The effect of communication therapy based on the Peplau model on sense of coherence and psychological well-being in people suffering from chronic renal failure undergoing hemodialysis: a quasi-experimental study

The effect of communication therapy based on the Peplau model on sense of coherence and psychological well-being in people suffering from chronic renal failure undergoing hemodialysis: a quasi-experimental study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of communication therapy based on the Peplau model on sense of coherence and psychological well-being in people suffering from chronic renal failure undergoing hemodialysis: a quasi-experimental study FATEMEH TAHMASEBIDEHKOEDI, ALI HASSANPOUR-DEHKORDI, SHAHRIAR SALEHI-TALI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6911240/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background and Aim : Hemodialysis is a stressful treatment for chronic kidney failure, often leading to psychological issues like anxiety and depression. Sense of coherence and psychological well-being are vital for coping with these stresses. This study aimed to evaluate the effect of therapeutic communication based on Peplau’s model on these parameters in hemodialysis patients Methods : This semi-experimental study involved patients with chronic kidney failure undergoing hemodialysis at Hajar Hospital in Shahrekord. Participants were randomly assigned to intervention (Peplau-based communication therapy) and control (routine care) groups. The intervention was delivered over 7–8 individual sessions. Data were collected using Antonovsky’s Sense of Coherence Scale and Ryff’s Psychological Well-Being Questionnaire, and analyzed with SPSS 28. Results : There were no significant demographic differences between groups. In the intervention group, sense of coherence and psychological well-being scores significantly improved immediately and three months post-intervention (P<0.001). No significant changes were observed in the control group. Clinical trial number : not applicable. Conclusion : Therapeutic communication based on Peplau’s model significantly enhanced psychological well-being and sense of coherence in hemodialysis patients. It is a practical and effective intervention to support mental health in this population. The Peplau Model Hemodialysis Sense of Coherence Psychological Well-Being Chronic Kidney Disease Communication Therapy Introduction Chronic kidney disease (CKD) is characterized by a range of pathophysiological mechanisms that lead to impaired kidney function and a gradual, irreversible reduction in glomerular filtration rate (GFR(( 1 ). This condition is recognized as a significant global health issue. In a 2024 study published in Nature, it was reported that kidney disease affects approximately 850 million individuals worldwide, with a global prevalence exceeding 10%. According to the Global Burden of Disease report in 2019, impaired kidney function was attributed to approximately 1.3 million deaths annually( 2 ). Available data suggest that the increasing burden of chronic kidney disease has a greater impact on developing countries than on developed ones( 3 ). In Iran, chronic kidney disease prevalence among adults was estimated at 11.68% as of 2020, with rates steadily increasing annually( 4 ). Chronic kidney disease is a progressive and irreversible condition that leads to electrolyte imbalances, endocrine disorders, anemia, metabolic acidosis, and uremia. It is associated with numerous complications, including involvement of multiple organs such as the heart, bones, blood vessels, and peripheral nerves, ultimately progressing to end-stage kidney disease (ESKD)( 5 , 6 ). To postpone death and complications like uremia, renal replacement therapies such as kidney transplantation and dialysis (including hemodialysis and peritoneal dialysis) are necessary. Hemodialysis remains the most widely used treatment modality for end-stage kidney disease( 7 ). Despite its role in delaying mortality and complications of chronic kidney disease and partially improving renal function, dialysis is a physically and emotionally demanding process for patients and caregivers, often resulting in significant physical, social, and psychological challenges( 6 , 8 , 9 ). The prevalence of psychological disorders among patients with kidney failure is significantly higher than in the general population. Available data indicate that, in Iran, the prevalence of depression and anxiety in these patients has been reported at 31.5% and 41.7%, respectively( 10 ). The chronic nature of kidney failure and stressors such as lifestyle restrictions, treatment complications, loss of independence, and prolonged dialysis sessions contribute to psychological issues like depression, anxiety, hopelessness, reduced quality of life, and increased suicide risk( 11 – 13 ). Therefore, Effective coping strategies can improve patient well-being, and one key factor gaining attention in recent years is the sense of coherence( 14 ). Sense of coherence, introduced by Antonovsky, is a personal orientation that emphasizes stress management through three core components: comprehensibility, manageability, and meaningfulness( 15 ). Individuals with a strong sense of coherence tolerate stress better, understand social support, and actively engage with healthcare teams. Hemodialysis patients typically have low to moderate sense of coherence, which is negatively linked to psychological disorders like anxiety. This sense also helps reduce disease burden and improve quality of life, especially in kidney disease( 16 – 18 ). Overall, sense of coherence plays a significant role in physical and mental health, particularly in enhancing psychological well-being( 19 , 20 ). Psychological well-being is a central concept in positive psychology, reflecting a person's mental balance and their positive evaluation of life through thoughts and emotions( 21 ). Ryff defines psychological well-being as an individual’s effort to realize their potential, meaning the ability to discover and develop one’s own talents( 22 ). Psychological well-being consists of six core components: self-acceptance, positive relationships, purpose in life, autonomy, personal growth, and environmental mastery( 23 ). In hemodialysis patients, psychological well-being is affected by treatment-related challenges and disease-related limitations, often leading to reduced quality of relationships with family and friends( 24 ). Therefore, a psychosocial intervention alongside standard treatment can help alleviate both physical and psychological complications in these patients( 25 ). Nurses have the closest contact with patients, and effective communication is essential in nursing care. Patients also seek interaction to better understand the physical, social, and psychological aspects of their illness( 26 , 27 ). In this context, nursing theories can be effective, with Hildegard Peplau's theory of therapeutic communication being particularly valuable( 28 ). In 1952, Hildegard Peplau defined nursing as an interpersonal relationship between a trained nurse and a patient in need of help( 29 ). In 1989, Peplau described three stages: orientation, working, and termination. In the orientation stage, patients realize their need for help, and nurses introduce themselves, explain the treatment, and gather important patient information, beginning to build trust. Here, the nurse is seen as a stranger( 30 – 32 ). The working phase includes identification, where patient needs and goals are set, and exploitation, where nursing interventions are applied. The nurse serves as teacher and counselor, empowering the patient to take on self-care. The final termination stage reviews goal achievement, intervention effectiveness, and ends the nurse-patient relationship( 31 , 33 , 34 ). Studies have shown that Peplau’s theory of therapeutic communication can effectively improve nurse-patient relationships, reduce stress in hemodialysis patients, and increase patient satisfaction( 35 ). Given the increasing number of hemodialysis patients and limited research, this study aimed to assess the impact of Peplau’s therapeutic communication model on sense of coherence and psychological well-being in chronic kidney failure patients at Hajar Hospital, Shahrekord. Methods Study design and participants We conducted a two- group pre/posttest quasi-experimental evaluating the impact of communication therapy based on Peplau theory on sense of coherence and psychological well-being among patients suffering from chronic kidney failure undergone hemodialysis. This study was performed in a hemodialysis center located in Hajar Hospital in Shahrekord, Iran from July to September 2024. At the first, ethical approval was obtained from the Ethics Committee of Shahrekord University of Medical Sciences, Shahrekord, Iran. The study sample size according to a similar study( 36 ), with α = 0.05, β = 90% and With a 20% expected dropout, 35 participants were included in each group. The final adjusted sample size for our study was 70 in total. In this study, participants were first selected through a census method, including all hemodialysis patients at Hajar Hospital who met the inclusion criteria. They were then randomly assigned to intervention and control groups using random allocation. The inclusion criteria were history of hemodialysis for at least 6 months, Informed consent of the patient indicating willingness to participate in the intended intervention, The patient’s age is equal to or greater than 18 years, Definitive diagnosis of ESRD confirmed by a nephrology specialist and the patient’s ability to learn. Exclusion criteria were withdrawal or unwillingness to continue participation in the study, discontinuation of the hemodialysis program during the study and occurrence of psychological or physical conditions preventing the patient from continuing cooperation. Data collection Data collection tools included a demographic