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Abstract
Objective: To evaluate whether visualization of humor movies during hemodialysis sessions improves subjective well-being and sense of humor, while decreasing stress / anxiety and depression levels, in hemodialysis patients. Material and Method: A pre-test / post-test design study with a non-equivalent control group was carried out in patients with chronic kidney disease undergoing hemodialysis, in two hemodialysis units of Diaverum Clinics. The study included 34 patients in the intervention group and 33 patients in the control group. The intervention consisted in the visualization of humor movies during hemodialysis sessions for ten sessions over a four-week period. The control group watched neutral movies. Data were collected using a sociodemographic and health information questionnaire (age, gender, nationality, education, occupation, marital status, dialysis session length, presence of hypertension and diabetes); the Subjective Happiness Scale; the satisfaction with life in general; the Depression Anxiety Stress Scale 21, and the Multidimensional Sense of Humor Scale. Student t-tests and t-tests for paired samples were performed. The response to change was evaluated using: the percentage of change, ceiling effect and floor effect, effect size, and the standardized response mean. Results: The levels of subjective happiness and sense of humor increased in the intervention group, but there were no significant increases in satisfaction with life in general. Only depression levels decreased significantly in the intervention group. Conclusions: The visualization of humor movies as a nursing intervention improved the levels of subjective happiness and sense of humor, while decreasing the perception of depressive symptoms.
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References
- Costa FG, Coutinho MPL. Hemodiálise e depressão: representação social dos pacientes. Psicol Estud. 2014;19(4),657-67. doi:10.1590/1413-73722381608.
- Moya Ruiz MA. Estudio del estado emocional de los pacientes en hemodiálisis. Enferm Nefrol. 2017 En-Mar;20(1):48-56.
- Sousa LM, Antunes AV, Baixinho CR, Severino SS, Marques-Vieira C, José HM. Subjective Wellbeing Assessment in People with Chronic Kidney Disease Undergoing Hemodialysis. In: Rath T, editor. Chronic Kidney Disease: from Pathophysiology to Clinical Improvements. InTechOpen; 2018. p.281-93.
- Mesa-Melgarejo L, Carrillo-Algarra AJ, Castiblanco RA, Reina LM, Ávila TM. Terapias de sustitución de la función renal: metaestudio y síntesis de evidencias cualitativas. Aquichan. 2017;17(3):328-52.
- Sousa LM, Antunes AV, Marques-Vieira CM, Valentim OS, José HM. Qualidade de vida e pessoa com doença renal crónica: um estudo transversal. In: R Missias-Moreira, ZN Sales, LCG Nascimento, OS Valentim, editors. Qualidade de vida e condições de saúde de diversas populações. Curitiba: Editora CRV; 2017(2):139-54.
- Bennett PN, Parsons T, Ben-Moshe R, Neal M, Weinberg MK, Gilbert K, et al. Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study. BMC Complement AlternMed. 2015 Jun 9; 15:176-82.
- Mehrabi Y, Ghazavi Z, Shahgholian N. Effect of fordyce’s happiness program on stress, anxiety, and depression among the patients undergoing hemodialysis. Iran J Nurs Midwifery Res. 2017 May-Jun; 22(3):190-4.
- Martin RA. Humor, laughter, and physical health: methodological issues and research findings. Psychol Bull. 2001 Jul;127(4):504-19. doi:10.1037/0033-2909.127.4.504.
- Sousa LM, Marques-Veira C, Severino SS, Pozo-Rosado JL, José HM. Fatores explicativos da apreciação de filmes cómicos em pessoas com doença renal crónica. Rev Inv Enferm. 2016 Apr; (15):49-55.
- Lyubomirsky S, Lepper HS. A measure of subjective happiness: Preliminary reliability and construct validation. Soc Ind Res. 1999 Feb 1;46(2):137-55. doi: 10.1023/A:1006824100041.
