Shahgholian and Yousefi BMC Nephrology (2018) 19:338

https://doi.org/10.1186/s12882-018-1138-4

RESEARCH ARTICLE Open Access

The lived experiences of patients

undergoing hemodialysis with the concept
of care: a phenomenological study
Nahid Shahgholian1 and Hojatollah Yousefi2*

Abstract
Background: Providing patient-centered care needs in patients with chronic renal failure undergoing hemodialysis
is important in inspiring their confidence to continue their treatment and promote their mental and social health.
Therefore, recognizing the concept of care from the viewpoint of these patients can be helpful in designing the
care programs of this vulnerable group. Accordingly, the aim of this study was to reveal the meaning and concept
of care based on the experience of patients with chronic renal failure undergoing hemodialysis.
Methods: Using a descriptive phenomenological method, this study was conducted on 17 patients who were
undergoing hemodialysis. Purposive sampling was performed and data was collected through 30 to 60 min,
face-to-face and in-depth semi-structured interviews. Data analysis was performed using Colaizzi’s method.
Results: Seventeen patients (9 women 8 men) aged between 24 and 83, and a minimum of 10 and maximum of 168
months history of hemodialysis participated in the study. After data analysis, 4 themes and 9 sub-themes
were extracted, and the concept of care emerged for the participants as empathy, companionship in everyday needs,
social support and concern, and good-quality dialysis.
Conclusions: Based on the results of this study, the concept of care from the viewpoint of patients emerged in the
form of empathy, companionship in everyday needs, social support and concern, and good-quality dialysis. It is
recommended that caregivers of patients consider these concepts in the design of patient-centered care programs.
Keywords: Lived experiences, Care, Hemodialysis, Phenomenology, Iran

Background Care is divided into three groups of professional care

Hemodialysis is the most common treatment for the by the health care team including nurses, home care by
end-stage chronic renal failure in Iran and in the world the family members, and social care. However, regardless
[1], so that by the end of 2016, the number of patients of who provides the care, there is still no specific mean-
undergoing dialysis is estimated to be 2,989,000, 89% of ing for this concept which can be used in all situations
which are hemodialysis patients. In Iran, by the end of [3]. Additionally, in spite of the care provided by the
2016, the number of patients undergoing hemodialysis health care team, family and society to these patients,
has been estimated to be 29,200 [2]. Hemodialysis in- they still believe that they don’t receive enough care [4].
creases patients’ longevity but, at the same time, imposes The word “care” has many meanings in Persian, such as
many restrictions on these patients and leads to many the provision of what is necessary for the health, welfare,
physical, mental, social and economic complications. maintenance, protection, attention, guard,, lookout on,
Minimizing these complications need a comprehensive and watch of someone. Accordingly, it seems that the
care for these patients. point of view of the patients towards this concept is dif-
ferent from the caregivers. Any successful planning and
* Correspondence: yousefi@nm.mui.ac.ir intervention for these patients need to familiarity with
2
Nursing and Midwifery Care Research Center, Adult Nursing Department,
School of Nursing and Midwifery, Isfahan University of Medical Science,
this concept based on the lived experience of the
Isfahan, Iran hemodialysis patients. The reason is that receiving this
Full list of author information is available at the end of the article

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Shahgholian and Yousefi BMC Nephrology (2018) 19:338 Page 2 of 7

