The aim of the study is to verify the mediating effect of life of meaning and post-traumatic growth in spirituality and psychological well-being (happiness, depression).

The research design is cross-sectional correlational study. Convenient sampling will be used to conduct to data collection. There are 300 patients with hemodialysis from a hemodialysis institution in the north Taiwan, and data collecting with self-administrated questionnaires. The instruments include demographic and disease-related information, Spiritual Health Scale short form, Chinese Happiness Inventory, Beck Depression Inventory-II, Life Attitude Profile, Posttraumatic Growth Inventory. The SPSS 22.0 statistical software will be used to analyze the data. Descriptive statistics, such as frequency, percentage, mean, and standard deviation (SD) will be used for participant characteristics and outcome measures. T-test, chi-square, ANOVA, post-hoc, ANCOVA, and Person's correlation will be conducted to test the relationships between the research variables.

Inclusion Criteria:

• Patients who are over 20 years old
• voluntarily participate in the study and sign the respondent consent form
• have received routine hemodialysis treatment for more than three months
• have clear consciousness and can communicate in Mandarin and Taiwanese.

Exclusion Criteria:

• Patients whose medical records record a diagnosis of schizophrenia
• patients are taking antidepressant drugs

adults with regularly hemodylysis