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Chapter I



Introduction:




The topic of this dissertation is "Quality of Life in Dialysis Patients: A Literature Review." There are a lot of studies that had investigated and compared the mortality and survival rates of Continuous Ambulatory Peritoneal Dialysis and Hemodialysis. But, there is little information available regarding the outcomes in terms of Quality of life in Continuous Ambulatory Peritoneal Dialysis and Hemodialysis, The main objective of this study is to compare the quality of life of patients using continuous Ambulatory Peritoneal Dialysis and Hemodialysis.


It is prevalent in the nursing profession to have dialysis patients undergoing depression. A lot of studies consider depression in dialysis patient as a relevant factor in determining the patients' survival. Patients show a sense of hopelessness which is closely associated with negative expectancies on the future and suicidal ideas [1](Jung et al, 2002). Continuous Ambulatory Peritoneal Dialysis and Hemodialysis partially corrects the symptoms in kidney diseases and also have additional financial charges. Undergoing dialysis affects the lives of these patients; their mobility is limited and often feels they are a burden in the family.


Hemodialysis is a treatment usually administered three times a week in a dialysis center or clinic. In Hemodialysis the patient's blood is continuously run in a machine for hours, it passes through a filter or dialyzer which transfers the impurities and excess fluid in a solution or dialysate by osmosis. After undergoing this procedure patients will experience a feeling of extreme fatigue, and it usually lasts until the next day. Patients are required to take less than a liter of fluid per day. Peritoneal Dialysis is administered by the patient himself in the comforts of his home; it is done to maintain the health of the patient. In this process a solution containing water, dextrose and chemicals are infused in the peritoneal cavity via a catheter that is surgically embedded in the abdomen of the patient. The diet of Peritoneal Dialysis patients is less restrictive compared to hemodialysis patients. [2](Ford and Kaserman , 2000)


Patients with Renal diseases are often treated in Dialysis centers and hospitals or at home. In Hong Kong a non-profit voluntary organization, namely, Hong Kong Kidney Foundation Limited was created on the year 1979. The operation of the foundation is under the Board of Governors. The foundation renders assistance, treatments and services to kidney disease patients. They also promote awareness of kidney diseases in public, promote organ donations and researches and lastly, support training for the medical staff. There are two hemodialysis centers provided by the Hong Kong Kidney Foundation (HKKF), in Kowloon City and Wo Che center. Kowloon City operates two shifts per day while Wo Che operates only once. The Hong Kong Kidney Foundation provides subsidies which amounts to $360 per hemodialysis. And on April 1997, Peritoneal Dialysis was launched to assist the patients in receiving home based peritoneal dialysis.[3] (HKKF, 1999)



Nowadays, there is an increase of patients and their families expecting excellent nursing care available. Evidence based medicine is becoming more relevant in the practice of health care. A nurse must have the responsibility of being aware in the latest developments in the medical field. Nurse Managers must help his or her staff in creating the hospital environment conducive in the latest medical practices. Health professionals must impose a culture of valuing research, which is very critical and vital in the application of researches into medical practice. Health professionals must be updated on the current knowledge and information on new medical breakthroughs to ensure the patients and the families an effective, safe and excellent care.[4] (Rolfe, 1998)


The government and trust managers have placed emphasis, in recent years the development of a culture of research in Nursing. The establishment of Health Services Fund in Hong Kong provided the Nurses to raise interest in taking research and gain skills.[5] (Chang, 2006) Researches play an important role in the practice of nursing. Researches helps nurses apply the appropriate findings and set forth excellent nursing practice.


The Quality of Life is a very important issue in the nursing profession, nurses helps the patients to live a good life as much as possible even though the patients have illnesses and decreasing capacity to live a normal life. In knowing the health care system it will be very big help in improving the life of the patients.[6] (Saryimaki, 1999)


Chapter one gives an explanation on the background of the research on Continuous ambulatory Peritoneal Dialysis and Hemodialysis. And outline the fundamental reasons for undertaking the study. The objectives of the study are also stated in this part of the research.


Chapter Two summarizes the available evidence on Continuous Ambulatory Peritoneal Dialysis and Hemodialysis. In this part of the study a justification and in-depth review will be made. A preliminary literature review on the factors affecting the mortality rate and such on the patients undergoing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis will also be discussed in this chapter and a definition of terms is also included. This chapter will be mainly based upon book references.


Chapter Three is the body of dissertation. A critical appraisal review would be given as a research methodology, which includes the preliminary literature search such as, electronic databases search, primary and secondary sources. The use of inclusion and exclusion criteria will be stated in this part of the study. And then a critique will be given on different papers discussing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis patients and give references about the quality of life of patients undergoing those methods. After obtaining the articles in my search, reading and critiquing will be the next step. By using those steps it enables the researcher to assess the merits of each article and their importance in building an understanding of the topic area. In critiquing the articles the Guidelines for critiquing research articles from Polit, Beck and Hungler will be used. The guidelines are used according to the related article that is going to be criticizes. The guideline have simple questions and is very accessible, it helps in identifying the direction the researches wishes to pursue. And I can be more specific in analyzing the purpose and objectives study.


Chapter Four and five discusses the results and analyzes the results of the different studies related to this topic. A conclusion will be made after the writer analyzes the results. A recommendation will be made that is relevant in the quality of life in Dialysis Patients undergoing either Continuous Ambulatory Peritoneal dialysis or Hemodialysis.


Dialysis imposes a lifetime stress on dialysis patients. By studying the Quality of Life of Patients undergoing dialysis treatments it would be a big help in identifying the factors that affect the quality of their life. Quality of Life can also compare the outcomes of Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis. Ever since the Peritoneal Dialysis was introduced a lot of debate has been going on how it compares with hemodialysis in terms of quality life. Most research studies that are available are quantitative studies that examine the quality of life and adaptation of renal patients. [7](Gokal, 1999) The best tools in measuring Quality of Life are psychological and social functions and physical function. The term Quality of Life broadly refers to well being. [8](Lindqvist, et al., 2000)



Studies on the Quality of Life of Dialysis patients in Hong Kong are limited compare to first world countries like United States and United Kingdom. More than 80% of End Stage Renal Disease (ESRD) is undergoing Continuous Ambulatory Peritoneal Dialysis in Hong Kong. Identifying the factors that will affect the Quality of Life of these patients is very important in order to give the patients appropriate care and medications. A study must be conducted on the Quality of Life of dialysis patients, and also a comparison between Continuous Ambulatory Peritoneal Dialysis and Hemodialysis. It is common to see some debates and comparisons regarding the Outcomes of CAPD and hemodialysis.[9] (Li and Szeto, 2003) In Hong Kong dialysis patients prefers using Hemodialysis over Continuous Ambulatory Peritoneal Dialysis as a long term renal replacement therapy. These patients believe that better quality of life can be achieved by using Hemodialysis. (Gokal, et al., 1999)


In order to understand the client's needs, the method of conducting a research is used. The primary focus of research must be having a literature review. There are several studies that are available regarding Quality of life of renal patients that also has comparison between Continuous Ambulatory Peritoneal Dialysis and Hemodialysis. ( Li and Szeto, 2003)


The main objective of this study is to discuss and compare the Quality of Life of Renal Patients undergoing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis.


The significance of this study is to: Bring to a conclusion based on the detailed literature search, comprehend the renal patients' self-esteem and to know the concept of Quality of life in a different literatures.

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