questionnaire, Ryff’s scales in order to measure PWB and SoC was measured by Antonovsky’s 13-item scale. Data were collected through questionnaires, which were completed before, immediately after, and two months after the intervention for both groups. Demographic information questionnaire The demographic questionnaire for patients with chronic kidney failure undergoing hemodialysis included information such as age, gender, marital status, education level, and disease-related details such as duration of illness and length of hemodialysis treatment. Antonovsky's Sense of Coherence (SOC) Questionnaire This study used the 13-item short form of Antonovsky’s Sense of Coherence questionnaire, assessing three dimensions: comprehensibility (5 items), manageability ( 4 ), and meaningfulness ( 4 ). Items are rated on a 7-point Likert scale, with total scores ranging from 13 to 91 and higher scores indicating stronger sense of coherence. In one study using the Sense of Coherence scale, Cronbach’s alpha ranged from 0.82 to 0.95. In another study, Antonovsky reported reliability for the 13-item version between 0.74 and 0.91. In Iran, Mohammadzadeh et al. also confirmed acceptable internal consistency, reporting a Cronbach’s alpha of 0.77( 37 , 38 ). Ryff Psychological Well-Being Questionnaire This study used the 18-item short form of the Psychological Well-Being questionnaire, measuring six subscales with a 6-point Likert scale. Scores range from 18 to 108, where higher scores indicate better psychological well-being( 39 ). Ryff reported the internal consistency of this questionnaire with Cronbach's alpha ranging from 0.82 to 0.92( 40 ). In the Iranian population, Khanjani et al. also confirmed its reliability with an acceptable Cronbach's alpha of 0.71( 41 ). Intervention Initially, the demographic questionnaire, Antonovsky’s Sense of Coherence questionnaire, and Ryff’s Psychological Well-Being questionnaire were provided to participants in both the intervention and control groups. Participants were instructed to seek clarification if they encountered any ambiguity in the questions. After completing the questionnaires, Peplau’s therapeutic communication model was implemented for the intervention group through 7–8 individual sessions, conducted in person in the inpatient dialysis unit before hemodialysis. The control group continued receiving routine care. In the orientation phase, during a 20–30-minute session, the researcher introduced themselves to the patients, conducted an initial assessment, and reviewed aspects such as medical history, previous dialysis experiences, patient knowledge of the disease and treatment, available support systems (family and friends), and key concerns. The required actions, physical setting, and available resources were explained briefly. Patient expectations from the healthcare team were clarified, initiating trust between the patient and nurse. In the identification phase, a 30–40-minute session was held in the presence of a psychologist. Patients were encouraged to express their emotions, and psychological and physical data were gathered. Dietary habits and fluid intake were assessed, and barriers to care were identified. Patients were asked to share any concerns about their illness, treatment process, and care expectations. A list of problems was compiled, and the most appropriate approach to support the patient was determined. This stage promoted a sense of belonging and self-efficacy in managing problems, reducing feelings of helplessness and hopelessness. In the exploitation phase, a care plan tailored to each patient's specific needs in the domains of psychological well-being and sense of coherence was implemented across three 40-minute sessions. The researcher supported patients in moving toward independence. Finally, in the termination phase, two 20–30-minute sessions were held for final evaluation, assessing goal achievement, the effectiveness of interventions, observable emotional and behavioral changes, and the overall therapeutic communication process. Data analysis Data were analyzed using SPSS v28. Qualitative variables were described by frequency and percentage, and quantitative variables by mean ± standard deviation. The Kolmogorov–Smirnov test assessed normality. Group differences were tested using Chi-square, Fisher’s exact test, independent and paired t-tests, and repeated measures ANOVA. A p-value < 0.05 was considered statistically significant. Results the mean age in the control group was 56.1 ± 15.3 years, and in the intervention group, it was 56.1 ± 17.0 years (P = 0.99). Most of the participants were men, married and had below diploma education levels. Dialysis duration averaged 3.3 years (±0.3) in the control group and 3.5 years (±1.3) in the intervention group. Demographic characteristics such as age, gender, marital status, education level, occupation, duration of dialysis treatment, frequency of dialysis per week, and duration of illness were statistically comparable between the two groups (all P > 0.05); these items are presented in Table 1. The results of between-group and within-group comparisons of the mean scores of sense of coherence and psychological well-being before, after, and two months after the intervention are presented in Table 2. Regarding the sense of coherence, there was a statistically significant improvement in the intervention group over time. The mean score increased from 35.5 ± 7.3 before the intervention to 46.4 ± 5.3 immediately after, and further to 47.9 ± 6.6 two months post-intervention (P < 0.001). The control group showed no significant changes during the same periods (P = 0.968). In terms of psychological well-being, the intervention group experienced a significant rise from a baseline score of 58.9 ± 7.9 to 64.9 ± 7.3 immediately post-intervention, reaching 66.0 ± 7.5 at the two-month follow-up (P < 0.001). The control group’s scores remained statistically unchanged (P = 0.623). Table1 Sociodemographic and clinical characteristics of the participants Characteristics Intervention (n=35) Control (n=35) P-value Gender Female Male 17 18 13 22 0.33* Employment status Nongovernment job Retired Housewife Employee Disabled 6 8 12 4 5 6 5 12 5 7 0.90* Marital status Single Married Divorced Other 3(8.6%) 25(71.4%) 7(20%) 2(5.7%) 30(85.7%) 3(8.6%) 0.32* Educational background Reading and writing skills (basic literacy) Below Diploma Diploma University education 6(17.1%) 12(34.3%) 7(20%) 10(28.6%) 6(17.1%) 11(31.4%) 7(20%) 11(31.4%) 0.99* Age 56.1±17.0 56.1±15.3 0.99** Duration of dialysis treatment (Year) 3.5±3.1 3.3±3.0 0.75** Frequency of hemodialysis per week 3.0±0.4 3.0±0.2 0.71** duration of illness (Year) 3.7±3.2 3.9±3.6 0.75** *chi-square **Independent t test P<0.05 indicates significance Table 2 Comparison of the two groups regarding sense of coherence and psychological well-being before, immediately and two months after intervention. Variable Groups Before the intervention Mean ±SD After the intervention Mean ±SD 2 months after the intervention Mean ±SD P- value Within groups Sense of coherence Control Intervention 34.1±6.8 35.69±8.069 35.5±7.3 46.43±5.299 34.2±7.2 47.86±6.648 0.968*** > 0.001*** P value between groups >0.226* <0.001** <0.001** Psychological well-being Control Intervention 55.1±7.9 58.9±7.9 55.6±7.6 64.9±7.3 54.7±0.8 66.0±7.5 0.623*** 0.001*** P value between groups 0.05* <0.001** <0.001** *Independent t test **Covariance analysis ***Repeated Measures ANOVA (Analysis of Variance) P<0.05 indicates significance Discussion The results of the study showed that the therapeutic communication intervention based on Peplau's model significantly improved the psychological well-being scores of patients with chronic kidney failure undergoing hemodialysis. This significant change was observed immediately after the intervention, with a more gradual increase continuing over the following two months. Similarly, a study by Negi et al. showed that psychological interventions based on therapeutic communication can improve quality of life and reduce psychological stress in patients. Most participants agreed that the nurse was supportive, attentive, and provided appropriate health information, showing genuine concern for their well-being. A significant positive correlation was found between the quality of nurse-patient communication and patient satisfaction. These findings align with the present study in terms of enhancing psychological well-being( 42 ). In line with the present findings, Kakavand et al. reported that although perceived social support and self-efficacy were not significantly related to each other, both showed a significant positive association with psychological well-being in patients. This supports the idea that enhancing internal and external support factors can contribute to improved psychological outcomes, consistent with the effects observed following the Peplau-based therapeutic communication intervention in this study( 43 ). In another study aimed at examining the impact of psychosocial interventions on individuals with kidney disease, findings revealed that such interventions had a positive effect on depression and quality of life. Overall, psychological components in these patients improved following the intervention, supporting the effectiveness of psychosocial approaches in enhancing mental well-being—findings that align with the current study’s results( 44 ). In hemodialysis patients, psychological well-being is affected by the challenges they face during treatment and the limitations imposed by the disease( 24 , 45 ) and as the results of the present study demonstrated, applying Peplau’s therapeutic communication model can enhance the psychological well-being of these patients. The results showed that the therapeutic communication intervention based on Peplau's model significantly increased the sense of coherence in patients with chronic kidney disease undergoing hemodialysis. This improvement was most notable immediately after the