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The Effect of Education on Hemodialysis Patients' Fatigue and Self-Care/ Eğitimin Hemodiyaliz Hastalarında Yorgunluk ve Öz Bakım Üzerine Etkisi

Year 2022, Volume: 17 Issue: 1, 1 - 9, 31.01.2022

Gonca Deveci Hatice Tel Aydın

https://doi.org/10.47565/ndthdt.2022.48

Abstract

Amaç: Bu araştırma, eğitimin hemodiyaliz tedavisi alan hastaların yorgunluk ve öz bakımlarına etkisini değerlendirmek amacıyla yapılmıştır.


Yöntem: Araştırma örneklemi rastgele seçilen (35 kontrol ve 35 müdahale grubu) 70 hastadan oluşmaktadır. Araştırma verileri Hasta Tanıtım Formu, Piper Yorgunluk Ölçeği, Öz-Bakım Gücü
Ölçeği uygulanarak elde edildi. Müdahale grubundaki hastalara, yorgunlukla başetme ve öz bakım gücünü destekleyen içerikte bireysel eğitim verildi. Eğitimlerin tamamlanmasının ardından
3. ve 6. aylarda tüm hastalara Piper Yorgunluk Ölçeği ve Öz Bakım Gücü Ölçeği tekrar uygulandı.

Bulgular: Eğitim öncesi değerlendirmede müdahale grubundaki hastaların %88.6’sının, kontrol grubundaki hastaların %91.4’ünün yorgunluk yaşadığı, müdahale grubundaki
hastaların öz-bakım puanı ortalamalarının 86.20, kontrol grubundaki hastaların öz bakım puanı ortalamalarının 79.11 olduğu, yorgunluk yaşama ve öz-bakım puanları açısından
gruplar arasında farklılık olmadığı belirlendi. Üçüncü ve altıncı aylarda yapılan değerlendirmelerde kontrol grubunun toplam yorgunluk ve öz bakım puanları değişmedi (yüksek yorgunluk
puanları ve düşük öz bakım puanları). Müdahale sonrası, müdahale grubunun yorgunluk puanları azalırken, öz bakım puanları artarken, yorgunluk ve öz bakım puanı arasında orta
derecede anlamlı bir negatif korelasyon bulundu.


Sonuç: Çalışmanın sonuçları, hemodiyaliz hastalarına verilen bireysel eğitimin yorgunluk puanlarını azalttığını ve öz bakım puanlarını artırdığını desteklemektedir.

Anahtar Kelimeler: Hemodiyaliz; Yorgunluk; Öz Bakım; Eğitim; Hemşirelik.