concept from the viewpoint of patients can develop the study was a qualitative research with descriptive
care provided for them and, using this concept, the care phenomenological method. This method is used to study
team can design a realistic patient-centered care plan experience and describe the concept from the perspec-
and provide an effective intervention. tive of patients who have lived with the illness, and cre-
Many conducted studies have focused on how to care ates a comprehensive description of the experienced
for these patients in order to reduce the complications phenomenon in order to achieve an understanding of its
of disease and treatment, increase the quality of life, re- essential structure and, beyond its description, provides
duce stress and improve the mechanisms of compatibil- an interpretation of the phenomenon [11]. Seventeen pa-
ity in these patients. However, none of these studies tients with end-stage renal disease, with purposive sam-
have investigated or considered the viewpoint of patients pling, participated in the research. Inclusion criteria: at
[5, 6]. Shafiee et al. compared the barriers of blood glu- least three month have elapsed from the start of
cose monitoring in diabetic patients from the viewpoint hemodialysis, no speech and hearing problems, speak
of patients, healthcare staff and family of the patients. fluent Persian, undergo hemodialysis in the hemodialysis
They found significant differences and argued that such unit of Al-Zahra hospital affiliated to Isfahan University
difference or disagreement results in the failure of dia- of Medical Sciences, Isfahan, Iran, and have a fixed and
betes control in these patients [7]. active medical file in this unit. This unit covers 40 pa-
Atashzadeh et al. also compared the concept of nurs- tients permanently. The patients were interviewed one
ing quality in the group of patients, doctors and nurses. day after dialysis time, in a stable condition, in a room
In this study, the researchers emphasized the disagree- that in an agreement with all patients had been selected
ments among these three groups and believed that these next to the dialysis unit. Sampling began from October
disagreements made the healthcare staff not be able to 23, 2015 and continued to reach saturation, when no
improve the quality of care expected by the patients and, new code was extracted, on February 20, 2016.
hence, the patients were not satisfied with the quality of In order to collect data and access valid and real infor-
the provided care [8]. Because of having a different treat- mation, a semi-structured in-depth interview (face-to--
ment process, patients undergoing hemodialysis have a face) was used as the main approach. Each interview
different experience of the concept of care. However, lasted for 30–60 min.
studies that investigated the experience of patients Each interview started with general questions and was
undergoing hemodialysis [9, 10] did not cover the con- followed up with a calm and flexible format. The inter-
cept of care from the viewpoint of the patients and view process actually depended on the respondents’ level
based on their experiences. Accordingly, it seems that of participation. A few questions were used as the inter-
conducting a qualitative research in this area, through a view guide (Table 1). At the same time, some exploring
deep understanding of the concept of care from the questions such as “could you please explain it more?” or
viewpoint of the patients and their experience of care, “can you clarify what you mean with an example?” were
can help approaching the view of the patients to that of asked to achieve rich and clear data.
professional, home and social caregivers. It also improve The first researcher then heard each recorded inter-
the quality of care, increase the effectiveness of care, view several times and transcribed to verbatim and gave
provide better services, and promote the patients’ health a number to each interview. In the same time, using
and quality of life. Colaizzi’s seven-step approach, data analysis was per-
Phenomenology is one of the qualitative research formed as follows. 1) The descriptions of the partici-
methods suitable for understanding the depth of experi- pants were repeatedly read in order to feel them out; 2)
ence and the concept of a phenomenon [11, 12]. Ac- 200 important expressions were extracted and num-
cording to Thorne (2016), phenomenology is a good bered; 3) Important expressions were written in scien-
method for discovering obscure concepts, including the tific language and the meanings were formulated; 4) The
concept of care, in nursing and other health-related pro- constructed concepts/themes were grouped based on
fessions [13]. Accordingly, using the descriptive phe-
nomenological method, the researcher decided to
Table 1 Interview Questions
investigate the concept of care from the viewpoint and
What problems hemodialysis has caused to you?
based on the experiences of the patients with chronic What concepts or meanings come into your mind when you hear the
renal failure undergoing hemodialysis. word “care”?
Whom do you think you need more to take care of you?
In what cases do you feel that you are cared for?
Methods Who supports you and how?
Given its purpose of revealing the meaning and concept What kind of care makes you feel better?
of care based on the experience of the patients with What do you expect from nurses in dialysis unit? How about doctors?
Which one of your needs will your family respond to?
end-stage renal disease undergoing hemodialysis, this
Shahgholian and Yousefi BMC Nephrology (2018) 19:338 Page 3 of 7

