Female patients undergoing dialysis treatment in the dialysis unit were given mandalas for 20-30 minutes and asked to paint during 6 dialysis session, personal information form, "Dialysis Symptom Index Scale", "Self-Care Power Scale for Chronic Dialysis Patients" were filled before and after the sixth dialysis session, t

Female patients undergoing dialysis treatment in the dialysis unit were informed about the study. Volunteer consent form, personal information form, "Dialysis Symptom Index Scale", "Self-Care Power Scale for Chronic Dialysis Patients" were filled at the beginning and after the sixth dialysis session

Female patients undergoing dialysis treatment in the dialysis unit were informed about the study. After women are informed about the effects of mandala application on health and how to paint mandala; voluntary consent form, personal information form, "Dialysis Symptom Index Scale", "Self-Care Power Scale for Chronic Dialysis Patients" were filled. One hour after the start of each dialysis session, the patients were given mandalas for 20-30 minutes and asked to paint. The women's own paints and mandalas were preserved for the next session. After the sixth dialysis session , the patients were asked to refill the scales with one-on-one interviews, and the verbal opinions and feedback of the patients about the application were taken.

Dialysis Symptom Index (DSI); The Dialysis Symptom Index (DSI) was developed by Weisbord et al. (2005) to determine the symptoms experienced by HD patients and the level of impact on patients. The Turkish reliability and validity of the scale was made by Önsöz and Yeşilbalkan (2013) and Cronbach's alpha value was reported as 0.84. DSI identifies 30 symptoms, either physical or emotional. In DSI, the symptoms experienced in the last week are answered as yes-no, and if the answer is yes, the extent to which the symptoms affected the patients who answered "yes" was evaluated as 0 = no, 1 = none, 2 = some, 3 = sometimes, 4 = very little, 5 = too much. The total scale score is obtained by adding the obtained scores. The score of the scale ranges from 0-150. The fact that the answers given to the scale increased towards 150 points indicates that the effect of the symptom in question increased. The internal consistency coefficient of the scale was determined as 0.84 (Usta, 2013).

The scale was developed by Besey Ören in 2010 for HD and peritoneal dialysis patients. The Self-Care Agency Scale is an easily understandable, 22-item, 3-point Likert-type scale. The items are scored as follows: 0=I always apply, 1=I sometimes apply, and 2=I do not apply at all. It was created for people to express their status of applying selfcare habits in their daily lives. The patient is asked to choose the most appropriate option for him. The total score obtainable from the tool ranges between 0 and 44. Subscale scores are obtained by summing the item scores under each subscale. Accordingly, scores obtainable from the subscales are 0-12 for the use of medicine, 0-10 for diet, 0-8 for self-monitoring, 0-4 for hygienic care, and 0-6 for mental state. It shows that as the score obtained from the scale decreases, self-care ability decreases.16 The α coefficient of the scale was 0.67.