AN EXPLORATORY STUDY TO ASSESS THE FUNCTIONAL

LIMITATIONS AMONG CHRONIC RENAL FAILURE PATIENTS IN

HEALING TOUCH HOSPITAL , AMBALA 2017

Project work submitted for the fulfillment of the requirement for the degree of

POST BASIC BSC NURSING

Of

Baba Farid University Of Health Sciences,

Faridkot,Punjab

(2017)

By

Post Basic Bsc Nursing 2nd year

SWIFT INSTITUTE OF NURSING GHAGGAR SARAI,

RAJPURA ,PUNJAB

1
 HEALING TOUCH HOSPITAL , AMBALA

CERTIFIED THAT THIS IS THE BONAFIED WORK OF

Chandni , Renu ,Kimi, Poonam, Meenakshi

AT

HEALING TOUCH HOSPITAL , AMBALA SUBMITTED IN PARTIAL FULFILLMENT OF THE

REQUIREMENT FOR THE DEGREE OF

BACHELOR OF SCIENCE IN NURSING(POST BASIC) OF The Baba Farid University Of Health

Science Faridkot,Punjab,2017

GUIDE CO GUIDE

Mr. Pravin Prakash.P Mr. Pravin Prakash.P

MSc.Nursing (Child Health Nursing) MSc.Nursing (Child Health Nursing)

Assistant Proffesor Assistant Proffesor

Swift Institute Of Nursing Swift Institute Of Nursing

Ghaggar Sarai,Rajpura Ghaggar Sarai,Rajpura

2
 CERTIFICATE

Certified that this is the bonafide work Of Ms.Chandni,Ms.Renu,Ms.kimi,

Ms.Poonam,Ms.Meenakshi At Swift Institute Of Nursing, Ghaggar Sarai,Rajpura Submitted in
the partial fulfillment of the requirement for the degree of Post basic Bsc.(N) from the Baba
farid university of health and science Faridkot,Punjab,2017.

Guide :

Mr. Pravin Prakash.P

MSc.Nursing (Child Health Nursing)

Assistant Proffesor

Swift Institute Of Nursing

Ghaggar Sarai,Rajpura

3
 ACKNOWLEDGEMENT

First and foremost we praise and thank God For his abundant grace

which enabled us to complete research work successfully.

The present study is the end product of team work. It is highly

impossible to express our in-depth Gratitude to all those who have

helped us to make our efforts a success and also have given a concrete

shape to our plan.

With profound gratitude we express our heart felt veneration

towards our esteemed, and valueable Guide Mr.Pravin Prakash.P,

MSc. Nursing (Child Health Nursing), Assistant Professor ,Swift

Institute of nursing , Ghaggar Sarai, Rajpura. Whose valuable

guidance has enabled us to persue this Project work with all its

challenges. Her endless patience, affectionate words of encouragement

that have shaped this Project work. She is a Guide with a vision and

have tremendous experience. We are lucky to have her as our Project

work guide.

We would like to express our deep sense of gratitude to our co-

guide Mr. Pravin Prakash, MSc. Nursing (Child Health Nursing)

Assistant Professor ,Swift Institute of nursing , Ghaggar Sarai,

Rajpura., For her guidance, suggestions and consistent encouragement

throughout the course of study.

We are thankful to Nursing superintendent of Healing Touch

Hospital, Ambala,Who gave us permission to collect data for Project

work from the selected wards of Healing Touch Hospital, Ambala.We

also thankful to our patients who have cooperated us in collection of

our data and answered all the questions.

4
We are deeply obliged for the cooperation that we received from the

staff nurses and sister in- charge of the selected units in the

hospital,without this could not have been accomplished.

Our sincere thanks and gratitude to Dr,Manider Director, Swift

Institute Of Nursing , Ghaggar Sarai,Rajpura.

We are thankful to Mr. Anil Kapoor, librarian of Swift Institute Of

Nursing , Ghaggar Sarai, Rajpura for her help whenever we needed

during the study.

We cannot forget to express our thanks to our beloved parents,for

permitting us to spend more time on conducting the study and help us

financially and supported us by their prayers and encouragement

with their love and affection,we wonder if this work have ever seen

the light of the day.

The completion of this work prompts us to acknowledge the

help,support and guidance of all those who are instrumental in

bringing it to its present form.

With many thanks

Ms.Chandni kumari

Ms.Renu Bala

Ms.Kimi

Ms.Poonam Koundal

Ms.Meenakshi Sharma

5
 INDEX

SR TOPIC PAGE NO.

NO.
1. INTRODUCTION 7-11
2. REVIEW OF LITERATURE 12-15
3. METHODOLOGY 16-19
a) Project work Design 17
b) Project work setting 17
c) Targeted population 17
d) Sample and sampling technique 18
e) Description of the tool 18
f) Content validity 19
g) Data collection procedure 19
h) Plan of data analysis 19
4. ANALYSIS AND INTERPRETATION 20-45
5. DISCUSSION 46-48
6. SUMMARY 49-50
7. CONCLUSION 51-54
8. REFERENCES 55-57
9. APPENDIX 58-63
10. ABSTRACT 64-65

6
 CHAPTER -1

INTRODUCTION

7
INTRODUCTION

Kidney is a vital organ and the main function of the kidney is to remove
waste products and excess water from the blood. The kidney process
about 200 liters of blood everyday and produce about 2 liters of urine.
The waste products are generated from normal metabolic process
including the breakdown of active tissues, ingested food, and other
substances 1 .