Keywords

hemodiyaliz yorgunluk öz bakım eğitim hemşirelik

References

  • 1. United States Renal Data System. (USRDS). (2020). Annual Data Report: End Stage Renal Disease // 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities, 2020. https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence prevalence-patient-characteristics-and-treatment-modalities. Date of access: 22 July 2021.
  • 2. Süleymanlar G, Utaş C, Arınsoy T, Ateş K, Altun B, Ecder T, and et al. A Population Based Survey of Chronic Renal Disease in Turkey – The CREDIT study. Nephrol Dial Transplant. 2011; 26:1862-71. DOI: 10.1093/ndt/gfq656
  • 3. Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (KDIGO 2012). Kidney Int Suppl, 2013;3: 1-150.
  • 4. Lewis SL, Heitkemper MM, Dirksen SR, O’brien PG, Bucher L. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 2-Volume Set. 7e Hardcover –April.2007: 6,1197-1130.
  • 5. Süleymanlar G, Ateş K, Seyahi N. T.C. Sağlık Bakanlığı ve Türk Nefroloji Derneği Ortak Raporu. 2020;136. http://www.nefroloji.org.tr/folders/file/registry_2019. Date of access: 20 July 2021.
  • 6. John JF, Thomas VJ. The Psychosocial Experience of Patients With End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service. ISRN Nephrology.2013;1-8. http://dx.doi.org/10.5402/2013 /308986
  • 7. Bonner A, Caltabiano M, Berlund L. Quality of Life, Fatigue, and Activity in Australians With Chronic Kidney Disease: A Longitudinal Study. Nursing & Health Sciences.2013; 15(3):360-367. DOI: 10.1111/nhs.12038
  • 8. Horigan AE, Rocchiccioli J, Trimm D. Dialysis and Fatigue: Implications For Nurses – A Case Study Analysis. Medsurg Nurs.2012; 21(3): 158–175.
  • 9. Horigan AE, Schneider SM, Docherty S, Barroso J. The Experience and Self-Management of Fatigue in Patients on Hemodialysis. Nephrol Nurs J.2013; 40 (2):113-22.
  • 10. Herdman, T.H. ve Kamitsuru, S. (Eds.). (2014). NANDA International Nursing Diagnoses: Definitions & Classification, 2015– 2017.Oxford, Wiley Blackwell, 133-357.
  • 11. Finkelstein F, Story K, Firanek C, Mendelssohn D, Barre P, and et al. Health-Related Quality of Life and Hemoglobin Levels in Chronic Kidney Disease Patients. Clin J Am Soc Nephrol.2009; 4: 33–38. DOI: 10.2215 /CJN. 00630208
  • 12. Joshwa B, Khakha CD, Mahajan S. Fatigue and Depression and Sleep Problems Among Hemodialysis Patients in a Tertiary Care Center. Saudi J KidneyDis Transpl.2012; 23(4):729-735. DOI: 10.4103/1319-2442.98149
  • 13. Gould DW, Brown G, Watson E,Vıana J, Smıth A. Physiological Benefits of Exercise in Pre-Dialysis Chronic Kidney Disease. Nephrology. 2014; 19:519–527. DOI:10.1111/nep.12285
  • 14. Öztürk B. (2011) Hemodiyaliz Tedavisini Sürdüren Hastalarda Tedaviye Uyumun ve Eğitim Gereksinimlerinin Değerlendirilmesi. İstanbul Bilim Üniversitesi Sağlık Bilimleri Enstitüsü. İstanbul, 123.
  • 15. Levey AS, Andreoli S, Du Bose T, Provenzano R, Collins AJ. Ckd: Common, Harmful, and Treatable World Kidney Day. Am J Kidney Dis. 2007; 49 (2):175-179. DOI: 10.1053/j.ajkd.2006.12.013
  • 16. Rahimi F, Gharib, A, Beyramijam M, Naseri O. Effect of Self-Care Education on Self Efficacy in Patients Undergoing Hemodialysis. Life Science Journal. 2014; 11:136-140. ISSN: 2372-613X (Online); doi prefix: 10.7537
  • 17. Rossi AP, Burris DD, Lucas FL, Crocker GA, Wasserman JC. Effects of A Renal Rehabilitation Exercise Program in Patients With CKD: A Randomized, Controlled Trial. Clinical journal of the American Society of Nephrology. 2014; 9 (12):2052-2058. DOI:10.2215/CJN.11791113
  • 18. Simmons L. Dorthea Orem’s Self Care Theory as Related To Nursing Practice in Hemodialysisi. Nephrology Nursing. 2009; 36(4):419-421.
  • 19. International Council of Nurses (ICN). (2010) Delivering Quality, Serving Communıtıes: Nurses Leadıng Chronıc Care Internatıonal Day. http://www.icn.ch/publications/2010-delivering-quality-serving-communities-nurses-leading-chronic care/Date of access: 20 July 2021.
