Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT05263323 |
| Other study ID # |
KSUAYSEASLIOKTAY001 |
| Secondary ID |
|
| Status |
Completed |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
April 15, 2017 |
| Est. completion date |
October 15, 2017 |
Study information
| Verified date |
February 2022 |
| Source |
Kahramanmaras Sutcu Imam University |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
ABSTRACT The Effect of the Training on Adaptation to Treatment Provided to Hemodialysis
Patients According to the Neuman Systems Theory on Self-Esteem and Perceived Social Support
Aim: The present study was conducted to determine the effect of the training provided to
hemodialysis patients according to Neuman Systems Theory on self-esteem and perceived social
support in pretest-posttest comparison semi-experimental fashion.
Material and Method: The study population consisted of 108 individuals. The sampling
consisted of 84 subjects, 42 of whom constituted the Study Group and 42 of whom constituted
the Control Group. The study was conducted in two dialysis centers between 15.04.2017 and
15.10.2017. In the study, the data were collected with Patient Identification Form, Neuman
Systems Evaluation Form, Coopersmith Self-Esteem Inventory, Social Support Perceived from
Family and Friends Scale and Hemodialysis Stressor Scale. In the Study Group, the training
was repeated to the individuals with the training book "Let Us Learn Hemodialysis", which was
prepared by the researcher, after the one-to-one training in houses in line with the Neuman
Systems Model. SPSS 20 program was used to evaluate the data. Descriptive statistical methods
(number, percentage), chi-square test, paired t test were used to evaluate the data.
Description:
Nursing care and education are of great importance in solving the existing or potential
problems of individuals dependent on hemodialysis due to chronic kidney failure and in
patients' adaptation to living with their diseases and treatment (Velioğlu 2012, Pektekin
2013). In this process, nurses benefit from nursing theory-based models to protect and
improve the health of sick/healthy individuals, to ensure that they receive optimal care, and
to accelerate their recovery process. One of these models is the Neuman Systems Model. The
Neuman Systems Model, a well-being-oriented holistic approach that considers patients an open
system, is a suitable model for holistic evaluation of patients and guiding nursing
practices, as it includes five variables characterizing the individual, namely physiological,
developmental, spiritual, psychological, and socio-cultural variables (Uysal et.al.2009). The
model concretely defines the nursing activities and the areas in which the nurse provides
service; facilitates the planning and implementation of the interventions, and can be used in
most of the working areas of nursing (Özer and Gökçe,2015).
Patients undergoing hemodialysis treatment go to dialysis centers, get connected to
hemodialysis machines, and fear death due to the illness, all of which cause them to feel
lonely. Under this circumstance, the social support systems perceived by the individual come
into play, and in case of deficiency, they experience difficulties in coping (Atik
et.al.2015). National and international literature has proven that hemodialysis patients
receive high social support from family, friends, and special people, which contributes
positively to their treatment process, quality of life, social appearance anxiety, and
self-esteem. (Atik et.al.2015; Alexopoulou et.al.2016; Silva et.al.2016; Theodoritsi
et.al.2016; Karadağ et.al.2013) Many patients undergoing hemodialysis treatment for chronic
kidney failure see the dialysis machine as an extension of their own body, consequently
leading to deterioration in their self-esteem. Skin, bone, digestive system, nervous system
changes, and fistulas related to uremia are factors that increase the loss of body image and
self-esteem (Yılmaz,2014). Interventions to be implemented by the nurse to increase
self-esteem help hemodialysis patients to use problem-focused coping strategies. Accordingly,
improving the role of nurses in boosting patients' self-esteem increases patients' adherence
to treatment and enables them to cope with problems more easily (Rezaei and Salehi,2016).
National and international studies show that hemodialysis patients' beliefs about their
disease and treatment play a significant role in their autonomy and self-esteem, education to
improve quality of life affects/increases patients' self-esteem, hemodialysis patients with
high self-esteem use problem-focused coping strategies, and individuals receiving
hemodialysis treatment have lower self-esteem levels than healthy individuals (Yılmaz ,2014;
Soltani-Nejad and Zeighami 2018; Rezaei and Salehi,2016; Jansen et.al.2014; Theofilou 2012).
There are studies in which nursing care and case presentations are made in line with the
Neuman Systems Model in our country and the international literature (Uysal et.al.2009; Özer
and Gökçe 2015; Braga et.al.2018; Ahmadi and Sadeghi 2017; Luz Omaria et.al.2016; Angosta
et.al.2014; Yarcheski et.al.2010; Sultan 2018; Özkan and Öztürk 2013; Mert and Barutçu 2013;
Güner and Kavlak 2015; Eren and Çalışkan 2018). These studies have shown that the integration
of the model into these case presentations and nursing care reflects positively on the
results and serves as a holistic guide in nursing practice. The use of models in the
education program that the nurses plan within the scope of their educator role increases the
effectiveness of the education, and these educational interventions reflect on the patient
behaviors. Neuman Systems Model, which defines the individual as an open system, is preferred
for more systematic and effective patient education in hemodialysis patients as it allows the
evaluation of many stressors affecting the individual during the hemodialysis treatment
process. The stages and content of the education process planned to eliminate the effects of
these stressors are compatible with the nursing intervention stages of the model.
Accordingly, this study aims to evaluate the effect of Neuman Systems Model guided
therapeutic training given to individuals receiving hemodialysis treatment on self-esteem and
perceived social support.