intervention and continued at a slower rate over the following two months. Similarly, the study by Sawma et al. highlighted that a stronger sense of coherence is closely linked with improved quality of life in hemodialysis patients. Despite the generally low coherence levels among participants, those with higher scores experienced better outcomes across various domains, including emotional stability, physical functioning, and social engagement. These results reinforce the value of interventions such as therapeutic communication that aim to support patients in finding meaning in their illness and managing their condition more effectively( 17 ). Consistent with the current findings, the study by Barlow and colleagues showed that various psychological interventions, including emotional support, relaxation-based therapies, and psychoeducational programs, had a positive impact on reducing anxiety and depression, while enhancing quality of life. This underscores the importance of integrating psychological support into routine care for patients with chronic conditions, particularly those undergoing hemodialysis( 25 ). In a related study examining the impact of therapeutic communication based on Peplau’s theory on anxiety and resilience, significant differences were observed between the intervention and control groups after the intervention. These findings suggest that educational interventions promoting therapeutic communication can be beneficial for patients with chronic illnesses and their caregivers( 46 ). On the other hand, sense of coherence has a strong negative relationship with psychological issues such as anxiety. It also plays a key role in reducing disease burden and improving survival quality, particularly in patients with kidney diseases( 16 – 18 ). In this study, the increase in sense of coherence was likely due to the opportunity provided by therapeutic communication, allowing patients to better understand the challenges of living with hemodialysis and to find new meaning in their lives. This enhancement in coherence may reduce psychological stress and improve quality of life, aligning with previous research. Chronic kidney failure and its long-term treatments, including hemodialysis, expose patients to physical, social, and psychological limitations that can ultimately lead to feelings of meaninglessness and hopelessness( 47 ). The findings of this study also highlight the importance of non-pharmacological interventions and emphasize the enhanced role of nurses within the healthcare team. Given their close and continuous interaction with patients, nurses can play a significant role in strengthening patients' sense of coherence and improving their quality of life. Strengths and limitations A key strength of this study is the use of Peplau’s psychosocial intervention, which is both cost-effective and practical, making it accessible for widespread implementation in clinical settings. Additionally, the intervention’s simplicity requiring no special equipment enhances its feasibility for patients with chronic kidney disease undergoing hemodialysis, who often face multiple physical and psychological challenges. This strengthens the potential impact and applicability of the findings in real-world healthcare environments. However, implementation of this theory relies heavily on the availability and training of nursing staff skilled in therapeutic communication. Without adequate staff training and time allocation, the effectiveness of the intervention may be reduced. Additionally, the intervention’s simplicity might overlook more complex psychological needs that require specialized mental health support. Conclusions The findings of this study indicate that therapeutic communication based on Peplau’s model positively influences both psychological well-being and sense of coherence in patients with chronic kidney disease undergoing hemodialysis. This approach can be considered an effective supportive intervention to improve mental health outcomes in this patient population. Abbreviations ANOVA Analysis of variance SOC Sense of Coherence Declarations Acknowledgment The authors would like to express their sincere gratitude to all the patients who participated in this study, as well as the nursing staff and management of Hajar Hospital in Shahrekord for their valuable cooperation and support throughout the research process. This study would not have been possible without their generous assistance and commitment. Author contribution All authors played a role in carrying out the study and preparing the manuscript. The study was designed and initiated by FT, AH, and SHS. FT took the lead in conducting the research, collecting and analyzing the data, and preparing and submitting the initial draft. AH was responsible for overseeing the study’s quality assurance. Both AHand SHS reviewed, edited, and contributed to the revision of the manuscript. All authors reviewed and approved the final manuscript. Ethics approval and consent to participate The study was approved by the ethics committee of Shahrekord University of Medical Sciences, with the ethics code IR.SKUMS.REC.1403.033. All patients were provided with detailed information about the study's purpose and procedures. Informed consent was obtained from each participant, and all processes were carried out in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable Funding This study is funded by Shahrekord University of Medical Sciences, and the grant number is 7182. Data availability No datasets were generated or analyzed during the current study. Competing interests The authors declare no competing interests Consent for publication Not applicable. References seyed-mazhari marjaan. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, kidney disease chapter. Tehran. Iran: Boshra Publication; 2008. Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024;20(7):473–85. Alvand S, Abolnezhadian F, Alatab S, Mohammadi Z, Hayati F, Noori M, et al. Prevalence of impaired renal function and determinants in the southwest of Iran. Bmc Nephrol. 2021;22(1):1–10. Ghelichi-Ghojogh M, Fararouei M, Seif M, Pakfetrat M. Chronic kidney disease and its health-related factors: a case-control study. Bmc Nephrol. 2022;23(1):1–7. Ouyang W, Chen H, Xu X, Zhang X, Fu L, Tang F, et al. Self-management program for patients with chronic kidney disease (SMP-CKD) in Southern China: protocol for an ambispective cohort study. Bmc Nephrol. 2022;23(1):1–11. Guan Y, He Y. Effect of advanced care on psychological condition in patients with chronic renal failure undergoing hemodialysis: A protocol of a systematic review. Medicine (Baltimore). 2019;98(10). Ghasemi Bahraseman Z, Mangolian Shahrbabaki P, Nouhi E. The impact of stress management training on stress-related coping strategies and self-efficacy in hemodialysis patients: a randomized controlled clinical trial. BMC Psychol. 2021;9(1):1–9. Jafari H, Ebrahimi A, Aghaei A, Khatony A. The relationship between care burden and quality of life in caregivers of hemodialysis patients. Bmc Nephrol. 2018;19(1):1–8. Rezaei Z, Jalali A, Jalali R, Khaledi-Paveh B. Psychological problems as the major cause of fatigue in clients undergoing hemodialysis: A qualitative study. Int J Nurs Sci. 2018;5(3):262–7. Najafi I, arjomand mohsen, sarateli aeidin. Principles of Internal Medicine, Kidney disease. Arjmand publication; 2010. Aini N, Wahyu AC. The correlation between family support and psychological well-being in patients with end-stage renal disease. Kontak; 2020. Mugi E, Githemo G, Wala J. Psychological Stressors among Hemodialysis Patients in Selected County Dialysis Centre’s in Kenya. Nur Prim Care. 2021;5(1):1–6. Ahmad MM, Al Nazly EK. Hemodialysis: Stressors and coping strategies. Psychol Health Med. 2015;20(4):477–87. Mc Gee SL, Höltge J, Maercker A, Thoma M V. Sense of coherence and stress-related resilience: Investigating the mediating and moderating mechanisms in the development of resilience following stress or adversity. Front Psychiatry. 2018;9:378. Endler PC, Haug TM, Spranger H. Sense of Coherence and Physical Health. A “Copenhagen Interpretation” of Antonovsky′ s SOC Concept. Sci World J. 2008;8(1):451–3. Uzdil N, Ceyhan Ö, Şimşek N. The effect of salutogenesis‐based care on the sense of coherence in peritoneal dialysis patients. J Clin Nurs. 2022;31(1–2):184–95. Sawma T, Sanjab Y. The association between sense of coherence and quality of life: a cross-sectional study in a sample of patients on hemodialysis. BMC Psychol. 2022;10(1):1–13. Song Y, Chen L, Wang W, Yang D, Jiang X. Social Support, Sense of Coherence, and Self-Management among Hemodialysis Patients. West J Nurs Res. 2022;44(4):367–74. Nilsson KW, Leppert J, Simonsson B, Starrin B. Sense of coherence and psychological well-being: improvement with age. J Epidemiol community Heal. 2010;64(4):347–52. Giglio RE, Rodriguez-Blazquez C, de Pedro-Cuesta J, Forjaz MJ. Sense of coherence and health of community-dwelling older adults in Spain. Int Psychogeriatrics. 2015;27(4):621–8. Boehm JK, Kubzansky LD. The heart’s content: the association between positive psychological well-being and cardiovascular health. Psychol Bull. 2012;138(4):655. Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci. 1995;4(4):99–104. Ryff CD, Singer B. Psychological well-being: Meaning, measurement, and implications for psychotherapy research. Psychother Psychosom. 1996;65(1):14–23. Dąbrowska-Bender M, Dykowska G, Żuk W, Milewska M, Staniszewska A. The impact on quality of life of dialysis patients with renal insufficiency. Patient Prefer Adherence. 2018;12:577. Barello S, Anderson G, Acampora M, Bosio C, Guida E, Irace V, et al. The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: A systematic review and a meta-analysis. Int Urol Nephrol. 2023;55(4):897–912. de Oliveira AM, Soares E. COMMUNICATION IN THE INTERPERSONAL RELATIONSHIP NURSE/PATIENT WITH AN INDICATION FOR KIDNEY TRANSPLANT. Ciencia, Cuid e Saude. 