Multiple Sclerosis, Education, Symptom Management
Conditions
Keywords
multiple sclerosis, fatigue, pain, sleep, urinary tract infections
Brief summary
The aim of this study is to evaluate the effects of face-to-face and distance nursing education, based on Pender's Health Promotion Model, on fatigue, pain, sleep, and urinary tract infections in MS patients who applied to the Multiple Sclerosis Outpatient Clinics of Sakarya Training and Research Hospital. With this research, the researcher aims to reduce MS symptoms and severity, prevent secondary problems, and improve quality of life.
Detailed description
Education is a crucial aspect of disease management in MS patients. A strategy aimed at improving patients' health and health behaviors, education provides benefits such as increasing their quality of life, self-efficacy, and confidence in ongoing care, reducing anxiety and stress, decreasing the frequency of disease symptoms, increasing patient participation in care plans, and improving their autonomy and self-management. Selecting the appropriate educational model is the first step in educational planning, and one of the most comprehensive and widely used models offered by nurses for patient education is Pender's Health Promotion Model. Introduced by Pender in 1982, Pender's Health Promotion Model (HPLP) focuses on enabling people to achieve higher levels of well-being. The model encompasses six areas of health promotion, including nutrition, physical activity (exercise), health responsibility, stress management, interpersonal relationships, and self-actualization, as well as the factors that influence these areas. Telenursing is a method that allows nurses to receive training to improve nursing services and enhance patient well-being. Telenursing is considered a component of telemedicine and, by definition, enables nurses to meet patients' healthcare needs through information and communication technologies. Telenursing offers a tool for providing continuous care to patients with chronic illnesses. This allows patients to receive the care they need without the need for long journeys, at a low cost, and in a way that positively impacts their recovery process.
Interventions
OTHERtelenursing
The nurse researcher developed training modules for MS symptoms (pain, fatigue, sleep, and urinary tract infections) in consultation with experts. These training modules were then presented via an online application (e.g., WhatsApp software or internet access address creation) with the approval and support of training and IT experts. In this context, volunteer patients who met the study criteria received training three days a week for six weeks via telenursing. Furthermore, as part of the telenursing program, patients were given the opportunity to call the researcher for 10-15 minutes from 8 a.m. to 8 p.m. on weekdays if they needed telephone consultation (Dehghani et al., 2023).
A focus group training program was planned for patients who met the study inclusion criteria during the MS Outpatient Clinic Days (Tuesday-Thursday, 9:00-16:00) at Sakarya Training and Research Hospital. The training, prepared according to Pender's Health Promotion Model , was provided by the research nurse. The literature suggests that the ideal number of focus group interviews should be 4-10 people, and that the number of groups should not exceed 10 to facilitate group dynamics and interaction. In our study, a total of 3-5 focus group training sessions were conducted (Öner and Karabudak, 2021; Çokluk et al., 2011).
OTHERControl arm
The control group received no intervention, and patients continued to receive their routine treatments. At the end of the study, volunteers in the control group received an Pender's Health Promotion Model-based education program prepared by the research nurse, either face-to-face or via telenursing, at their request.
Sponsors
ugurlu
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
Because participants and researchers are aware of the assigned groups, double-blinding is not possible. However, study evaluation and scale scoring will be masked wherever possible. The MS medical support team who assisted with survey completion and the statistician who evaluated the data are blinded to the study. (Both groups will be blinded.) Data will be analyzed after the study is completed to support blinding.
Intervention model description
The study population will consist of patients diagnosed with MS who present to the Multiple Sclerosis Outpatient Clinics of the Department of Neurology at Sakarya Education and Research Hospital. A total of 3,552 patients have been admitted to the Multiple Sclerosis Outpatient Clinics in the last year. Participants will be assigned to the intervention and control groups according to their order of presentation to the clinic, using computer-assisted block randomization to ensure an equal and homogeneous number of participants in each group. Considering the possibility of participants who did not meet the study criteria withdrawing from the study, 90 randomly selected participants from the population will be randomly assigned to the experimental and control groups (Group 1, Group 2, and Group 3), each consisting of 30 patients with MS.
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* Patients who are willing to participate in the study, * Age between 18-55, * Literate, * Diagnosed at least 1 year ago, * Diagnosed with Relapsing-Remitting MS (the most common type, RRMS, which progresses with attacks and remissions), * A specialist (psychologist or psychiatrist) has determined that their cognitive level is suitable for participation in the study, * Scoring their pain 4 points or higher on the Visual Analog Scale (VAS), * Scoring 4 or higher on the Fatigue Severity Scale (FSS), * Scoring 10 or higher on the Epworth Sleepiness Scale (ESS), * Having not used any other complementary and alternative treatments in the last 6 months, * Patients who own or have a family member who owns a smartphone, tablet, or computer will be included (Eren, 2018).
Exclusion criteria
* Patients who are unwilling to participate in the study for any reason, * Have a communication disability, * Have a hearing or visual impairment, * Have failed to attend three consecutive training sessions unless medically indicated, * Have not completed 70% of the training program (or 17 of 24 sessions) (Alonso Martínez et al., 2023), * Have developed serious physical or mental illnesses during the study period, * Have been found to be unsuitable for participation in the study (as assessed by a psychologist or psychiatrist), * Have used other complementary therapies such as acupuncture, yoga, meditation, etc. during the study period, * Have been in an attack phase of the disease or have conditions requiring hospitalization during the intervention will not be included in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| TELENURSING EDUCATION | Up to the 12th week after educational interventions | Based on Pender's Health Enhancement Model, telenursing provides education to MS patients, reducing patient fatigue, pain intensity, and urinary tract infections, while improving patient sleep quality. 1\. The total score obtained from the application of fatigue technology (FSS) is reduced as it decreases; a higher score indicates increased fatigue. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| FACE TO FACE EDUCATION | Up to the 12th week after educational interventions | Pender's face-to-face patent training, based on his health improvement model, reduces pain, pain crying, and exhaustion in MS patients while also improving sleep quality. 1\. The total score obtained from the application of fatigue technology (FSS) is reduced as it decreases; a higher score indicates increased fatigue. |
Countries
Turkey (Türkiye)
Outcome results
None listed