Dear Nader Aghakhani,

Thank you for the very interesting question. I think a nurse has a great role to play in decreasing the anxiety and depression in hemodialysis  patients. She can explain the procedure to the patient, mention that everything will be fine and answer any related queries.

Shariful islam

Hi Nader 

The Socratic method  or maieutics helps here too. This kind of questioning can be used to pursue thoughts about anxiety and depression as well as meaning of suffering and life, to get to the truth about these feelings and moods, to open up issues and problems, to uncover assumptions  and misunderstandings about treatment and prognosis , to analyze the concept of hemodoialysis, to distinguish what we know from what we don't know about chronic diseases, to follow out logical implications of thoughts of how to lead a "NORMALl" life WITH this disorder and not solely to focus on the suffering of the disorder or to control the role of the disorder in the patient's  life through this discussion. To discuss what is health and what is a normal life along with "known people" who never ever suffered from any kind of sickness. These kinds of discussions can lead to knew insights about the fragility or robustness of life and to an attitudinal change towards the haemodialysis. Without all these modern days aids (glasses, pace makers, hearing aids, transplanted hearts and livers and so on) we are claimed to die on average at 40 years of age:)

The physician is responsible for informed consent, but the nurse is additionly important to clarify procedures in her words to the patient. Allthough a physician can tell everything to the patient one day, the next day the patient doesn`t remember. The role of a good nurse is equally important for building trust and reducing anxiety in patients.

How can a nurse and a doctor cooperate about solving this problem?

If you want my paper about Miss B and Miss P where the Socratic method is more in details elucidated you can give me your private mail on message board. 

As someone who has benefited from the care of both nephrologists and nephrology nursing I would suggest that the role of nurses in helping patients to understand what they are going through, what they may expect and what they can do to improve the outcome is essential to patient health, both mental and physical. The diagnosis of renal failure, itself, for many is traumatic and can be confusing. When the need for dialysis (whether hemo or peritoneal) becomes apparent it is also traumatic and can sound more like a death sentence than a way to go on with life. Doctors can be reassuring, but it is the nurse who really provides the reassurance and the understanding to the patient.

It seems to me, as an observer, that most nephrologists work well and closely with nurses. Those who don't are easily "outed" by patients and lose credibility quickly (IMPO).

Doctors may understand what the patients are going through, and sympathize with them in most cases. Nurses both understand and empathize. The difference is everything to the patient. I should also observe here that most nephrologists never touch the patient, other than to occasionally poke them in the ankles and, if the patient is lucky, shake their hand.  Nurses touch the patients constantly, providing reassurance and comfort.

Nurses are the front line of patient care, in the minds of every nephrology patient and transplant recipient with whom I have spoken.

I should also observe that chronic renal failure is not the only form, nor the most disquieting, that can be reserved for acute renal failure. The former is progressive while the latter is sudden, requiring even greater comfort and care in many cases.

ATB

LIG