their similarity; 5) Nine sub-themes were formed; 6) Table 2 Demographics’ variables of participants
Similar sub-themes were organized in larger clusters and Variable frequency
four main themes were obtained; 7) In order to ensure Number Percent %
the accuracy of his/her impressions, the researcher Sex female 9 53
returned them again to the participants, but there was
male 8 47
no need to review and repeat the interviews. The re-
Education illiterate 4 23.5
searcher reached the data saturation after 17 interviews.
To evaluate validity and reliability of the data, Guba and Primary to Diploma 9 53
Lincoln evaluative criteria were used [14]. Accordingly, in College 4 23.5
order to make the research believable, the review of the Married status Married 9 53
co-researchers and participants was also used. Single, widow 5 29.4
Likewise, to ensure the reliability of the data, after
divorce 3 17.6
hearing, and analyzing the interviews, the peer review,
Underlying disease diabetes 9 53
PhD in nursing, reread and refined the data. The re-
search team used the described methods to minimize Polycystic 2 11.75
the influence of their pre-existing ideas and beliefs on hypertension 2 11.75
the current research findings. unknown 4 23.5
To provide transferability in this research, the re- Duration of dialysis (month) 10–24 9 53
searcher used the full introduction of the research, de-
25–48 5 29.4
scribed the background and stages of the research fully
> 49 3 17.6
and tried to choose samples in maximum variations.
This research was approved by the Ethics Committee
of Isfahan University of Medical Sciences No. 293333. The concept of empathy was shaped by the feeling of re-
After receiving the necessary permission from the uni- ceiving psychosocial support from the treatment team and
versity, the researcher entered the research site. While emotional support from the family. Help with daily activ-
introducing herself and providing the necessary informa- ities and the provision of adequate nutrition were the
tion to the patients, the researcher explained the pur- sub-themes that formed the theme of accompaniment in
pose and process of the research. After filling out the meeting daily needs. Social support and concern, was an-
written informed consent form, the time and place of other theme that, in explaining the phenomenon of care,
the interview was determined by an agreement between was formed by a sense of society’s understanding of the
the participants and the researcher. During the inter- patient’s condition, provision of employment opportun-
view, feedback and oral consent were also obtained. ities and financing. High-quality dialysis was another
Additionally, to maintain anonymity, each interview was theme which included the sub-themes of meticulous care
given a number. Before beginning the interviews, the during dialysis and advanced or unbroken dialysis ma-
participants’ permission was obtained, and they were as- chine (Table 3).
sured that their names and information would remain
confidential. The participants had the absolute discretion
to leave the study whenever they wished. Emotional support
Because of numerous dialysis sessions, the participants
Results spent a lot of time with healthcare staff including nurses
Seventeen patients (9 female and 8 male) aged between and doctors. As such, they expected the medical staff to
24 and 83, and minimum of 10 and maximum of 168 support them psychologically and emphasized their
months of treatment duration participated in the re- empathy:
search. In terms of education, the participants ranged
from illiterate to master’s degree; seven were married ‘When nurses listen to me, I’m sure they care for me.’
and their spouses took care of them; and, diabetes was (Participant 5)
the most common underlying disease causing chronic
renal failure (Table 2). ‘When I was hospitalized for my heart condition, I’d
Analyzing interviews, 200 inferential codes, 9 sub-themes like to visit the staff of my own ward (hemodialysis); I
and 4 main themes were extracted. From the perspective of was very alone.’ (Participant 7)
the hemodialysis patients, the care phenomenon was de-
fined through the formation of concepts such as empathy, Emotional support of the family was another extracted
accompaniment in meeting daily needs, social support and concept and participants stated that emotional support
concern, and high-quality dialysis. of family members is an integral part of care:
Shahgholian and Yousefi BMC Nephrology (2018) 19:338 Page 4 of 7

Table 3 Themes and subthemes

themes subthemes
Emotional support Psychological support by the treatment team
Family emotional support
Accompaniment in meeting daily needs Assistance for daily activities
Provide proper nutrition
social support and concerns Society’s Understanding of the patient conditions
Provide employment opportunities
Financing
High-quality dialysis Careful care during dialysis
intact dialysis machine

