The Effects of Face-to-face and Tele-nursing Education on Fatigue, Pain, Sleep, and Urinary Tract Infections in Patients With Multiple Sclerosis.

Investigation of the Effects of Education Provided Through Face-to-face and Tele-nursing Based on Pender's Health Promotion Model on Fatigue, Pain, Sleep, and Urinary Tract Infections ın Patients With Multiple Sclerosis: a Randomized Controlled Trial.

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.

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.

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.