Chronic renal failure occurs when the kidneys are no longer able to
function and cant remove toxins from the individuals blood. The first
publication that demonstrated low level of exercise capacity in
haemodialysis patient appeared in 1977.Chronic renal failure are
limited in ability to pe rform physical exercise. Despite significant
progress in technological as pects of renal replacement thera py and
medical advances, patient remain limited physically, which negatively
impacts overall health, quality of life, there are many patients who
have co-morbid medical conditions that may contribute to limited
exercise capacity, the markedly low functioning in the best of the
patients indicates that there is a need to intervene to increase
functioning. Patients with renal fa ilure face many challenges due to
their condition which may leave them feeling tired and depresse d
.Relationships and independency are also threatened 2 .

Heamodialysis is now used as a life -sustaining therapy for more

than3,00,000 patients in the United Sta tes who have chronic renal
failure. Patients with advanced chronic ren al failure, patients with
advanced renal failure, including those undergoing maintenance
heamodialysis, commonly suffer from reduced physical exercise
capacity 3 .

Chronic renal failure pa tients usually have impaired exercise capacity

and often have diminished muscle strength. There are clearly a number
of cause for impaired exercise capacity . chronic renal failure patients

8
are commonly very physically inactive, patient showed an increase in
work rate, endurance time, power and fatigue, and reduced time for
stairs climb 4 .

Kidney patients often get bone disease bone disease because the
body's calcium and phosphorous are not in balance. When the
phosphorous level is too high, the calcium l evel may be too low. When
it happens, body pulls calcium out of bones causing bones to become
weak 5 .

Kidney disease affect patient not only physically but also emotionally,
socially and spiritually. Dies and fluid restrictions may seem almost
impossible at first patients may be irritable, confused, experienced
sleep disturbance, or changes in appetite enables patient to continue
working, travel, socialize, care for other family members, etc. Patients
remain limited physically, which negatively impacts overa ll health,
quality of life, and outcomes ( i.e. hospitalization, mortality) 6 .

Chronic renal failure patients undergoing H emodialysis live with

varying degree of physical and psychological symptoms. The many
medical problems that result from chronic renal f ailure lead to
reduction in physical in physically functioning and medical
complications such as cardiovascular, anemia and neurological
complication. All these complications lead to diminished working
capacity as energy level often precipitates and an ina bility peruse full
time employment. The initiation of long term dialysis of long term
dialysis treatment increases survival, but health related quality of life
remains impared 7 .

NEED FOR THE STUDY

Project worker had interaction with chronic renal failure

patients during clinica l posting.

9
 And observed the limitations imposed by c hronic renal
failure and Hemodialysis in their day to day activities of
daily life, specially related to physical changes.
Renal disease patients unable to perform self ca re task
such as bathing, grooming, eating, toileting etc. to live
normal routine life. The current study helps to improve
nursing care.
Study findings would help to structure specific nursing
interventions

PROBLEM STATEMENT

An exploratory study to assess the functional limitations among

chronic renal failure patients i n Healing Touch Hospital, Ambala, 2017.

OBJECTIVES

To assess the functional limit ations among chronic renal failure

patients.

SUB OBJECTIVES

To administer the interview schedule on identification of socio -

demographic data.
To develop and administer interview schedule to assess functional
limitations in performing day -to day activities.
To analysis the collective data and interpret the results.

ASSUMPTIONS

Patients with chronic renal failure patients may have various functional
limitations in performing their daily life activities.

10
OPERATIONAL DEFINITIONS

FUNCTIONAL LIMITATIONS : - Restrictions laid due to chronic

renal failure on an individuals ability to perform activities
required activities required in their daily lives.
CHRONIC RENAL FAILURE : It is a progressive loss in renal
function over a period of months or years, requiring treatment
with any form of chronic dialysis or transplantation.

LIMITATIONS

The study is limited to Healing Touch Hospital, Ambala only.

The study is limited to dialysis unit only.

11
 CHAPTER-2

REVIEW OF LITERATURE

12
REVIEW OF LITERATURE

A study was conducted by Martins Mr. Cesarino , to evaluate the

quality of life of chronic rena l failure patients receiving heamodialysis.
They investigated 125 chronic renal failure patients under
heamodialysis treatment and assessed the daily activities by means of
semi structured interview. The results evidenced that these individuals
quality of life is impaired , on the physical and emotional aspects."

A study was conducted by Cleary J, Drennan J , to evaluate

quality of life of patients who are on he amodialysis for chronic
renal failure. The aims of the study was to compare the quality of
life between the general population who are adequately dialyzed
ad than inadequately dialyzed. Findings revealed that receiving
heamodialysis has limitations in a number of areas including
physical functioni ng and physical role, etc.