‘I’d like my wife and my children to listen to me and Social support and concern
spend more time with me; when they are with me, I’m Increasing the society’s understanding of the condition
not afraid of the disease.’ (Participant 3) of the patients was another theme. The patients
expressed their dislike of the pity of others and stated
What the statements of the participants implied that they wanted others to understand them. Thus, in-
was that the empathy of the health staff, especially stead of pity that might annoy them, they expected
the nurses, and the emotional support of family others to help and support them when necessary:
members made the patients feel secure and less wor-
ried and, thus, they considered empathy as a concept ‘People don’t understand us; if they did, they would,
of care. for example, give up their seat to us in the bus, or
give us they turn in the pharmacy or doctor’s office.’
(Participant 12)
Accompaniment in meeting daily needs
The participants stated that because of their old age, ‘Everyone is very busy and there is no support. Many
underlying diseases, fatigue and boredom, they often people pity us but I don’t like it.’ (Participant 10)
need the help and support of their family for doing daily
activities including healthcare activities: Providing job opportunities and financing were the
sub-themes emphasized by the participants. Because of
‘I have a blurred vision and can’t see clearly; I can’t frequent dialysis sessions, job loss, insufficient ability to
shave my face or trim my fingernails; my wife or my work hard and continuously, medical expenses, trans-
children have to do these for me.’ (Participant 10) portation costs and disproportion between income and
treatment or life costs, the patients had economic prob-
Providing an adequate nutrition by the family was an- lems. As such, they believed that having a suitable job
other sub-theme of accompaniment in meeting daily and being secured financially is a kind of care:
needs. Because of their illness, nutritional restrictions
are necessary for these patients, and because of their ‘I lost my job because of dialysis; charity doesn't help
physical conditions, the provision of a special diet re- much; I wish the association helped more and the
quires the collaboration and support of their family: insurance covered the cost of all drugs; or at least we
could have a good job.’ (Participant 3)
‘My wife knows which kinds of foods contain
phosphorus and potassium, and when it comes to Participants’ remarks implied that the society has to
cooking, she is careful and controls my regimen; I change its attitude towards the condition of these pa-
can’t do it myself.’ (Participant 2) tients. As the lack of an organized program to support
patients has led to a lot of economic problems for them,
‘My family should make me a meal, I can’t do it providing a job in proportion with the physical condition
myself’ (Participant 3) and dialysis time of these patients can help them benefit
from a systematic economic support.
Participants’ statements indicated that family accom-
paniment was essential for daily activities such as pro- High-quality dialysis
viding personal health and support in going on a diet. Since hemodialysis is very sensitive process, patient care
Hence, in the opinion of the participants, accompani- and control during dialysis is important. Thus, a meticulous
ment was one of the concepts of care. care during dialysis is highly important for the participants:
Shahgholian and Yousefi BMC Nephrology (2018) 19:338 Page 5 of 7

