BACKGROUND OF THE STUDY:

Worldwide, studies comparing the dialysis population to the general population have consistently demonstrated that dialysis patients of all ages report a poorer quality of life in comparison to healthy controls or norm based scores.¹ The evidences indicates that HD patients perceive their physical quality of life as being worse than their psychosocial (mental) quality of life, with their psychosocial quality of life closer to, and not always significantly different from, population norms.²

Kidney diseases are silent killers which largely affect the quality of life. Chronic kidney disease, also known as chronic renal disease, is the progressive loss in renal function over a period of months or years. Chronic kidney disease is a widespread medical condition that is progressive in nature.³

The prevalence of ESRD in India has increased in the last two decades. It has become the main cause for morbidity and mortality. It decreases patients’ overall quality of life (QOL). It was proven that the QOL of ESRD patients are very poor and they have to undergo lifelong treatment for their survival. QOL is used to evaluate the general wellbeing of individuals and societies. It may vary according to the patient as well as the disease condition.⁴

STATEMENT OF THE PROBLEM:

A study to assess the health related quality of life among clients undergoing hemodialysis in selected hospitals at Bangalore with a view to develop an information booklet.

OBJECTIVES:

To assess the health related quality of life among client undergoing hemodialysis, in selected hospitals.

To find out the association between health related quality of life and selected demographic variables.

ASSUMPTIONS:

1. Client undergoing hemodialysis may have specific needs related to their living pattern.

2. Clients undergoing hemodialysis may have some knowledge regarding their disease condition.

3. The health related quality of life of clients undergoing hemodialysis may be impaired.

HYPOTHESIS:

H1: There will be significant association between the health related quality of life of client undergoing hemodialysis and selected demographic variables.

RESEARCH METHODOLOGY:

Research Approach

In view of the nature of the problem selected for the study and the objectiveness to be accomplished, a quantitative research approach was considered for the present study.

Research Design

A descriptive design was adapted for the present study. The present study tends to assess the health related quality of life of clients with chronic kidney diseases by using researcher developed rating scale.

Setting of the study

This study was conducted in the dialysis unit of Gayathri Hospital, Bangalore.

Research variable

Here health related quality of life of clients undergoing hemodialysis.

Demographic variable

The demographic variables in this study include age, gender, educational qualification, occupation, habits, type of family, duration of dialysis and previous exercise regimen.

Population

In the present study, the target population comprises of hemodialysis clients between age group 35-70 years, attending the dialysis unit of Gayathri Hospital, Bangalore.

Sample

In the present study, the sample consists of 100 hemodialysis clients who fulfill the inclusion criteria.

Sampling technique

Purposive sampling technique.

Tool for data collection

Section A: Comprises of the socio demographic profile of the client undergoing hemodialysis.

Section B: The investigator developed a five point rating scale to assess the health related quality of life of clients undergoing hemodialysis.

RESULTS:

Major findings of the study are;

1. Finding related to demographic data:

With regards to age, 9 % of the respondents were in the age group of 35-45, 32% of respondents were in the age group of 46-55 years, 36% of respondents fall under the age group of 56-65 and 23% of respondents were found in the age group of 66-70.

Regarding gender, 65% of the respondents were male whereas 35% were female.

On educational status 16% were non literate, 26% were having primary education, 31% completed secondary education, 17% completed PUC and 10% were graduates.

Regarding occupation 5% were laborers, 9% agriculture, 9% retired, 35% were private employee and 42% were unemployed.

Regarding the type of the family 48% of the respondents were from nuclear family, 37 were from joint family and 15% were from extended family.

Regarding personal habits 7% of the respondents have habit of smoking, 15% of the respondents are alcoholic, 9% have habit of both smoking and alcoholism, 25% of the respondents have the habit of chewing tobacco and 33% of respondents are not having any habits of smoking, alcoholism or chewing tobacco.

Regarding duration of hemodialysis, 5% of the respondents were found below 2 years, 37% of respondents between 2-4 years, 39% between 4-6 years and 19% above 6 years.

2. Finding related to overall health related quality of life of client undergoing hemodialysis:

Out of 100 clients, 43% were having worst possible HRQoL, 57% were having better possible HRQoL and no one has best possible HRQoL. The overall mean score of HRQoL of clients undergoing hemodialysis is 50.3% and SD of 20.5.

3. The association between selected demographic variables and the health related quality of life of clients undergoing hemodialysis:

a. Relationship between the age and HRQoL: There was a significant association between age and health related quality of life. The Chi-square value was 9.30, p<0.05 level. Relationship between gender and HRQoL

b. There is a significant association between gender and health related quality of life.

The calculated chi-square value was 6.35, p<0.05 level.

c. Relationship between educational status and HRQoL: There was no significant association between health related quality of life and educational status The chi-square value computed for educational status was 6.92, p<0.05 .

d. Relationship between occupation and HRQoL: There was a significant association between occupation and the health related quality of life as the calculated chi-square value was 10.58, p<0.05 level.

e. Relationship between type of family and HRQoL: There was significant association between type of family and health related quality of life as the calculated chi-square value was10.95, p<0.05 level.

f. Relationship between personal habit and HRQoL: There was significant association between personal habit and health related quality of life as the calculated chi-square value was13.64, p<0.05 level.

g. Relationship between duration of dialysis and HRQoL: There was significant association between duration of dialysis and health related quality of life as the calculated chi-square value was12.65, p<0.05 level.

