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Continuing care of the dialysis patient

Psychological care, Nephrology nursing

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Continuing care of the dialysis patient

  2. 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. 3. PHYSICAL CHALLENGES • CKD - most symptomatic of any chronic disease group
  4. 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. 5. •Fluid and dietary restrictions •Threat of reduced life expectancy •Dialysis Access: coping with permanent invasive procedures
  6. 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. 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. 8. •Prevalence of depression is high in patients with CKD
  11. 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. 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. 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
  15. 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. 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. 17. INFORMATION GROUPS •Enable teaching, reassurance, and group support, encourage active participation in treatment, and facilitate the asking of questions
  18. 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. 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.