questionnaire). 159

    Appendix B (Herth Hope Index Questionnaire). 168

    Appendix C (Beck Depression Questionnaire). 170

    Appendix D (Characteristics Questionnaire). individual).175

    English abstract.

    Source:

     

    102- Kopple JD, Wang H, Casaburi R, Fournier M, Lewis MI, Taylor W, Storer TW. Exercise in Maintenance Hemodialysis Patients Induces Transcriptional Changes in Genes Favoring Anabolic Muscle. J Am Soc Nephrol 2007;18:2975-86.

    103- Yurdalan SU, Kondu S, Malkoç M. Assessment of Health-Related Fitness in the Patients with End-Stage Renal Disease on Hemodialysis: Using Eurofit Test Battery. Renal Failure 2007; 29:955-960.

    104- Venkataraman R, Sanderson B, Bittner V. Outcomes in patients with chronic kidney disease undergoing cardiac rehabilitation. Am Heart J 2005;150:1140-46.

    105- Kutner NG, Zhang R, Huang Y, Herzog CA. Cardiac rehabilitation and survival of dialysis patients after coronary bypass. J Am Soc Nephrol 2006;17:1175-80.

    106- Bennett PN, Breugelmans L, Barnard R, Agius M, Chan D, Fraser D, McNeill L, Potter L. Sustaining a hemodialysis exercise program: a review. Seminars in Dialysis 2010;23(1):62-73.

    107- Li M, Porter E, Lam R, Jassal SV. Quality improvement through the introduction of interdisciplinary geriatric hemodialysis rehabilitation care. American Journal of Kidney Diseases 2007;50:90-97.

    108- Rostami M, Baraz Pordanjani Sh, Farzianpour F, Rasekh A. Effect of Orem Self Care Model on families' quality of life in health care centers of Masjed Solaiman in 2007-2008. Journal of Arak University of Medical Sciences. Summer 2009; 12(2): 51-59.

    109- Heydari M, Shahbazi S. Investigating the effect of the self-care training program on the quality of life of the elderly. Journal of Nursing Research Center of Tehran University of Medical Sciences (Iran Nursing Journal). May 1391: 25 (75): 1-8.

    110- Braz S., Mohammadi A., Broumand B. The effect of diet training on laboratory indicators and overweight between two dialysis sessions in patients treated with maintenance hemodialysis. Journal of Shahrekord University of Medical Sciences, spring 2015. 8 (1). 20-27.

    111- Habibzadeh H, Davrpanah M, Khalkhali H R. Investigating the effect of using the ORM care model on the self-efficacy level of hemodialysis patients in teaching hospitals affiliated to Urmia University of Medical Sciences in 2019. Urmia College of Nursing and Midwifery bimonthly, June 1391. 10(2): 190-199.

    112- Wicks MN, Bolden L, Mynatt S, Rice MC, Acchiardo SR. Insight Potentially Prevents and Treats Depressive and Anxiety Symptoms in Black Women Caring for Chronic Hemodialysis Recipients. Nephrol Nurs J 2007 Nov-Dec;34(6):623-9.

    113-Birinder SB, Osu, Ivan A, Chan M, Pa, et al. Progressive resistance training during hemodialysis: Rationale and method of a randomized controlled trial. Hemodialysis International 2006; 10(3): 10-303.

    114- Riahi Z, Esfarjani F, Marandi SM, Kalani N. The effect of intradialytic exercise training on the quality of life and fatigue in hemodialysis patients (Persion).   Journal of Research in Rehabilitation Sciences 2012;8(2):219.

    115- Fallah R., Golzari M., Dastani M., Zahiruddin A.R., Mousavi S.M., Akbari M.A. Effectiveness of spiritual intervention in a group way to improve hope and mental health in women with breast cancer.  Journal of Thought and Behavior. Spring 2019. 5(19). 69-80.

    116- Qazlesflou M.

Investigating the effect of rehabilitation program implementation on the quality of life, hope and depression of hemodialysis patients
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