1. Quality of life and patient needs
Dr/ Magda Bayoumi
Lecturer
Nursing College
King Saud University

2. Chronic illnesses are usually requiring many nursing and medical interventions. The development of these diseases affects patients’ quality of life, potentially influencing their physical and mental health, functional status, independence, general wellbeing, personal relationships, and social functioning.

3. End-stage renal disease (ESRD) and its ensuing treatments negatively affect quality of life.
Nurses aware of these facts can explore new ways to assess more accurately and identify specific problem areas for individual patients, and take action to ameliorate them.

4. Chronic or maintenance dialysis is indicated in chronic renal failure, known as end-stage renal disease (ESRD).
People with ESRD commonly have a wide range of symptoms associated with their loss of kidney function.

5. Dialysis is used to remove excess fluids and uremic waste products from the body when the kidneys cannot do.
The methods of dialysis therapy include hemodialysis, continuous renal replacement therapy, and various forms of peritoneal dialysis.

6. In the presence of uremic signs and symptoms affecting all body systems such as nausea and vomiting, severe anorexia, increasing lethargy, mental confusion, hyperkalemia, and fluid overload.
Although other symptoms, like swelling of the hands and feet, may indicate serious clinical problems. Moreover, like dry mouth or trouble falling asleep, undoubtedly has an impact on their quality of life.

7. PROBLEMS ASSOCIATED WITH DIALYSIS
Cardiovascular problems.
Shunt problems.
Infections.
Bone disorders.
Gastrointestinal problems.
Sleep disorders.
Psychological problems.
Nutritional problems.
Problems related to medications.

8. HEMODIALYSIS PATIENTS NEEDS
According to Maslow, human needs are classified in a pyramidal hierarchy, where the base is formed by the most essential basic physiological needs, and self-actualization at the top of the pyramid (Maslow and lowrey, 1998).

9. To meet clients' self-actualization needs, the nurse must focus on strengths and possibilities of clients, and to use holistic approach in providing nursing care, which provides a sense and direction, and hope, and engaging in teaching that aimed at improve total quality of life for dialysis patient.

10. HEMODIALYSIS PATIENTS QOL
Health related quality of life refers to measures of patient’s functioning, well-being and general health perception in each of three domains; physical, psychological, and social.
The choice of dimensions is influenced by the severity and nature of the disease. Not all dimensions are equal of importance.

11. The WHO Quality of Life Group has defined quality of life as individuals’ perception of their position in life in the context of the culture and value system in which they live, and in relation to their goals, expectations, standards and concerns.

12. quality of life as a person’s perception of his/her position in life, within the culture and value systems, and in relation to own goals, expectations, values and concerns.

13. Furthermore, patients’ quality of life is determined by their subjective interpretation of their losses and gains in the process of being ill.

14. Domains of QOL General health perception. Physical function.
Social function.
Psychological function.
Illness impact.

15. General health perception:
general health perceptions reflect individual differences in evaluating health self-assessed health status.

16. Physical function:
Is defined as the patient's ability to perform daily life activities. It is particularly important for assessing the impact of chronic disease.

17. Social function
It is the ability to interact in a community with family and friends, to work and to carry the role of spouse, parents or siblings.
In a broader view, social wellbeing can be derived from individual perceptions, motivations, attitudes, and behaviors and circumstances external to the individual.

18. Psychological function:
psychological status domains include cognitive aspects such as alertness, confusion, or impaired thought and concentration.

19. Illness impact
This consists of reported physical and psychological symptoms, sensations, pain, health problems or feeling not directly observable.

20. QOL ASSESSMENT
The proper measures for assessing quality of life in patients with chronic kidney disease remain unclear. The questionnaire of kidney disease QOL short form version 1.3 (KDQOL SF TM) is valuable for assessing the health-related quality of life inpatients treated with chronic dialysis

21. This short form consisting of 36 items (SF-36) is a self-administrated tool that has been widely used and validated as a quality of life (QOL) assessment tool Moreover, health-related quality of life is an important measure of how disease affects patients’ lives. Dialysis patients have been shown to have lower QOL relative to healthy controls.

22. Information about the quality of life of patients having various types of renal replacement therapy will assist physicians, Nurses, patients and their families to make decisions on treatment selection. There is a need to establish support groups for patients having renal replacement therapy in order to enhance their quality of life, especially in the psychological domain.

23. Moreover, patient QOL tends to decline over time, with the perception of the quality of physical health deteriorating more than mental health. However, many patients continue to feel hopeless, anxious, and worried about finances, loss of sexual function, family burden, and loss of independence.

24. SELF-CARE
The Orem model is based upon the philosophy that all patients wish to care for themselves. When an individual is unable to meet own self-care requisites, a self-care deficit occurs. It is the job of the registered nurse to determine these deficits and define a support modality. Nurses are encouraged to rate their patients’ dependencies for each of the self-care deficits on the following scale: total compensation, partial compensation, and educative/supportive.

25. EDUCATIONAL PROGRAMS IN HEMODIALYSIS
Education focuses in increasing patients’ ability to manage, cope with the dialysis in all aspects and improve the QoL.

26. The nephrology nurse is a professional practitioner who possesses sufficient knowledge in delivering health care to individual with renal failure who may be at any stage of the therapeutic continuum.
She/he will be committed to providing the highest possible quality care to patients and their families.

27. Special emphasis is placed on support, education, prevention of complications and rehabilitation to encourage patients towards independence and self-care.

28. Predictors of Quality of Life in Hemodialysis patients.
Quality of Life (QoL) is a consistent and powerful predictor which affects the outcome in End-Stage Renal Disease (ESRD) patients on dialysis. Patients with low scores for health-related quality of life might benefit from physical and psychosocial rehabilitation, positive thinking, and motivation. Therefore, periodic assessment of QoL is necessary among these patients.

29. QoL Scores in HD patient.

30. QoL for HD patient & factor affecting it.

31. Needs and factors affecting it

33. CONCLUSION
Measurement of the QoL IS VERY IMPORTANT for dialysis patient to improve the care was provided.
The correlation between QoL and Patient needs indicate The statistically significant negative correlation with decreasing total score of the QoL as the total need score increases.

34. The total score of QoL turned to be negatively correlated with patient age and dialysis duration, and positively correlated to the level of education in the hemodialysis patients.
Conversely, the total needs score is positively correlated to age and negatively correlated with the education level. All these correlations are statistically significant. The strongest correlation is between QoL and age.

35. Recommendation
The developed self-care program for hemodialysis patients should be implemented on a wider scale and evaluated for further improvement.
The self-care program might be applied in other similar situations as on peritoneal dialysis patients, and evaluated for further improvement.
Nurses need to be trained on administration of the self-care program

36. Thank You