2016;15(4). Lederer S, Fischer MJ, Gordon HS, Wadhwa A, Popli S, Gordon EJ. Barriers to effective communication between veterans with chronic kidney disease and their healthcare providers. Clin Kidney J. 2015;8(6):766–71. Maghsoodi S, Zarea K, Haghighizadeh M-H, Dashtbozorgi B. The Effect of Using Peplau’s Therapeutic Relationship Model on Anxiety of Coronary Artery Bypass Graft Surgery Candidates. Jundishapur J Chronic Dis Care. 2014;3(3). Peplau HE. Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. Bloomsbury Publishing; 1988. Abdi A, Dalvand S, Vahedian-Azimi A, Gheshlagh RG, Kurdi A. Prevalence of depression among Iranian patients under hemodialysis: a systematic review and meta-analysis. J Nephropathol. 2018;7(4):224–32. Arabacı LB, Taş G. Effect of Using Peplau’s Interpersonal Relation Nursing Model in the care of a juvenile delinquent. J Psychiatr Nursing/Psikiyatri Hemsireleri Dern. 2019;10(3). Peplau HE. Peplau’s theory of interpersonal relations. Nurs Sci Q. 1997/01/01. 1997;10(4):162–7. Fawcett J, Desanto-Madeya S. Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. Fa Davis; 2012. McCarthy CT, Aquino-Russell C. A comparison of two nursing theories in practice: Peplau and Parse. Nurs Sci Q. 2009;22(1):34–40. Cheraghi F, khatiban mahnaz, Borzou S, hosayni parasto, Vatandost S. Application of Peplau’s theory of Interpersonal Relations in Nursing Practice: A systematic review study. Sci J Nursing, Midwifery Paramed Fac. 2017;3:1–11. Moradi S, Fallahi-Khoshknab M, Rahgoi A, Vahedi M. The effect of Therapeutic Communication based Peplau’s theory on anxiety and Resilience of patients admitted to the corona ward of Khatam Al-Anbia Hospital in Tehran. Iran J Nurs Res. 2023;18(2):17–27. Mahammadzadeh A, Poursharifi H, Alipour A. Validation of Sense of Coherence (SOC) 13-item scale in Iranian sample. Procedia-Social Behav Sci. 2010;5:1451–5. Antonovsky A. The structure and properties of the sense of coherence scale. Soc Sci Med. 1993;36(6):725–33. yasaei sekeh masoomeh, Shafiabadi A, Farzad V. Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) on psychological well-bing and Its Components in hemodialysis patients. Educ Res [Internet]. 2018;13(55):149–62. Available from: https://edu.bojnourd.iau.ir/article_544682.html Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol. 1989;57(6):1069. Khanjani M, Shahidi S, Fathabadi J, Mazaheri MA, Shokri O. Factor structure and psychometric properties of the Ryff’s scale of Psychological well-being, short form (18-item) among male and female students. Thoughts Behav Clin Psychol. 2014;9(32):27–36. Negi S, Kaur H, Singh GM, Pugazhendi S. Quality of nurse patient therapeutic communication and overall patient satisfaction during their hospitalization stay. Int J Med Sci Public Heal. 2017;6(4):1. Kakavand A, Keshavarz S, Dashtdar H, Shirmohammadi F. Relationships between Perceived Social Support and Self-Sufficiency with Psychological Well-Being in elderly patients with cardiovascular diseases: the Mediating Role of psychological capital. Med J mashhad Univ Med Sci [Internet]. 2020;63(4):2535–45. Available from: https://mjms.mums.ac.ir/article_17184.html Powathil GG, Kr A. Psychosocial Interventions for Persons with End-Stage Renal Disease-A Scoping Review. Soc Work Health Care. 2021;60(6–7):481–98. Jones DJW, Harvey K, Harris JP, Butler LT, Vaux EC. Understanding the impact of haemodialysis on UK National Health Service patients’ well‐being: A qualitative investigation. J Clin Nurs. 2018;27(1–2):193–204. Moradi S, Fallahi-Khoshknab M, Rahgoi A, Vahedi M. The effect of Therapeutic Communication based Peplau’s theory on anxiety and Resilience of patients admitted to the corona ward of Khatam Al-Anbia Hospital in Tehran. Iran J Nurs Res [Internet]. 2023;18(2):17–27. Available from: http://ijnr.ir/article-1-2748-fa.html Brownie S, Scott R, Rossiter R. Therapeutic communication and relationships in chronic and complex care. Nurs Stand. 2016;31(6). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 26 Aug, 2025 Reviews received at journal 05 Aug, 2025 Reviews received at journal 02 Aug, 2025 Reviewers agreed at journal 02 Aug, 2025 Reviews received at journal 31 Jul, 2025 Reviewers agreed at journal 29 Jul, 2025 Reviewers agreed at journal 25 Jul, 2025 Reviewers agreed at journal 23 Jul, 2025 Reviewers invited by journal 23 Jul, 2025 Editor invited by journal 25 Jun, 2025 Editor assigned by journal 18 Jun, 2025 Submission checks completed at journal 18 Jun, 2025 First submitted to journal 17 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6911240","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":489537231,"identity":"d710c52f-8fa0-46e5-b6ea-76e546c77f8f","order_by":0,"name":"FATEMEH TAHMASEBIDEHKOEDI","email":"","orcid":"","institution":"Shahrekord University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"FATEMEH","middleName":"","lastName":"TAHMASEBIDEHKOEDI","suffix":""},{"id":489537236,"identity":"20d328fe-d862-4e09-a946-38b0212a125f","order_by":1,"name":"ALI HASSANPOUR-DEHKORDI","email":"data:image/png;base64,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","orcid":"","institution":"Shahrekord University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"ALI","middleName":"","lastName":"HASSANPOUR-DEHKORDI","suffix":""},{"id":489537240,"identity":"aa440112-1edf-41bc-8dd3-ad444ff7336f","order_by":2,"name":"SHAHRIAR SALEHI-TALI","email":"","orcid":"","institution":"Shahrekord University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"SHAHRIAR","middleName":"","lastName":"SALEHI-TALI","suffix":""}],"badges":[],"createdAt":"2025-06-17 07:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6911240/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6911240/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87573587,"identity":"b3ea3c15-8408-412b-a891-0c1e78d46d9e","added_by":"auto","created_at":"2025-07-25 11:20:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":777300,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6911240/v1/e7776da6-e857-465d-b4ff-86d5831cc447.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of communication therapy based on the Peplau model on sense of coherence and psychological well-being in people suffering from chronic renal failure undergoing hemodialysis: a quasi-experimental study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic kidney disease (CKD) is characterized by a range of pathophysiological mechanisms that lead to impaired kidney function and a gradual, irreversible reduction in glomerular filtration rate (GFR((\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This condition is recognized as a significant global health issue. In a 2024 study published in Nature, it was reported that kidney disease affects approximately 850\u0026nbsp;million individuals worldwide, with a global prevalence exceeding 10%. According to the Global Burden of Disease report in 2019, impaired kidney function was attributed to approximately 1.3\u0026nbsp;million deaths annually(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Available data suggest that the increasing burden of chronic kidney disease has a greater impact on developing countries than on developed ones(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Iran, chronic kidney disease prevalence among adults was estimated at 11.68% as of 2020, with rates steadily increasing annually(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eChronic kidney disease is a progressive and irreversible condition that leads to electrolyte imbalances, endocrine disorders, anemia, metabolic acidosis, and uremia. It is associated with numerous complications, including involvement of multiple organs such as the heart, bones, blood vessels, and peripheral nerves, ultimately progressing to end-stage kidney disease (ESKD)(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). To postpone death and complications like uremia, renal replacement therapies such as kidney transplantation and dialysis (including hemodialysis and peritoneal dialysis) are necessary. Hemodialysis remains the most widely used treatment modality for end-stage kidney disease(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Despite its role in delaying mortality and complications of chronic kidney disease and partially improving renal function, dialysis is a physically and emotionally demanding process for patients and caregivers, often resulting in significant physical, social, and psychological challenges(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe prevalence of psychological disorders among patients with kidney failure is significantly higher than in the general population. Available data indicate that, in Iran, the prevalence of depression and anxiety in these patients has been reported at 31.5% and 41.7%, respectively(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The chronic nature of kidney failure and stressors such as lifestyle restrictions, treatment complications, loss of independence, and prolonged dialysis sessions contribute to psychological issues like depression, anxiety, hopelessness, reduced quality of life, and increased suicide risk(\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Therefore, Effective coping strategies can improve patient well-being, and one key factor gaining attention in recent years is the sense of coherence(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSense of coherence, introduced by Antonovsky, is a personal orientation that emphasizes stress management through three core components: comprehensibility, manageability, and meaningfulness(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Individuals with a strong sense of coherence tolerate stress better, understand social support, and actively engage with healthcare teams. Hemodialysis patients typically have low to moderate sense of coherence, which is negatively linked to psychological disorders like anxiety. This sense also helps reduce disease burden and improve quality of life, especially in kidney