Research Article
Ann Nurs Res Pract. 2023; 8(1): 1052.
Quality of Life, Social Support, Fatigue and Satisfaction from Nursing Care in Dialysis Patients: The Impact of Sociodemographic and Clinical Profile
Paraskevi Theofilou¹*, Christina Vassilopoulou¹ and Foteini Tzavella²
1Hellenic Open University, School of Social Sciences, Patra, Greece
2University of Peloponnese, School of Health Sciences, Department of Nursing, Tripoli, Greece
*Corresponding author: Paraskevi Theofilou Hellenic Open University, School of Social Sciences,Patra, Greece.
Received: December 08, 2022; Accepted: January 03, 2023; Published: January 09, 2023
Abstract
Chronic kidney disease is a global public health problem, which, in combination with an aging population, is expected to increase its impact in the coming years. The aim of this research is to study the effect of the sociodemographic and clinical profile of hemodialysis patients on their quality of life, social support, fatigue and satisfaction from nursing care. A quantitative, primary, non-experimental survey was conducted using the questionnaires “Multidimensional Scale of Perceived Social Support”(a≥ 0.908),FAS (a≥ 0.658), Missoula-VITAS Quality of Life (a≥ 0.622) and nursing care (a = 0.944). The study involved 69 patients with dialysis of a University Hospital, with most having the disease for 0-10 years. The majority of the patients in the research are men, aged 51-80, married with 1-2 children, with an educational level up to that of High school, who live in a city and receive an income of 500-1,500 euros. Data analysis was performed at a significance level of 5%, using the parametric criteria independent samples t-test, ANOVA and the non-parametric Mann Whitney, Kruskal Wallis and Spearman. The necessary ethical issues were observed. Age affected social support (p <0.05) and fatigue (p<0.05). The educational level affected physical fatigue (p= 0.040) and spirituality (p= 0.037). Residence affected spirituality (p = 0.036) and nursing care (p = 0.039). Occupational status influenced social support from friends (p = 0.001). Years in dialysis affected social support (p ≤ 0.027), interpersonal relationships (p = 0.013) and physical fatigue (p = 0.027). It seems that age, educational level, place of residence, professional status and years of dialysis influence the research factors.
Keywords: Dialysis; Quality of life; Fatigue; Social support; Nursing care
Introduction
Hemodialysis is a time-consuming and expensive treatment and requires more restrictions on diet and fluid intake. Longterm hemodialysis causes loss of freedom, dependence on the caregiver, disruption of marriage, family, social life and reduction or lack of income. All these factors affect patients’ quality of life [1].
Terms like human development and social welfare are frequently used as equivalent or analogous terms. Quality of life (QOL) is considered as the interplay of various factors of social, health, economic and environmental conditions that cumulatively and often in unknown ways, interact to affect both human and social development at the level of the individual and societies. Current patterns of urban development are based on the ideas of imported Western countries and use capital and natural resource intensive systems. Capital intensity divides the urban population into rich and poor urbanites. Resource intensity is destroying the rural hinterland. The end result is that while there is an affluent class with a very high quality of life, the majority of urban dwellers have very poor environmental quality. Decision makers on the development strategy of urban centers often do not consider this human element. Population migration to urban centers, especially industrial cities, is driving the growth of metropolitan areas [2].
Perceptions of quality of life are influenced by urbanization and living standards, creating a perception that is limited to specific areas of human life. First, it directs attention to the positive aspects of people’s lives, thus contrasting with the deficit orientation of these disciplines. Second, it extends traditional objective measures of health, wealth, and social functioning to include subjective perceptions of well-being. Quality of life is the product of the interaction between social, health, economic and environmental conditions that affect human and social development. The notion that quality of life refers to an indefinite number of states and does not entail valuing life style [2].
Health-related quality of life (HRQoL) is a measure that reflects individuals’ subjective experiences of their health status. HRQoL systematically focuses on measuring the relationship between health and health status with quality of life (QoL). It is a dynamic multidimensional model and consists of three main dimensions: the physical, social and mental dimensions of health [3]. Despite the lack of consensus on the definition of QoL, it can be understood as satisfaction or happiness with life, focusing on the areas that the individual considers important. Likewise in the case of HRQOL, what is considered a health indicator is the evaluation of the person’s general physical condition, functional impairment, and ability to perform household activities, social interactions, cognitive function and emotional state in relation to their health status. HRQOL measurement tools can facilitate clinical decision-making, assess quality of care, assess population health needs, and help understand how the causes and effects of causes of health problems increase the effect of treatment on physical health, in work performance and personal life. Thus, improvements in QOL become as important as clinical-laboratory responses to interventions, expanding the field of therapeutic outcomes [4].
