Como bien lo menciona, es importante tener en cuenta las percepciones de cada paciente, para lo cual es fundamental el rapport, la escucha y el acompañamiento. Cuando se hace únicamente un ejercicio para cuantificar un indicador se pierde de vista el componente psicológico del proceso donde las necesidades, ideas y procesos de los pacientes no se pueden estandarizar.

La OMS, establece que la calidad de vida es la percepción que un individuo tiene de su lugar en la existencia en el contexto de la cultura y del sistema de valores en los que vive; lo anterior en relación con sus objetivos, sus expectativas, normas y sus inquietudes.

Si bien se parte de elementos mínimos, como las condiciones materiales; el trabajo, salud, educación; ocio y relaciones sociales, etc. Es fundamental humanizar el proceso y acercarse al paciente para identificar que necesita en este momento, para valorar si se esta en condiciones de apoyarlo en eso que requiere.

A partir de lo anterior, es posible medir el impacto en el otro (paciente) de mis acciones.

La calidad de vida cruza necesariamente con las relaciones humanas, por lo que solo se puede mejorar cuando estas son acciones altamente humanitarias.

Individual approach evidence and implementation may better

Not only taking care of their patients in the purely biomedical aspects, but also in the Psychosocial aspects, since, in effect, patients who undergo hemodialysis present a multitude of problems of this type, with sexual dysfunctions as well, serious depression with direct suicidal tendencies -autolysis- or "allowing oneself to die" due to non-compliance with the prescriptions and lack of therapeutic adherence (a clear example would be not following the prescribed diet, drinking more water than allowed, and a long etcetera); all this without forgetting the labor problems generated by dependence on the "machine", interpersonal problems due to the possible dysmorphophobia that the self-perception of their body scheme, coloration, etc. may generate. To be able to elaborate more on this, you can consult contributions in this regard, here in "RG", from my Research Team and mine ("EMOTIONAL COMPETENCES FOR CAREGIVERS"; "SELF-ESTEEM: EMERGING AND TRANSCENDENT PSYCHOSOCIAL VARIABLE"; "OPTIMISM INTELLIGENT, HUMOR AND RESILIENCE SUPPORTS OF SELF-ESTEEM, CUSHIONS OF DEPRESSION AND PAIN AND POTENTIALS OF HEALING AND COATING WITH STRESS AND ILLNESS ";" Health-Sick Personal Communication (PS-E) as the key to all health praxis and interaction ";" PSYCHOLOGICAL INTERVENTION IN CHRONIC KIDNEY INSUFFICIENCY "," PSYCHOPATHOLOGY AND HEMODIALYSIS ";" SYMPOSIUM: PSYCHOLOGICAL AND PSYCHOSOCIAL ASPECTS OF CHRONIC PATHOLOGIES (THE EXPERIENCE OF CHRONIC RENAL DISEASE; INFANT; AIDS; SPINAL CORD INJURIES) " :"COMPETENCIAS EMOCIONALES PARA LOS CUIDADORES"; "LA AUTOESTIMA: VARIABLE PSICOSOCIAL EMERGENTE Y TRASCENDENTE"; "EL OPTIMISMO INTELIGENTE, EL HUMOR Y LA RESILIENCIA APOYOS DE LA AUTOESTIMA, AMORTIGUADORES DE LA DEPRESIÓN Y DEL DOLOR Y POTENCIADORES DE LA CURACIÓN Y DEL AFRONTAMIENTO AL ESTRÉS Y LA ENFERMEDAD";"La Comunicación Personal Sanitario- Enfermo (PS-E) como clave de toda la praxis e interacción sanitaria"; "INTERVENCIÓN PSICOLÓGICA EN LA INSUFICIENCIA RENAL CRÓNICA", "PSICOPATOLOGÍA Y HEMODIÁLISIS";"SIMPOSIO: ASPECTOS PSICOLÓGICOS Y PSICOSOCIALES DE LAS PATOLOGÍAS CRÓNICAS (LA VIVENCIA DEL ENFERMAR EN LAS CRONICOPATÍAS; EL TRASTORNO RENAL CRÓNICO; LA HOSPITALIZACIÓN INFANTIL; EL SIDA; LOS LESIONADOS DE MÉDULA ESPINAL)"

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According to the patient condition and hemodialysis keep on the client to fluid restriction, salt restricted diet and measuring their intake and output are very important to increase their quality of life. It depends on the associated complication which may decrease the QoL. Stress management, family role in patience, love and tender care also can increase QoL.

The individual approach means individual physical/ physiological, psychological, social, and spiritual approach

Although advances in dialysis treatment have contributed to improved survival of patients with end-stage renal disease, such individuals particularly those treated by hemodialysis, health-related quality of life is much lower for those patients than for the general population. Impaired health-related QoL, dependence on others, and poor rehabilitation all contribute to physical and emotional disabilities that may persist even in well dialyzed ESRD patients.

Health care staff should understand the health-related QoL of patients undergoing hemodialysis. The rich information collected can help health professionals to determine which patients may be at risk for diminished health-related QoL. It has direct consequences for clinical decision-making, rehabilitation and management of individual patients. This can be accomplished through health education and promotion of awareness about the disease, treatment options, complications and self-care activities. Counseling, on the other hand, is an important intervention that health professionals - with appropriate training - can provide. Developments of HD technology, treatment of comorbidity, continuous patients' education, social and psychological support may improve the HRQoL in these patients, too.

To improve the health quality of patients during hemodialysis treatment can be done with humanist approaches, such as patiently listening to the problems that inform repeatedly by patient. Besides, the family also should be able to provide motivation or religious approach to the patient's recovery during the treatment

yes, the social and spiritual problem of the patient should be addressed

We should consider health-related quality of life as a main goal in care plan of hemodialysis patients.

Physical exercise has shown good results and is a low-cost therapy.

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Longer years under dialysis, increased age, increased number of co-morbid conditions are associated with poor health-related quality of life, while higher income and conducting exercise are associated with better one. Highlighting the need of the healthcare providers to develop and implement potential strategies that would improve health-related quality of life of this patient population in a necessity.