Effects of Integrated Indirect Forest Experience on Emotion, Fatigue, Stress and Immune Function in Hemodialysis Patients.

Hyoyoung Kang,Youngran Chae

doi:10.3390/ijerph18041701

Abstract

Background: Most hemodialysis patients may experience physiological and psychological stress. Exposure to nature has been reported to reduce psychological and physiological stress levels and improve immune function. This study aimed to investigate psychological and physiological effects of integrated indirect forest experience on chronic renal failure patients undergoing hemodialysis. Methods: As a quasi-experiment, this study employed a nonequivalent control group, repeated measurements, and a non-synchronized design. In total, 54 participants were included: 26 and 28 patients in the experimental and control groups, respectively. During hemodialysis, five types of forest therapy stimuli (visual, auditory, olfactory, tactile, and motor) were applied 3 times per week for 4 weeks during 15 min sessions. Results: Positive, but not negative, emotion measures differed between the groups after the intervention. Fatigue and physiological stress levels were significantly reduced in the experimental group, whereas no significant difference was found between the groups with respect to measures of psychological stress. Activation of both the parasympathetic and sympathetic nervous systems was similar in both groups, as was the number of natural killer cells. Conclusion: Integrated indirect forest experience may help increase positive emotions and reduce fatigue and stress levels during hemodialysis in patients with chronic renal failure.

Highlights

Chronic renal failure is an irreversible disease associated with gradual loss of kidney function [1]
Seventy-nine percent of hemodialysis participants complain of fatigue [6], which tends to increase after hemodialysis [7]
This study aimed to verify the effects of integrated indirect forest experience on the measures of emotion, fatigue, and stress, heart rate variability (HRV), and natural killer cells (NK) cells count in patients with chronic renal failure undergoing hemodialysis

Summary

Introduction

Chronic renal failure is an irreversible disease associated with gradual loss of kidney function [1]. In Korea, affected patients tend to choose hemodialysis (81,760 (75.1%). Patients), rather than renal transplant or peritoneal dialysis [2]. Most hemodialysis patients continue to undergo dialysis for over 4–5 h, 3–4 times weekly, for the rest of their life [3]. Patients may experience physiological and psychological stress due to restrictions that prevent them from maintaining their daily routines [4]. The primary factor that causes stress in patients is fatigue [5]. Psychological stress in hemodialysis patients tends to be caused by tensions provoked by dependence on hemodialysis machines [8], loss of pride, uncertainty about the future, and feelings of guilt toward family [9], among others. It is critical to develop stress management interventions for hemodialysis patients

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Conclusion