¿Cómo influye en los pacientes crónicos de hemodiálisis la organización de actividades de ocio durante sus sesiones?

Abstract

The search for the satisfaction of the chronic patient in hemodialysis and the improvement of his quality of life is an objective studied in recent years. Work addressing this perspective has multiplied in the face of evidence that patients in this treatment are subjected to multiple physical and psychosocial stressors that require the activation of a series of coping strategies, not only to cope with the demands and changes in lifestyle caused by the disease, but also to deal with its psychological effects, such as uncertainty, fear and lack of control1. It is noted that, in general, the nurse is better prepared for the technical aspects of treatment and the physiological parameters of the patient than for the patient's mental state. Sometimes action is taken when the symptoms are evident and do not help to prevent them. Health professionals tend to assume that the assessment they make of the state of health and Quality of Life of the patients in their care is consistent with that of the patients themselves. However, several studies indicate that there are discrepancies. Subjective aspects such as pain, anxiety and depression are where there is less agreement between nurse and patient2. The diversity of patients in a haemodialysis unit must be taken into account. They differ from one another according to different important parameters that must be taken into account when addressing levels of mental health and that, at the same time, will influence the strategies that the patient will use to improve his or her situation: seniority, concomitant diseases or pluripathology, age, sex, option for a kidney transplant, vascular access, hours of session duration, higher level of studies, having developed a more qualified work activity, having more limitations to carry out work activities, more pain or discomfort, or more anxiety or depression decreases satisfaction in a statistically significant way5. Quality of Life is worse in those over 65 years old and with a temporary catheter6. Patients who have been on dialysis for less time mobilise the search for social support. They also resort more to distraction, trying not to think too much about their problem. Thus, using the company of others to distract themselves or carry out activities that are pleasurable has positive effects because it helps to focus attention on other aspects by reducing negative emotions and repetitive thoughts (rumination). On the contrary, it seems that those who take more time tend to be socially isolated and confrontational, i.e. they try to avoid being with others and acknowledge that they are more angry about their situation. Stress maintained over time together with emotional inhibition and anger produces low immune response and increased depression. Unlike other chronic patients, people on dialysis show a worsening of psychological well-being over time³.