‘Some personnel don’t set up the machine based on The participants’ statements in the present research
my condition and my blood pressure drops.’ suggested a significant role of the empathy of the family
(Participant 7) members in the care and support for the patients. In this
regard, a research has shown that family members, espe-
‘Every time during dialysis they control my blood cially one’s spouse, have the most important role in pro-
pressure five times; I’m afraid of drops in my blood viding mental health services to a patient with chronic
pressure during dialysis; I have spasm in my legs.’ illness. The patients considered their spouse as the key
(Participant 13) person in supporting them, that is, the support of the
patient’s spouse was the most important source of sup-
An unbroken or advanced dialysis machine was an- port during the illness [17]. Asgari et al. also obtained
other issue that the participants referred to and stated the two concepts of family unification and empathy and
that a high-quality dialysis is almost impossible without responsible accountability of nurses [18], which is in line
a well-functioning dialysis machine: with the results of this research.
Therefore, it can be concluded that although
‘The machines are broken and don't lose weight well; hemodialysis patients are exposed to mental stressors,
we’re thirsty between two dialysis; we drink water and empathy and psychological support can help them with
get short of breath; our pressure drops under the these stressors. Empathy from different sources such as
dialysis; they disconnect us quickly from the machine family and health care staff can reduce the physical and
and going home we are not well.’ (Participant 4) psychological problems of these patients, thereby helping
the patients to cope with the illness more easily, keep
Accordingly, the participants considered high-quality away from isolation and gain more vitality and energy.
dialysis as a part of care and emphasized the importance Accompaniment in meeting daily needs of the patients
of a meticulous care during dialysis and the proper func- was another extracted main theme and the participants
tioning of the dialysis machines. emphasized that accompanying them with daily activities
Based on the results of the research, the lived experi- and providing appropriate nutrition is a concept of care.
ence of dialysis patients shows that care for these pa- These patients usually suffer from pain, energy short-
tients means empathy, accompaniment in meeting daily ages, insomnia and heart condition, and limitation in
needs, social support and concern, and high-quality dia- their physical activity disrupts their physical functioning
lysis. These concepts thus have to be considered in the in such a way that they have difficulty in doing their
care plans designed for these patients by the medical daily activities [1]. Uremia causes irritability, loss of ap-
staff, domiciliary caregivers and social agents. petite, insomnia, fatigue, memory loss, impaired judg-
ment and poor concentration and, consequently, these
patients sometimes need help in doing their simplest
Discussion daily tasks [19, 20].
The four main themes of emotional support, accompani- Another need of these patients is the provision of
ment in meeting daily needs, social support and concern, food by the family and based on the prescribed diet.
and high-quality dialysis were considered by the partici- Most of the participants stated that, because of fatigue
pants as the concepts of care; and, it seems that the partic- and decreased energy, they are not able to prepare the
ipants of the present study emphasized the psychological recommended food, do not have the incentive to follow
aspects of care more than its physical aspects. the diet, and need the support of their family. Haririan
The results of the study conducted by Georgia showed et al. showed that supporting the patients increases
that most hemodialysis patients suffer from a heavy bur- their compliance with therapeutic regimen, especially
den of psychological problems [15]. food regimen, thereby improving the quality of life in
The empathy of the medical staff was one of the con- them [21]. In a qualitative research investigating the
cepts of care and the participants emphasized the effect- barriers of adherence to therapeutic regimen in the
iveness of the relationship with the nurses and doctors patients with type 2 diabetes, the participants have
and remarked that this relationship can be soothing and stated that one of the factors impeding the compliance
reassuring for them. Davison and Simpson believe that with therapeutic regimen has been inadequate family
the role of personnel in communicating with the pa- support [7].
tients and their family is very important and can raise From the statements of the participants and the men-
their hope. They argue that the nurse’s speaking to the tioned studies it can be concluded that accompaniment
patients about their situation can sometimes be the in meeting the daily needs of the patients is a very im-
source of relief and hope for the health and well-being portant factor that should be considered in designing a