- Pais-Ribeiro JL. Validação transcultural da Escala de Felicidade Subjectiva de Lyubomirsky e Lepper. Psicol Saúde Doenças [Internet]. 2012 [cited 2018 Sep 10]; 13 (2): 157-168. Available from: http://www.scielo.mec.pt/scielo.php?pid=S1645-00862012000200003&script=sci_arttext&tlng=es.
- Sousa LM, Vieira CM, Severino SS, Pozo-Rosado JL, José HM. Validation of the Subjective Happiness Scale in people with Chronic Kidney Disease. Enferm Global. 2017 Jul; 16 (3):60-70.: doi:10.6018/eglobal.16.3.266571.
- Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994 Mar [cited 2018 Sep 10];23(2):129-38. Available from: https://psycnet.apa.org/record/2015-49222-001.
- Ferreira-Valente MA, Pais Ribeiro JL, Jensen MP. Contribución adicional para la validación de la versión portuguesa de la Escala de Interferencia del Inventario Breve de Dolor. Clín Salud. 2012 Mar [cited 2018 Sep 10];23(1):89-96. Available from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-52742012000100005.
- Sousa LMM, Marques-Vieira CMA, Severino SSP, Pozo Rosado JL, José, MHG. Validación del Índice de Bien-estar Personal en personas con enfermedad renal crónica. Enferm Nefrol. 2016 Jun; 19(2):135-41. doi:10.4321/S2254-28842016000200005.
- Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995 Mar 1;33(3):335-43. doi:10.1016/0005-7967(94)00075-U.
- Pais-Ribeiro JL, Honrado A, Leal I. Contribuição para o estudo da adaptação portuguesa das escalas de ansiedade, depressão e stress (EADS) de 21 itens de Lovibond e Lovibond. Psicol Saúde Doenças. 2004 Nov [cited 2018 Sep 10];5(2):229-39. Available from: http://www.scielo.mec.pt/scielo.php?pid=S1645-00862004000200007&script=sci_arttext&tlng=en.
- Sousa LM, Marques-Vieira CM, Severino SS, Pozo-Rosado JL, Gomes JC, José HM. A Depression Anxiety Stress Scale em pessoas com doença renal crónica. Rev Port Enferm Saude Ment. 2017 Jun; 17:50-7.: doi:10.19131/rpesm.0182.
- Thorson JA, Powell FC. Development and validation of a multidimensional sense of humor scale. J Clinic Psychol. 1993 Jan;49(1):13-23. doi:10.1002/1097-4679(199301)49:1<13::AID-JCLP2270490103>3.0.CO;2-S.
- José H, Parreira P. Adaptação para Português da Escala Multidimensional do Sentido de Humor MSHS. Referência.[Internet]. 2008 [cited 2018 Sep 10];6:7-18. Available from: http://hdl.handle.net/10400.14/7524.
- Sousa LMM, Marques-Vieira CM, Severino S, Pozo-Rosado J, Antunes AV, José H. Validation of the multidimensional sense of humor scale in people with chronic kidney disease. J Nurs Educ Pract. 2018; 8(3):72-9. doi:10.5430/jnep.v8n3p72.
- Moussa MT, Lovibond P, Laube R, Megahead HA. Psychometric properties of an arabic version of the depression anxiety stress scales (DASS). Res Soc Work Pract. 2017 May;27(3):375-86. doi:10.1177/1049731516662916.
- Sousa LM, Marques-Vieira C, Severino S, Caldeira S. Propriedades psicométricas de instrumentos de avaliação para a investigação e prática dos enfermeiros de reabilitação. In C. Marques-Vieira, L. Sousa (Eds). Cuidados de Enfermagem de Reabilitação à Pessoa ao Longo da Vida. Loures: Lusodidacta. 2017:113-122.
- Angst F, Goldhahn J, Drerup S, Kolling C, Aeschlimann A, Simmen BR, S et al. Responsiveness of five outcome measurement instruments in total elbow arthroplasty. Arthritis Care Res. 2012 Nov;64(11):1749-55.
