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Bayoumi M. (2012). Identification of the needs of haemodialysis patients using the concept of Maslows hierarchy of
needs. Journal of Renal Care 38(1), 43-49.
SUMMARY
Along with basic survival and other clinical outcomes, patients quality of life is an important indicator to reflect the needs of
these patients. Human needs are classified in Maslows hierarchy, where the most essential basic physiological need provides
the base, and self actualisation is at the top of pyramid.
Aim: The aim of this study is to identify the patients needs who are on maintenance haemodialysis using concept of Maslows
hierarchy.
Method: The descriptive study was conducted in the dialysis unit of Suez Canal University Hospitals. The study included 50
patients attending the dialysis unit.
Results: The findings showed that the patients highest need was for self-esteem (92.0%), whereas the lowest was for love
and belonging (38.0%). Statistically significant relationships were revealed between the identified love and belonging needs
and patients age and the duration of dialysis (p 0.008). The total needs score was lower with the longer duration of dialysis
(59.6 7.3), compared to those with a duration less than 24 months (65.7 8.1), p 0.02.
Conclusion: Based on the main study findings it is concluded that haemodialysis patients highest need was for self-esteem,
and the lowest was for love and belonging. These needs increased with longer duration of dialysis. Nurses need to be aware of
these findings in order to be able to supply the necessary support to help the patient regain his/her self-concept.
INTRODUCTION
B I O D ATA
M a g d a B a y o u m i is currently working
as an Assistant Professor, Dean College
of Health Science, King Khalid University
in the Medical & Surgical Departments.
She has been a lecturer in the Faculty of
Nursing, King Saud University for four
years and before that working in haemo
and peritoneal dialysis for seven years. She was awarded
a PhD in 2007. Her main interests are in nursing research,
adding to new nursing knowledge for the benefit of patients,
families and communities. This encompasses all aspects of
health including promotion and prevention. She applies the
scientific approach in an effort to solve problems using
evidence-based practice to improve quality of care especially
for dialysis patients.
CORRESPONDENCE
Magda Bayoumi
Dean College of Health Science,
Medical & Surgical Nursing,
King Khalid University, KKU,
Mohail-Asser, Saudi Arabia
Tel.: 966535203797
Fax: 966-7-2855389
mbayeome@kku.edu.sa
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The patients identified theirs and their familys needs and the
problems associated with complications of the disease and its
management. Additional attention and support are required for
patients who identify themselves as more nonadherent to enable
them to live with ESRD and benefit from the treatment (Lam et al.
2010). RRT is very prescriptive and patients have to adhere to strict
fluid and dietary restrictions (Rambod et al. 2010), also RRT is
extremely time consuming with a rigid appointment schedule
which has to be complied with, all this adds to stressors and complications for managing the disease (Christensen et al. 2002).
The hypothesis of this study is that when nurses have identified
the prioritised patient needs they are better able to offer support which helps the patient regain his/her self-actualisation,
giving back the ability to solve problems and cope realistically
with life as it now has to be lived, with renal failure.
Curtin and Mapes (2001) defined self-management as clients
positive efforts to oversee and participate in their health care
to optimise health, prevent complications, control symptoms,
marshal medical resources and minimise the intrusion of the
disease into their preferred lifestyle.
In order to benefit from the RRT ESRD patients must make fundamental life style changes which include dietary and fluid restrictions, adherence to the medication regime, recognition of signs
and symptoms associated with potential complications, vascular
access care (Richard 2006) and many social and family changes.
However, this study has categorised the life style changes according to Maslows human needs which in turn are classified in a
pyramidal hierarchy, where the base is the most essential basic
physiological and biological needsurvival, and self-actualisation
which is the top of the pyramid (Maslow & Lowrey 1998).
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Needs
Questions numbers
Physiological
2,5,31
Self-esteem
Self-actualisation
24, 28
Hospitals during the study period were recruited for this study;
date from July to September 2008.
EXCLUSION CRITERION:
1. Those without enough education to understand the project.
2. Those patients who due to mental disabilities were unable to
answer questions and were unable to determine his/her needs.
3. Unwillingness to participate.
ETHICAL APPROVAL
The researcher approached patients individually at the time of
dialysis session, explaining the purpose of the study and the
importance of identifying their needs. All participants gave
their verbal consent.
