Certificate Renal Course 1999

Psychological support for the End Stage Renal Failure Patients

Ms Bonnie Tam

Introduction

Pre-dialysis and Pre-transplant group
    1. importance and purpose of drugs and diets
    2. choosing the treatment best suited to patient’s social situation and lifestyle;
    3. problem of the employjment and finances due to illness
    4. problem of housing, taking treatment needs into consideration
    5. role change within relationship and effects on f amily memebrs / carers
    6. difficult in sexual and affectionate relationships
    7. effect of ESRF effect on leisure activities and weekdays.

Method of psychological support

  1. Straightforward teaching

    2. effects of renal failure, treatment modalities : drugs, dialysis and transplantation.

  2. Group support e.g. patient support group
  3. Reassurance - ensure patient’s concern are realistic, focusing on the real problems rather than rumours or hearsay
  4. Encouraging active

    5. Co-operative interaction between patients and staff, rather than passive acceptance.

  5. Introducing topics and encouraging questions, especially on subjects that may patients feel inappropriate to raise with busy medical staff at clinic appointments.

 

How much information ?

  1. introduce dialysis / and the transplant patient
  2. honesty - important part of contract between patient and team.
  3. time of session is important - since adjustment of at least 6 moth is desirable e.g.

a) negotiating with employers

b) making adaptation to housing or moving house, especially for elderly patient.

c) early application for relevant social security benefits to minimise financial problems

 

Factors underlying sexual inadequacy in renal patients

1. Pathophysiological factors

2. Psychosocial factors

Renal Transplantation

Psychological issues
  • Control
  • Self-image
    		•
  • Dependency
    		•
  • Stigma
    		•
  • Abandonment
    		•
  • Anger
    		•
  • Death

    • Factors to consider

    vIllness intrusiveness

    vDevelopmental stage

    vPersonality

    vCulture

    Increased self-directedness

    1. Introduction of the rationale to the patient

    2. Promotion of effective decision making

    3. Establishment of a behavioural contract

    4. Promotion of self-monitoring by Patients e.g. self-care dialysis checklist

    5. Sustained use of staff support and problem solving

    Helping the family

    1. Provision of immediate emotional comfort

    2. Help to build up resources

    Challenges to the family

    1. Cognitive

    2. Emotional

    3. Behavioural

    4. Interpersonal

    Tasks for health care professionals :

     

     

     

     

     

     

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