The Effect of the Training on Adaptation to Treatment Provided to Hemodialysis Patients

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.