Table1: Classification of Respondents by Personal Characteristics.

n=100

Characteristics	Category	Respondents
Characteristics	Category	Number	Percent
Age group (years)	35-45	9	9.0
	46-55	32	32.0
	56-65	36	36.0
	66-70	23	23.0
Gender	Male	65	65.0
Gender	Female	35	35.0
Educational Qualification	Non-literate	16	16.0
	Primary	26	26.0
	Secondary	31	31.0
	PUC	17	17.0
	Graduation and above	10	10.0
Occupational status	Laborer	5	5.0
	Agriculture	9	9.0
	Private	35	35.0
	Retired	9	9.0
	Non employed	42	42.0
Type of family	Nuclear	48	48.0
	Joined	37	37.0
	Extended	15	15.0
Personal habits	Smoking	7	7.0
	Alcoholism	15	15.0
	Both	20	20.0
	Tobacco	25	25.0
	No	33	33.0
Duration of dialysis(in years)	Below 2	5	5.0
	2-4	37	37.0
	4-6	39	39.0
	Above 6	19	19.0

Table 2: Overall Health Related Quality of Life among Clients undergoing Hemodialysis. n=100

Quality of Life Level	Category	Respondents
Quality of Life Level	Category	Number	Percentage
Worst possible (poor)	≤ 50% Score	43	43.0
Better possible (average)	51-75% Score	57	57.0
Best possible (good)	> 75% Score	0	0.0
Total		100	100.0

IMPLICATIONS OF THE STUDY:

The findings of the study have implications for nursing education, nursing practice, nursing research and nursing administration.

Nursing education:

The health delivery system at present is giving more emphasis on preventive aspects and health promotion. The study also implies that health personal have to be trained well on how to teach the clients with chronic kidney disease to improve their health related quality of life. Nursing curriculum must emphasize on thorough knowledge about the healthy lifestyle practices and thereby preventing the newly emerging lifestyle diseases such as kidney diseases. The health care providers are the key personnel in imparting education to the clients. There is a need for in-service education programme for the health care providers for preparing them to function effectively as a counselor for clients.

Nursing practice:

Nurses are the heart of the hospitals, they play prominent role in the health promotion and maintenance. It is a practicing profession, so the researcher generally integrates finding into practice. Along with the changing scenario of health care delivery system, the emphasis is shifted from care oriented approach to preventive approach. The findings of the study indicate that health care members should be made aware of the need of improving the health related quality of life of the clients undergoing hemodialysis. This study stresses on need of involvement of nursing staff in planning and conducting education programme. Health education should be given on the aspect of maintaining healthy lifestyle practices, regular exercise frequent monitoring and control of lifestyle diseases which in turn improve the health related quality of life.

Nursing administration:

Having thorough knowledge regarding the healthy ways to improve HRQoL, the nurse administrator should arrange continuing education programme such as workshops, short term courses protocols , seminars as a part of in-service education programme that influence the knowledge of the nurses, hence it is the responsibility of the nurse administrator to create awareness and organize or make arrangements for appropriate opportunities in the hospital as well as communities for continuing education regarding improving the HRQoL of client undergoing hemodialysis.

Nursing research:

The importance of research in nursing is to build the body of knowledge. The aim of nursing research is to expand and broaden the scope of nursing. The expanded role of nurse is to emphasize those activities which promote health maintaining behavior among the people. The findings of the study serve as the basis for the professionals and the students to conduct further studies. The present study reveals that there is a worst health related quality of life among client undergoing hemodialysis. This study enlightens that there is a need of educational programme in the hospitals to improve the HRQoL. In western countries many research studies have been conducted regarding health related quality of life but in Indian context only few literatures were found. It is the responsibility of all the health professionals to provide sufficient listed material of the programme to improve the HRQoL of clients undergoing hemodialysis.

RECOMMENDATIONS FOR FURTHER STUDY:

1. A similar kind of study can be done with larger population

2. A comparative study can be done in rural and urban settings

3. An experimental study can be conducted by administering structured teaching programme

CONCLUSION:

Quality of life (QoL) is important for all people, especially those with chronic illnesses such as end stage renal failure (ESRF). QoL can be a difficult concept to define, as it is highly subjective and intricately linked to psychological, physical and social aspects. People with ESRF often experience many physical changes which can negatively impact on their psychological status and interfere with their social functioning. Nurses are in an ideal position to enhance their patient’s QoL as they spend large portions of time with the patient. There are various QoL measurement tools available to monitor patient QoL and nurses should be aware that their perception of the patient’s QoL may differ from the patient’s perception. It is vital that nurses value the importance of patient QoL and recognize the need for a multifaceted approach involving physical, psychological and social aspects.⁵

REFERENCES:

1. A Stewart, et al. Long term functioning and wellbeing outcomes associated with physical and exercise in patients with chronic conditions in the medical outcomes study. J Clin Epidemiol. Vol 47, 719-730, 1994.

2. B. S. Cheema and M. A. Singh, “Exercise Training in Patients Receiving Maintenance Hemodialysis: A Systematic Review of Clinical Trials,” American Journal of Nephrology, Vol. 25, No. 4, 2005, pp. 352-364. doi:10.1159/000087184.

3. Priscilla L, Karen B. Medical Surgical Nursing, 4^th Edition, Elsevier, India 2008, Page no- 1250-1300.

4. Chiang CK¹, et al. “Health-related quality of life of hemodialysis patients in Taiwan: a multicenter study”. Blood Purif. 2004; 22(6): 490-8. Epub 2004 Oct 27.

5. Tallis, K (2005). How to improve the quality of life in patients living with end stage renal failure. Ren Soc Aust J 1(1) 18–24.

Received on 28.03.2016 Modified on 20.04.2016

Asian J. Nur. Edu. and Research.2016; 6(4): 425-428.

DOI: 10.5958/2349-2996.2016.00080.X