disease(\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Overall, sense of coherence plays a significant role in physical and mental health, particularly in enhancing psychological well-being(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePsychological well-being is a central concept in positive psychology, reflecting a person's mental balance and their positive evaluation of life through thoughts and emotions(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Ryff defines psychological well-being as an individual\u0026rsquo;s effort to realize their potential, meaning the ability to discover and develop one\u0026rsquo;s own talents(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Psychological well-being consists of six core components: self-acceptance, positive relationships, purpose in life, autonomy, personal growth, and environmental mastery(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In hemodialysis patients, psychological well-being is affected by treatment-related challenges and disease-related limitations, often leading to reduced quality of relationships with family and friends(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Therefore, a psychosocial intervention alongside standard treatment can help alleviate both physical and psychological complications in these patients(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Nurses have the closest contact with patients, and effective communication is essential in nursing care. Patients also seek interaction to better understand the physical, social, and psychological aspects of their illness(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In this context, nursing theories can be effective, with Hildegard Peplau's theory of therapeutic communication being particularly valuable(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 1952, Hildegard Peplau defined nursing as an interpersonal relationship between a trained nurse and a patient in need of help(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In 1989, Peplau described three stages: orientation, working, and termination. In the orientation stage, patients realize their need for help, and nurses introduce themselves, explain the treatment, and gather important patient information, beginning to build trust. Here, the nurse is seen as a stranger(\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). The working phase includes identification, where patient needs and goals are set, and exploitation, where nursing interventions are applied. The nurse serves as teacher and counselor, empowering the patient to take on self-care. The final termination stage reviews goal achievement, intervention effectiveness, and ends the nurse-patient relationship(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Studies have shown that Peplau\u0026rsquo;s theory of therapeutic communication can effectively improve nurse-patient relationships, reduce stress in hemodialysis patients, and increase patient satisfaction(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Given the increasing number of hemodialysis patients and limited research, this study aimed to assess the impact of Peplau\u0026rsquo;s therapeutic communication model on sense of coherence and psychological well-being in chronic kidney failure patients at Hajar Hospital, Shahrekord.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eWe conducted a two- group pre/posttest quasi-experimental evaluating the impact of communication therapy based on Peplau theory on sense of coherence and psychological well-being among patients suffering from chronic kidney failure undergone hemodialysis. This study was performed in a hemodialysis center located in Hajar Hospital in Shahrekord, Iran from July to September 2024. At the first, ethical approval was obtained from the Ethics Committee of Shahrekord University of Medical Sciences, Shahrekord, Iran. The study sample size according to a similar study(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), with α\u0026thinsp;=\u0026thinsp;0.05, β\u0026thinsp;=\u0026thinsp;90% and With a 20% expected dropout, 35 participants were included in each group. The final adjusted sample size for our study was 70 in total. In this study, participants were first selected through a census method, including all hemodialysis patients at Hajar Hospital who met the inclusion criteria. They were then randomly assigned to intervention and control groups using random allocation. The inclusion criteria were history of hemodialysis for at least 6 months, Informed consent of the patient indicating willingness to participate in the intended intervention, The patient\u0026rsquo;s age is equal to or greater than 18 years, Definitive diagnosis of ESRD confirmed by a nephrology specialist and the patient\u0026rsquo;s ability to learn. Exclusion criteria were withdrawal or unwillingness to continue participation in the study, discontinuation of the hemodialysis program during the study and occurrence of psychological or physical conditions preventing the patient from continuing cooperation.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData collection tools included a demographic questionnaire, Ryff\u0026rsquo;s scales in order to measure PWB and SoC was measured by Antonovsky\u0026rsquo;s 13-item scale. Data were collected through questionnaires, which were completed before, immediately after, and two months after the intervention for both groups.\u003c/p\u003e\n\u003ch3\u003eDemographic information questionnaire\u003c/h3\u003e\n\u003cp\u003eThe demographic questionnaire for patients with chronic kidney failure undergoing hemodialysis included information such as age, gender, marital status, education level, and disease-related details such as duration of illness and length of hemodialysis treatment.\u003c/p\u003e\n\u003ch3\u003eAntonovsky's Sense of Coherence (SOC) Questionnaire\u003c/h3\u003e\n\u003cp\u003eThis study used the 13-item short form of Antonovsky\u0026rsquo;s Sense of Coherence questionnaire, assessing three dimensions: comprehensibility (5 items), manageability (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), and meaningfulness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Items are rated on a 7-point Likert scale, with total scores ranging from 13 to 91 and higher scores indicating stronger sense of coherence. In one study using the Sense of Coherence scale, Cronbach\u0026rsquo;s alpha ranged from 0.82 to 0.95. In another study, Antonovsky reported reliability for the 13-item version between 0.74 and 0.91. In Iran, Mohammadzadeh et al. also confirmed acceptable internal consistency, reporting a Cronbach\u0026rsquo;s alpha of 0.77(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eRyff Psychological Well-Being Questionnaire\u003c/h3\u003e\n\u003cp\u003eThis study used the 18-item short form of the Psychological Well-Being questionnaire, measuring six subscales with a 6-point Likert scale. Scores range from 18 to 108, where higher scores indicate better psychological well-being(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Ryff reported the internal consistency of this questionnaire with Cronbach's alpha ranging from 0.82 to 0.92(\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). In the Iranian population, Khanjani et al. also confirmed its reliability with an acceptable Cronbach's alpha of 0.71(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eIntervention\u003c/h2\u003e\u003cp\u003eInitially, the demographic questionnaire, Antonovsky\u0026rsquo;s Sense of Coherence questionnaire, and Ryff\u0026rsquo;s Psychological Well-Being questionnaire were provided to participants in both the intervention and control groups. Participants were instructed to seek clarification if they encountered any ambiguity in the questions. After completing the questionnaires, Peplau\u0026rsquo;s therapeutic communication model was implemented for the intervention group through 7\u0026ndash;8 individual sessions, conducted in person in the inpatient dialysis unit before hemodialysis. The control group continued receiving routine care.\u003c/p\u003e\u003cp\u003eIn the orientation phase, during a 20\u0026ndash;30-minute session, the researcher introduced themselves to the patients, conducted an initial assessment, and reviewed aspects such as medical history, previous dialysis experiences, patient knowledge of the disease and treatment, available support systems (family and friends), and key concerns. The required actions, physical setting, and available resources were explained briefly. Patient expectations from the healthcare team were clarified, initiating trust between the patient and nurse.\u003c/p\u003e\u003cp\u003eIn the identification phase, a 30\u0026ndash;40-minute session was held in the presence of a psychologist. Patients were encouraged to express their emotions, and psychological and physical data were gathered. Dietary habits and fluid intake were assessed, and barriers to care were identified. Patients were asked to share any concerns about their illness, treatment process, and care expectations. A list of problems was compiled, and the most appropriate approach to support the patient was determined. This stage promoted a sense of belonging and self-efficacy in managing problems, reducing feelings of helplessness and hopelessness.\u003c/p\u003e\u003cp\u003eIn the exploitation phase, a care plan tailored to each patient's specific needs in the domains of psychological well-being and sense of coherence was implemented across three 40-minute sessions. The researcher supported patients in moving toward independence.\u003c/p\u003e\u003cp\u003eFinally, in the termination phase, two 20\u0026ndash;30-minute sessions were held for final evaluation, assessing goal achievement, the effectiveness of interventions, observable emotional and behavioral changes, and the overall therapeutic communication process.