• Difficult to quantitate because theoretical domains are not yet well developed.
• Quality of life must be viewed as an adaptational / coping response to the overwhelming demands of life-threatening illness and its management.
• Quality of life must evolve from a multi-dimensional framework which includes physiologic, psychologic, and social well-being and satisfaction as a central, core concept.
• Effective nursing assessment of patients’ overall quality of life and adaptation facilitates the measurement of these interactive domains with physiologic and psychologic markers.

Rehabilitation means restoration ( Barriers, 1994). The ideal rehabilitation opportunity is a coordinated program of medical treatment, education, counseling, dietary and exercise regimens designed to maxmize the vocational potential, functional status, and quality of life of patients.

Outcomes goals include:

• Employment for those who are able to work.
• Enhanced fittness to improve physical functioning for all patients.
• Improved understanding about adaptation and the options for living well with dialysis.
• Increased control over the effects of ESRD and its treatment.
• Resumption of activities enjoyed before the initiation of dialysis.

• Restoration of pre-uraemic level of biological, psychological and social adaptation : driving force of renal rehabilitation.
• Identification of problems faced
• Formulation of strategies for measuring success of various Renal Rreplacement Therapy

• Encouragement
• Education : disease and its treatment.
• Exercise
• Employment
• Evaluation :
• Information on the status of rehabilitation interventions and outcomes to guide policy making.
• Clinical measurement tools.

• functional status ( physcal and mental )
• quality of life
• patient satisfaction,
• resource utilization

• Kt/V
• nutritional status,
• infection rates
• viability of dialysis access
• increased haematocrit

• technical style
• interpersonal style

• Clinical end points death, laboratory values, S/S
• Functional status : physical, mental, social and role
• General well-being : health perceptions, energy/fatigue, pain , life satisfaction
• Satisfaction with care : access, convenience, financial coverage, and quality

• Measuring , managing and improving Quality in the ESRD setting, substantial attention was focused on the application of quality assessment, quality assurance, and quality improvement (QA/QI) to enhance outcomes for ESRD patients.
• For the QA/QI process to benefit patient care and improve outcomes several specific objectives must be impl,emented :

• Data must be used to teach not judge.
• Introducing cost effectiveness is a key component to successful QA/QI.