A study was conducted by Kauidi E to evaluate the Health -related

quality of life in c hronic renal failure patients. I t consists of a
number of components like functional status, psychological and
social functioning, cognition. Chronic renal failure patients
display emotional disturbances, as well a s non-adherence to
treatment, fluid and food intake due to depression, anxiety, social
withdrawal and cardiovascular and other co-existing disease.
They have very low functional capacity and there was physical
limitations in their daily activities.

13
A study was conducted in 5 European countries by Mapes DL, Lopes AA,
Satayathums, Mc. Cullough KP,using SF-36 they determine d scores for
first physical component, second men tal component, third kidney
disease component. They concluded that lower scores of three major
components of qualify of life were strongly associated with higher risk
of death in he amodialysis patients.

A study was conducted by Martins MR, Cesarino CB , on quality of life

chronic rental failure patients on he amodialysis. They concluded that
the individuals quality of life is impaired, with lower scores for
physical, emotional and vitality aspects. There was a negative
correlation between time spend on he amodialyhsis and the physical
component and between he amodialysis time and daily activities such as
work, house work and practical activities. Physical and leisure time
activities were the most affected ones.

A study was conducted by Cristovao F on stress, coping and quality of

life among chronic he amodialysis patients. The results showed that
patients perceived high levels of stress, and that psychosocial str ess
are as problematic as the physiological ones. Although their quality of
life was satisfactory , patients were dissatisfied about their physical well
being.

A study was conducted by Chang CK, Peng YS, Chiang SS, Yang CS,

on health related quality of life of heamodialysis patient. They

concluded that the phys ical and mental aspect of quality of life are
sustaintially lower for he amodialysis patients, expect for higher bodily
pain tolerance. A number of demographic and clinical characteristics
have a significant impact on healt h related quality of life in
heamodialysis patients.

14
A study was conducted by Jiang MM, LiL, on assessment of
health-related quality of life in he amodialysis patients with SF -36.
They concluded that the quality of life in he amodialysis patients
is impaired. Greater attention should be given to improve quality
of life.

15
 CHAPTER-3

METHODOLOGY

16
METHODOLOGY

The methodology is the most important part of Project work as it

is the framework for conducting the study. The chapter deals with
the methodology adopted to assess the functional limitations of
chronic renal failure patients in dialysis unit at Healing Touch
Hospital, Ambala.

DESIGN OF RESEARCH PROJECT

An exploratory design was considered appropriate for present

study to assess the functional limitations of chronic renal failure
patients.

SETTING OF RESEARCH PROJECT

For present stu dydialysis unit of Healing Touch Hospital, Ambala

is selected, Which is a multi-speciality hospital,having a strength
of 500 beds, that includes A well equipped emergency
unit,Critical care units including ICU, CCU, NICU, different wards
and a dialysis unit having a strength of 20 beds. It is situated in
Sultanpur Chowk, Near Dhulkot Barrier, Ambala -Chandigarh
Highway, Ambala, Haryana.

TARGETED POPULATION

Chronic renal failure patients receiving he amodialysis in Healing

Touch Hospital of all ages.

17
 SAMPLE

A sample of 30 chronic renal failure patients on hemodialysis

were selected from Healing Touch Hospital, Ambala . While they
were undergoing Haemodialysi s.

SAMPLING TECHNIQUE

Purposive sampling techniqu e was used to conduct the study

purposive samples are selected based on judgement of the
Project worker to achieve particular objective of the Project work
at hand.

Inclusion criteria :- All patients from age of 25 -70 years.

Exclusion criteria :- All the patients were willing to share the

information.

DESCRIPTION OF THE TOOL

It is semi-structured tool of questionnaire developed on the basis of

review of literature, Interview method is fully used for exploratory
study. It has 2 sections, Section A and section B.

Section-A

-It includes demographic characteristics which include, Age,Academics

,Qualification,Income,Family,Occupation etc.

SECTION-B

-It includes open ended semi -structured questionaire, that contains 15

questions regarding chronic renal failure.

18
ETHICAL CONSIDERATION :

-Permission to conduct the study was taken from Principal and

Nursing Superintendent.

-Verbal consent of the patient is taken.

-Patient is ensured that his/her personal information will not

be disclosed to anyone.

CONTENT VALIDITY

Validity of the tool was co nfirmed by an expert Mr. Pravin Prakash.P

and from other experts and their suggestions were incorporated in the
project work.

PLAN OF DATA ANALYSIS

Data was planned to be analyzed by using descriptive analysis in the

month of july for 2 weeks, at Healing Touch Hospital, Ambala.

19
 CHAPTER-4

ANALYSIS AND INTERPRETATION

20
ANALYSIS AND INTERPRETATION

This chapter deals with analysis and interpretation of data collected to

assess the functional limitations experienced by chronic renal failure
patients in Healing Touch Hospital, Ambala. Analysis and interpretation
was done in accordance with the objectives laid down for t he study.
The data was analyzed by calculating the score in terms of mean
percentage and S.D.

