Hand Reflexology for Fatigue and Anxiety in Hemodialysis Patients

Inclusion Criteria: * Adults aged 18 years and older. * Diagnosed with End-Stage Renal Disease (ESRD) and undergoing maintenance hemodialysis for at least three months. * Receiving hemodialysis treatment two or three times per week. * Fully alert, conscious, and able to communicate clearly. * Able to understand the Arabic language. * Willing to participate in the study and provide informed consent. Exclusion Criteria: * Presence of ulcers, wounds, burns, infections, or skin diseases on the hands or forearms. * Deformities, fractures, or orthopedic disorders affecting the hands or upper limbs. * Peripheral neuropathy, vascular problems, or Raynaud's phenomenon in the hands. * Diagnosis of major psychiatric disorders (e.g., psychosis, bipolar disorder, generalized anxiety disorder). * Active systemic diseases that contribute to fatigue or anxiety (e.g., cancer, heart failure, lupus). * Use of sedatives, anxiolytics, or sleeping pills within 48-72 hours prior to data collection. * Current use of complementary or alternative therapies aimed at managing anxiety or fatigue. * History of drug or alcohol abuse. * Presence of implanted cardiac devices (e.g., pacemaker, implantable cardioverter defibrillator). * Hemodynamic instability or unstable vital signs during hemodialysis sessions. * Missing more than two scheduled intervention sessions during the study period.