NEEDS OF PATIENTS UNDERGOING HEMODIALYSIS
Monday, January 1, 2018
- Avdiaj Armando, Under-graduate Nurse, Department of Nursing, University of West Attica
According to estimates, the number of patients undergoing hemodialysis is expected to increase dramatically within next years due to the ageing of population and prevalence of other co morbidities such as diabetic mellitus, coronary artery disease, hypertension and several others. 1-5
However, the exact number of patients seems to vary globally which is attributed to various obstacles such as inadequate data registries or failure to adopt a commonand widely accepted methodology that will permit meaningful comparative research.1-5
Importantly, available evidence illustrates that hemodialysis as a method of renal replacement implies a heavy emotional burden for individuals and their family while several needs of patients emerge on surface. 1-5
First and foremost, patients need elaborate information regarding their disease including fistula or any other vascular access for hemodialysis machine in order to manage long-term treatment and accept the
new demanding reality of life. According to patients'
reports, the knowledge of kidney disease, the care of vascular access, treatment options, and medications were the most important educational needs.6 In Greek population, more informed about hemodialysis were single patients, University graduates, employees, younger patients and those having very good relations with nursing staff, doctors and other patients.5
A sincere relation between health professionals and hemodialysis patients is a valuable tool for both sides. Indeed, a stable relation between these two parties promotes changes in regard to health-related behavior.Meanwhile, an effective relation not only strengthens patients' self-care but also enables them to adhere to the therapeutic regimen. 2-5
It is essential for health professionals who provide care to this sensitive population to evaluate adherence to dietary and fluid limitations. Interestingly, non adherence to treatment is a major issue for hemodialysis patients which is associated with increased morbidity and mortality, multiple interventions and prolonged hospitalizations.2-6 Adherence to therapeutic recommendations and the proposed diet were associated with higher score of quality of life in 320 Greek hemodialysis patients, out of whom 57,2% were men. 7 Other significant factors affecting non adherence to fluid and diet include age, marital status, and family and friend support. 1
Research has given rise to a large amount of problems associated with the painful procedureof hemodailysis that limits normal life. Machine dependency is often experienced by this complex population since hemodialysis is the only choice to achieve life maintenance. Dependency on dialysis machine is associated with gender, education level, job, place of residence, degree of information, adherence to treatment guidelines, relations with nursing staff, change in body image, difficulties in social and family environment, concealment of problem, and need for help in daily activities.8It is imperative to familiarize patients with this demanding and time consuming procedure as well as to encourage expression of their feelings.
During recent decades, there is growing recognition of social support -issues in hemodialysis patients. 9,10Social support is a modifiable psychosocial factor associated with patients’ perception of quality of life. Interestingly, the more support hemodialysispatients have from their significant others, family and friends, the better quality of life they have. 9
Additionally more, providing support that meets the needs of patients and address their specific concerns, seems to relieve them from anxiety and depression.10,11An one point increase of the support from friends seems to reduce by 57% the probability of having high levels of anxiety. It is also shown that an one point increase of the support from significant others, family and friends reduces by 77%, 71% and 56% respectively the probability of experiencing high levels of depression. 10 In 395 Greek hemodialysis patients, the total score of quality of life was 2.5 and 4.4 points lower for patients with moderate and high levels of depression, respectively, compared to patients with low levels of depression.11 The above findings underline the need for early and appropriate evaluation of problems arousing from mental dimension.
Finally, age plays a vital role in defining patients' needs as advanced age is associated with cognitive and physical impairment and worse quality of life. 2‑5Given that hemodialysis represents a staggering economic burden on the healthcare system of each country, a key challenge confronting health care professionals is to discern patients' needs.Download PDF