The table 1 depicts the gender of study subjects. Males were 90% and
females were 10%. The 55% were not able to maintain personal
hygiene. As per ability to do self medication 30% were not able to take
medication on their own. Social interaction was reported by 40% study
subjects and ability to travel was among 30% .Ability to use toilet was
observed among 90%. Exercise was done by 40% study subjects. The
ability to handle finances was 45% and as per relation with spouse
70% were satisfied with their relations.

Table 1 Distribution of study subjects are as per

identification profile

N=30

PROFILE n(%)
Age
<25 years 3(15%)
25 to 40 years 4(10%)
41 to 55 years 4(10%)
56 to 70 years 8(20%)
>70 years 10(45%)

Gender

21
Male 25(90%)
Female 5(10%)
Marital Status
Married 20(70%)
Unmarried 6(10%)
Widow 4(20%)
Divorcee 0

Education
Illiterate 3(15%)
Primary 7(10%)
Higher Secondary 15(10%)
graduate and above 5(20%)

Occupation
Student 1(5%)
Self employed 5(25%)
Service personnel 15(50%)
Unemployed 9(10%)

22
The table 2 depicts that 15% study - subjects were able to perform
activities like bathing, brushing, eating etc . 15% were doing household
work. 15% study subjects were going to college, office or work. 10%
study subjects were dependent on caretaker, 10% were not doing any
work, only performing their activities of daily living, 5% wer e doing
correspondence study, us ing internet and wathcing T.V.

Table 2 Distribution of study subjects as per activities

of daily

N-=30

PROFILE n(%)
Activities of daily living
Doing all activities like bathing, brushing, eating etc. 9(20%)
Doing household work. 3(15%)
Going college or office or work. 4(20%)
Not doing anything because of are taker 2(10%)
Doing agricultural work and spend time with friends 2(10%)
Goes to nearby religious place and watch T.V.in an evening 3(5%)
Instead of self care, not doing any activity 3(10%)
Always lie on bed, does not do anything 2(5%)
Doing study, using - internet and watching T.V. 2(5%)

23
The table 3 depicts that 30% of study subjects were able to perform
activities with assistance,30% of study subjects were doing their activities
by their own and 40% of study subjects were not able to perform their
activities on their own.

Table 3 Distribution of study subjects as per Ability to do

activities

N=30

PROFILE n(%)

Activities by own?

Yes,but some work with assistance 6(30%)

Yes 6(30%)
; No 18(40%)

24
The table 4 depicts that 25% of study subjects were facing weakness while
doing ADL, 10% experienced leg pain,10% had sleeping problem, 10% had
walking problems, 10% had whole body pain, and 5% had headache
problem.

Table 4 Distribution as per limitations faced by

study subjects

N=30

PROFILE n(%)
Type of limitations?

W eakness 5(25%)
Legs pain 7(15%)
Walking problem 3(10%)
Sleeping problem 5(10%)
Whole body pain 2(10%)
Diet problems 2(10%)
Inability to use stairs 2(10%)
Not any limitation 2(5%)
Headac he 2(5%)

25
The table 5 depicts that 45% of study subjects were able to perform their
personal hygiene on their own, 55% of study subjects were not able to
maintain their personal hygiene on their own.90% of study subjects were
able to take their food with their own hands and 10% of study subjects were
not able to take their food with own hands.70% of study subjects were able'
to take their medication from their medicine box and 30% of study subjects
were not able to do this.90% of study subjects were able to use toilet by
their own and 10% of study subjects were not able to use toilet on their
own.

Table 5 Distribution of study subjects as per ability to do

activities of daily living

N=30

PROFILE n(%)
Personal hygiene by their own?
Yes 25(45%)
No 5(55%)

Take food with your own hands?

Yes 25(90%).
No 5 ( 1 0 % )

Self medication?
Yes 24(70%)
No 6(30%)

Use toilet by own?

Yes 25(90%)
No 5(10%)

26
The Table 6 depicts that 40% of study subjects were able to interact
with society and 60% of study subjects were not able to interact with
society. 60% of study subjects were able to do recreational activities
in family and 40% of study subjects were not able to do recreational
activities in family.

Table 6 Distribution of study subj ects as per ability to

socialize

N=30

PROFILE n(%)

Interaction in Society?

Yes 22(40%)

No 8(60%)

Recreational activities in family?

Yes 24(60%)

No 6(40%)

27
The table 7 depicts that 30% of study subjects were comfortable while
t ra ve llin g a n d 7 0% of stu d y su b ject s we re n o t co mf o rt a b le wh ile
travelling.40% of study subjects were able to visit market alone and 60% of
study subjects were not able to visit market alone.70% of study subjects were
able to go out with friends and family and 45% of study subjects were not able
to go out with family and friends.

Table 7 Distribution of study subjects as per abilit y to

travel

N=30

PROFILE n(%)
Comfortable in travelling?
Yes 8(30%)

No 22(70%)
Visit market alone?
Yes 6(40%)
No 22(60%)

Go out with friends and family?

Yes 16(55%)

No 14(45%)

28
The Table 8 depicts that the 70% of study subjects were facing walking
difficulties while perfor ming activities of daily living and 30% study
subjects were not facing walking difficulties.

