PSYCHOSOCİAL ADAPTATİON & SOCİAL SUPPORT IN HEMODİALYSİS PATİENTS Mukadder Mollaoğlu*, Mansur Kayataş*, Birsen Yürügen** *Cumhuriyet University, Sivas **Okan University, İstanbul TURKEY

BACKGROUND For End Stage Renal Disease (ESRD) which is a life-threatening chronic disease, hemodialysis is an unpleasant and restrictive treatment modality. Patients with ESRD undergo a number of lifestyle, dietary, and fluid restrictions in order to accommodate their illness.

BACKGROUND Psychosocial adjustment to physical disease is a complex multivariate process. Several factors that are associated with psychological adjustment of dialysis patients have been identified in the literature, among them coping strategies, attributions, social support, and locus of control can be listed. Social support is especially important factor that is associated with psychological adjustment of these patients because of their relationship with adherence to dietary and fluid restrictions.

BACKGROUND Social support is an important source in decreasing the negative psychological reactions such as hopelessness and depression. With this effect, social support helps to decrease the harmful effects of negative events in life on physical health and emotional well-being, and it serves as a buffer while coping with stres. Thus, social support seem to be important characteristics not only for general well-being of the patients but for their compliance with the requirements of hemodialysis as well.

PURPOSE The purpose of this study was to examine the relationship between psychosocial adjustment and perceived social support in patients receiving hemodialysis treatment for chronic renal failure.

METHOD Participants The 68 patients with end stage renal disease who received treatment at the department of HD Patients who were alert, could communicate verbally, could understand the questions, were willing to participate in the research were included in the research sample.

METHOD Instruments Personal Information Form Psychosocial Adjustment to Illness Scale – Self-Report Version (PAIS-SR ), Multidimensional Scale of Perceived Social Support ( MSPSS )

Ethical considerations Approval was obtained from the University Ethics Committee. Before signing the consent form, each participant received an oral explanation of the study procedures, risks and benefits of participation, and the right to withdraw at any time.

Data analysis Descriptive analyses were used to describe the demographics and study variables. Mean scores and standard deviations are given as descriptive statistics. Independent t-tests and one-way analyses of variance (ANOVA) were used to calculate differences in psychosocial adjustment among the different demographic groups and clinical conditions. Statistical significance was accepted as p<0.05.

Table 1: Characteristics of the study patients Age (yr) 51.16±11.43 Gender: female, male (%) 28 (41.2) , 40 (58.8) Marital status: married, single ( %) 48 (70.2); 20 (29.8) Education level no formal education primary secondary tertiary 12 (17.6) 22 (32.4) 24 (35.3) 10 (14.7) Employment status: employment, unemployment (%) 27 (39.7),41 (60.3) Time on dialysis (months) <12 13-24 25-36 37-48 >48 8 (11.8) 11 (16.2) 15 (22.0) Dialysis frequency (weekly): <2 sessions,>2 sessions (%) 14 (20.6), 54 (79.4)

Table 2: Mean scores and SD of the PAIS-SR Mean (SD) Health care 6.86(4.78) Vocational 8.18(5.57) Domestic 7.90(4.16) Sexual 8.34 (4.13) Extended family 3.60(3.12) Social 9.14 (5.01) Psychological 8.26 (4.35) Total PAIS-SR 52.28(19.73) SD: Standard deviation; PAIS-SR: Psychosocial adjustment to illness scale-self report

Table 3: Mean scores and SD of the MSPSS Mean (SD) Family support 23.3 (4.8 ) Significant other’s support 15.6 (6.8 ) Friend support 21.1 (7.9) Total MSPSS score 58.1 (8.2 ) SD: Standard deviation; MSPSS: Multidimensional scale of perceived social support.

Table 3: Patients’ Characteristics and Psychosocial Adjustment to Illness Scale-Self Report Health care Mean±SD Vocational Domestic Sexual Extended Family Social Psychological Age (yr) 28-37 38-47 48-57 58-67 68-77 7.88±3.72 8.07±3.62 9.88±2.71 8.04±2.61 8.32±3.06 6.55±0.88 7.14±3.75 6.11±3.33 7.20±2.48 6.92±13.0 6.77±4.43 8.57±5.00 7.00±4.44 6.50±3.94 5.39±3.30 6.14±3.07 6.72±6.01 6.00±5.29 8.88±3.14 6.89±3.10 2.22±1.39 4.09±2.62 3.85±2.85 2.77±1.84 2.63± 2.01 5.55±3.08 6.92±5.90 8.55±6.34 8.17±4.41 6.57±4.28 4.62±3.81 5.07±3.42 5.60±4.09 7.86±5.37 7.99±5.71 F p 1.238 0.298 0.321 0.899 1.490 0.202 0.940 0.462 1.299 0.274 1.246 0.295 3.554 0.006** Gender Female male 8.52±2.81 8.48±3.24 6.88±3.68 7.03±2.80 6.13±4.54 9.05±5.26 3.54±2.73 2.82±1.88 8.28±5.18 7.12±4.62 6.17±5.10 7.04±4.77 t 0.048 0.962 0.024 0.832 -0.209 0.835 -2.420 0.018* 1.138 0.264 1.018 0.311 -0.738 0.463 Illness duration ≤1 years  2–5 years  6–10 years ≥11 years 9.93±3.43 8.54±3.09 7.22±1.98 7.18±2.82 7.00±2.73 7.09±3.38 7.00±2.29 6.45±2.46 8.81±4.86 6.20±4.10 7.55±4.06 5.54±1.63 4.70±3.49 7.32±5.06 7.00±3.00 9.87±4.52 8.00±2.53 6.77±3.94 8.11±4.75 7.10±4.09 3.71±2.19 3.06±2.21 3.00±2.26 1.77±1.48 6.93±4.72 6.90±5.06 6.87±4.25 6.00±4.97 2.411 0.072 0.129 0.942 2.169 0.097 2.645 0.054 0.444 0.722 1.498 0.222 0.092 0.964

Significant other’s support r= .589 p= .017* Total MSPSS r= .829 Table 4: Correlations (spearman) between perceived social support and psychosocial adjustment to illness Variables Total PAIS-SR Family support r= .986 p= .000* Friend support r= .685 p= .018* Significant other’s support r= .589 p= .017* Total MSPSS r= .829 p= .001*

CONCLUSİONS In HD patients’ psychosocial adjustment was affected negatively. They faced the most difficulties in extended social environment, sexual relationships, psychological and vocational relationships. Significant correlations were found between HD patients’ psychosocial adaptation and their education, income level, their age, gender and social support.

Recommendations Nurses are in a strategic position to provide holistic care for patients’ needs and responsible for assessing the progress of patients with chronic illness and its impact on patients. This care should include psychosocial as well as physical aspects of health. In providing this care, nurse should be aware of a patient's needs and must help patients express their feelings about their family and chronic illness.

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