Psychological care, Nephrology nursing

1. CONTINUING CARE OF
THE DIALYSIS PATIENT
Reynel Dan Galicinao
SA 1565

2. OBJECTIVES
At the end this session, the participants will be able to:
1. Outline the physical challenges of a dialysis patient
2. Describe the patients’ struggles beyond physical
symptoms
3. Define self-efficacy and empowerment
4. Explain the importance of personal interaction
5. Incorporate health education in practice

3. PHYSICAL CHALLENGES
• CKD - most symptomatic
of any chronic disease
group

4. •Insomnia, sexual problems, low fertility
•Complex medication and treatment regimens and
their side effects
•Hemodialysis complications: after dialysis a
“washed-out” feeling can occur that may last up to
24 hours

5. •Fluid and dietary restrictions
•Threat of reduced life expectancy
•Dialysis Access: coping with permanent invasive
procedures

6. BEYOND PHYSICAL SYMPTOMS
•Social and Financial
•Restricted choices of occupation, hobbies, leisure
activities
•Inability to socialize with friends and colleagues
•Uncertainty about the future: life’s goals and
values are drastically altered
•Reliance on dialysis can result in a loss of
autonomy and control

7. • Body image concerns: dialysis access surgery can
affect self-esteem and feelings of sexual attractiveness
and desirability
• Role changes threaten the identity, pride, and self-
image of patients who do not wish to become a
burden or liability
• Patients have to contend with possibly losing all they
have become and achieved throughout their life

8. •Prevalence of depression is high in patients with
CKD

9. COPING AND ADAPTATION

10. TRANSITIONAL
PROCESS

11. IDENTIFY HOW YOUR PATIENTS COPE
•Identify patients’ coping styles, as those using
emotion-focused methods may run an increased
risk of not being able to handle their illness well
•Nurses could also assist patients to use problem-
focused strategies by providing support,
information, and problem-solving strategies

12. •The use of a particular coping style or strategy is
largely a product of a person’s attitudes and beliefs
•Previous experience of ill health, knowledge of
disease, and personal style may all influence the
interpretation of illness
•Patients with identical symptoms and conditions
may see the threat very differently and therefore
cope very differently

13. CARE PROVIDERS CAN IMPACT COPING
•Patients may find it more difficult to adapt when
clinicians devote their energies to the technical
aspects of care at the expense of personal
interaction

14. SELF EFFICACY AND
EMPOWERMENT

15. • Self-efficacy
• a person’s feelings and thoughts about their own
capability of accomplishing a task
• Empowerment
• the process of helping people acquire the skills and
knowledge required to increase control over their own
life

16. EDUCATE YOUR PATIENTS
• To help patients recognize and act on symptoms
• Make the most effective use of medicines and treatments
• Understand the implications of professional advice
• Access social and employment services and leisure
activities
• Develop strategies to deal with the psychological
consequences of their illness

17. INFORMATION GROUPS
•Enable teaching, reassurance, and group support,
encourage active participation in treatment, and
facilitate the asking of questions

18. PERSONAL INTERACTION WITH PATIENTS
•Nurses need to know more about when and how to
assess psychological state and implement
psychological care
•To make themselves available for patients to talk to
•Nurses must strive to incorporate emotional care
into their practice

19. Because of their frequent contact with
patients who have a long-term illness,
nurses are in a prime position to
facilitate patients’ self-management of
their condition.