Table 8 Distribution of study subjects as per difficulties in

walking

N=30

PROFILE n(%)

Walking difficulties?

Yes 18(70%)
No 12(30%)

29
The table 9 depicts that 40% of study subjects were able to do light
exercises and 45% of study subjects were able to handle finances and
55% of study subjects were not able to handle finances.

Table 9 Distribution of study subjects are per ability to do

exercise and handle finances .

N=30

PROFILE n(%)

Exercises?

Yes 13 (40% )
No 17(60%)

Handle finances?

Yes 14(45%)
No 16(55%)

30
Table 10 depicts that the 70% of study subjects have good relationships
with their spouse, 5% of study subjects had not good relationships with
their spouse, 15% of the study subjects were not responding about the
relationship with their spouse, 20% were satisfie d with their sexual life.
10% of study subjects were not s atisfied with their sexual life, 60% of
study subjects were not responding about their sexual life and 10% of
study subjects were not applicable.

Table 10 Distribution of study subjects as per Pers onal

Relation with Spouse .

N=30

PROFILE n(%)
Relation with spouse?

Good 14(70%)
Not good 5(5%)
Not applicable 4(10%)
No response 7(15%)

Satisfaction of sexual life?

Satisfied 7(20%)
Not satisfied 3(10%)
No response 17(60%)
Not applicable 3(10%)

31
Fig-1 Discussion of study subjects as per age

The Fig-1 depicts study subjects chosen as per age.25% people were
between the age of 25 -40 yrs,10% were between the age of 41 -55
yrs,40% were between the age of 56 -70 years and 25% were the age of
more than 70 yrs.

Age
45.00%
40.00%
35.00%
30.00%
25.00%
20.00% 40%
15.00%
25% 25%
10.00%
5.00% 10%
0.00% 0
<25 25-40 41-55 56-70 >70

32
Fig-2 Distribution of study subject as per gender

Fig 2 depicts that 18% of study subjects were males and 2% of

study subjects were females.

Gender
20.00%
18.00%
16.00%
14.00%
12.00%
10.00%
18%
8.00%
6.00%
4.00%
2.00%
2%
0.00%
Male Female

33
Fig-3 Distribution of study subjects as per marital status

Fig 3 depicts 70 % of study subjects were married,10% were

unmarried,20% were widow, and there were no study subjects that were
divorced.

Marital status
80%

70%

60%

50%

40%
70%
30%

20%

10% 20%
10%
0% 0%
Married Unmarried Widow Diavorced

34
Fig-4 Distribution of study objects as per education

Fig 4 depicts that 25% study subjects were illiterate,105 were primary
educated,105 were middle school educated,20% were higher secondary
educated and 40% were graduate.

Education
45%
40%
35%
30%
25%
20% 40%
15%
10% 20%
15%
5% 10% 10%
0%
Illeterate Primary Middle Higher secondary Graduate

35
Fig-5 Distribution of subjects as per occupation

Fig 5 depicts that 5% study subjects were students,25% study subjects

were self employed,50% study subjects were service personal,10% study
subjects were pensioner and 10% study subjects were unemployed.

Occupation
60%

50%

40%

30%
50%
20%

25%
10%
10% 10%
5%
0%
Student Self employed Service Personal Pensioner Unemployed

36
Fig-6 Distribution of study as per residential area

Fig 6 depicts that 65% study subjects were of urban area and 35% of
study subjects were of Rural area.

Residential area

35% Rural Area

Urban area
65%

Fig-7 Distribution of study subjects as per religion

Fig 7 depicts that 40% of study subjects were of hindu religion

and 60% of study subjects were of sikh religion.

Religion

40% Sikh
Hindu
60%

37
Fig-8 Distribution of study subjects as per ability to do
personal hygiene

Fig 8 depicts that 55% of study subjects were able to maintain

personal hygiene and 45% of study subjects were not able to
maintain personal hygiene.

Personal hygiene

45% Yes
55% No

Fig-9 Distribution of study subjects as per ability to take

food

Fig 9 depicts that 90 % of study subjects were able to take their

food by themselves and 10% were not able to do so.

Ability to take food

10%

yes
no
90%

38
Fig-10 Distribution of study subjects as per ability to take
medicine

Fig 10 depicts 70 % of the study subjects were able to take

medicine and 30 % study subjects were not able to take
medicine.

Ability to take medicine

30%

yes
no

70%

39
Fig-11 Distribution of study subjects as per ability to
interact in society

Fig 11 depicts that 60% of the study subjects were able to

interact in the society and 40% of the study subjects were not
able to interact in the society.

Interact in society

40%
Yes
No
60%

40
Fig-12 Distribution of study subjects as per ability to
travel

Fig 12 depicts that 70% of the study subjects were able to travel
and 30% of the study subjects were not able to travel

Ab ility to travel

30%
Yes
No

70%

41
Fig-13 Distribution of study as per ability to visit market
alone

Fig 13 depicts that 60% of the study subjects were not able to
visit market and 40% of the study subjects were able to visit
market.