of the patients [16]. care plan for these patients.
Shahgholian and Yousefi BMC Nephrology (2018) 19:338 Page 6 of 7

From the viewpoint of the participants, support nurses should have the sufficient knowledge and skill
through increasing the society’s understanding of the pa- to prevent such problems [4].
tients’ condition, providing appropriate jobs and finan- The nurse should have enough information about the
cing were other care-related concepts. The type of the patient and the dialysis machine in order to implement a
support and the patient’s perception of it contribute to safe and high-quality dialysis program [25]. Therefore,
its effectiveness, so that the participants stated that they meticulous care during dialysis was considered by the
dislike pity and expect others to understand their condi- participants to be essential. The participants complained
tions, and believed that effort to achieve this goal is re- about broken machines, their frequent alarms and their
lated to the concept of care. Siegert et al. found that inability to lose weight and believed that the existence of
dialysis exerts a pressure on the patients and their fam- unbroken dialysis machines is the proof of a high-quality
ily, but the reaction of others can have a significant im- dialysis. Dialysis machine is an integral part of treatment
pact on their mental status [22]. Therefore, it seems that for these patients and the proper function of the ma-
changing society’s attitudes and understanding towards chine can directly affect the outcome of the treatment
these patients would help to support these patients in- and complications of the dialysis [26]. Thus, according
stead of pity them. to the participants, high-quality dialysis was one of the
The necessity of employment and financing were two concepts of care that should be considered in the design
other sub-themes extracted from the statements of the of a care program for these patients.
participants and emphasized by most of them. As these Although qualitative research gives us a deep under-
patients spend a considerable amount of time doing dia- standing of the phenomenon, because of the expansion
lysis and medical care and are often not in a good condi- of different topics, one cannot get all the dimensions of
tion, they often encounter many limitations with regard a topic in interviews with a limited number of individ-
to their employment, lose their jobs and have many eco- uals. Accordingly, revealing new themes is likely only
nomic problems. Accordingly, they expect the govern- through conducting more interviews with a diverse sam-
ment and the association for the support of kidney ple of participants not captured in this study. Therefore,
patients to provide the ground for their employment although data saturation in this research was reached,
and believe that such a support is one of the concepts of additional participants in future studies may address
care. Rafiee and Rambod also showed that many more dimensions of the concept of care.
hemodialysis patients had lost their jobs and experienced
many economic and social problems and were unable to Conclusions
provide some of their own and their family needs [23]. According the findings, we can answer the research
However, it should be noted that financial problem of question that “what is the lived experience of
the patients is not specific to our country, as Hui-Dan et hemodialysis patients with the concept of care?” From
al. also found that most hemodialysis patients have a lot the viewpoint of the patients, empathy, accompaniment
of financial problems [24]. in meeting daily needs, social support and concern, and
The support of social organs for patients, especially high-quality dialysis constitute the concept of care. One
economic support, reduces the problems of these pa- of the unique results of the present study, compared
tients and plays an important role in tolerating the dis- with other similar ones, was the emphasis of the partici-
ease. Most of the participants of this study were satisfied pants on the mental aspects of care. Accordingly, these
with the support of social organizations, but did not aspects have to be considered in the care plans designed
consider it enough and expected more support, espe- by the healthcare team for these patients.
cially more financial support [9]. Therefore, designing a
social support program, including economic support for Abbreviation
these patients seems to be essential. PhD: Doctor of Philosophy
High-quality dialysis was another extracted main
theme and, in this regard, a meticulous care during dia- Acknowledgements
lysis and using a well-functioning dialysis machine were The current article resulted from the research project No. 293333 which was
approved by the Isfahan Kidney Disease Research Center. Hence, it is incumbent
emphasized by the participants. They stated that care upon us to express our gratitude for the genuine cooperation of the chairman
during dialysis, including minute adjustment of the and the members of this center and all those who helped us in this research,
dialysis machine, blood pressure control, precise especially the participants.