TOOLS
S t r u c t u r e d i n t e r v i e w q u e s t i o n n a i r e f o r m : Used to collect patients background data about age, sex, work status,
level of education, duration of dialysis and caregivers (the caregiver information included the relationship to the patientif
spouse, sibling, children and parents).
N e e d s a s s e s s m e n t f o r m : Used for assessment of the needs
of patients undergoing haemodialysis therapy. It is based on
Maslows principles, and includes sections for physiological,
safety and security; love and belonging needs, self-esteem and
self- actualisation.
PREPARATORY PHASE
The researcher developed the assessment forms and the questionnaire. A review of the current and past literature, which
related to various aspects of the problem was done using textbooks, scientific journals and internet. The patients needs
questionnaire was developed to measure the level of satisfaction of the five basic needs according to hierarchy of Maslows
in English and Arabic. Thirty-three questions were categorised
into five types of need as shown below (Table 1).
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Frequency
Percent
Age (years)
Frequency
Percent
<40
20
40.0
<24
15
30.0
40+
30
60.0
24+
35
70.0
Range
19.0--52.0
Range
5.060
MeanSD
40.310.7
Mean SD
035.6 17.6
Gender
Caregiver
Male
24
48.0
Parents
16.0
Female
26
52.0
Spouse
26
52.0
Siblings
6.0
Children
13
26.0
Education
Illiterate
10.0
Read/write
11
22.0
Basic
12.0
Secondary
16
32.0
University
12
24.0
Single
21
42.0
Married
29
58.0
Unemployed/housewife
29
58.0
Working
21
42.0
Urban
12
24.0
Rural
38
76.0
Marital status
Job status
Residence
STATISTICAL DESIGN
Data entry was done using Epi-Info 6.04 computer software
package, statistical analysis was done using SPSS 12.0 statistical software packages. Data were presented using descriptive
statistics in the form of frequencies and percentages for qualitative variables, and means and standard deviations for quantitative variables. The nonparametric Mann-Whitney or Kruskal
Wallis tests were used instead. Pearson correlation analysis was
used for assessment of the inter-relationships among quantitative variables, and Spearman rank correlation for ranked variables. Statistical significance was considered at p-value 0.05.
RESULTS
The socio-demographic characteristics of patients in the study
sample are described in Table 2. Table 3 shows the duration of
dialysis and the status of the caregiver and Table 4 demonstrates patients identified needs as reported by them. The
highest need was for self-actualisation (92.0%), whereas the
lowest was for love and belonging (38.0%). Overall, 72% of
the patients declared they had some needs.
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Needs:
Frequency
Percent
No
18
36.0
Yes
32
64.0
Total needs
(mean SD)
Self-actualisation
15
30.0
Yes
35
70.0
31
62.0
Yes
19
38.0
Physiological
No
14.0
Yes
43
86.0
Self-esteem
No
8.0
Yes
46
92.0
Total
No
14
28.0
Yes
36
72.0
Needs
Score (25100)
Range
Mean SD
Self-actualisation
25.0100.0
60.8 19.2
33.372.2
60.1 8.9
33.3100.0
69.2 17.3
Physiological
44.675.0
59.2 7.3
Self-esteem
40.075.0
57.9 7.8
45.2--81.2
61.4 8.0
Total needs
MannWhitney test
p-value
1.32
0.25
0.09
0.76
1.13
0.29
1.66
0.20
1.28
0.26
H = 0.79
0.68
5.33
0.02a
1.65
0.20
Age (years)
<40
63.0 7.0
40+
60.4 8.5
Gender
Male
61.7 7.4
Female
61.2 8.6
Education
No formal education
59.6 8.0
Educated
62.3 7.9
Marital status
Single
59.5 6.0
Married
62.8 9.0
Job status
Unemployed/housewife
60.3 7.2
Working
63.0 8.9
Caregiver
Spouse
62.2 9.2
Children
59.7 7.3
Parents/siblings
61.7 5.5
65.7 8.1
24+
59.6 7.3
Residence
Urban
58.6 8.8
Rural
62.3 7.6
DISCUSSION
Table 6 shows the relationship between the participants identified needs and their socio-demographic details. As the table
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Variables
Need
0.60a
QOL score
Age (years)
Education (reference: illiterate)
Dialysis duration (months)
0.11
b
0.16
0.38a
therapy using Maslows hierarchy but the findings have important implications for all nurses and physicians. Maslows base
need is the physiological and biological need to survive which
has to be met before moving to the next higher level. Each
level has specific needs, which require to be fulfilled before the
next level can be reached (see Figure 1). This continues until
the highest level of self-actualisation or self-coping strategies is
achieved (Yah & Chou 2007).