  • 20. Johansen KL, Finkelstein FO, Revicki DA, Evans C, Wan S, and et al. Systematic Review of The Impact of Erythropoiesis Stimulating Agents on Fatigue in Dialysis Patients. Nephrol Dial Transplant. 2012; 27: 2418–25. DOI: 10.1093/ndt/gfr697
  • 21. Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM. The Revised Piper Fatigue Scale: Psychometric Evaluation in Women With Breast Cancer. Oncology Nursing Forum. 1998; 25(4):677-684.
  • 22. Can G. (2001) Evaluation of Fatigue and Care Needs in Breast Cancer Patients. Istanbul University Institute of Health Sciences. İstanbul.130.
  • 23. Kearney B, Fleisher B. Development of an Instrument to Measure Exercise of Self-Care Agency. Res Nurs Health. 1979; 2:25-34. DOI: 10.1002/nur.4770020105
  • 24. Nahcıvan N. (1993) Self-Care Power and the Effect of Family Environment on Healthy Youngs, Istanbul University Institute of Health Sciences. Istanbul, 106.
  • 25. Biniaz V, Tayybi A, Nemati E. Different Aspects of Fatigue Experienced by Patients Receiving Maintenance Dialysis in Hemodialysis Units. Nephro-Urology. 2013;5(4):897-900. DOI: 10.5812/numonthly.11667
  • 26. Davison SN, Jhangri GS. The İmpact of Chronic Pain On Depression, Sleep, and The Desire to Withdraw From Dialysis in Hemodialysis Patients. Journal of Pain and Symptom Management. 2005;30(5):465-473. DOI:10.1016 /j.jpainsymman.2005.05.013
  • 27. Jablonski A. The Multidimensional Characteristics of Symptoms Reported by Patients on Hemodialysis. Nephrology Nursıng Journal. 2007; 34 (1):29-37.
  • 28. Caplin B, Kumar S, Davenport A. Patients Perspective of Haemodialysis-Associated Symptoms. Nephrol Dial Transplant. 2011; 26(8):2656-63. DOI: 10.1093 /ndt /gfq763
  • 29. Akın S, Mendi B, Öztürk B, Cinper C, Durna Z. Assessment of Relationship Between Self-Care and Fatigue and Loneliness in Haemodialysis Patients. J Clin Nurs.2013; 23(5-6): 856-64. doi: 10.1111/jocn.12248. PMID: 23808612 DOI:10.1111/jocn.12248
  • 30. Ovayolu N, Torun S, Uçan Ö, Elçi A. Hemodiyaliz Hastalarının Öz-Bakıma İlişkin Tutumları ve Sosyodemografik Özellikleri Özbakım Gücü Arasındaki İlişki. Nefroloji Hemşireliği Dergisi.2007; 21-25.
  • 31. Bağ E, Mollaoğlu M. The Evaluation of Self-Care and Self-Efficacy in Patients Undergoing Hemodialysis. Journal of Evaluation in Clinical Practice.2010;16:605-610. DOI:10.1111/j.1365-2753.2009.01214.x
  • 32. Fırat Kılıç H, Alpar ŞE. The Effect of Group Training İmplemented on Hemodialysis Patients for Their Stress Management, Psychosocial Adjustment and Self-Care Strength. International Journal of Human Sciences.2016; 13(1):654-767. Retrieved from https://www.j-humansciences.com/ojs/index.php/IJHS/article/view/3422.
  • 33. Mohamed SK, El-Fouly Y, El-Deeb M. Impact Of A Desıgned Self-Care Program on Selected Outcomes Among Patients Undergoing Hemodialysis. Impact Journals. 2016;4, (5):73- 90.
  • 34. Lee B, Lin CC, Chaboyer W, Chiang CL, Hung CC. The Fatigue Experience of Haemodialysis Patients in Taiwan. J Clin Nurs.2007; Feb,16(2),407-13. DOI: 10.1111/j.1365-2702.2005.01409.x
  • 35. Heidarzadeh M, Atashpeikar S, Jalilazaret T. Relationship Between Quality of Life and Self-Care Ability in Patients Receiving Hemodialysis. IJNMR.2010;15(2): 71-76.
  • 36. Horigan AN, Barroso JV. A Comparison of Temporal Patterns of Fatigue in Patients on Hemodialysis. Nephrol Nurs J.2016; 43(2): 129–139.
  • 37. Mohamed SA. The Effectiveness of an Educational Intervention on Fatigue in Hemodialysis Patients: A Randomized Controlled Trial. IOSR Journal of Nursing and Health Science.2014; 3(4):40-50. DOI:10.9790/1959-03434050
  • 38. Patterson E, Wan YWT, Sidani S. Nonpharmacological Nursing Interventions for the Management of Patient Fatigue: A Literature Review. Journal of Clinical Nursing.2013; 22:2668–2678. DOI: 10.1111/jocn.12211
  • 39. Slesnıck N, Pıenkos S, Doss-Mcquıtty S, Schıller B. The Chronic Disease Self-Management Program – A Pilot Study in Patients Undergoing Hemodialysis. Nephrol News Issues.2015; 29(4):22–3,27–8,30–2.