Ability to visit market

40%
Yes
No
60%

42
Fig-14 Ability to use toilet

Fig 14 depicts that 90% of the study subjects were able to use
toilet and 10% of the study subjects were not able to use toilet.

Ability to use toilet

10%

Yes
no
90%

43
Fig-15 Distribution of study as per ability to handle
finances

Fig 15 depicts that 55% of the study subjects were able to

handle finances and 45% of the study subjects were not able to
handle finance

Handle Finances

45% Yes
55% No

44
Fig-16 Distribution of study subjects as per satisfaction of
sexual life

Fig 16 depicts that 20% of study subjects were satisfied with their sexual
life,10% were not satisfied with their sexual life, 60% study subjects were
not responsive and 10% were not applicable in this.

70%
Satisfaction with sexual life
60%

50%

40%

30% 60%

20%

10% 20%
10% 10%
0%
Satisfied Not satisfied Noresponse Not applicable

45
CHAPTER-5

DISCUSSION

46
 DISCUSSION

This chapter deals with the discussion of the subjects undertaken including its major
finding, the conclusion drawn from finding, implication of the study, recommendation
and study limitation. The study was to assess the functional limitations experienced by
chronic renal failure patients in Healing Touch Hospital, Ambala. Data was
collected in the month of July.

The sample size was 20 patients with chronic renal failure admitted in dialysis unit. The
data was collected by interview schedule by the Project worker from study subjects.
Content validity of the tool was done by experts from field of Community health
nursing. The data was analyzed using both differential and inferential statistics, such as
percentage and Mean,S.D.

To maintain the positive health there should be proper functioning of whole organs of
the body if even a single organ is not able to perform the proper functioning then it will
lead to the changes in whole body functions and it limit the functions of activities of
daily living. Present study describing the functional limitation experienced by chronic
renal failure patients at Healing Touch Hospital, Ambala. According to study
findings 25%study subjects were facing weakness,10% study subjects were facing
walking problems. The another _ study was conducted-in Turkey in 2007.The findings
revealed that 55% study subjects were facing weakness.

The study findings shown 70% had good relationship with their spouse and
20% of study subjects were satisfied with sexual life. The another study

47
conducted on sexual functioning in Banglore in 2005.The finding of study
revealed that 45% of study subjects had reduced sexual interest after the onset
of kidney disease , and another 35% after beginning dialysis.

The study finding shown 40% of study subjects were interacting in society, and
70% of study subjects were not comfortable during travelling. The study was
conducted at USA in 2008. The findings of the study revealed that HD patients
are suffering from a chronic disease, it highly affect the patient's quality of life,
social activities and social relationships.

The study findings shown 60% of study subjects were not visiting the market
along and 45% of study subjects were going out with friends and family, 70% of
study subjects had walking difficulties and 60% of study subjects were not doing
any exercise and 45% of study subjects were doing their personal hygiene
activities by their own and 90% of study subjects were taking food with their
own hands. The similar study was conducted in Chennai in 2003. The findings of
study revealed that the difficulties faced by these people are in majority, and this
influence their routine activities, the visits to the doctor and going outside with
the family disrupts. Everyday activities, such as getting up at the right time,
going to work, going to school, making meal, participating in sports was also
disrupted.

48
CHAPTER-6

SUMMARARY

49
 SUMMARY

The purpose of this study was to find out the functional

limitations experienced by the chronic renal failure patients in selected hospital,
Healing Touch Hospital, Ambala . The present study design was exploratory in
nature, conducted over a period of 2 weeks. Interview schedule was used to
collect the data. Data was collected from 20 chronic renal failure patients in
Healing Touch Hospital, Ambala. The findings revealed that majority of the
study subjects were not able to do the activities by their own, personal hygiene
activities, taking medication, interaction in society, handle finances and
study subjects faced weakness, walking limitations. Along with this few study
subjects were also not able to travel, visit market, exercises and all the study
subjects faced walking difficulties. This study showed that the chronic renal failure
patients have various functional limitations.

50
CHAPTER-7

CONCLUSION

51
 CONCLUSION

The study shown that the 20 study subjects are involved, 90% were male and
10% were female. The findings of the study showed that majority of study
subjects were not able to do activities by their own, personal hygiene activities,
taking medication, interaction with society, handle finances and study subjects
faced weakness, walking limitations. Along with this few study subjects were not
able to travel, visit market, exercises and all the study subjects walking
difficulties.

RECOMMENDATIONS

This study can be replicated on a large sample thereby generalizing the

study for a large population.

A comparative study can be conducted between acute renal failure

patients and chronic renal failure patients.

An experimental study can be conducted by administering structured

teaching programmed regarding quality of life of CRF patients.

Nurses should do specialized study in Nephrology, so that they can

expertise in this field in order to provide better care.

52
 NURSING IMPLICATIONS

The present study enhances the health personnel to provide guidance and
counseling programmed which help the chronic renal failure patients
receiving hemodialysis to improve the capability in order to improve the
activites of daily living. Study findings can be used to structure specific
nursing interventions and also reducing economic burden by making
certain policies.

