Evaluating Effect of Cognitive Behavioral Nursing on Quality of Life in Hemodialysis Patients

Objective: To assess effect of cognitive behavioral nursing on quality of life in hemodialysis patients. Methods: We invite 120 patients to join our study from January 2018 to January 2020. They were diagnosed as chronic renal failure in the hospital. In addition, the patients receive hemodialysis treatment in treatment process. In study beginning step, the participants were randomly assigned to a control group (n=60) and intervention group (n=60). For participants of control group, the patients receive the common nursing intervention in hemodialysis process. Additionally, the intervention group patients receive cognitive behavioral nursing on the basis of routine nursing. Result: In depression assessment and anxiety assessment, the control group and intervention group have similar assessment in depression status and anxiety status. In after nursing intervention part, the two groups have different assessment in research result. In health literacy assessment, the two group patients improve their health literacy in four elements. In addition, intervention group has better improvement that that of control group. In addition, the research result of coping style assessment and quality of life assessment are similar, that the two groups have different improvement in research result, that intervention group has better improvement than that of control group. Conclusion: the cognitive behavioral nursing improves some aspects of chronic renal failure patients, that include mental health, health literacy of patient, coping style level of patient and quality of life.


Introduction
Chronic renal failure is a common disease in the department of nephrology, that its etiology mainly comes from the chronic kidney function injury caused by many kinds of kidney diseases [1]. In chronic kidney function injury process, endotoxin in the body cannot be metabolized in time, and toxin retention in the body of patients will cause damage to their kidney function, forming a vicious circle as patient's chronic kidney function was injured [2,3]. Base on the reports, hemodialysis can effectively remove the toxin molecules in the blood and control the progression of the patient's disease in chronic kidney patients [4,5]. However, in hemodialysis process, patients affected by the condition, patient easy to produce bad emotion. As patient's poor health behavior, it is not conducive to their disease control [6].
In Krespi's research report, it indicated the lifestyle of patients on hemodialysis is strict as patient's requirements often cause significant emotional, physical, and mental stress, resulting in a loss of autonomy, independence, and function [7,8]. In addition, hemodialysis patients are exposed to non-compliance risks in a wide range of self-care management areas as the hemodialysis patients lack cognitive behavioral nursing in treatment process. The patients lack cognition of kidney failure and personal safety experience of kidney failure [9,10]. The aim of this study is evaluating the effect of cognitive behavioral nursing on quality of life in hemodialysis patients.

Participants Enrollment and Survey Methods
We invite 120 patients to join our study from January 2018 to January 2020. They were diagnosed as chronic renal failure in the hospital. In addition, the patients receive hemodialysis treatment in treatment process. In study beginning step, the participants were randomly assigned to a control group (n=60) and intervention group (n=60). For participants of control group, the patients receive the common nursing intervention in hemodialysis process. Additionally, the intervention group patients receive cognitive behavioral nursing on the basis of routine nursing. About collected data, it includes depression assessment and anxiety assessment, health literacy assessment, coping style assessment, quality of life assessment. The questionnaire includes the following: Self-Rating Anxiety Scale (SAS), Self-rating depression scale (SDS), Health Literacy Surveillance Rapid Assessment Questionnaire, (HLSRAQ), Simple coping Style questionnaire, World Health Organization Quality of Life Instrument (WHOQOL-BREF) [11][12][13][14][15].
In detail of cognitive behavioral nursing, it contains: (1) Cognitive nursing: with the help of health knowledge manuals and videos, the patient is given detailed information about chronic renal failure, and then the patient is given information about hemodialysis. In addition, we communicate with patients to evaluate whether their irrational beliefs have objective basis. We will remove non-patient rational beliefs and restore rational beliefs. (2) Behavioral nursing: We let patients understand the importance of diet control. In this process, we listed the dietary precautions, smoking cessation and alcohol, avoiding greasy, spicy and pungent food, and explained to patients how to calculate the amount of fluid in and out. In addition, we collected and recorded the amount of fluid in and out of patients, and controlled the daily water intake and rest schedule. We will record the patient's bedtime, sleep time, wake time and wake time. At the same time, we adjust patients' sleep and rest habits to help them develop a better healthy rest and rest. In the relationship between the hospital and the patient, we strengthen the contact with the patient's family, adjust the patient's behavior, and require the patient's family to do a good job of monitoring the patient's health behavior.

Statistical Analysis
Our data analyzer performed the statistical analysis by SPSS 22.0. The P value, t-test and chi-square test were associated with collection result were analyzed. Besides, the mean standard deviation for statistical description.

Result
In table 1, it indicates depression assessment and anxiety assessment of two groups, that the higher score means the patients had more serious depression or more serious anxiety. In before nursing intervention part, the control group and intervention group have similar assessment in depression status and anxiety status (54.39±6.86 vs 55.47±6.53, 54.21±6.90 vs 55.28±6.61). In after nursing intervention part, the two groups have different assessment in research result. The intervention group patients have better performance in SAS research and SDS research than that of control group patients. The Table 2 shows the health literacy assessment of patient, it contains health knowledge, health beliefs, health behavior and health skills. In before nursing intervention part, the patients of two group have best performance in health knowledge assessment (5.04±1.26 vs 5.17±1.32), and the two groups have similar assessment in result. In after nursing intervention part, the two group patients improve their health literacy in four elements. In addition, intervention group has better improvement that that of control group. In patients' coping style assessment, the patient's reorganization of self-cognition and seek social support are about 73 score in two group research (72.53±6.12 vs 72.67±6.15, 73.27±6.45 vs 73.40±6.39). Additionally, their escape fantasy assessment has similar score in result (60.38±8.47 vs 60.29±8.51). In after nursing intervention part, the two groups have different improvement in research result, that intervention group has better improvement than that of control group (Table 3). In quality of life research, it indicates patient's quality of life before nursing intervention and after nursing intervention (Table 4). In before nursing intervention group, the two groups have similar quality of life, that physiological assessment and environment assessment are approximately 69 and psychological assessment and social relations assessment are approximately 70. On the other hand, intervention group patients have better performance in those 4 parts than that of control group.

Discussion and Conclusion
Chronic renal failure from most kidney diseases in end stage. In process of chronic renal failure, patient's glomerular filtration rate will be declined, it causes a rise in blood uremic nitrogen so that patients are accompanied by cardiovascular and other diseases [16,17]. Chronic renal failure significantly reduces the lifespan of patients. Chronic renal failure patients have an increased risk of cardiovascular disease and may develop end stage renal disease [18]. In fact, hemodialysis is the main clinical method to treat chronic renal failure. It mainly extracorporeal circulation device to introduce patients' blood into the dialyzer, and activated carbon and adsorbent to adsorb and filter the toxin molecules in the blood [19].
Base on the results above, the cognitive behavioral nursing improves some aspects of chronic renal failure patients, that include mental health, health literacy of patient, coping style level of patient and quality of life. In depression assessment and anxiety assessment, the intervention group patients have better mental health than that of control group patients, that is similar to Aishath's report, the mental health of the patient have small improvement [20]. In health literacy research and coping style research, they are similar, that they have moderate improvement in the intervention group report result. The result is similar to Gema's research, but intervention group patients have better performance in Gema's research [21]. The quality of life research indicates the quality of life of two groups patients are improved after nursing intervention, but cognitive behavioral nursing provides more effect in the outcome.