Health-related quality of life is a cultural concept as revealed by the differential association between HRQOL and clinical outcomes such as patient compliance or survival. HRQOL is recognized as a key health outcome for studies that assess the quality of health care, assess the impact of illness, and analyze cost-effectiveness. In addition, HRQOL has been shown to be clinically important in improving hemodialys is outcome in hemodialysis patients [5].
The aim of this research is to study the effect of the sociodemographic and clinical profile of hemodialysis patients on their quality of life, social support, fatigue and satisfaction from nursing care.
Method
Research design
A quantitative, primary, non-experimental survey was conducted including specific variables, such as quality of life, social support and fatigue among hemodialysis patients as well as the satisfaction from nursing care.
Sample
The research population is considered to be all dialysis patients in Greece. Regarding the sample, 69 patients on hemodialysis participated in the research with most to have the disease 0-10 years. The majority of patients are men, aged 51-80 years, married with 1-2 children, with educational level up to that of Lyceum, who live in a city and receive an income of 500-1,500 euros. The criteria for entering or excluding the sample were considered: 1) the conduct of the session of hemodialysis, 2) the age over 18 years, 3) the Greek language and 4) diagnosed with end-stage chronic kidney disease.
Questionnaires
For the needs of this research, 3 questionnaires were used: 1) “Multidimensional Scale of Perceived Social Support” [6], 2) Fatigue Assessment Scale (FAS) by Michielsen et al. [7] and 3) Missoula VITAS Quality of Life Index by Theofilou et al. [8]. It emerged from these questionnaires a questionnaire of 60 questions divided into 5 sections.
The 1st section includes 9 questions related to socio-demographic data of the patients, such as gender, age, marital status, number of children, education level, place of residence, employment, monthly income and years in hemodialysis.
The 2nd section refers to perceived social support which was measured according to the “Multidimensional Scale of Perceived Social Support” [6]. The questionnaire includes 12 questions on a 7-point Likert scale 1-7 (1= Strongly Disagree, 2=Strongly Disagree, 3=Disagree, 4=Neutral, 5=Agree, 6=Strongly agree, 7=Strongly agree), and 3 subsections of 4 questions about social support from others, from family and friends. The 3rd section refers to patient fatigue which was measured with the Fatigue Assessment Scale (FAS) questionnaire by Michielsen et al. [7]. The questionnaire includes 10 questions on a five-point Likert scale 1-5 (1= Never, 2=Sometimes, 3= Regularly, 4=Often, 5=Always) and 2 subsections of 5 questions about physical and mental fatigue.
The 4th section includes 16 questions about perceived quality of life of patients which was measured by the Missoula-VITAS Quality of Life questionnaire Index of Theofilou et al. [8]. The questionnaire includes 1 question about global quality of life five-point Likert scale 1-5 (1=Very poor, 2=Poor, 3=Average, 4=Good, 5=Very good) and 15 questions divided into 5 subsections of 3 of quality-of-life questions about symptoms, functioning, interpersonal relationships, wellness and spirituality. In each subsection the 1st question refers to evaluation (scale from -2 to +2), the 2nd to satisfaction (scale from -4 to 4) and the 3rd in importance (from 1 to 5).
The 5th section includes 13 questions on a five-point Likert scale from 1 to 5 (1= Not at all, 2=Little, 3=Moderate, 4=Quite a bit, 5=Too much), related to nursing care.
All procedures were performed in accordance with the ethical standards of the 1964 Declaration of Helsinki, as revised in 2000. Completing the questionnaires was voluntary and was done by the patients themselves. Before the procedure, all participants were informed about the purposes of the research, anonymity, voluntary withdrawal in case they felt uncomfortable and they were given a written consent form.
From Tables 3-4 it appears that in the "Physical fatigue" factor, Technological - University education graduates showed a lower average value (M.O.=2.49) compared to Primary School graduates (M.O.=3.23, p=0.029) and High School (M.O.=3.14, p=0.024).