Life with dialysis requires coping and adaptation by the
patients in order to survive (the first requirement of Maslows
hierarchy). Dietary and fluid restrictions are mandatory due to
hyperkalaemia, high blood pressure and fluid retention
(Thomas et al. 2009). Thirst is one of the physiological problems, and thirst is a frequent and stressful symptom experienced by haemodialysis patients. The education of the patient
regarding fluid restrictions and diet are part of the basic
physiological needs, which have to be fulfilled. Jacob and
Locking-Cusolito (2004) have emphasised that all educational
programmes should teach patients on HD how to deal with
physiological issues to improve total Quality of Life. They give
examples for management of thirst that might help other
dialysis patients thus improving coping strategies.
Safety and security is the second stage in the Maslows hierarchy; it is divided into physical and psychological safety. The
physical safety is protecting person from potential or actual
harm. Patients need to feel safe and secure during dialysis
sessions. They need to understand why the machine alarms so
they are not frightened by the noises. Occasionally microembolic findings have been noted after the venous chamber, or
microbubbles can be seen which could pass the air trap
towards the venous line without alarming, so to achieve safety
during dialysis sessions a specifically designed ultrasound
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parents renal disease and dialysis therapy impacted significantly on the childrens lives.
This study assessed the need for love and belonging, the findings
indicated that these are the least identified needs. This might be
explained by the nature of family relations, and compassion
towards chronically ill patients in Middle Eastern communities,
such as ours. However, it was found that the scores of love and
belonging needs were statistically significantly lower among
patients aged more than 40 years, demonstrating that older
patients have a greater need expressions for the feelings of love
and belonging. This is quite plausible, as aging people might
easily feel neglected and are over-sensitive to day-to-day behaviours that they could interpret as lack of love and belonging.
ESRD is marked by extreme loss of personal control and the
challenge of lifelong behavioural changes (Quinan 2007). The
change of role within the family and status both socially and
financially which chronic illness involves and is very evident in
RRT, serves to decrease self-esteem. The body image disturbances caused through fistula or Peritoneal Dialysis all decrease
self-esteem which is Maslows next level and correlates with
psychological distress (Partridge & Robertson 2010).
Jansen et al. (2010) indicate that dialysis patients beliefs about
their illness and treatment play an important role in their perceived autonomy and self esteem. Stimulating positive beliefs
and altering maladaptive practices might contribute to a
greater sense of autonomy and self-esteem, and to social reactions in general.
Stressors for patients on HD are associated with management
of the chronic illness, however coping for dialysis patients can
be adaptive or maladaptive. Adaptive coping can produce
desirable outcomes, such as employment and successful functioning within family dynamics (Quinan 2007) whereas maladaptive coping leads to nonadherence, poor treatment outcomes and family confrontations.
Pollice et al. (2010) consider the need to integrate a psychological and functional needs assessment for patients undergoing
dialysis procedures, which lead to limitations in activities and a
high level of disability. One of the often used coping strategies
is turning to religion by haemodialysis patients, the belief as
the basic and most important aspect of human life (Cinar et al.
2009). How this is manifested will very much depend on the
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local culture and beliefs but the use of this strategy can be productive or destructive. Turning to God can be an excuse but it
can also drive the patient to better coping.
The final stage of Maslows needs is self-actualisation. This is
the realisation of self and the acceptance of life as it presents
itself, illness not-withstanding, but making the most of the
opportunities which are presented and living life to the full.
The relationship between identified self-actualisation needs as
assessed among patients in this study sample showed that the
scores were slightly lower among younger educated females,
and among single unemployed or housewives, or when the
patients caregiver was a parent or a sibling, also place of residence and the duration of dialysis was statically significant.
