Laughter Therapy Application in Hemodialysis Patients
Condition: Comfort; Acceptance Processes; Hemolysis; Laughter Therapy; Treatment Adherence; Patients
MeSH terms: Hemolysis
Study type: Interventional

Summary: 
      Background: A randomized controlled study was conducted on the effects of laughter therapy on
      increasing the acceptance of the disease, compliance with treatment and comfort levels in
      patients receiving hemodialysis treatment.

      Materials and methods: The study was conducted with 42 (experimental group=21, control
      group=21) patients treated in the hemodialysis unit. Eight sessions of laughter yoga were
      applied to the hemodialysis patients in the experimental group for four weeks, two days a
      week. Data were used on the Patient Information Form, the Acceptance Scale, the End Stage
      Renal Failure - Compliance Scale, and the Hemodialysis Comfort Scale.
    

Detailed description: 
      Kidney Failure is an important public health problem due to its increasing prevalence and
      high costs worldwide. Especially patients in the end stage of renal failure (ESRD) are faced
      with a life-threatening chronic disease. These patients need lifelong treatment and care to
      minimize the negative effects of impaired kidney function and to maintain life.

      In the treatment and recovery processes of chronic diseases such as kidney failure,
      individuals' acceptance of the disease, compliance with the treatment and their comfort level
      are very important. The stage of acceptance of the disease is when the individual learns to
      live with the chronic disease by adapting to various complications and changes related to the
      chronic disease. Not accepting the disease results in submission to the problems brought
      about by the disease and causes an increase in the sense of dependency and a decrease in the
      sense of self-efficacy and self-esteem. It is very difficult for patients with end-stage
      renal disease who receive hemodialysis (HD) treatment among chronic diseases to accept the
      disease because they are affected by many physical, mental, spiritual and social aspects. It
      has been reported that patients receiving HD treatment often experience problems in the
      acceptance process of the disease. In the literature, it has been emphasized that acceptance
      of the disease is effective in reducing the physical, psychosocial and emotional problems
      caused by HD treatment. In addition, it has been shown that accepting the disease is
      effective in increasing the quality of life by reducing symptoms such as fatigue,
      constipation, loss of appetite, sexual dysfunction and stress in HD patients. On the other
      hand, it has been determined that individuals with low acceptance level of the disease have
      increased complaints about the disease and treatment. In studies related to the subject, it
      has been determined that patients' acceptance of the disease is at different levels.

      Another important step in the treatment and recovery processes of chronic diseases is
      compliance with treatment. Compliance with treatment in the management of HD disease greatly
      affects the success of treatment. Compliance with treatment in HD patients; It is considered
      as compliance with fluid-diet-drug intake and participation in hemodialysis sessions. In
      studies, 55-77% of individuals receiving HD treatment have fluid restriction 30-70% diet
      restriction, 38-75% of drug intake and participation in 30-69% HD sessions have been found to
      have problems with it. This situation increases hospitalization, morbidity and mortality
      rates in individuals receiving HD treatment and creates a heavy burden on the health system.
      Therefore, it is important to increase patients' acceptance of the disease and their
      compliance with treatment.

      Many physical and psychosocial symptoms occur during the disease and treatment processes, and
      the care needs of individuals who experience physical, social, economic and psychological
      problems increase, and there is a significant decrease in the quality of life and comfort.
      Helping patients with their needs, providing peace and being able to overcome problems gain
      priority. Therefore, the comfort that defines this situation; plays an important role in the
      care of individuals with chronic diseases. Comfort; It is defined as meeting the needs of
      individuals, solving their problems, reaching the desired result and peace by considering
      them as a whole in terms of physical, psychological, social and environmental aspects. Today,
      many complications and unmet basic needs of individuals with chronic diseases affect their
      comfort levels negatively. In the studies conducted, the comfort level of individuals
      receiving HD treatment is low and moderate. In the literature, problems such as painful
      invasive procedures, fatigue, decrease in energy, itching, bone/joint pain, numbness or
      tingling in the feet, sleep problems, dry mouth, decreased sexual desire and arousal
      experienced by individuals who receive HD treatment can lower their comfort levels.
      negatively. In order for patients to cope with the problems related to HD treatment, the
      level of comfort needs to be increased.

      It is seen that some complementary methods are used in the literature to increase the health
      level of patients receiving HD treatment and to ensure that they can lead a quality life. One
      of these methods is laughter therapy. Laughter therapy; Developed in India in 1995, yoga is a
      group-based initiative that includes breathing exercises and simulated laughter. It is also a
      type of exercise done by singing songs, laughing for no reason and playing childish games.
      Laughter therapy for cardiovascular disease; irritable bowel syndrome, chronic obstructive
      pulmonary disease, diabetes, cancer. It has been dealt with many diseases such as and
      Parkinson's and it has been found to have beneficial effects on these diseases. In a
      randomized controlled experimental study conducted by Bennet et al. in patients receiving HD
      treatment, it was found that laughter therapy reduced the symptoms of depression. In the
      study of Sousa et al., it was determined that laughter therapy increases subjective happiness
      and significantly reduces symptoms of depression. In other studies conducted in patients
      receiving HD treatment, laughter therapy has positive effects on anxiety, depression, stress,
      and happiness was determined. There are also studies that show that laughter therapy
      regulates blood pressure in patients receiving HD treatment. In all these studies, it was
      observed that laughter therapy is a safe and feasible intervention in patients receiving HD
      treatment. When the literature is examined, no studies have been found on the effects of
      laughter therapy on the acceptance of the disease, compliance with the treatment and comfort
      level, although complementary methods are frequently used in studies on patients. In this
      direction, it was aimed to evaluate the effects of laughter therapy on acceptance of the
      disease, compliance with treatment and comfort levels in patients receiving HD treatment.
    

Intervention name(s): Laughter Therapy; Control
Intervention type(s): Behavioral; Other
Intervention description(s): In this study, laughter therapy was applied to the experimental group three times a week (on Mondays, Wednesdays, and Fridays) for a total of 12 sessions. Each session started with other patients in the HD unit while the patient was receiving HD treatment (1 hour after HD started) and lasted 30-45 minutes. The number of patients who will take part in each laughter session is based on the number of patients attending that session in the hemodialysis unit.; The patients in the control group, on the other hand, did not undergo any intervention other than their routine treatment and care. Laughter therapy was applied for four weeks to HD patients in the control group who wanted the results of the research.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: While the patients were randomized; In order to keep the possibility of being affected by each other at a minimum level, the work was continued with the same application group in the same session group. 72 days in universe, hemodialysis days and sessions at time of day, next Wednesday, Friday = 36 patients); Tuesday, Thursday, evening patient control (n=36 patients are guided by the drawing method.
Masking: None (Open Label)
Primary purpose: Supportive Care