Results
Table 1 presents the demographics of the respondents.73.9% (N=51) were men and 26.1% (N=18) were women. Regarding marital status, 66.7% (N=46) were married or cohabiting, 23.2% (N=16) single, 7.2% (N=5) widowed and2.9% (N=2) from divorcees. Regarding age, 34.8% (N=24) are 61-70 years old, 24.6% (N=17) 51-60,14.5% (N=10) 71-80, 10.1% (N=7) to 40, 10.1% (N=7) over 80 and 5.8% (N=4) 41-50 years old.What is the effect of demographic profile on levels of perceived social support, fatigue, quality of life and nursing care? In the present research question, the statistically significant results are presented.
Factors
Ν
f%)
Gender
Male
51
73,9
Female
18
26,1
Age
=40
7
10,1
41-50
4
5,8
51-60
61-7017
2424,6
34,871-80
10
14,5
>80
7
10,1
Family status
Single
16
23,2
Married/roommate
46
66,7
Divorced
2
2,9
Widowed
5
7,2
Number of children
0
2
4,9
1
9
22,0
2
318
643,9
14,64
5
12,2
6
1
2,4
Education
Lack of education
3
4,3
Primary education
13
18,8
Obligatory education
9
13,0
Secondary education
25
36,2
Technological education
4
5,8
University education
11
15,9
Master
1
1,4
PhD
3
4,3
Residence
Town
48
69,6
Village
18
26,1
City
3
4,3
Work status
Public servant
9
13,0
Private servant
2
2,9
Student
1
1,4
Freelancer
8
11,6
Housewives
4
5,8
Unemployed
7
10,1
Pensioner
38
55,1
Monthly income
Without income
3
4,6
500-1.000
29
44,6
1.001-1.500
15
23,1
1.501-2.000
12
18,5
>2000
6
9,2
Years of dialysis
0-5
37
54,4
6-10
18
26,5
11-20
11
16,2
>20
2
2,9
Table 1: Sociodemographic and clinical factors.
Age
Table 2 presents the statistically significant results of the Spearman correlations of age with the survey factors. It appears that age was positively correlated with the factors "Social support from others" (r=0.244, p<0.05), "Physical fatigue" (r=0.265, p<0.05), "Mental fatigue" (r=0.320, p<0.01) and negatively with the factor "Social support from friends" (r=-0.253, p<0.05).
Dimensions
Age
Social support - others
,244*
Social support - friends
-,253*
Physical fatigue
,265*
Mental fatigue
,320**
*p<0,05,**p<0,01
Table 2: Statistically significant Spearman correlations of age with survey factors.
Educational level
Table 3 presents the statistically significant results of the ANOVA and Kruskal Wallis tests of the research factors in terms of educational level, where there was a statistically significant difference in mean values in the "Physical fatigue" factor (F (3,64) =2.939, p=0.040) and statistically significant difference in mean scores in the factor "Quality of life-Spirituality" (H (3) =8.500, p=0.037).
Dimension
Educational level
Ν
Μ.Ο.
F (3,64)
p-value
Test
Physical fatigue
To primary education
15
3,23
2,939
0,040
ANOVA
Obligatory-secondary education
34
3,14
Technological-university education
15
2,49
Master-PhD
4
2,30
Dimension
Educational level
Ν
Μ.B.
Η(3)
p-value
Test
Quality of life
To primary education
15
21,30
8,500
0,037
Kruskal
Spirituality
Obligatory-secondary education
33
37,26
Wallis
Technological-university education
15
37,37
Master-PhD
4
42,13
Table 3: Statistically significant results of ANOVA and Kruskal Wallis tests of the survey factors with educational level.
Educational level(Ι)
Educational level(J)
Mean difference(I-J)
p-value
To primary education
Obligatory-secondary education
0,08922
0,752
Technological-university education
,74000*
0,029
Master-PhD
0,93333
0,073
Obligatory-secondary education
To primary education
-0,08922
0,752
Technological-university education
,65078*
0,024
Master-PhD
0,84412
0,084
Technological-university education
To primary education
-,74000*
0,029
Obligatory-secondary education
-,65078*
0,024
Master-PhD
0,19333
0,707
Master-PhD
To primary education
-0,93333
0,073
Obligatory-secondary education
-0,84412
0,084
Technological-university education
-0,19333
0,707
Table 4: Post hoc analysis LSD for “Physical fatigue” * Educational level.