- Guedes CR, Alvarenga BD, Rotella I, Vilella DV. Habilidades do Enfermeiro no Diagnóstico e Cuidado ao Portador de Depressão/Nursing Skills in Diagnosis and Care For Patients With Depression. Rev Ciênc Saúde. 2015;5(4):13-9. doi:10.21876/rcsfmit.v5i4.402.
- Ganz FD, Jacobs JM. The effect of humor on elder mental and physical health. Geriatr Nurs. 2014 May; 35(3):205-11.
- Ko HJ, Youn CH. Effects of laughter therapy on depression, cognition and sleep among the community dwelling elderly. Geriatr Gerontol Int. 2011 Jul;11(3):267-74.
- Beh-Pajooh A, Jahangiri M, Zahrakar K. Humor skills training and reducing depression in patients with spinal cord injury. J Iran Psychol. 2010; 6(1):227-36.
- Low LF, Goodenough B, Fletcher J, Xu K, Casey AN, Chenoweth L, et al. The effects of humor therapy on nursing home residents measured using observational methods: The SMILE cluster randomized trial. J Am Med Dir Assoc. 2014; 15(8):564-9.
- Tse MM, Lo AP, Cheng TL, Chan EK, Chan AH, Chung HS. Humor Therapy: Relieving Chronic Pain and Enhancing Happiness for Older Adults. J Aging Res. 2010;33:1-9.
- Ghodsbin F, Jahanbin I, Sharif F. The effects of laughter therapy on general health of elderly people referring to jahandidegan community center in shiraz, iran, 2014: a randomized controlled trial. Int J community based Nurs midwifery. 2015 Jan; 3(1):31-8.
- Low LF, Brodaty H, Goodenough B, Spitzer P, Bell JP, Fleming R, et al. The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes. BMJ open. 2013 Jan; 1;3(1):e002072.
- José H, Parreira P. Adaptação para Português da Escala Multidimensional do Sentido de Humor MSHS. Referência. 2008;SII(6):7-18.
- Sousa LM, José HM. Benefícios do humor na saúde Revisão Sistemática da Literatura. Enformação. 2016;7:22-32.
- Wellenzohn S, Proyer RT, Ruch W. Humor-based online positive psychology interventions: a randomized placebo-controlled long-term trial. J Posit Psychol. 2016 Nov;11(6):584-94. doi:10.1080/17439760.2015.1137624.
- Bennett PN, Parsons T, Ben-Moshe R, Weinberg M, Neal M, Gilbert K, et al. Laughter and humor therapy in dialysis. Sem Dial. 2014 Sep;27(5):488-93.
- Herdman HT, Kamitsuru S, (eds). Nursing Diagnoses: Definitions & Classification 2018-2020. 11th ed. Stuttgart: Thieme; 2017:184-383.
- International Council of Nurse. International Classification for Nursing Practice (ICNP®). Geneva: International Council of Nurse; 2015.
References
Costa FG, Coutinho MPL. Hemodiálise e depressão: representação social dos pacientes. Psicol Estud. 2014;19(4),657-67. doi:10.1590/1413-73722381608.
Moya Ruiz MA. Estudio del estado emocional de los pacientes en hemodiálisis. Enferm Nefrol. 2017 En-Mar;20(1):48-56.
Sousa LM, Antunes AV, Baixinho CR, Severino SS, Marques-Vieira C, José HM. Subjective Wellbeing Assessment in People with Chronic Kidney Disease Undergoing Hemodialysis. In: Rath T, editor. Chronic Kidney Disease: from Pathophysiology to Clinical Improvements. InTechOpen; 2018. p.281-93.
Mesa-Melgarejo L, Carrillo-Algarra AJ, Castiblanco RA, Reina LM, Ávila TM. Terapias de sustitución de la función renal: metaestudio y síntesis de evidencias cualitativas. Aquichan. 2017;17(3):328-52.
Sousa LM, Antunes AV, Marques-Vieira CM, Valentim OS, José HM. Qualidade de vida e pessoa com doença renal crónica: um estudo transversal. In: R Missias-Moreira, ZN Sales, LCG Nascimento, OS Valentim, editors. Qualidade de vida e condições de saúde de diversas populações. Curitiba: Editora CRV; 2017(2):139-54.
