The goal of this clinical trial is to learn if hand reflexology massage can help reduce fatigue and anxiety in adult patients undergoing hemodialysis treatment. The main questions it aims to answer are: * What are the levels of fatigue and anxiety in hemodialysis patients? * Is hand reflexology massage more effective than usual care in reducing fatigue and anxiety after eight sessions? * Do these improvements last over time? * Does a patient's age, gender, education level, how long they've been on dialysis, or their financial status affect how much they benefit from the massage? Researchers will compare patients who receive hand reflexology massage plus standard care to those who receive only standard care to see if the massage leads to greater reductions in fatigue and anxiety. Participants will: * Be randomly assigned to one group that receives hand reflexology massage or another group that continues with routine care only * Attend 8 short sessions (about 27 minutes each) of hand reflexology massage over four weeks, given during their regular dialysis visits * Complete brief questionnaires about their fatigue and anxiety levels before the study starts, after the 4th session, and after the 8th session * Continue their normal medical treatments throughout the study This study focuses on a safe, non-drug therapy that nurses can easily provide. Hand reflexology involves gentle pressure on specific points of the hands linked to stress relief and relaxation. It is chosen because it is practical during dialysis, avoids touching swollen or sensitive feet, and respects cultural preferences. The results could help improve the comfort and well-being of hemodialysis patients in Iraq and similar healthcare settings.
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Change in Fatigue Levels as Measured by the Arabic FACIT-Fatigue Scale (FACIT-F)
Timeframe: 4 weeks
Change in Anxiety Levels as Measured by the Arabic Beck Anxiety Inventory (Ar-BAI)
Timeframe: 4 weeks