From Table 3 it can be seen that in the factor "Quality of life - Spirituality", the graduates of Primary School (M.B.=21.30) showed a lower average rank compared to the graduates of Middle School-Lyceum (M.B.=37.26, adj.p=0.050) and Technological - University education graduates (M.B.=37.37, p=0.023).
From Tables 5-6 it appears that in the factor "Quality of life - spirituality" the average value of the people who are in the town (M.O.=9.53) is statistically higher than the corresponding value of those who are in the village (M.O.=-1.47, p=0.015).
Dimension
Place of residence
Ν
Mean
F(2,64)
p-value
Test
Quality of life-spirituality
TownVillage
City47
17
39,53
-1,47
-1,673,510
0,036
ANOVA
Dimension
Place of residence
Ν
Mean
Η(2)
p-value
Test
Nursing care
Town
48
31,60
6,486
0,039
Kruskal
Village
17
44,62
Wallis
City
3
23,50
Table 5: Statistically significant results of ANOVA and Kruskal Wallis tests of survey factors with place of residence.
Place of residence(I)
Place of residence (J)
Mean difference(I-J)
p-value
Town
Village
11,00250*
0,015
City
11,19858
0,232
Village
Town
-11,00250*
0,015
City
0,19608
0,984
City
Town
-11,1986
0,232
Village
-0,19608
0,984
Table 6: Sost hoc analysis LSD for “Quality of life-spirituality” * Place of residence.
From Table 5 it appears that in the factor "Nursing care" the average rank of people who are in the city (M.B.=31.60) is statistically lower than the corresponding one of those who are in a village (M.B.=44.62, p=0.019).
Employment
Table 7 presents the statistically significant results of the Kruskal Wallis tests of the survey factors in terms of employment, where a statistically significant difference in mean ranks was found in the factor "Social support from friends" (H
Dimension
Employment
Ν
Μ.Β.
Η(3)
p-value
Social support - friends
Public-Privateemployee
11
36,68
15,456
0,001
Freelancer
8
55,25
Unemployed/student/housewife
12
41,17
Pensioner
37
27,20
Table 7: Statistically significant results of Kruskal Wallis tests of survey factors with employment.
Place of residence
Table 5 presents the statistically significant results of the ANOVA and Kruskal Wallis tests of the survey factors in terms of place of residence, where a statistically significant difference in mean values for the factor occurred "Quality of life-spirituality" (F (2,64) =3.510, p=0.036) and statistically significant difference in means of grades in the factor "Nursing care" (H (2) =6.486, p=0.039). (3) =15.456, p=0.001). From Table 7 it follows that in the factor "Social support from friends", the average rank of people who are self-employed (M.B.=55.25) is statistically higher than the corresponding one of those who are retired (M.B.=27.20, adj.p.=0.002) public-private employees (M.B.=36.68, p=0.043). In addition, in the same factor the average rank of pensioners (M.B.=27.20) is statistically lower than the corresponding one of the unemployed (M.B.=41.17, p=0.033).
Years on dialysis
Table 8 presents the statistically significant results of the Kruskal Wallis tests of the research factors in terms of years on dialysis, where a statistically significant difference in mean ranks was found in the factors "Social support from others" (H (2) =7.968, p=0.019), "Social support from family" (H (2) =7.213, p=0.027), "Quality of life-interpersonal relationships" (H (2) =8.700, p=0.013) and mean values in the "Physical fatigue" factor (F (2,65) =3.825, p=0.027).
Dimensions
Years on dialysis
Ν
Μ.Β.
Η(2)
p-value
Test
Social support - others
0-5
37
28,69
7,968
0,019
KruskalWallis
6-10
18
39,33
>10
13
44,35
Social support - family
0-5
37
28,95
7,213
0,027
KruskalWallis
6-10
18
39,42
>10
13
43,50
Quality of life - social relations
0-5
35
27,54
8,700
0,013
KruskalWallis
6-10
17
34,82
>10
13
45,31
Dimension
Years on dialysis
Ν
Μ.Ο.
F (2,65)
p-value
Test
Physical fatigue
0-5
6-10
>1037
18
132,75
3,47
2,923,825
0,027
ANOVA
Table 8: Statistically significant results of Kruskal Wallis tests and ANOVA of survey factors with years on dialysis.