weight control and having sufficient skill in dialysis,

Funding
is of particular importance. Kaba et al. wrote that Not applicable.
patients undergoing hemodialysis always suffer an
anxiety caused by possible problems and the likeli- Availability of data and materials
hood of death during dialysis and, hence, dialysis Not applicable.
Shahgholian and Yousefi BMC Nephrology (2018) 19:338 Page 7 of 7

Authors’ contributions 15. Georgia G, Fotoula B. Identification of stress in chronic haemodialysis.

Mrs. NS contributed in interview, analyzing, and interpreting the patient data Health Sci J. 2013;7(2).
and writing the manuscript. Dr. HY contributed in Data interpretation, 16. Davison SN, Simpson C. Hope and advance care planning in patients with
manuscript writing and editing, and all authors have read and approve the end stage renal disease: qualitative interview study. Bmj. 2006;333(7574):886.
final version of manuscript. 17. Nagpal N, Boutin-Foster C, Melendez J, Kubiszeswki P, Uehara K, Offidani E,
Faussett Z, Chen R, Redel C, Waltrous C, Smith B. Experiences of patients
Ethics approval and consent to participate undergoing dialysis who are from ethnic and racial minorities. J Ren Care.
This research was approved by the Ethics Committee of Isfahan University of 2017;43(1):29–36.
Medical Sciences No. 293333. Then, after filling out the written informed 18. Asgari MR, Mohammadi E, Fallahi Khoshknab M, Tamadon MR. The
consent form, the time and place of the interview was determined by an perception of chronic renal failure patients from advocacy resources in
agreement between the participants and the researcher. adjustment with hemodialysis: a qualitative study. JCCN. 2011;3:133–44.
19. Thomas N. Renal nursing. Chichester: West Sussex, UK, John Wiley & Sons
Consent for publication Inc.; 2014.
Not applicable. 20. Peikani FA, Shahgholian N, Kazemi A. The effect of health-belief-model-
based training on behaviors preventing peritonitis in patients on peritoneal
Competing interests dialysis. Int J Prev Med. 2018;9:72.
The authors declare that they have no competing interests. 21. Haririan HR, Aghajanloo A, Ghafouri Fard M. Assessment of Informational
and Instrumental Support In Hemodialysis Patients In The Hospitals of
Zanjan University of Medical Sciences. Preventive Care in Nursing &
Publisher’s Note Midwifery Journal. 2011;1(1):25–30 [In Persian].
Springer Nature remains neutral with regard to jurisdictional claims in published 22. Ziegert K, Fridlund B, Lidell E. “Time for dialysis as time to live”: experiences
maps and institutional affiliations. of time in everyday life of the Swedish next of kin of hemodialysis patients.
Nurs Health Sci. 2009;11(1):45–50.
Author details 23. Rafii F, Rambod M, Hosseini F. Perceived social support in hemodialysis
1
Critical Care Nursing Department, Faculty of Nursing and Midwifery, Isfahan patients. HAYAT. 2009;15(1):5–12.
University of Medical Science, Isfahan, Iran. 2Nursing and Midwifery Care 24. Hui-Dan yu. Petrini M A. The HRQoL of Chinese patients undergoing
Research Center, Adult Nursing Department, School of Nursing and hemodialysis. J Clin Nurs. 2010;19(6):658.
Midwifery, Isfahan University of Medical Science, Isfahan, Iran. 25. Hashemi MS, Shahgholian N. Kidney failure and replace renal therapy.
Tehran: Tehran heidari publication; 2013. p. 64–6. [In Persian]
Received: 23 July 2018 Accepted: 14 November 2018 26. Davenport A, Cox C, Thuraisingham R. Achieving blood pressure targets
during dialysis improves control but increases intradialytic hypotension.
Kidney Int. 2008;73(6):759–64.
References
1. Daugirdas JT, Blake PG, Ing TS. Handbook of dialysis. Philadelphia: Wolters
Kluwer Health; 2015.
2. Iranian Consortium of Dialysis. Calendar of Dialysis by the End of 2016.
Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal
Disease in Islamic Repoblic Of Iran 1395.Available From : http://www.
icdgroup.org/Content/Upload/pdf/1395.pdf
3. Gittell JH, Godfrey M, Thistlethwaite J. Interprofessional collaborative
practice and relational coordination: improving healthcare through
relationships. J Interprof Care. 2013;27(3):210–3.
4. Kaba E, Bellou P, Iordanou P, Andrea S, Kyritsi E, Gerogianni G.
Problems experienced by haemodialysis patients in Greece. Br J Nurs.
2007;16(14):868–72.
5. Dehkordi Mardanian L, Shahgholian N. An investigation of coping styles of
hemodialysis patients. Iran J Nurs Midwifery Res. 2013;18(1):42–6.
6. Rambod M, Rafii F. Perceived social support and quality of life in Iranian
hemodialysis patients. J Nurs Scholarsh. 2010;42(3):242–9.
7. Shafiei F, Shahgholian N, Amini M, Abazari P, Amini P. Barriers to blood
glucose level Management in the Health Care System: view points of
patients, families and medical personnel. Iranian Journal of Endocrinology
and Metabolism. 2012;14(1):25–31 [In Persian].
8. Atashzadeh Shoorideh F, Pazargadi M, Zagheri Tafreshi M. The concept of
nursing care quality from the perspective of stakeholders: a
phenomenological study. Journal of Qualitative Research in Health Sciences.
2012;1(3):214–28.
9. Kazemi M, Nasrabadi AN, Hasanpour M, Hassankhani H. Experience of
Iranian persons receiving hemodialysis: a descriptive, exploratory study. Nurs
Health Sci. 2011;13(1):88–93.
10. Hatthakit U. Lived experiences of patients on hemodialysis: a meta-
synthesis. Nephrol Nurs J. 2011;39(4):295–304.
11. Holloway I, Wheeler S. Qualitative research in nursing and healthcare, 3th.
Willy – Blackwed; 2013.
12. Doosti Irani M, Abazari P, Babaei S, Shahgholian N. Facilitators of adherence
to self-management in type 2 diabetic patients: a phenomenological study.
Iranian Journal of Endocrinology and Metabolism. 2009;11(3):257–64 [In
Persian].
13. Thorne S. Interpretive description: qualitative research for applied practice.
Abingdon: Routledge; 2016.
14. Polit DF, Beck CT. Essentials of Nursing Research, vol. 333. Philadelphia:
Lippincott, Williams and Wilkins; 2014.