1. 13th Annual Interdisciplinary Research Conference
School of Nursing, Midwifery and Health
Influences of spirituality on Quality of life and general well-being in patients with end-stage renal disease
Ali Alshraifeen
 13th Annual Interdisciplinary Research Conference
7- 8th November 2012

2. Outline: Background Justification Study aims Method Results Summary
General
ESRD in Scotland
Difficulties facing ESRD patients
Justification
Study aims
Method
Quantitative
Qualitative
Results
Summary

3. Background
Chronic illness: physical or mental conditions that affect the daily functioning of individuals for intervals >3 months/year, or for a duration of hospitalisation >1 month (Theofanidis 2007)
Chronic illness has significant physical, psychological, social, economical, and spiritual effects on the individual (Delaney 2005)
ESRD: a long term condition to both kidneys, it is debilitating and progressive
Kidneys are unable to remove metabolic waste products from the body (Tanyi & Werner 2003)
ESRD: patients need to start renal replacement therapy (HD, PD, RX) (
HD is the most commonly used method of treatment (National Kidney Foundation)
HD: Haemodialysis
PD: Peritoneal dialysis
RX: Renal transplant 3

4. First patient dialysed in Scotland in 1960
ESRD in Scotland
First patient dialysed in Scotland in 1960
December 2010: accepted for renal replacement therapy (RRT): HD, PD, and kidney transplantation (SRR, 2010)
The number of prevalent patients is still rising; increasing cost of treatment, pressure on patient, staff, and the NHS

5. Psychological ( depression, anxiety, low self esteem)
Difficulties facing patients with ESRD
Physical (reduced mobility, fatigue, joint pain, site infection, cardiovascular)
Psychological ( depression, anxiety, low self esteem)
Social (loss of role and identity)
Logistic (fluid and diet restrictions, no choice of treatment)
Spiritual (inability to practice beliefs, fulfil spiritual needs, feeling tested)
Together = poorer quality of life/ well-being

6. Justification of the study
Interest in studying spirituality increasingly emerging in the literature
Spirituality: important aspect of health and well-being in people with chronic health conditions (Parsian & Dunning 2009)
Higher levels of spiritual health may lead to an improved quality of life and coping (Morrison 2005)
Providing spiritual care may lead to an improved coping with the various challenges facing patients with chronic illnesses (Yao 2009)
Is spirituality linked with health outcomes in patients with chronic illness (ESRD)?

7. Why ESRD…
Minimal information in the literature linking spirituality and the needs of patients with ESRD
There is a lack of research addressing spirituality and its contribution to adjustment in patients with ESRD (Tanyi &Werner 2003)

8. Study aims
To investigate the influences of ESRD on patients’ quality of life (QoL) and general well-being
To examine the factors that can affect these influences (age, gender, hope, social support)
To examine the relationship between spirituality and the QoL and general well-being of patients with ESRD

9. Spirituality framework
Spiritual health: a fundamental dimension of people’s overall health and well-being (physical, mental, emotional, social, and vocational)
Fisher’s (1998) spiritual well-being model :
Personal domain
Communal domain
Environmental domain
Transcendental domain
Personal domain: one inter-relates with oneself with regards to meaning, purpose, and values in life
Communal domain: expressed in the quality and depth of inter-personal relationships between self and others
Environmental domain: a sense of awe and wonder; the notion of unity or connectedness with the environment
Transcendental domain: the relationship of self with something or someone beyond the human level (i.e. ultimate concern, cosmic force, God, etc

10. Cross-sectional survey
Study Design
Quantitative
Cross-sectional survey
(May May 2010)
Questionnaires
72 participants
Qualitative
December 2011-ongoing
Grounded theory
30 participants
In-depth interviews

11. Quantitative Cross-sectional survey (questionnaires)
Quality of life Measure (SF-36v2): validated by analysing the scores from patients with 25 different health conditions
General health questionnaire (GHQ-28): to measure depression, anxiety and insomnia, social dysfunction, and coping
The multidimensional scale of perceived social support (MSPSS)
Herth hope index (HHI)
The spiritual well-being questionnaire (SWBQ)
The brief COPE scale to assess patients’ coping with stressful events
Understanding spirituality and it’s effects on a person’s well-being using a single instrument is difficult. Therefore

12. Participants
All ESRD patients in 5 Health Boards in Scotland (800 participants) eligible
Estimated number of distributed study packs (364, 45.5% of the total sample)
Number of completed questionnaires (n=72)
Inclusion criteria:
ESRD patients/on HD
On dialysis ≥6 months
English speaking
>18 years old
Exclusion criteria:
Distressed patients
Psychological, neurological, or communication problems

13. Data analysis and results
Data analysis (PASW 18)
Results
Overall response rate (19.8%) out of estimated 364
50% of the sample were 56 years and older (n=36)
Majority were retired (n=49)
Majority were on HD for 6months- 5 years (n=44)
Majority lived with families (n=46)
More males (56.9%)
Females= 31
Males= 41

14. Quality of life Quality of life domains Mean score Standard Deviation
Physical Functioning
25.75
12.61
Role Physical
26.24
11.48
Bodily Pain
33.19
11.52
General Health
43.22
6.04
Vitality
47.62
6.78
Social Functioning
36.27
5.28
Role Emotion
35.66
15.59
Mental Health
43.66
6.07
MCS
47.84
7.52
PCS
26.53
7.26
Scores on the SF-36: norm-based scoring was used according to Jenkinson et al (1999). Scores above or lower than 50 which is the average score for the UK general populations
PCS (RP, PF, BP),
MCS (MH, RE, SF),
VT and GH links to both PCS and MCS
MH, VT, MCS scores means they were the less affected