Years on dialysis (I)
Years on dialysis (J)
Mean difference (I-J)
p-value
0-5
6-10
-,72072*
0,008
>10
-0,17713
0,548
6-10
0-5
,72072*
0,008
>10
0,54359
0,105
> 10
0-5
0,17713
0,548
6-10
-0,54359
0,105
Table 9: Post hoc analysis Bonferonni "Physical fatigue"* Years on hemodialysis.
From Table 8 it can be seen that in the factor "Social support from others", the average rank of people with 0-5 years on hemodialysis (M.B.=28.69) is statistically lower than the corresponding one of of people with more than 10 years (M.B.=39.33, adj.p.=0.034).
From Table 8 it appears that in the factor "Social support from family", the average rank of people with 0-5 years on hemodialysis (M.B.=28.95) is statistically lower than the corresponding one of people with more than 10 years (M.B.=39.42, p=0.018).
From Table 8 it appears that in the factor "Quality of life - interpersonal relationships", the average rank of people with 0-5 years on hemodialysis (M.B.=27.54) is statistically lower than the corresponding of people over 10 years old (M.B.=45.31, adj. p=0.011). From Tables 8 and 9 it follows that in the "Physical fatigue" factor, the average value of people with 0-5 years on hemodialysis (M.O.=2.75) is statistically lower than the corresponding value of people with 6-10 years (OR=3.47, p=0.008).
Discussion
The aim of this research is to study the effect of the sociodemographic and clinical profile of hemodialysis patients on their quality of life, social support, fatigue and satisfaction from nursing care.
In the research question, the effect of the demographic profile on the levels of perceived social support, fatigue, quality of life and nursing care was studied. It turned out that older patients feel that they receive higher social support from people outside the family and lower from friends. In addition, older patients reported being more physically and mentally tired. Similarly in the research of Nugraha et al, 2020[9], elderly patients feel more support from the family and friendly environment, but at the same time more fatigue, which comes from both age and comorbidities [9]. Greater perceived physical fatigue was also present in patients with a lower educational level, who at the same time presented a lower quality of life in the spiritual domain. This finding also results from the research of Tsiamis et al [10], which reinforces that patients with a lower educational level in Greece present a lower quality of life but also greater perceived physical fatigue. After all, the feeling of fatigue is directly linked to the quality of life [10]. Urban residents showed a higher quality of life in the spiritual domain than rural residents, with the latter, however, reporting more satisfaction with the nursing care they receive According to Zyoud et al [5], patients' area of residence is associated with quality of life in the spiritual domain, as urban centers offer more solutions of spiritual satisfaction. On the other hand, the reality of Greece, it is possible to offer greater satisfaction from nursing care to non-urban residents’ areas, as it often frees them from timeconsuming commutes, long-hour waits and from the coldness of large centers [11]. The feeling of social support from friends was stronger among the self-employed and lower among the retired. This may be due to the greater social exclusion and the difficulty that pensioners in Greece feel in accessing care structures, as well as psychological support structures [12]. In addition, patients with more than 10 years of hemodialysis reported feeling more social support from others and family compared to patients with 0-5 years of hemodialysis, while at the same time they showed higher satisfaction with interpersonal relationships but greater physical fatigue. These results do not agree with the results of The odoritsi et al, [13], where patients with more than 6 and more than 10 years of hemodialysis feel less social support. Also, in this research, patients with more years of treatment felt less satisfied with their interpersonal relationships and their relationships with the medical staff [13]. Nevertheless, all studies agree that patients with more years since the start of hemodialysis show more fatigue [14-20].
Conclusion
The results of the present research are generalizable to the patients of the artificial kidney unit of the Regional University Hospital. In addition, the results cannot be generalized for dialysis patients aged 51-80 years, with an education level up to high school, who live in a city and have been patients for up to 10 years, because the sample size was small and did not allow every case the application of parametric statistical tests that have greater power.
A future Pan-Hellenic research is proposed, comparative, in different Hospitals, public and private with stratified sampling, where the size of the sample will be determined by a mathematical formula from the size of the population (Creswell, 2013). Furthermore, it is proposed to change the questionnaire that refers to the quality of life with a questionnaire that, according to previous research, ranges in satisfactory levels of reliability (a>0.7). Finally, it is proposed to add additional factors that can improve the quality of life and reduce fatigue, according to the study of the theoretical framework, as those studied, namely nursing care and social support showed a low.
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