NURSING EDUCATION

The present study emphasizes the importance of client education for future
nursing personnel regarding maintaining quality of life in chronic renal failure
patients receiving hemodialysis. This can be achieved through the integration of
this topic in the curriculum which includes the technological advancements,
changing trends and concept.

NURSING PRACTICE

The nurses are the key person in the health team, who play a vital role in the
health promotion and maintenance. The newely appointed staff nurses can be
given opportunity to learn the importance of quality of life in chronic renal failure
patient on hemdialysis along with the experience staff nurse who can insist the
recent advancement ,technology and practice in clinical field. Study would help to
structure specific nursing interventions to provide good quality care to CRF
patients.

53
NURSING ADMINISTRATION

The present study reveals the functional limitations experienced by the

chronic renal failure patients receiving hem dialysis. Patients have various
functional limitations. The in service education conducted by hospital
administration is very much important, to upgrade the knowledge among
nurses in order to give planned care.

54
CHAPTER-8

REFERENCES

55
 1. National kidney foundation clinical practice guidelines for CKD (Online)
2 0 0 2 ( c i t e d 2 0 1 2 D e c 5 ) A v a i l a b l e
from: URL:http//www. kidney.org/professional/KDOQU Iguidelines ckd

2. Black,J. M., & Jacobs, E.M.(2005). Nursing care of clients with renal
disorders. Medical Surgical Nursing (5 th ed.). W.B. Saunders.

3.Baldree, K.S., Murphy, S.P.,& Powers, M.J. (1982). Stress identification and
coping patterns in patients on hemodialysis Nursing Project work. 31(2). 107-
12.

4. Cristovao, F.(1999). Stress, Coping and Quality of Life among Chronic

Hemodialysis Patients. EDTNA, CRCA Journal.25(4): 35-8,44.

5. Data Statistics: Dialysis. Retrieved September 10, 2008, from

http://www.globaldialysis.com/stats.asp.

6. Gurkhis, J.A., & Menke, E.M.(1988). Identification of stressors a n d u s e o f

c o p i n g m e t h o d s i n c h r o n i c h e m o d i a l y s i s patients.Nursing Project
work. 37(4): 236-9, 248.

7. Ignaviticus, D.D.,et.al.(1995). Interventions for clients with chronic renal

failure. Medical Surgical Nursing (2 nd ed.). W.B. Saunders.

8. Montagnac, R., et. al. (1992). Psychological impact of periodic hemodialysis inthe
adults. Journa of Nephrology. 13(4): 145-9.

9. Martin Mr. Cesarino quality of life in chronic renal failure patient receiving
hemodialysis, Oct 2005 Department of occupation medicine UK. http//www.pubmed.
com.

56
10. Cleary J, Dremman j quality of life on hemodialysis for chronic renal failure Sept.
2005 Department of Nephrology, http//www.mediline. com

11. Kouli E, Health related quality of life in chronic renal failure patients, January 2004,
Laboratory of sport medicine, Aristotle university, Thessalonki. http//www.mediline. com

12. Mapes DL, Lpes AA, Satayathums, Mc Cullough KP, Health related quality of life
in chronic renal failure, Dec. 2003, Kyoto University, Japan. http//www.mediline.com.

13. Martin-Diaz F, Reig-Ferrer-Cascales R, Assessment oh health related

quality of life in Chronic dialysis patient with SF-36 hemodialysis patients,
Dec. 2006, Dept. of Public health and caring services, Uppsala University,
Uppsala, Sweden, http/www.mediline.com.

14. Cristovao F, Strees, coping and quality of life among chronic

hemodialysis patients, Dec. 2006, Dept. of Public health and caring services,
Uppsalal University, Uppsala, Sweden. http/www.mediline.com

15. Chang CK, Peng YS, Chiang SS, Yang CS, Health related quality of life of
hemodialysis patients in Taiwan, oct, 2006, National Taiwan University,
Taipei, Taiwan, http//pubmed.com.

16. Jiang MM, Li L, Assessment of health quality of life in hemodialysis

patients with SF-36, July 2006, University of France, France.
http//mediline.com.

57
CHAPTER-9

APPENDICES

58
To

The Principal

Swift Institute Of Nursing

Ghaggar Sarai, Rajpura

Subject: - Permission regarding Project work

Respected madam,

With due respect we are the student of Post Basic Bsc (n) 2 nd year, as a
part of our curriculum requirement, want to conduct our Project work
study to assess the functional limitation among chronic renal failure
patients in Dialysis Unit. Kindly allow us to do Project work.

Thanking you.

Yours Sincerely,

Chandni

Renu

Kimi

Poonam

Meenakshi

59
To

The Nursing Superintendent,

Healing Touch Hospital,

Ambala,

Subject: Letter to An Expert for Content Validity

Respected Madam,

We the students of Post Basic Bsc(n) 2 nd year of Swift Institute of

Nursing,Ghaggar Sarai, Rajpura are working on a Project Work. This
Projectwork submitted as a requirement for fulfillment of nursing degree.

