O efeito da intervenção relaxamento, imagens mentais e espiritualidade (RIME) sobre a qualidade de vida e resiliência de pacientes em tratamento de hemodiálise

Abstract

Chronic Kidney Disease is complex and fatal, considered a public health problem. Patients undergoing haemodialysis treatment may have their quality of life altered due to negative aspects arising from the disease and treatment. The general objective of the study was to verify the effect of brief psychotherapeutic Intervention Relaxation, Mental Images and Spirituality (RIME) on the quality of life and resilience of hemodialysis patients. Method: three articles were elaborated: the first article, a systematic review whose objective was to verify in the scientific literature the history, use and benefits of RIME intervention, in the various health/disease contexts. The searchies were carried out at the BVSPsi, CINAHL, MEDLINE, SciELO, SCOPUS and Web of Science databases in September and October 2018. According to the results, RIME promoted resignification of the symbolic pain of death of patients outside the possibility of cure; provided quality of life in the dying process; contributed to the quality of life of breast cancer patients with healing possibilities; favoured the emotional well-being of ostomates patients; brought benefits in the quality of life of patients with head and neck cancer; promoted empowerment for women with breast cancer and strengthened their libido; and promoted resignification of the spiritual pain of bereaved youths, offering a satisfactory return from mourning preparation. The second article, a randomized clinical trial, aimed to verify the effect of RIME intervention on quality of life, resilience, well-being and hopelessness of haemodialysis patients. The sample consisted of 46 participants, distributed in intervention group (GI=22) and control group (CG=24). Both groups were homogeneous regarding age, gender, schooling and other comorbidities. The perception of quality of life of GI was better in almost all domains of the Kidney Disease and Quality-of-Life Short-Form (KDQOL-SFTM) scale compared to CG, with statistical significance in the domains overload of kidney disease (p=0,012), global health (p=0,012) and emotional well-being (p=0,041); there was an increase in resilience levels in GI, post-intervention (p=0,018); improvement of well-being and hopelessness, with statistical significance (p=0,001), indicating a lower level of hopelessness in GI. The third article, a quasi-experimental study, aimed to evaluate the quality of life and resilience of hemodialysis patients residents of a city in the north of Portugal before and after the RIME intervention, and to identify the factors that interfere in the resilience of these patients. The sample consisted of 17 participants. The perception of quality of life was better in almost all domains of the scale, with significant difference in dimensions: physical function (p=,006) and emotional function (p=0,021) in the post-intervention period. In the assessment of resilience, there was an increase with statistical significance at the end (p=0,002); linear regression analyses revealed that religion, other comorbidities, leisure activities and a history of transplantation are factors related to increased resilience; and antidepressant and antihypertensive medications are factors related in decreased resilience. It is concluded that the RIME intervention is beneficial to the health of patients with chronic kidney disease and its applicability should be stimulated as a support tool, in the context of haemodialysis patients.