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS v28. Qualitative variables were described by frequency and percentage, and quantitative variables by mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The Kolmogorov\u0026ndash;Smirnov test assessed normality. Group differences were tested using Chi-square, Fisher\u0026rsquo;s exact test, independent and paired t-tests, and repeated measures ANOVA. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003ethe mean age in the control group was 56.1 \u0026plusmn; 15.3 years, and in the intervention group, it was 56.1 \u0026plusmn; 17.0 years (P = 0.99). Most of the participants were men, married and had below diploma education levels. Dialysis duration averaged 3.3 years (\u0026plusmn;0.3) in the control group and 3.5 years (\u0026plusmn;1.3) in the intervention group. Demographic characteristics such as age, gender, marital status, education level, occupation, duration of dialysis treatment, frequency of dialysis per week, and duration of illness were statistically comparable between the two groups (all P \u0026gt; 0.05); these items are presented in Table\u0026nbsp;1.\u003c/p\u003e\n\u003cp\u003eThe results of between-group and within-group comparisons of the mean scores of sense of coherence and psychological well-being before, after, and two months after the intervention are presented in Table\u0026nbsp;2. Regarding the sense of coherence, there was a statistically significant improvement in the intervention group over time. The mean score increased from 35.5 \u0026plusmn; 7.3 before the intervention to 46.4 \u0026plusmn; 5.3 immediately after, and further to 47.9 \u0026plusmn; 6.6 two months post-intervention (P \u0026lt; 0.001). The control group showed no significant changes during the same periods (P = 0.968).\u003c/p\u003e\n\u003cp\u003eIn terms of psychological well-being, the intervention group experienced a significant rise from a baseline score of 58.9 \u0026plusmn; 7.9 to 64.9 \u0026plusmn; 7.3 immediately post-intervention, reaching 66.0 \u0026plusmn; 7.5 at the two-month follow-up (P \u0026lt; 0.001). The control group\u0026rsquo;s scores remained statistically unchanged (P = 0.623).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable1\u003c/strong\u003e Sociodemographic and clinical characteristics of the participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntervention (n=35) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl (n=35) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;17\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;13\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.33*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNongovernment job\u003c/p\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003cp\u003eEmployee\u003c/p\u003e\n \u003cp\u003eDisabled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 12\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;12\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.90*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3(8.6%)\u003c/p\u003e\n \u003cp\u003e25(71.4%)\u003c/p\u003e\n \u003cp\u003e7(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2(5.7%)\u003c/p\u003e\n \u003cp\u003e30(85.7%)\u003c/p\u003e\n \u003cp\u003e3(8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.32*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational background\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eReading and writing skills\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(basic literacy)\u003c/p\u003e\n \u003cp\u003eBelow Diploma\u003c/p\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003cp\u003eUniversity education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(17.1%)\u003c/p\u003e\n \u003cp\u003e12(34.3%)\u003c/p\u003e\n \u003cp\u003e7(20%)\u003c/p\u003e\n \u003cp\u003e10(28.6%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(17.1%)\u003c/p\u003e\n \u003cp\u003e11(31.4%)\u003c/p\u003e\n \u003cp\u003e7(20%)\u003c/p\u003e\n \u003cp\u003e11(31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 0.99*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e56.1\u0026plusmn;17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e56.1\u0026plusmn;15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.99**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of dialysis treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e3.5\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e3.3\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.75**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of hemodialysis per week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3.0\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 3.0\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.71**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eduration of illness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e3.7\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e3.9\u0026plusmn;3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.75**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*chi-square\u003c/p\u003e\n\u003cp\u003e**Independent t test\u003c/p\u003e\n\u003cp\u003eP\u0026lt;0.05 indicates significance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Comparison of the two groups regarding sense of coherence and psychological well-being before, immediately and two months after intervention.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore the intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter the intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 months after the intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- value\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWithin groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eSense of coherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e34.1\u0026plusmn;6.8\u003c/p\u003e\n \u003cp\u003e35.69\u0026plusmn;8.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e35.5\u0026plusmn;7.3\u003c/p\u003e\n \u003cp\u003e46.43\u0026plusmn;5.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e34.2\u0026plusmn;7.2\u003c/p\u003e\n \u003cp\u003e47.86\u0026plusmn;6.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.968***\u003c/p\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026gt;\u003c/span\u003e0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eP value between groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt;0.226*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003ePsychological well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e55.1\u0026plusmn;7.9\u003c/p\u003e\n \u003cp\u003e58.9\u0026plusmn;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e55.6\u0026plusmn;7.6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64.9\u0026plusmn;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e54.7\u0026plusmn;0.8\u003c/p\u003e\n \u003cp\u003e66.0\u0026plusmn;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.623***\u003c/p\u003e\n \u003cp\u003e0.001***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eP value between groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Independent t test\u003c/p\u003e\n\u003cp\u003e**Covariance analysis\u003c/p\u003e\n\u003cp\u003e***Repeated Measures ANOVA (Analysis of Variance)\u003c/p\u003e\n\u003cp\u003eP\u0026lt;0.05 indicates significance\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of the study showed that the therapeutic communication intervention based on Peplau's model significantly improved the psychological well-being scores of patients with chronic kidney failure undergoing hemodialysis. This significant change was observed immediately after the intervention, with a more gradual increase continuing over the following two months. Similarly, a study by Negi et al. showed that psychological interventions based on therapeutic communication can improve quality of life and reduce psychological stress in patients. Most participants agreed that the nurse was supportive, attentive, and provided appropriate health information, showing genuine concern for their well-being. A significant positive correlation was found between the quality of nurse-patient communication and patient satisfaction. These findings align with the present study in terms of enhancing psychological well-being(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). In line with the present findings, Kakavand et al. reported that although perceived social support and self-efficacy were not significantly related to each other, both showed a significant positive association with psychological well-being in patients. This supports the idea that enhancing internal and external support factors can contribute to improved psychological outcomes, consistent with the effects observed following the Peplau-based therapeutic communication intervention in this study(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). In another study aimed at examining the impact of psychosocial interventions on individuals with kidney disease, findings revealed that such interventions had a positive effect on depression and quality of life. Overall, psychological components in these patients improved following the intervention, supporting the effectiveness of psychosocial approaches in enhancing mental well-being\u0026mdash;findings that align with the current study\u0026rsquo;s results(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). In hemodialysis patients, psychological well-being is affected by the challenges they face during treatment and the limitations imposed by the disease(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) and as the results of the present study demonstrated, applying Peplau\u0026rsquo;s therapeutic communication model can enhance the psychological well-being of these patients.