The Effect of Hope-focused Motivational Interview on Individuals Receiving Hemodialysis Treatment

Chronic kidney failure is an important health problem in the world and in our country. If crf is not diagnosed early and intervened in a timely manner, a picture called end-stage renal disease emerges and compels individuals to undergo dialysis treatment. This high-cost treatment makes individuals dependent on the health institution on certain days and hours of the week and negatively affects the quality of life of the individuals. High morbidity rates and poor quality of life also negatively affect the family and social life of these patients and hinder their economic productivity. Dialysis or kidney transplantation treatments are required for patients with esrd to survive. Since it is difficult to provide suitable conditions (donor finding, economic, etc.) For kidney transplantation, the predominant treatment method all over the world is hemodialysis with a rate of approximately 90 percent, although there are some differences between countries. The prevalence of end-stage renal disease requiring renal replacement therapy in turkey is 988.4 per million population. When looking at the type of rrt of all patients who received rrt at the end of 2018, it is seen that 74.82% received hemodialysis treatment. With the use of hemodialysis treatment as a treatment method for individuals with a diagnosis of crf, their lifespan has been prolonged, however, the type of treatment and the constant dependence on the hospital caused the psychosocial problems of individuals to increase. hemodialysis treatment patients become dependent on dialysis machines, healthcare professionals and family members throughout the treatment process, they experience role losses and domestic problems, become a risky group in terms of mental illnesses as a result of economic difficulties due to losses and an isolated life from the society. The most common mental problems in hemodialysis treatment patients; depression, restriction of social life, anxiety of losing independence, anxiety and hopelessness. Therefore, patients' adaptation to treatment processes and coping with the difficulties they encounter necessitate psychosocial interventions.

According to Babur, Abram grouped the reactions of individuals who received hemodialysis treatment treatment into five periods. He named the first period as "Uremic Period". In this period, the individual has not started dialysis yet, and with the diagnosis of CRF, hopelessness, fear of death, weakness, etc. findings indicate that it can be seen. He defined the second period as the "Anxiety Period" (Beginning of Dialysis). The anxiety period is the period in which individuals experience concerns about treatment. The third period was defined as the "Honeymoon Period" (the first three weeks in dialysis), and it was emphasized that the individual feels better, apathy decreases and euphoria may be experienced with the regression of symptoms in this period. The next period is the "Depression Period". It starts with the individual realizing the situation after 8-9 dialysis. This period, in which treatment compliance difficulties and depression are common, usually lasts 3-12 months. The last period has been defined as the "Adaptation Period". During this period, the individual has gotten used to the dialysis machine and tries to return to his normal life. There are forward plans and expectations. When the characteristics of these five periods are evaluated, although each period contains its own specific emotional and behavioral responses, it is a situation that should be evaluated to develop / strengthen hope and hope. Snyder evaluated hope in two dimensions: emotional and cognitive. The first dimension, "agency", is the desire to reach the goal and the feeling of strength to achieve the goal. It includes being able to make successful decisions in achieving the past, present and future goal. The second dimension of hope is called "pathway". Pathway dimension includes the individual's belief that he or she can plan successfully to achieve his goals. Both dimensions are related to each other and increase each other's effects in a positive way. It is a healing force that promotes well-being necessary for healthy coping. Snyder stated that as a result of studies conducted with different ethnic groups, hopeful thinking is not inherited, it is learned from childhood. Therefore, he argued that hopeful thinking can be taught and enhanced. Hope has been accepted as a basic personality trait and has been defined as a fundamental resource in human life. In other words, individuals with a high level of hope have goals they want to achieve, and individuals strive to achieve these goals. The high level of hope is important in increasing the life satisfaction of individuals.

It is seen as an effective coping mechanism that makes the individual feel safe and relate to reality, increases motivation, prevents feelings of pessimism or helplessness in case of illness, and contributes to compliance with treatment. As they increase, their compliance with treatment increases and as a result, it can be effective in reducing the symptoms of the disease.

Snyder defines it as the ability to produce ways to achieve desired goals and the motivation to use these paths. They believe that if an individual has a high level of hope, they can find many ways to achieve their goals. This belief motivates the individual that good events will happen in the future. In this direction, motivational interview enables the individual to understand their problems and put them into action for change. With motivational interview, it will be easier for the individual to notice the obstacles that may occur in achieving his goal, and he will be able to make expressions that will motivate himself about his anxiety, desire, desire for change and skill. In this context, it is predicted that with a hope-oriented motivational interview, individuals will be able to recognize their goals more easily and determine their paths. Studies involving hope-enhancing intervention are based on Snyder's Hope Theory in positive psychology. Diabetes, hypertension, depression, CRF, unstable angina, In addition to individuals with chronic diseases, hope-enhancing interventions were applied to individuals with caregiver roles such as caregivers of patients diagnosed with post-traumatic stress disorder, and mothers of children diagnosed with cancer. At the same time, different segments of society, pregnant women, married students, etc. In order to examine the effects of healthy individuals on mental health. As a result of the practices that strengthen hope, depression, anxiety, and stress levels decreased in individuals, and their well-being was observed to increase. The concept of hope is also an important concept in terms of psychiatric nursing care and practices. Moore expresses hope as the heart of Psychiatric Nursing practices. Hope, which is accepted as a fundamental element of human existence, is important in terms of preventive mental health in psychiatric nursing care and practices. Therefore, increasing patients' hope has been accepted as an important intervention in medicine, nursing and mental health. In the Classification of Nursing Interventions (NIC), this intervention was included as the title of "instilling hope", and many interventions to increase and develop the hope of the individual within the scope of the intervention (Bulechek et al. Although there are descriptive studies aimed at evaluating hope in the studies conducted in the field of nursing, intervention studies specifically aimed at increasing and developing hope are limited. When the content of the limited number of studies was examined, it was seen that the effectiveness of nursing interventions in different patient groups was evaluated. Considering the psychosocial difficulties of individuals with CRF, which is a chronic disease, it is thought that conducting an intervention study with this patient group would be effective. When psychiatric nursing practices and consultation-liaison psychiatric nursing roles are evaluated within the scope of their roles, it is predicted that hope-oriented motivational interviewing can be effective in bringing and maintaining healthy life behaviors aimed at re-evaluating the lives of individuals, protecting and improving their mental health. In this context, it was aimed to determine the effect of hope-oriented motivational interview on the depression, anxiety, stress and hope levels of individuals receiving hemodialysis treatment within the scope of the study. It is thought that the results to be obtained from the research will contribute to the literature.