The Effect of Education on Hemodialysis Patients' Fatigue and Self-Care/ Eğitimin Hemodiyaliz Hastalarında Yorgunluk ve Öz Bakım Üzerine Etkisi

Year 2022, Volume: 17 Issue: 1, 1 - 9, 31.01.2022

Gonca Deveci Hatice Tel Aydın

https://doi.org/10.47565/ndthdt.2022.48

Abstract

Aim: The study was done to evaluate the effect of education on the fatigue and self-care of patients receiving hemodialysis treatment.

Method: The study sample consisted of 70 patients, randomly selected (35 controls and 35 intervention groups). The study datas were obtained by using the Patient Identification Form, Piper Fatigue Scale and Self-Care Agency Scale. Individual training on the content supporting coping with fatigue and self-care power was given to patients in the intervention group. Piper Fatigue Scale and Self-Care Agency Scale were reapplied to all patients at the 3th and 6th months following the completion of the training sessions.

Results: In the pre-training evaluation, %88.6 of the intervention group and 91.4% of the control group experienced fatigue. The mean self-care score of the intervention group was 86.20 and the control group was 79.11. In addition, there was no significant difference between the intervention and control groups in terms of their fatigue and self-care scores. In the evaluations at the third and sixth months, the control group’s total fatigue and self-care scores had not changed (high fatigue scores and low self-care scores). Post-intervention, the fatigue scores of the intervention group decreased while self-care scores increased, with a moderately significant negative correlation found between the fatigue and self-care score.

Conclusion: Results supported that individual training given to hemodialysis patients decreased fatigue scores and increased self-care scores.