\u003c/p\u003e\u003cp\u003eThe results showed that the therapeutic communication intervention based on Peplau's model significantly increased the sense of coherence in patients with chronic kidney disease undergoing hemodialysis. This improvement was most notable immediately after the intervention and continued at a slower rate over the following two months. Similarly, the study by Sawma et al. highlighted that a stronger sense of coherence is closely linked with improved quality of life in hemodialysis patients. Despite the generally low coherence levels among participants, those with higher scores experienced better outcomes across various domains, including emotional stability, physical functioning, and social engagement. These results reinforce the value of interventions such as therapeutic communication that aim to support patients in finding meaning in their illness and managing their condition more effectively(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Consistent with the current findings, the study by Barlow and colleagues showed that various psychological interventions, including emotional support, relaxation-based therapies, and psychoeducational programs, had a positive impact on reducing anxiety and depression, while enhancing quality of life. This underscores the importance of integrating psychological support into routine care for patients with chronic conditions, particularly those undergoing hemodialysis(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In a related study examining the impact of therapeutic communication based on Peplau\u0026rsquo;s theory on anxiety and resilience, significant differences were observed between the intervention and control groups after the intervention. These findings suggest that educational interventions promoting therapeutic communication can be beneficial for patients with chronic illnesses and their caregivers(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). On the other hand, sense of coherence has a strong negative relationship with psychological issues such as anxiety. It also plays a key role in reducing disease burden and improving survival quality, particularly in patients with kidney diseases(\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In this study, the increase in sense of coherence was likely due to the opportunity provided by therapeutic communication, allowing patients to better understand the challenges of living with hemodialysis and to find new meaning in their lives. This enhancement in coherence may reduce psychological stress and improve quality of life, aligning with previous research. Chronic kidney failure and its long-term treatments, including hemodialysis, expose patients to physical, social, and psychological limitations that can ultimately lead to feelings of meaninglessness and hopelessness(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). The findings of this study also highlight the importance of non-pharmacological interventions and emphasize the enhanced role of nurses within the healthcare team. Given their close and continuous interaction with patients, nurses can play a significant role in strengthening patients' sense of coherence and improving their quality of life.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eA key strength of this study is the use of Peplau\u0026rsquo;s psychosocial intervention, which is both cost-effective and practical, making it accessible for widespread implementation in clinical settings. Additionally, the intervention\u0026rsquo;s simplicity requiring no special equipment enhances its feasibility for patients with chronic kidney disease undergoing hemodialysis, who often face multiple physical and psychological challenges. This strengthens the potential impact and applicability of the findings in real-world healthcare environments. However, implementation of this theory relies heavily on the availability and training of nursing staff skilled in therapeutic communication. Without adequate staff training and time allocation, the effectiveness of the intervention may be reduced. Additionally, the intervention\u0026rsquo;s simplicity might overlook more complex psychological needs that require specialized mental health support.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings of this study indicate that therapeutic communication based on Peplau\u0026rsquo;s model positively influences both psychological well-being and sense of coherence in patients with chronic kidney disease undergoing hemodialysis. This approach can be considered an effective supportive intervention to improve mental health outcomes in this patient population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANOVA \u0026nbsp; Analysis of variance\u003c/p\u003e\n\u003cp\u003eSOC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Sense of Coherence\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to all the patients who participated in this study, as well as the nursing staff and management of Hajar Hospital in Shahrekord for their valuable cooperation and support throughout the research process. This study would not have been possible without their generous assistance and commitment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors played a role in carrying out the study and preparing the manuscript. The study was designed and initiated by FT, AH, and SHS. FT took the lead in conducting the research, collecting and analyzing the data, and preparing and submitting the initial draft. AH was responsible for overseeing the study\u0026rsquo;s quality assurance. Both AHand SHS reviewed, edited, and contributed to the revision of the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of Shahrekord University of Medical Sciences, with the ethics code IR.SKUMS.REC.1403.033. All patients were provided with detailed information about the study\u0026apos;s purpose and procedures. Informed consent was obtained from each participant, and all processes were carried out in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is funded by Shahrekord University of Medical Sciences, and the grant number is 7182.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analyzed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eseyed-mazhari marjaan. Brunner and Suddarth\u0026rsquo;s Textbook of Medical-Surgical Nursing, kidney disease chapter. Tehran. Iran: Boshra Publication; 2008.\u003c/li\u003e\n \u003cli\u003eFrancis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol. 2024;20(7):473\u0026ndash;85.\u003c/li\u003e\n \u003cli\u003eAlvand S, Abolnezhadian F, Alatab S, Mohammadi Z, Hayati F, Noori M, et al. Prevalence of impaired renal function and determinants in the southwest of Iran. Bmc Nephrol. 2021;22(1):1\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003eGhelichi-Ghojogh M, Fararouei M, Seif M, Pakfetrat M. Chronic kidney disease and its health-related factors: a case-control study. Bmc Nephrol. 2022;23(1):1\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eOuyang W, Chen H, Xu X, Zhang X, Fu L, Tang F, et al. Self-management program for patients with chronic kidney disease (SMP-CKD) in Southern China: protocol for an ambispective cohort study. Bmc Nephrol. 2022;23(1):1\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eGuan Y, He Y. Effect of advanced care on psychological condition in patients with chronic renal failure undergoing hemodialysis: A protocol of a systematic review. Medicine (Baltimore). 2019;98(10).\u003c/li\u003e\n \u003cli\u003eGhasemi Bahraseman Z, Mangolian Shahrbabaki P, Nouhi E. The impact of stress management training on stress-related coping strategies and self-efficacy in hemodialysis patients: a randomized controlled clinical trial. BMC Psychol. 2021;9(1):1\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eJafari H, Ebrahimi A, Aghaei A, Khatony A. The relationship between care burden and quality of life in caregivers of hemodialysis patients. Bmc Nephrol. 2018;19(1):1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eRezaei Z, Jalali A, Jalali R, Khaledi-Paveh B. Psychological problems as the major cause of fatigue in clients undergoing hemodialysis: A qualitative study. Int J Nurs Sci. 2018;5(3):262\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eNajafi I, arjomand mohsen, sarateli aeidin. Principles of Internal Medicine, Kidney disease. Arjmand publication; 2010.\u003c/li\u003e\n \u003cli\u003eAini N, Wahyu AC. The correlation between family support and psychological well-being in patients with end-stage renal disease. Kontak; 2020.\u003c/li\u003e\n \u003cli\u003eMugi E, Githemo G, Wala J. Psychological Stressors among Hemodialysis Patients in Selected County Dialysis Centre\u0026rsquo;s in Kenya. Nur Prim Care. 2021;5(1):1\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eAhmad MM, Al Nazly EK. Hemodialysis: Stressors and coping strategies. Psychol Health Med. 2015;20(4):477\u0026ndash;87.\u003c/li\u003e\n \u003cli\u003eMc Gee SL, H\u0026ouml;ltge J, Maercker A, Thoma M V. Sense of coherence and stress-related resilience: Investigating the mediating and moderating mechanisms in the development of resilience following stress or adversity. Front Psychiatry. 2018;9:378.\u003c/li\u003e\n \u003cli\u003eEndler PC, Haug TM, Spranger H. Sense of Coherence and Physical Health. A \u0026ldquo;Copenhagen Interpretation\u0026rdquo; of Antonovsky\u0026prime; s SOC Concept. Sci World J. 2008;8(1):451\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eUzdil N, Ceyhan \u0026Ouml;, Şimşek N. The effect of salutogenesis‐based care on the sense of coherence in peritoneal dialysis patients. J Clin Nurs. 2022;31(1\u0026ndash;2):184\u0026ndash;95.\u003c/li\u003e\n \u003cli\u003eSawma T, Sanjab Y. The association between sense of coherence and quality of life: a cross-sectional study in a sample of patients on hemodialysis. BMC Psychol. 2022;10(1):1\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003eSong Y, Chen L, Wang W, Yang D, Jiang X. Social Support, Sense of Coherence, and Self-Management among Hemodialysis Patients. West J Nurs Res. 2022;44(4):367\u0026ndash;74.\u003c/li\u003e\n \u003cli\u003eNilsson KW, Leppert J, Simonsson B, Starrin B. Sense of coherence and psychological well-being: improvement with age. J Epidemiol community Heal. 2010;64(4):347\u0026ndash;52.