Background <p>The aim of this study was to determine the impact on the quality of life of patients on maintenance hemodialysis following nursing interventions grounded in the health ecology model.</p> Methods <p>A simple sampling method was used to select 188 maintenance hemodialysis patients who attended our dialysis center between January and February 2024. The patients were divided into an intervention group and a control group using a random number table method. The control group received conventional nursing measures, while the intervention group received nursing interventions based on the health ecology model. The patients were assessed at the time of enrollment and after six months of follow-up, using the Health Promotion Lifestyle Scale, Social Support Rating Scale, Electronic Health Literacy Scale, and SF-36 Quality of Life Scale. The compliance rates for blood calcium, phosphorus, and potassium concentrations were recorded.</p> Results <p>At six months post-intervention, patients in the intervention group had significantly higher scores than those in the control group for health-promoting lifestyles, social support ratings, e-health literacy scores, and quality of life ability scores (<i>p</i> &lt; 0.05). The intervention group also had superior compliance rates for standardized blood calcium, phosphorus, and potassium concentrations compared to those measured in the control group. This difference was statistically significant (<i>p</i> &lt; 0.05).</p> Conclusion <p>Nursing interventions based on the health ecology model effectively enhance the quality of life and promote health in maintenance hemodialysis patients.</p> Trial registration <p>The research was conducted as a prospective, randomized, controlled trial and was retrospectively registered with the China Clinical Trial Registry under the identifier ChiCTR2400088458, with the registration date of August 20, 2024.</p>