Key Words: Hemodialysis, fatigue, self-care power, education, nursing

Keywords

hemodialysis fatigue self-care power education nursing

References

  • 1. United States Renal Data System. (USRDS). (2020). Annual Data Report: End Stage Renal Disease // 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities, 2020. https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence prevalence-patient-characteristics-and-treatment-modalities. Date of access: 22 July 2021.
  • 2. Süleymanlar G, Utaş C, Arınsoy T, Ateş K, Altun B, Ecder T, and et al. A Population Based Survey of Chronic Renal Disease in Turkey – The CREDIT study. Nephrol Dial Transplant. 2011; 26:1862-71. DOI: 10.1093/ndt/gfq656
  • 3. Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (KDIGO 2012). Kidney Int Suppl, 2013;3: 1-150.
  • 4. Lewis SL, Heitkemper MM, Dirksen SR, O’brien PG, Bucher L. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 2-Volume Set. 7e Hardcover –April.2007: 6,1197-1130.
  • 5. Süleymanlar G, Ateş K, Seyahi N. T.C. Sağlık Bakanlığı ve Türk Nefroloji Derneği Ortak Raporu. 2020;136. http://www.nefroloji.org.tr/folders/file/registry_2019. Date of access: 20 July 2021.
  • 6. John JF, Thomas VJ. The Psychosocial Experience of Patients With End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service. ISRN Nephrology.2013;1-8. http://dx.doi.org/10.5402/2013 /308986
  • 7. Bonner A, Caltabiano M, Berlund L. Quality of Life, Fatigue, and Activity in Australians With Chronic Kidney Disease: A Longitudinal Study. Nursing & Health Sciences.2013; 15(3):360-367. DOI: 10.1111/nhs.12038
  • 8. Horigan AE, Rocchiccioli J, Trimm D. Dialysis and Fatigue: Implications For Nurses – A Case Study Analysis. Medsurg Nurs.2012; 21(3): 158–175.
  • 9. Horigan AE, Schneider SM, Docherty S, Barroso J. The Experience and Self-Management of Fatigue in Patients on Hemodialysis. Nephrol Nurs J.2013; 40 (2):113-22.
  • 10. Herdman, T.H. ve Kamitsuru, S. (Eds.). (2014). NANDA International Nursing Diagnoses: Definitions & Classification, 2015– 2017.Oxford, Wiley Blackwell, 133-357.
  • 11. Finkelstein F, Story K, Firanek C, Mendelssohn D, Barre P, and et al. Health-Related Quality of Life and Hemoglobin Levels in Chronic Kidney Disease Patients. Clin J Am Soc Nephrol.2009; 4: 33–38. DOI: 10.2215 /CJN. 00630208
  • 12. Joshwa B, Khakha CD, Mahajan S. Fatigue and Depression and Sleep Problems Among Hemodialysis Patients in a Tertiary Care Center. Saudi J KidneyDis Transpl.2012; 23(4):729-735. DOI: 10.4103/1319-2442.98149
  • 13. Gould DW, Brown G, Watson E,Vıana J, Smıth A. Physiological Benefits of Exercise in Pre-Dialysis Chronic Kidney Disease. Nephrology. 2014; 19:519–527. DOI:10.1111/nep.12285
  • 14. Öztürk B. (2011) Hemodiyaliz Tedavisini Sürdüren Hastalarda Tedaviye Uyumun ve Eğitim Gereksinimlerinin Değerlendirilmesi. İstanbul Bilim Üniversitesi Sağlık Bilimleri Enstitüsü. İstanbul, 123.
  • 15. Levey AS, Andreoli S, Du Bose T, Provenzano R, Collins AJ. Ckd: Common, Harmful, and Treatable World Kidney Day. Am J Kidney Dis. 2007; 49 (2):175-179. DOI: 10.1053/j.ajkd.2006.12.013
  • 16. Rahimi F, Gharib, A, Beyramijam M, Naseri O. Effect of Self-Care Education on Self Efficacy in Patients Undergoing Hemodialysis. Life Science Journal. 2014; 11:136-140. ISSN: 2372-613X (Online); doi prefix: 10.7537
  • 17. Rossi AP, Burris DD, Lucas FL, Crocker GA, Wasserman JC. Effects of A Renal Rehabilitation Exercise Program in Patients With CKD: A Randomized, Controlled Trial. Clinical journal of the American Society of Nephrology. 2014; 9 (12):2052-2058. DOI:10.2215/CJN.11791113
  • 18. Simmons L. Dorthea Orem’s Self Care Theory as Related To Nursing Practice in Hemodialysisi. Nephrology Nursing. 2009; 36(4):419-421.
  • 19. International Council of Nurses (ICN). (2010) Delivering Quality, Serving Communıtıes: Nurses Leadıng Chronıc Care Internatıonal Day. http://www.icn.ch/publications/2010-delivering-quality-serving-communities-nurses-leading-chronic care/Date of access: 20 July 2021.
  • 20. Johansen KL, Finkelstein FO, Revicki DA, Evans C, Wan S, and et al. Systematic Review of The Impact of Erythropoiesis Stimulating Agents on Fatigue in Dialysis Patients. Nephrol Dial Transplant. 2012; 27: 2418–25. DOI: 10.1093/ndt/gfr697