\u003c/li\u003e\n \u003cli\u003eGiglio RE, Rodriguez-Blazquez C, de Pedro-Cuesta J, Forjaz MJ. Sense of coherence and health of community-dwelling older adults in Spain. Int Psychogeriatrics. 2015;27(4):621\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eBoehm JK, Kubzansky LD. The heart\u0026rsquo;s content: the association between positive psychological well-being and cardiovascular health. Psychol Bull. 2012;138(4):655.\u003c/li\u003e\n \u003cli\u003eRyff CD. Psychological well-being in adult life. Curr Dir Psychol Sci. 1995;4(4):99\u0026ndash;104.\u003c/li\u003e\n \u003cli\u003eRyff CD, Singer B. Psychological well-being: Meaning, measurement, and implications for psychotherapy research. Psychother Psychosom. 1996;65(1):14\u0026ndash;23.\u003c/li\u003e\n \u003cli\u003eDąbrowska-Bender M, Dykowska G, Żuk W, Milewska M, Staniszewska A. The impact on quality of life of dialysis patients with renal insufficiency. Patient Prefer Adherence. 2018;12:577.\u003c/li\u003e\n \u003cli\u003eBarello S, Anderson G, Acampora M, Bosio C, Guida E, Irace V, et al. The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: A systematic review and a meta-analysis. Int Urol Nephrol. 2023;55(4):897\u0026ndash;912.\u003c/li\u003e\n \u003cli\u003ede Oliveira AM, Soares E. COMMUNICATION IN THE INTERPERSONAL RELATIONSHIP NURSE/PATIENT WITH AN INDICATION FOR KIDNEY TRANSPLANT. Ciencia, Cuid e Saude. 2016;15(4).\u003c/li\u003e\n \u003cli\u003eLederer S, Fischer MJ, Gordon HS, Wadhwa A, Popli S, Gordon EJ. Barriers to effective communication between veterans with chronic kidney disease and their healthcare providers. Clin Kidney J. 2015;8(6):766\u0026ndash;71.\u003c/li\u003e\n \u003cli\u003eMaghsoodi S, Zarea K, Haghighizadeh M-H, Dashtbozorgi B. The Effect of Using Peplau\u0026rsquo;s Therapeutic Relationship Model on Anxiety of Coronary Artery Bypass Graft Surgery Candidates. Jundishapur J Chronic Dis Care. 2014;3(3).\u003c/li\u003e\n \u003cli\u003ePeplau HE. Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. Bloomsbury Publishing; 1988.\u003c/li\u003e\n \u003cli\u003eAbdi A, Dalvand S, Vahedian-Azimi A, Gheshlagh RG, Kurdi A. Prevalence of depression among Iranian patients under hemodialysis: a systematic review and meta-analysis. J Nephropathol. 2018;7(4):224\u0026ndash;32.\u003c/li\u003e\n \u003cli\u003eArabacı LB, Taş G. Effect of Using Peplau\u0026rsquo;s Interpersonal Relation Nursing Model in the care of a juvenile delinquent. J Psychiatr Nursing/Psikiyatri Hemsireleri Dern. 2019;10(3).\u003c/li\u003e\n \u003cli\u003ePeplau HE. Peplau\u0026rsquo;s theory of interpersonal relations. Nurs Sci Q. 1997/01/01. 1997;10(4):162\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eFawcett J, Desanto-Madeya S. Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. Fa Davis; 2012.\u003c/li\u003e\n \u003cli\u003eMcCarthy CT, Aquino-Russell C. A comparison of two nursing theories in practice: Peplau and Parse. Nurs Sci Q. 2009;22(1):34\u0026ndash;40.\u003c/li\u003e\n \u003cli\u003eCheraghi F, khatiban mahnaz, Borzou S, hosayni parasto, Vatandost S. Application of Peplau\u0026rsquo;s theory of Interpersonal Relations in Nursing Practice: A systematic review study. Sci J Nursing, Midwifery Paramed Fac. 2017;3:1\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eMoradi S, Fallahi-Khoshknab M, Rahgoi A, Vahedi M. The effect of Therapeutic Communication based Peplau\u0026rsquo;s theory on anxiety and Resilience of patients admitted to the corona ward of Khatam Al-Anbia Hospital in Tehran. Iran J Nurs Res. 2023;18(2):17\u0026ndash;27.\u003c/li\u003e\n \u003cli\u003eMahammadzadeh A, Poursharifi H, Alipour A. Validation of Sense of Coherence (SOC) 13-item scale in Iranian sample. Procedia-Social Behav Sci. 2010;5:1451\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eAntonovsky A. The structure and properties of the sense of coherence scale. Soc Sci Med. 1993;36(6):725\u0026ndash;33.\u003c/li\u003e\n \u003cli\u003eyasaei sekeh masoomeh, Shafiabadi A, Farzad V. Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) on psychological well-bing and Its Components in hemodialysis patients. Educ Res [Internet]. 2018;13(55):149\u0026ndash;62. Available from: https://edu.bojnourd.iau.ir/article_544682.html\u003c/li\u003e\n \u003cli\u003eRyff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol. 1989;57(6):1069.\u003c/li\u003e\n \u003cli\u003eKhanjani M, Shahidi S, Fathabadi J, Mazaheri MA, Shokri O. Factor structure and psychometric properties of the Ryff\u0026rsquo;s scale of Psychological well-being, short form (18-item) among male and female students. Thoughts Behav Clin Psychol. 2014;9(32):27\u0026ndash;36.\u003c/li\u003e\n \u003cli\u003eNegi S, Kaur H, Singh GM, Pugazhendi S. Quality of nurse patient therapeutic communication and overall patient satisfaction during their hospitalization stay. Int J Med Sci Public Heal. 2017;6(4):1.\u003c/li\u003e\n \u003cli\u003eKakavand A, Keshavarz S, Dashtdar H, Shirmohammadi F. Relationships between Perceived Social Support and Self-Sufficiency with Psychological Well-Being in elderly patients with cardiovascular diseases: the Mediating Role of psychological capital. Med J mashhad Univ Med Sci [Internet]. 2020;63(4):2535\u0026ndash;45. Available from: https://mjms.mums.ac.ir/article_17184.html\u003c/li\u003e\n \u003cli\u003ePowathil GG, Kr A. Psychosocial Interventions for Persons with End-Stage Renal Disease-A Scoping Review. Soc Work Health Care. 2021;60(6\u0026ndash;7):481\u0026ndash;98.\u003c/li\u003e\n \u003cli\u003eJones DJW, Harvey K, Harris JP, Butler LT, Vaux EC. Understanding the impact of haemodialysis on UK National Health Service patients\u0026rsquo; well‐being: A qualitative investigation. J Clin Nurs. 2018;27(1\u0026ndash;2):193\u0026ndash;204.\u003c/li\u003e\n \u003cli\u003eMoradi S, Fallahi-Khoshknab M, Rahgoi A, Vahedi M. The effect of Therapeutic Communication based Peplau\u0026rsquo;s theory on anxiety and Resilience of patients admitted to the corona ward of Khatam Al-Anbia Hospital in Tehran. Iran J Nurs Res [Internet]. 2023;18(2):17\u0026ndash;27. Available from: http://ijnr.ir/article-1-2748-fa.html\u003c/li\u003e\n \u003cli\u003eBrownie S, Scott R, Rossiter R. Therapeutic communication and relationships in chronic and complex care. Nurs Stand. 2016;31(6).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"The Peplau Model, Hemodialysis, Sense of Coherence, Psychological Well-Being, Chronic Kidney Disease, Communication Therapy","lastPublishedDoi":"10.21203/rs.3.rs-6911240/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6911240/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Aim\u003c/strong\u003e: Hemodialysis is a stressful treatment for chronic kidney failure, often leading to psychological issues like anxiety and depression. Sense of coherence and psychological well-being are vital for coping with these stresses. This study aimed to evaluate the effect of therapeutic communication based on Peplau’s model on these parameters in hemodialysis patients\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This semi-experimental study involved patients with chronic kidney failure undergoing hemodialysis at Hajar Hospital in Shahrekord. Participants were randomly assigned to intervention (Peplau-based communication therapy) and control (routine care) groups. The intervention was delivered over 7–8 individual sessions. Data were collected using Antonovsky’s Sense of Coherence Scale and Ryff’s Psychological Well-Being Questionnaire, and analyzed with SPSS 28.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: There were no significant demographic differences between groups. In the intervention group, sense of coherence and psychological well-being scores significantly improved immediately and three months post-intervention (P\u0026lt;0.001). No significant changes were observed in the control group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Therapeutic communication based on Peplau’s model significantly enhanced psychological well-being and sense of coherence in hemodialysis patients. It is a practical and effective intervention to support mental health in this population.\u003c/p\u003e","manuscriptTitle":"The effect of communication therapy based on the Peplau model on sense of coherence and psychological well-being in people suffering from chronic renal failure undergoing hemodialysis: a quasi-experimental study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 11:04:27","doi":"10.21203/rs.3.rs-6911240/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-26T08:43:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-05T21:42:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-02T15:29:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62352443246323189824755938736089206704","date":"2025-08-02T14:25:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-31T17:41:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21275839674434442283875872688739635701","date":"2025-07-29T08:55:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336011071513106591494901257217221978151","date":"2025-07-25T12:57:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221108905799954857407588718628350450589","date":"2025-07-23T06:14:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-23T06:11:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-25T09:00:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-19T00:35:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-19T00:33:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-06-17T07:01:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"13e5a268-604f-4fbe-bcb2-bf98275e3ce7","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T08:38:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-25 11:04:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6911240","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6911240","identity":"rs-6911240","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}