Iran Journal of Nursing

Background & Aims: Chronic kidney disease is a destructive and irreversible process, which reduces glomerular filtration, decreases the ability of the kidneys to retain fluids and electrolytes, and disrupts water and urea balance, thereby leading to uremia. This disease is accompanied by constant hospitalization, reduced quality of life, high mortality, and extreme medical costs. End-stage kidney disease refers to the irreversible loss of the renal function, in which case the kidneys are unable to support the life of the patient, and kidney transplantation is considered to be the treatment of choice. Due to the unevenness of this process, the majority of the patients in the world must remain under hemodialysis treatment until the kidney transplant is performed. Today, hemodialysis is a common treatment for chronic kidney failure. The patients receiving hemodialysis experience limitations in their physical, mental, and social functioning and self-care activities in patients; this could play a key role in their adaptation to the disease process, improving the quality of life, and reducing the number of hospitalizations, length of hospital stay, treatment costs, and mortality. Given the importance of self-care in hemodialysis patients and the need for care and treatment planning, the present study aimed to assess the ability of self-care and its influential factors in hemodialysis patients.

Materials & Methods: This cross-sectional study was conducted with the permit of the Ethics Committee of Guilan University of Medical Sciences, Iran (IR.GUMS.REC.1395.310), starting in January 2016 until November 2017. The sample population included the patients referring to the hemodialysis ward of Razi Hospital in Rasht, who were selected via simple random sampling. Based on the Morgan table, the number of the sample was determined per 187 dialysis patients at this center to be 126. In order to compensate for the possible loss of the patients, 137 patients were enrolled in the study. During the study, four patients were excluded due to unwillingness to continue participation, and seven patients were excluded due to weakness and lethargy while completing the questionnaire; finally, 126 patients were evaluated. The inclusion criteria were the age of 18-75 years, ability in self-care, minimum dialysis history of three months, willingness to participate, and absence of physical and motor disabilities, mental retardation, and mental disorders. The exclusion criteria were weakness, lethargy, restlessness, and withdrawal from the study. Data were collected using a questionnaire consisting of two sections; the first section included individual-social data, and the second section was the modified form of the 28-item Chinese version of the self-care ability assessment, scored based on a five-point Likert scale (Not at All=1, Rarely=2, Usually=3, Often=4, Always=5). The final score was within the range of 28-140, and the higher score than 84 indicated desirable self-care ability. The reliability of the tool has been confirmed using the test-retest method at the Spearman's correlation-coefficient of 0.85 and internal consistency at the Cronbach's alpha of 0.83 in previous studies. The reliability of the instrument in the present study was obtained with 20 pilot samples at the Cronbach's alpha of 0.80. Data analysis was performed in SPSS version 16 using descriptive statistics (mean, frequency, percentage) and analytical tests (independent t-test, correlation-coefficient, analysis of variance, and logistic regression).

Results: The mean age of the participants was 54.9 ± 16.1 years, and the mean duration of hemodialysis was 35.72 ± 33.35 months. The mean score of self-care capacity in the patients was 94.63 ± 21.57, and 71.4% of the patients had optimal self-care capacity. No significant correlation was observed between gender and self-care capacity, while men had a higher mean self-care score compared to women. Pearson's correlation-coefficient indicated an inverse, significant correlation between age and self-care ability, so that the older patients had lower self-care capacity (P=0.013; r=-0.22). In addition, a significant association was denoted between education level and self-care capacity based on the variance analysis, so that the patients with higher education levels had a higher self-care ability (P<0.0001; F=9.53). No significant associations were observed between smoking habits and alcohol consumption, marital status, and duration of hemodialysis with the self-care capacity of the patients. Based on the multivariate regression model and using the backward method, the results indicated that age was an important influential in the factor reduction of the self-care capacity of the hemodialysis patients, and the increased age of the patients than the total mean age was associated with their lower self-care ability by 1.5 times (β=-0.786; df=1; RR=0.456; CI=0.204-1.018).
Conclusion: Although the majority of the patients undergoing hemodialysis had favorable self-care capacity, the findings indicated that these patients faced limitations in self-care due to aging, the treatment process, and the problems resulting from the disease. Given the importance of self-care in improving the conditions of patients and preventing and controlling the complications of diseases and treatment methods, it is recommended that educational and counseling measures appropriate to the age of patients be taken in their care program in order to improve their self-care capacity, so that they would be fully involved in self-care as a member of the healthcare team. In addition, nurses should take steps toward educating patients individually as an important nursing task by applying the necessary changes in the training programs for hemodialysis patients in order to change the state of self-care in these patients.