Bennett PN, Parsons T, Ben-Moshe R, Neal M, Weinberg MK, Gilbert K, et al. Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study. BMC Complement AlternMed. 2015 Jun 9; 15:176-82.
Mehrabi Y, Ghazavi Z, Shahgholian N. Effect of fordyce’s happiness program on stress, anxiety, and depression among the patients undergoing hemodialysis. Iran J Nurs Midwifery Res. 2017 May-Jun; 22(3):190-4.
Martin RA. Humor, laughter, and physical health: methodological issues and research findings. Psychol Bull. 2001 Jul;127(4):504-19. doi:10.1037/0033-2909.127.4.504.
Sousa LM, Marques-Veira C, Severino SS, Pozo-Rosado JL, José HM. Fatores explicativos da apreciação de filmes cómicos em pessoas com doença renal crónica. Rev Inv Enferm. 2016 Apr; (15):49-55.
Lyubomirsky S, Lepper HS. A measure of subjective happiness: Preliminary reliability and construct validation. Soc Ind Res. 1999 Feb 1;46(2):137-55. doi: 10.1023/A:1006824100041.
Pais-Ribeiro JL. Validação transcultural da Escala de Felicidade Subjectiva de Lyubomirsky e Lepper. Psicol Saúde Doenças [Internet]. 2012 [cited 2018 Sep 10]; 13 (2): 157-168. Available from: http://www.scielo.mec.pt/scielo.php?pid=S1645-00862012000200003&script=sci_arttext&tlng=es.
Sousa LM, Vieira CM, Severino SS, Pozo-Rosado JL, José HM. Validation of the Subjective Happiness Scale in people with Chronic Kidney Disease. Enferm Global. 2017 Jul; 16 (3):60-70.: doi:10.6018/eglobal.16.3.266571.
Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994 Mar [cited 2018 Sep 10];23(2):129-38. Available from: https://psycnet.apa.org/record/2015-49222-001.
Ferreira-Valente MA, Pais Ribeiro JL, Jensen MP. Contribución adicional para la validación de la versión portuguesa de la Escala de Interferencia del Inventario Breve de Dolor. Clín Salud. 2012 Mar [cited 2018 Sep 10];23(1):89-96. Available from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-52742012000100005.
Sousa LMM, Marques-Vieira CMA, Severino SSP, Pozo Rosado JL, José, MHG. Validación del Índice de Bien-estar Personal en personas con enfermedad renal crónica. Enferm Nefrol. 2016 Jun; 19(2):135-41. doi:10.4321/S2254-28842016000200005.
Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995 Mar 1;33(3):335-43. doi:10.1016/0005-7967(94)00075-U.
Pais-Ribeiro JL, Honrado A, Leal I. Contribuição para o estudo da adaptação portuguesa das escalas de ansiedade, depressão e stress (EADS) de 21 itens de Lovibond e Lovibond. Psicol Saúde Doenças. 2004 Nov [cited 2018 Sep 10];5(2):229-39. Available from: http://www.scielo.mec.pt/scielo.php?pid=S1645-00862004000200007&script=sci_arttext&tlng=en.
Sousa LM, Marques-Vieira CM, Severino SS, Pozo-Rosado JL, Gomes JC, José HM. A Depression Anxiety Stress Scale em pessoas com doença renal crónica. Rev Port Enferm Saude Ment. 2017 Jun; 17:50-7.: doi:10.19131/rpesm.0182.
Thorson JA, Powell FC. Development and validation of a multidimensional sense of humor scale. J Clinic Psychol. 1993 Jan;49(1):13-23. doi:10.1002/1097-4679(199301)49:1<13::AID-JCLP2270490103>3.0.CO;2-S.
José H, Parreira P. Adaptação para Português da Escala Multidimensional do Sentido de Humor MSHS. Referência.[Internet]. 2008 [cited 2018 Sep 10];6:7-18. Available from: http://hdl.handle.net/10400.14/7524.