This study has demonstrated that the length of time a patient
is receiving HD treatment alters his/her needs. In this study,
patients duration of dialysis ranged between five and 60
months, with a mean of approx. 35 months. Hsieh et al.
(2010) demonstrate that treatment outcomes, biochemical
results and quality of life decline after 16 months. The findings
from this study agree with Hsieh et al. (2010) and both
showed that duration of treatment over 16 months did impact
on patients needs. This finding cannot be generalised to units
in other countries but was demonstrated in this study.
The total needs score was lower with the longer duration of dialysis pointing to an ever-increasing level of need as the duration
of dialysis lengthens. Moreover, this is corroborated by the finding of a statistically significant negative correlation between the
needs scores and duration of dialysis, which means that as the
duration increases, the needs score decreases, that is, more
needs. The same finding was revealed regarding love and
belonging showing those who had been receiving treatment for
more than 24 months had more needs, compared to those with
less than 24-month dialysis duration. The increasing needs
which corresponded to the longer duration of dialysis might be
attributed to progress of the disease with associated more
deficits in the patients physiological and psychological functioning. It might also be explained by the effect of the long term
caring because of the increased burden, and consequently less
ability to fulfil the Egyptian patients needs.
CONCLUSION
Based on the study findings it is concluded that haemodialysis
patients highest need was for self-actualisation, and the
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lowest was for love and belonging. These needs increased with
longer duration of dialysis. Therefore to fulfil the haemodialysis patients needs the healthcare team must first identify
these needs to be able to optimise patient management.
Nurses play an important role in the care of HD patients. They
are with the patient during treatment and can identify the
patients stressors, coping methods and social support.
Through this they can assist patients to alleviate stressors and
maintain the effective coping strategies and support resources.
CONFLICT OF INTEREST
The author confirms there is no conflict of interest.
REFERENCES
Belasco A.G. & Sesso R. (2002). Burden and quality of life of caregivers
for hemodialysis patients. American Journal of Kidney Diseases
3 9(4), 805-812.
Christensen J.A., Wiebe S.J. & Moran J.P. et al. (2002). Effect of a
behavioral self-regulation intervention on patient adherence in
Hemodialysis. Health Psychology Journal 2 1(4), 393-397.
Cinar S., Barlas G.U., Alpar S.E. (2009). Stressors and coping strategies
in Hemodialysis patients. Pakistan Journal of Medicine Sciences
2 5(3), 447-452.
Curtin R.B. & Mapes D. (2001). Health care management strategies of
long-term dialysis survivors. Nephrology Nursing Journal 2 8(4),
385-392.
Davison S.N. (2010). End-of-life care preferences and needs: perceptions of patients with chronic kidney disease. Clinical Journal of
American Society of Nephrology 5 (2), 163-166.
Dunn S.A., Lewis S.L. & Bonner P.N. et al. (1994). Quality of life for
spouses of CAPD patients. ANNA Journal 2 1(5), 237-246, 257.
Hsieh R.L., Huang H.Y. & Chen S.C. et al. (2010). Changes in physical functional performance and quality of life in hemodialysis patients in
Taiwan: a preliminary study. Journal of Nephrology 2 3(1), 41-48.
Jacob S. & Locking-Cusolito H. (2004). Thirst distress and interdialytic
weight gain: how do they relate? CANNT Journal 1 4(3), 6-7.
Jansen D.L., Rijken M. & Heijmans M. et al. (2010). Perceived autonomy
and self-esteem in Dutch dialysis patients: the importance of illness
and treatment perceptions. Psychology Health 2 5(6), 733-749.
Jonsson P., Karlsson L. & Forsberg U. et al. (2007). Air bubbles pass the
security system of the dialysis device without alarming. Artificial
Organs 3 1(2), 132-139.
Lam L.W., Twinn S.F. & Chan S.W. (2010). Self-reported adherence to a
therapeutic regimen amongpatients undergoing continuous
ambulatory peritoneal dialysis. Journal of Advanced Nursing
6 6(4), 763-773.
Lindqvist R., Carlsson M. & Sjdn P.O. (2000). Coping strategies and
health-related quality of life among spouses of continuous ambu-
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