The Effect of Roy Adaptation-Based Nursing Intervention on Stress, Psychosocial Adjustment and Self-Care Power in Hemodialysis Patients: A Randomized Controlled Experimental Study

1. Introduction and Objective Chronic Renal Failure (CKD) is a chronic and progressive deterioration in the functions of the kidney (Ammirati, 2020). Dialysis and renal transplantation applications play an important role in the treatment of CKD (Zhang and et al. 2020). However, dialysis is the most preferred treatment method because renal transplantation is not suitable for every patient and the risk of rejection is high (Imtiaz and Alam, 2021; Bleyer, 2022). Hemodialysis treatment is used in 70% of the patients in the world (Bello and et al. 2022) and in 76.9% of the patients in Turkey (Süleymanlar, 2020).

While hemodialysis treatment saves patients from death and enables them to continue living, it also brings with it some physical, psychological, social and economic problems (Aksoy and Oğur, 2015). Loss of physical strength and endurance, body image disorder, fear of death, financial difficulties, diet, fluid intake, restricted activities, being dependent on machinery and hospital at certain days and hours of the week, invasive procedures applied in each session, loss of social relations, and dependence on medical treatment cause this disease to be perceived as an extreme source of stress, and changes caused by the disease in family and marital life increase the severity of the stress (Topbaş & Bingöl, 2017).

The stress experienced negatively affects the psycho-social adaptation and self-care power of patients (Varol & Sivrikaya, 2018). While patients' non-compliance with treatment increases morbidity, mortality and economic problems (Sultan et al., 2022), inadequacy in self-care power causes problems in controlling the disease process and symptoms and meeting patients' own needs (Avanji et al., 2021; Gamze and Entertainment, 2013). Therefore, holistic nursing care has an important place in increasing the psycho-social adjustment and self-care power of hemodialysis patients.

The use of models will guide nurses in providing standardization in holistic nursing care (Jasemi et al., 2017). The Roy Adaptation Model (RAM), one of the models widely used in nursing, creates a framework for determining the adaptation needs of individuals, families and groups, and focuses on the changes that occur in the adaptive system of the human and the environment. In this model, which includes four areas of adaptation: physiological, self-concept, role function and interdependence, the human being is defined as a biopsychosocial entity who is in constant interaction with his/her environment and is affected by stimuli (Roy et al., 2009). Associating the Roy Adaptation Model with patients undergoing hemodialysis treatment and providing training in line with this model may yield correct results in terms of nursing practice (Vicdan & Karabacak, 2014). In the literature, in the care of epilepsy (Erdoğan, 2021), cancer (Pehlivan et al., 2022), Covid-19 (Çaylar and Terzi, 2021), bariatric surgery (Guven et al., 2021) and many other diseases (Dağcan et al., 2021; Başayar et al., 2020; Yoldaş et al., 2019; Ilkaz et al., 2018), the Roy adaptation model was used. As a result of these studies, it was determined that patients' compliance with treatment increased and that nursing interventions gave positive results.

In the literature, there are descriptive (Vicdan and Karabacak, 2014) and experimental studies (Vicdan and Karabacak, 2016) and case reports (Özdemir, 2022) studies showing the benefits of using the Roy adaptation model in hemodialysis patient education in terms of adaptation to illness. However, there is no experimental study evaluating stress, self-care power and psychosocial adaptation in hemodialysis patients by performing interventions according to the Roy adaptation model. For this reason, this study is important in terms of enabling patients to cope with stress and increasing their self-care power by increasing the adaptation to illness with the nursing interventions applied to the patients according to the Roy adaptation model.