The effect of a care plan based on the Roy Adaptation Model on level of Fatigue in hemodialysis patients

Document Type : Original Quantitative and Qualitative Research Paper


1 Department of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Nursing, Bojnord University of Medical Sciences, Bojnord, Iran

3 Department of Nephrology, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Statics, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Fatigue and lack of energy is a common symptom in hemodialysis patients that affects patients' self care. It can also result in job loss, increased dependence to special health care and increased mortality.
Aim: This study examines the effect of employing a care plan based on the Roy Adaptation Model on level of fatigue in hemodialysis patients.
Method: This clinical trial was performed on 54 hemodialysis patients admitted in Ghaem and Emam Reza Hospitals in 2010 (random allocated: 28 patients in intervention and 26 patients in control group). The intervention group received the care plan trough a face to face training program in 4 sessions at 3- week interval followed by a follow-up period for 4 weeks later, while the control group only received the regular services from hospital. The data were collected using demographic questionnaire, modified Piper Fatigue Scale, and Roy assessment tool. Data were analyzed using student and paired t test and also two-tailed analysis of variance with SPSS version 13.
Results: The results showed no significant difference in terms of fatigue between two groups before intervention but they were significantly different after the intervention (P =0.000). Patients’ fatigue was decreased 19% in patients in intervention group.
Conclusion: The findings of this study indicate that the care plan based on the Roy Adaptation Model is an effective, low cost and non-invasive nursing intervention for decreasing fatigue in hemodialysis patients


1. O’Sullivan D. An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis. Journal compilation 2007
2. Sajadi A, Farmahini Farahani B, Esmaeilpoor Zanjani S, Durmanesh B, Zare M. Effective factors on fatigue in patients with chronic renal failure undergoing hemodialysis. Intensive Iranian Journal of Critical Care Nursing 2010; 3 (1) :33-8.
3. Putzki N, Katsarava Z , Vago S, Diener HC, Limmroth V. Prevalence and severity of multiple sclerosis associated fatigue in treated and untreated patients. Eur Neuraol 2008; 59 () : 139 – 42.
4. Hadjimichael O, Vollmer T, Oleen Burkey M. Fatigue characteristics in multiple sclerosis: the north American research committee on multiple sclerosis survey. Health Qual Life Outcomes 2008;14 (6) : 100-11.
5. Valko PO, Bassetti C L, Bloch KE, Held U, Baumann CR. Validation of the fatigue severity scale in a swiss cohort. Sleep 2008 ;31 (11) :1601-7.
6. Masoodi R, Khairi F, Ahmadi F, Mohamadi E. The Effect of self Care Plan Based on the Orem Model on fatigue and Activities of Daily living of Multiple sclerosis patients. Journal of rehabilitation 2008;10 (3) :43-52.
7. Sundaram R. Hand book of sign and symptom. Lippincott: Williams Swilkins; 2006.
8. Cynthia S, Susan M, Ruth R. Exercise in the management of fatigue in-patient on peritoneal dialysis. Nephrol Nurs J. 2008;35 (5) :469-75.
9. Tsay SH. Acupressure and fatigue in patients with end-stage renal disease–a randomized controlled trial. International Journal of Nursing Studies 2004; 41 () : 99–106.
10. Jhamb M, Weisboard S, Steel M. Fatigue in patients receiving maintenance dialysis. Am J Kidney Dis2007;52 (2) :353-65.
11. Mollaoglu M. Fatigue in People Undergoing Hemodialysis. Journal Dialysis & Transplantation 2009; 15(5): 306-17.
12. Chang W, Hung K, Huang J, Wu K. Tsai T. Chronic Fatigue in Long-Term Peritoneal Dialysis Patients. Am J Nephrol 2001;21:479–85.
13. Beraz Sh, Mohamadi E, Boromand B. the effect of self-care education on quality of life and physiological complication in patients of undergoing hemodialysis. kordestan University of Medical Sciences Journal 2005;10 () :69-79.
14. Beraz Sh, Mohamadi E, Boromand B. A comparative study on the effect of two methods of self-care education (direct and indirect) on quality of life and physical problems of hemodialysis patients. Arak University of Medical Sciences Journal 2006; 9 (1) :17-22.
15. Whittemore R, Roy C. Adapting to Diabetes Mellitus: A Theory Synthesis. Nurs Sci Q 2002; 15 (4) : 311-17.
16. SadeghNejad M. Evaluating the effect of using nursing care plan based on « Roy Adaptation Model» on the adaptation of type II diabetics patients. [Thesis]. In press 2009
17. Bakan G, Akyol A. Theory-guided interventions for adaptation to heart failure. Journal compilation. 2007; 13(4): 47-53.
18. Diaz-Buxo JA, Lowri EG, Lew LN, etal. Quality of life evaluation using short form 36: Comparison in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis 2000; 35 (2) : 293-300.
19. Tsay ShL, Healsted M. Self care efficacy, depression and quality of life among patients Hemodialysis in Taivan. Int J Nurs Stud 2002;39:245-51.
20. Shichiri M, Nishio Y, Ogura M, Marumo F. Effect of low-protein, very-low-phosphorus diet on diaمراقبت
betic renal insufficiency with proteinuria. Am J Kidney Dis. 1991 Jul; 18 (1) : 26-32.
21. Durose CL, Holdsworth M, Watson V, Przygrodzka F. Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. J Am Diet Assoc. 2004; 104 (1) : 35-42.
22. Sarrafi M. The effect of self care education on knowledge, attitude and physical status of patients undergoing hemodialysis. Shahid Beheshti University of Medical Sciences 1994
23. Baraz Sh. Mohamadi E. Boromand B. The effect of foot diet education on laboratory findings and overweight among tow dialysis session in patients undergoing maintenance hemodialysis. Journal of Shahrkord University of Medical Sciences 2006;8 (3) :20-27.
24. Salehi s. The effect of foot diet education on laboratory findings and overweight among tow dialysis session in patients undergoing maintenance hemodialysis. [Thesis]. In press 2002.
25. Schlatter S, Ferrans CE. Teaching program effects on high phosphorus levels in patients receiving hemodialysis. ANNA J. 1998 Feb; 25 (1) : 31-6.