Discussion
HYPERTENSION, COMPLICATIONS, ACUTE CORONARY SYNDROME
This study aimed to determine the role of a self-management program based on the 5 A nursing intervention model in the quality of life of hemodialysis patients. According to the findings, there were significant differences between the two groups after the intervention regarding the specific dimensions of life quality, such as cognitive performance, symptoms, sleeping status, dialysis, social support, and renal complications. Farbod et al. (2019) analyzed the effects of a 5 A self-management model on the quality of life of patients with hypertension. They reported that the mean scores of different areas of quality of life (physical, psychological, social, and environmental) and the total score of quality of life increased significantly in the intervention group as opposed to the control group after the intervention [The total score of the general quality of life significantly increased among the patients in the intervention group; however, it significantly decreased in the control group. These findings indicated a significant difference between the two groups regarding the quality of life scores in all dimensions. In other words, most of the scores were improved in the intervention group; however, the scores declined in the control group. In fact, the intervention improved the general quality of life scores significantly in most dimensions. Ginanjar et al. (2017) used cell phones and the 5 A model to enhance the quality of life among patients with hypertension. According to their results, the scores of patients increased on all In line with other studies, this survey indicated the favorable effects of the 5 A model on the quality of life of many patients with chronic conditions due to its person-based characteristics. The declined quality of life scores in the control group could be attributed to the specific sampling conditions. Many patients had constraints in attending the group sessions and doctor visits due to the public instructions during the COVID-19 pandemic, which could affect their quality of life.Contrary to the survey by Javanoosh et al. (2016) examining the effect of the self-management program based on the 5 A model on the quality of life of the elderly with acute coronary syndrome, the results showed an increase in the average scores of all aspects of the quality of life in the intervention group, but, this increase was not statistically significant. This lack of significance can be due to the old age of the participants, as many factors are influential in their quality of life, and many functions and activities are reduced and declined per se due to the nature of acute coronary syndrome [In addition to imposing high costs and excessive burdens on society due to side effects and dependence on health centers, hemodialysis can cause unfavorable changes to the quality of life. The first step in the 5 A model is based on a patient’s personal assessment, and each patient’s conditions and problems are considered in all steps. Hence, this model should be applied to hemodialysis patients more often. Moreover, non-attendance follow-ups via phone can help identify at-risk cases and prevent re-hospitalization or the emergence of risk factors in patients before the onset of a condition.The researcher did not find any study investigating the effect of the self-management program based on the 5 A model on the quality of life of hemodialysis patients, and this study is one of the newest in this field. Therefore, we recommend using this model to improve the quality of life of dialysis patients. Also, we need more studies with larger samples.This study faced certain limitations. For instance, there was only one dialysis center in the designated city; thus, the research team had to perform sampling in only one ward. Despite the iterated research emphasis, this limitation may have led to the distribution and sharing of information between the two groups, accounting for the insignificance of some dimensions. Moreover, many factors the researcher could not control may have affected the quality of life.