  • 21. Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM. The Revised Piper Fatigue Scale: Psychometric Evaluation in Women With Breast Cancer. Oncology Nursing Forum. 1998; 25(4):677-684.
  • 22. Can G. (2001) Evaluation of Fatigue and Care Needs in Breast Cancer Patients. Istanbul University Institute of Health Sciences. İstanbul.130.
  • 23. Kearney B, Fleisher B. Development of an Instrument to Measure Exercise of Self-Care Agency. Res Nurs Health. 1979; 2:25-34. DOI: 10.1002/nur.4770020105
  • 24. Nahcıvan N. (1993) Self-Care Power and the Effect of Family Environment on Healthy Youngs, Istanbul University Institute of Health Sciences. Istanbul, 106.
  • 25. Biniaz V, Tayybi A, Nemati E. Different Aspects of Fatigue Experienced by Patients Receiving Maintenance Dialysis in Hemodialysis Units. Nephro-Urology. 2013;5(4):897-900. DOI: 10.5812/numonthly.11667
  • 26. Davison SN, Jhangri GS. The İmpact of Chronic Pain On Depression, Sleep, and The Desire to Withdraw From Dialysis in Hemodialysis Patients. Journal of Pain and Symptom Management. 2005;30(5):465-473. DOI:10.1016 /j.jpainsymman.2005.05.013
  • 27. Jablonski A. The Multidimensional Characteristics of Symptoms Reported by Patients on Hemodialysis. Nephrology Nursıng Journal. 2007; 34 (1):29-37.
  • 28. Caplin B, Kumar S, Davenport A. Patients Perspective of Haemodialysis-Associated Symptoms. Nephrol Dial Transplant. 2011; 26(8):2656-63. DOI: 10.1093 /ndt /gfq763
  • 29. Akın S, Mendi B, Öztürk B, Cinper C, Durna Z. Assessment of Relationship Between Self-Care and Fatigue and Loneliness in Haemodialysis Patients. J Clin Nurs.2013; 23(5-6): 856-64. doi: 10.1111/jocn.12248. PMID: 23808612 DOI:10.1111/jocn.12248
  • 30. Ovayolu N, Torun S, Uçan Ö, Elçi A. Hemodiyaliz Hastalarının Öz-Bakıma İlişkin Tutumları ve Sosyodemografik Özellikleri Özbakım Gücü Arasındaki İlişki. Nefroloji Hemşireliği Dergisi.2007; 21-25.
  • 31. Bağ E, Mollaoğlu M. The Evaluation of Self-Care and Self-Efficacy in Patients Undergoing Hemodialysis. Journal of Evaluation in Clinical Practice.2010;16:605-610. DOI:10.1111/j.1365-2753.2009.01214.x
  • 32. Fırat Kılıç H, Alpar ŞE. The Effect of Group Training İmplemented on Hemodialysis Patients for Their Stress Management, Psychosocial Adjustment and Self-Care Strength. International Journal of Human Sciences.2016; 13(1):654-767. Retrieved from https://www.j-humansciences.com/ojs/index.php/IJHS/article/view/3422.
  • 33. Mohamed SK, El-Fouly Y, El-Deeb M. Impact Of A Desıgned Self-Care Program on Selected Outcomes Among Patients Undergoing Hemodialysis. Impact Journals. 2016;4, (5):73- 90.
  • 34. Lee B, Lin CC, Chaboyer W, Chiang CL, Hung CC. The Fatigue Experience of Haemodialysis Patients in Taiwan. J Clin Nurs.2007; Feb,16(2),407-13. DOI: 10.1111/j.1365-2702.2005.01409.x
  • 35. Heidarzadeh M, Atashpeikar S, Jalilazaret T. Relationship Between Quality of Life and Self-Care Ability in Patients Receiving Hemodialysis. IJNMR.2010;15(2): 71-76.
  • 36. Horigan AN, Barroso JV. A Comparison of Temporal Patterns of Fatigue in Patients on Hemodialysis. Nephrol Nurs J.2016; 43(2): 129–139.
  • 37. Mohamed SA. The Effectiveness of an Educational Intervention on Fatigue in Hemodialysis Patients: A Randomized Controlled Trial. IOSR Journal of Nursing and Health Science.2014; 3(4):40-50. DOI:10.9790/1959-03434050
  • 38. Patterson E, Wan YWT, Sidani S. Nonpharmacological Nursing Interventions for the Management of Patient Fatigue: A Literature Review. Journal of Clinical Nursing.2013; 22:2668–2678. DOI: 10.1111/jocn.12211
  • 39. Slesnıck N, Pıenkos S, Doss-Mcquıtty S, Schıller B. The Chronic Disease Self-Management Program – A Pilot Study in Patients Undergoing Hemodialysis. Nephrol News Issues.2015; 29(4):22–3,27–8,30–2.
There are 39 citations in total.

Details

Primary Language English
Subjects Nursing
Journal Section Article
Authors

Gonca Deveci 0000-0002-3399-5572

Hatice Tel Aydın 0000-0002-1518-8080

Publication Date January 31, 2022
Published in Issue Year 2022 Volume: 17 Issue: 1

Cite

Vancouver Deveci G, Tel Aydın H. The Effect of Education on Hemodialysis Patients’ Fatigue and Self-Care/ Eğitimin Hemodiyaliz Hastalarında Yorgunluk ve Öz Bakım Üzerine Etkisi. JoNN. 2022;17(1):1-9.
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