MATERIALS AND METHODS Type of the Research This research has a pretest-posttest comparative
controlled quasi-experimental design.
Place and Time of the Research The research was carried out at Kahramanmaraş Sütçü İmam
University Research and Application Hospital Hemodialysis Service and Necip Fazıl City
Hospital Hüsnü Öksüz Dialysis Center between 15.04.2017 and 15.10.2017.
Universe and Sample of the Research All patients registered and treated in Kahramanmaraş
Sütçü İmam University Research and Application Hospital Hemodialysis Service (Experimental
group) and Necip Fazıl City Hospital Hüsnü Öksüz Dialysis Center (Control group) constituted
the research universe (N:108). Experimental and control groups were formed by purposive
sampling. The entire universe was included in the sample without selecting a sample. The
study was carried out with 84 patients, experimental (n:42) and control (n:42). Inclusion
criteria for the study;
- Being over 18 years old
- Being literate
- Not being deaf
- Being able to communicate in Turkish
- Continuing hemodialysis treatment for at least 6 months
- Not receiving a medical diagnosis of psychiatric illness
- Being conscious, cooperative
Data Collection Tools Patient Information Form The patient information form used in the study
consists of a total of 23 questions. It was prepared under the guidance of the relevant
literature (Özdemir and Taşçı 2013; Biçer et.al.2013; Davaridolatabadi and Abdeyazdan 2016;
Mutlu ve Duyan,2012,Neuman 1996, Fawcett 2001, Alligood and Tomey 2006, Horigan and Barroso
2016) and includes questions about the patient characteristics and hemodialysis treatment
characteristics.
Neuman Systems Evaluation Form The form consisting of 21 questions prepared by a thorough
literature review (Velioğlu 2012, Uysal et.al.2009, Özer and Gökçe 2015, Mert and Barutçu
2013, Güner and Kavlak 2015, Alligood 2014, Fawcett and Madeya 2013, Turner and Kaylor 2015,
Neuman and Fawcett 2011, Neuman 1996, Fawcett and Gigliotti 2001, Alligood and Tomey 2006)
allows the patients to be evaluated based on their internal, interpersonal, and external
stressors, in line with Neuman's model, which refers to the patient as an open system that
interacts with these stressors.
Neuman Systems Model-Based Patient Education Guidelines After the literature review, the
education topics of patients receiving hemodialysis treatment were created by the researchers
within the scope of primary, secondary, and tertiary prevention intervention modes outlined
in the Neuman system model (Velioğlu 2012, Özer and Gökçe 2015, Arreguy-Sena et.al.2018,
Karadakovan and Kaymakçı 2011). This Neuman Systems Model-based training guideline prepared
for the individuals in the experimental group was published as a training booklet called
"Let's Learn Hemodialysis" and distributed to the patients. At the end of the research, the
training booklet was also distributed to the individuals in the control group.
Scale of Perceived Social Support from Family (PSS-FM) and Friends (PSS-FR) The study used
the "Perceived Social Support from Family and Friends Scale" developed to determine the
social support score perceived by the patients from their family and friends, which was
adapted into Turkish by Eskin (Eskin 1993), and confirmed for validity and reliability. The
scale is two independent scales, each including 20 items (Kahriman and Polat 2003).
Coopersmith Self-Esteem Inventory (Adult Form) (SEI) The "Coopersmith Self-Esteem Inventory"
consisting of 25 items was used to evaluate the self-esteem level of the patients. The
reliability study in our country was conducted by Turan and it was determined as a valid and
reliable scale (Turan and Tufan,1987).
Hemodialysis Stressor Scale (HSS) The hemodialysis stressor scale was adapted to Turkish
society by Kara (Kara 2006). Hemodialysis Stressor Scale is a five-point Likert-type scale
consisting of 23 items. An increase in the score obtained from the scale indicates an
increase in the perceived stress level (Kara 2006).
Data Collection First of all, the patients in the research group were informed about the
purpose and importance of the study, and their written and verbal consents were obtained for
voluntary participation. Data were collected from the patients in the experimental group in
four stages. In the first stage, data were collected through scales and forms. In the second
stage, the patients received training prepared in line with the Neuman Systems Model at their
homes on a day when they did not go to the hemodialysis unit, and a printed model-based
training guide was distributed. The third stage included training repetition and
question-answer steps in the dialysis center. In the fourth and final stage, data were
collected once again for the last time. Data collection for individuals in the control group
included two stages, one at the beginning and one at the end of the study.
Data Analysis Data analysis was performed in a computer environment using SPSS 20 software.
Descriptive statistical methods (number, percentage) and chi-square test were used.
Parametric tests were used as the scales had normal distribution. In the comparison of
quantitative data for scales with normal distribution, independent t-test was used for the
difference between the two groups, paired t-test for the pre-test post-test comparative
analysis in the same group, and one-way analysis of variance for the comparison of the means
of more than two groups.
Ethical Aspect of the Research Following the approval of Atatürk University Faculty of Health
Sciences Ethics Committee (Number: 2016/12/04, Date: 09.01.2017), written permission was
obtained from the Chief Physician of KSU Research and Application Hospital and the General
Secretariat of Kahramanmaraş Public Hospitals Union to conduct the research. The purpose of
the study was explained to the participating patients. Verbal and written informed consent
forms were obtained.