The title of Project work is " An exploratory study to assess the functional
limitations among chronic renal failure in Healing Touch Hospital , Ambala." In
this connection we have prepared a questionnaire for data collection. Therefore,
we request you kindly allow to conduct Project work in dialysis unit.

Guide: Mr. Pravin Prakash.P

Thanking you,

Your's obediently,

Chandni Nursing Superintendent

Renu Healing Touch Hospital

Kimi Ambala.

Poonam

Meenakshi

60
 TOOLS

INTERVIEW SCHEDULE ON SOCIODEMOGRAPHIC

CHARACTERISTICS OF CHRONIC RENAL FAILURE PATIENTS

Identification data of chronic renal failure patients

Name: Bed no: Uhid no: Ward/Unit:

Address: Diagnosis: IPID.no: Date:

Socio Demographic characteristics of Chronic Renal failure patients

1:Age in years:

(a) <25 yrs (b) 25 to 40 yrs (c) 40 to 55 yrs (d) 55 to 70 yrs

(e) > 70 yrs

2: Gender : (a) Male (b) Female

3: Annual income :

(a) < 100,000 (b) 100,001 to 300,000 (c) 300,001 to 500,001 (d) > 500,000

4. Education :

(a) Illiterate (b) Primary (c) Middle (d) High secondary (e) Graduate and above

5:Occupation

(a)Self employed (b)Service Personnel (c) Unemployed (d) Pensioner personnel

6: Marital status:

(a)Married (b)Unmarried (c)Widow (d)Divorcee

61
 7: Type of family:

(a)Nuclear Family(b)Joint Family(c)Extended

8: Residential area: (a)Rural Area (b)Urban Area

9: Religion:

(a)Hindu(b)Muslim(c)Sikh(d)Christian(e)Any other

10: Do you have a habit of:

(a)Cigarette smoking(b)Tobacco chewing(c)Alcohol drinking(d)Not Any

OPEN ENDED INTERVIEW SCHEDULE ON FUNCTIONAL LIMITATIONS

AMONG CHRONIC RENAL FAILURE PATIENTS

1: Are you able to do your activities of daily living by your own?

2. Are you able to do activities regarding personnel hygiene (brushing

teeth, combing, dressing, bathing, nail cutting etc)?
3. Are you able to take food with your hands?
4. Are you able to take self medication from medication box?
5. Are you able to interact in your society (neighbours,
relatives, friends etc )?
6. Are you able to do recreational activities in your family (gossips,
playing luddo, chess, cards etc) ?
7. Do you feel comfortable while travelling (coming to hospital, office
etc)?
8. Do you visit the market alone ( half mile)?

62
9. Are you able to go out socially with friends or family (marriage, meetings,
parties, Gurudwara etc.)?
10. Are you able to use toilet yourself?
11. Do you have any walking difficulties to do any activity ( climbing stairs,
walking etc.)?
12. Are you able to do some light exercise ( walk, yoga, rotation of arms and
legs while sitting etc.)?
13. Are you able to manage finance (salary, pension, pocket money, LiC etc.)?
14. Do you have a good relationship with your spouse?
15. Are you satisfied with your sexual life?

63
 ABSTRACT

Chronic renal failure is characterized by progressive destruction of renal mass

with irreversible sclerosis and loss of function of kidney and nephrons over a
period of at least months to many years. Hemodialysis is established as life
saving measures for patients with chronic renal failure. The most important
practical application of quality of life is done in Chronic Renal Failure patients.
In such diseases quality of life can be altered by effects of treatment. Quality of
life is an important concern for nurses, physician and health care administrators.
The health related quality of life consists of a number of components like
functional status, physiological and-social functioning. ADL(Activity of Daily
Living) are self care task comprising bathing, grooming, dressing, toileting,
eating. These activities are usually preserved in this population. Hemodialysis
patients have difficulties their homes and with their partners. They worry that
the body image may affect their sexual activity and their relationship with their
partners. Skin changes can cause patients to feel unattractive. Self image
may affect sexual interest functioning. Chronic Renal Failure patients display
emotional disturbances, social withdrawal. They have a very low functional
capacity and there was various functional limitations in their activities of daily
living. An exploratory study on functional limitations experienced by the chronic
renal failure patients in Healing Touch Hospital ,Ambala(2017). The present
study's aim was to assess the functional limitations experienced by chronic renal
failure patients. Exploratory design was used for the study. The sample of 20
patients was taken. Interview schedule was used to collect the data about
identification and socio demographic data of study subjects. Steps were carried
out in preparing the tool:- literature review, preparation of blue print, expert
opinion and validity of content were taken, feasibility of tool was checked by
doing pilot study. The pilot study was conducted on two patients. Ethical and

64
legal issues were taken into consideration throughout the study. The data
analysis was done by using both descriptive and inferential statistics, mean
and S.D. Majority of patients were male and the study subjects were not able to
do activities on their own, personal hygiene activities, taking medication,
interaction with society, handle finances and study subjects faced weakness,
walking limitation. Also study subjects were not able to travel, visit market,
exercise and faced walking difficulties. This study showed that chronic renal
failure patients have various functional limitations.

65