15. Patients quality of life
Patients scored considerably less than the UK population average norms
Most affected domains of QoL were the physical domains (PF, RP, BP, PCS) and SF, and RE
Scores on the Vitality, Mental Health and overall MCS were close to general population average

16. Demographics and quality of lifePF RP BP GH VT SF MH
MCS
PCS
Age
R=-.237*
p=.045
R=-.094
p=.430
R=-.052
p=.665
R= -.111
p=.351
R=.024
p=.842
R=.067
p=.579
R= .169
p=.157
R= .234*
p=.048
R=-.343**
p=.003
Gender
R= -.183
p=.123
R=.-070
p=.557
R= .113
p=.346
R=-.089
p=.458
R= .108
p=.368
R=.082
p=.495
R=-.007
p=.950
R=-.083
p=.480
R= -.135
p=.258
Living alone
R=-.025
p=.837
R= .174
p=.144
R=.037
p=.758
R=.041
p=.735
R= -.120
p=.314
R= 113
R=-.090
p=.451
R= -.112
p=.348
R= .133
p=.267
Working status
R= -.192
p=.107
R= -.119
p=.319
R= .150
P=.209
R=-.035
p=.771
p=.350
R= 133
p=.264
R= .112
R= .107
p=.369
R= -.162
p=.173
Period on dialysis
R=-.036
p=.765
R=.058
p=.628
R= .134
p=.263
R= .139
p=.246
R=-.067
p=.577
R=.086
p=.473
R= .159
p=.181
R=.091
p=.445
R=.055
p=.644
**P< 0.01 (1-tailed), * P< 0.05 (2-tailed), PF (physical functioning), RP (role physical), BP (bodily pain), GH (general health), VT (vitality), RE (role emotion), SF (social functioning), MH (mental health), MCS (mental component summary scores), PCS ((physical component summary scores)

17. Socio-demographic characteristics
Demographics and well-being
Socio-demographic characteristics
General well-being
Age
R= -.292* (p=.013)
Gender
R= .297* (p=.011)
Living status
R= (p= .107)
Working status
R= (p=.721)
Period on dialysis
R= (p=.133)

18. Demographics and quality of life and well-being
Pearson product moment correlation was conducted between socio-demographic characteristics and the SF-36 domains and patients well-being
Age associated negatively with the overall PCS (r= -.343**, p=.003) and Physical Functioning domain (r= -.237*, p=.045)
Age positively associated with the overall MCS (r= .234*, p=.048)
Age associated negatively with general well-being (r= -.292*, p=.013)
Gender associated positively with general well-being(r=.297, p=.011)
Increasing age associated with better mental health and worse physical health
Increasing age associated with reduced stress and anxiety, therefore better general well-being
Female patients reported more stress and anxiety (worse general well-being)

19. Spirituality and quality of life
Scale
MCS
PCS
Spiritual well-being total score
R= .013 (p= .911)
R= .119 (p= .321)
Importance of religion in your life
R= .229 (p= .053)
R= (p= .432)
Importance of spirituality in your life
R= .131 (p= .272)
Frequency of church/religious group attendance (apart from weddings or funerals)
R= .157 (p= .189)
R= (p= .681)
Frequency of prayer
R= .101 (p= .398)
R= .057 (p= .635)

20. Spirituality and quality of life
Borderline significant associations between the importance of religion in patients lives and SF (R= .226, p= .057)and MCS (R= .229, p= .053)
Total Religion subscale (Brief COPE) associated positively with the overall MCS score (r=.231, p=.051), indicating that more use of religion associated with better mental health
No significant correlations between spirituality and patient’s general well-being
Increasing importance of religion might be associated with better mental health and more social activities
The overall Brief COPE results are not presented; however we found the Total Religion Subscale was associated with the overall MCS scores as you can see

21. Summary
Patients with ESRD reported a marked decrease in all domains of QoL, mainly (PF, RF, BP, GH and PCS) compared to the UK general population
MCS & Vitality scores were very close to the general population norms
Increasing age associated with reduced physical functioning; however better mental health and general well-being
Females reported worse general well-being
Importance of religion associated with better mental health and social functioning
No significant associations between spirituality and general well-being

22. References
Delaney, C. (2005) the spirituality scale: development and psychometric testing of a holistic instrument to assess the human spiritual dimension. Journal of Holistic Nursing. vol. 23, pp
Fisher, J (1998) spiritual health: its nature and place in the school curriculum. PhD thesis. The University of Melbourne
Morrison, D. (2005) nephrology nursing: spirituality and tough nursing. Canadian Association of Nephrology Nurses and Technicians (CANNT). Conference presentation
National Kidney Foundation. Available online:
Parsian, N., Dunning, T., (2009) developing and validating a questionnaire to measure spirituality: a psychometric process. Global Journal of Health Science. vol.1(1), pp.2-11
Scottish Renal Registry, (November 2003). [Online] available from
Tanyi, R., Werner, J., (2003) adjustment, spirituality, and health in women on haemodialysis. Clinical Nursing Research. vol. 12(3), pp
Theofanidis, D. (2007) chronic illness in childhood: psychosocial adaptation and nursing support for the child and family. ICUS and Nursing Web Journal. Vol
Yao, C. (2009) spiritual care in palliative care team. Conference presentation at the 24th General Conference of the World Fellowship of Buddhists Symposium on Buddhist Wisdom in Caring for the Dying and Bereaved

23. Any questions ?