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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

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

8. 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.

9. 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.

10. 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)

11. 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

12. 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.

13. 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± ±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

14. 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*

15. 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.

16. 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.

17. Thanks for your patience