Sousa LMM, Marques-Vieira CM, Severino S, Pozo-Rosado J, Antunes AV, José H. Validation of the multidimensional sense of humor scale in people with chronic kidney disease. J Nurs Educ Pract. 2018; 8(3):72-9. doi:10.5430/jnep.v8n3p72.
Moussa MT, Lovibond P, Laube R, Megahead HA. Psychometric properties of an arabic version of the depression anxiety stress scales (DASS). Res Soc Work Pract. 2017 May;27(3):375-86. doi:10.1177/1049731516662916.
Sousa LM, Marques-Vieira C, Severino S, Caldeira S. Propriedades psicométricas de instrumentos de avaliação para a investigação e prática dos enfermeiros de reabilitação. In C. Marques-Vieira, L. Sousa (Eds). Cuidados de Enfermagem de Reabilitação à Pessoa ao Longo da Vida. Loures: Lusodidacta. 2017:113-122.
Angst F, Goldhahn J, Drerup S, Kolling C, Aeschlimann A, Simmen BR, S et al. Responsiveness of five outcome measurement instruments in total elbow arthroplasty. Arthritis Care Res. 2012 Nov;64(11):1749-55.
Guedes CR, Alvarenga BD, Rotella I, Vilella DV. Habilidades do Enfermeiro no Diagnóstico e Cuidado ao Portador de Depressão/Nursing Skills in Diagnosis and Care For Patients With Depression. Rev Ciênc Saúde. 2015;5(4):13-9. doi:10.21876/rcsfmit.v5i4.402.
Ganz FD, Jacobs JM. The effect of humor on elder mental and physical health. Geriatr Nurs. 2014 May; 35(3):205-11.
Ko HJ, Youn CH. Effects of laughter therapy on depression, cognition and sleep among the community dwelling elderly. Geriatr Gerontol Int. 2011 Jul;11(3):267-74.
Beh-Pajooh A, Jahangiri M, Zahrakar K. Humor skills training and reducing depression in patients with spinal cord injury. J Iran Psychol. 2010; 6(1):227-36.
Low LF, Goodenough B, Fletcher J, Xu K, Casey AN, Chenoweth L, et al. The effects of humor therapy on nursing home residents measured using observational methods: The SMILE cluster randomized trial. J Am Med Dir Assoc. 2014; 15(8):564-9.
Tse MM, Lo AP, Cheng TL, Chan EK, Chan AH, Chung HS. Humor Therapy: Relieving Chronic Pain and Enhancing Happiness for Older Adults. J Aging Res. 2010;33:1-9.
Ghodsbin F, Jahanbin I, Sharif F. The effects of laughter therapy on general health of elderly people referring to jahandidegan community center in shiraz, iran, 2014: a randomized controlled trial. Int J community based Nurs midwifery. 2015 Jan; 3(1):31-8.
Low LF, Brodaty H, Goodenough B, Spitzer P, Bell JP, Fleming R, et al. The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes. BMJ open. 2013 Jan; 1;3(1):e002072.
José H, Parreira P. Adaptação para Português da Escala Multidimensional do Sentido de Humor MSHS. Referência. 2008;SII(6):7-18.
Sousa LM, José HM. Benefícios do humor na saúde Revisão Sistemática da Literatura. Enformação. 2016;7:22-32.
Wellenzohn S, Proyer RT, Ruch W. Humor-based online positive psychology interventions: a randomized placebo-controlled long-term trial. J Posit Psychol. 2016 Nov;11(6):584-94. doi:10.1080/17439760.2015.1137624.
Bennett PN, Parsons T, Ben-Moshe R, Weinberg M, Neal M, Gilbert K, et al. Laughter and humor therapy in dialysis. Sem Dial. 2014 Sep;27(5):488-93.
Herdman HT, Kamitsuru S, (eds). Nursing Diagnoses: Definitions & Classification 2018-2020. 11th ed. Stuttgart: Thieme; 2017:184-383.
International Council of Nurse. International Classification for Nursing Practice (ICNP®). Geneva: International Council of Nurse; 2015.