Table 2
2. Facilitate the movement of patients in the direction control of the situation and show greater involvement in
of functional beliefs the treatment process. Getting patients to move in the
direction of healthy beliefs is also relevant, such as, that
3. Encourage social support, particularly from family
one is vulnerable to a host of infections, that the
members and friends
treatment will result in benefits. Social support helps
4. Enhance the patients self-management behaviours, patients feel reassured that there are resources beyond
namely self-regulation, self-monitoring, and self- their own. Self-management approaches have been found
reinforcement to improve clinical outcomes and to reduce costs. Finally
getting patients to address barriers, rather than being
5. Break down the barriers to adherence
defeated by the same, is very pertinent.
Illustrations of the same are presented in Table 2.
Guideline 4
Rationale
Facilitate patient / family adjustment to the impact of the
Treatment recommendations for the patient include disease.
medication and diet. Getting the patient to adhere to the
same is thus an important goal. Research has indicated Patients can be helped to adjust to the impact of the
that certain factors affect adherence adversely: a) lack disease in the following areas (see Table 3)
of knowledge or understanding about the disease/ 1. Coming to terms with their appearance
treatment, b) dysfunctional health beliefs, c) lack of social
support and isolation, d) poor self-management 2. Reaching higher levels of independence
techniques, e) practical barriers to adherence. 3. Assessing and addressing job difficulties
There is evidence that knowledge about the disease and 4. Building up self- esteem
treatment can reduce anxiety, help the patient feel in
Family members can also be helped via counselling or When progression of the disease takes place, the role of
family therapy to address the following issues: the mental health professional is to help the patient a)
make a decision about the treatment procedure, b) adjust
1. Increasing resources to deal with additional to the process, c) Integrate the disease into ones life-
responsibility. style.
2. Helping the patient to increase adherence. Table 4 Presents an illustration of the same
3. Coping with the patients negative moods and
behaviour. 4. Finding alternative ways to achieve
intimacy (for spouses). Table 4 - Aspects and Manner of Help to be
Provided Regarding Progression of the
Rationale Disease
This disease has an impact on all areas of life-physical,
social, marital, emotional, occupational, financial, etc. Aspect Manner of help provided
Physically, the patients may experience pain and manifest Making a decision Information should be
a change in skin colour, reduction in strength and weight about the procedure provided to the patient such as
fluctuations and decreased activity levels and physical the need to
independence.. Patients may have trouble reestablishing create an access, the duration
normal social relationships. If chronic illness interferes of each dialysis session, the
with hobbies, leisure and work activities, then the self - likely
concept may be damaged. The increase in expenditure, experience during the session,
because of prolonged intake of medication, special diet, the dietary and medical
transportation and hospitalization, may cause a financial prescriptions
crunch.
and life style changes
Patients are not the only ones affected. As the saying Adjusting to the Patients can be helped to
goes Individuals dont develop illnesses, families do. treatment process a) understand the benefits of
Disruption in the life of one family member places treatment
increased responsibility on the family and the spouse, if b) identify problems in following
the patient is married. Moreover, patients go through the treatment and make attempts
alterations in mood and increases in anxiety and to solve them and
dependency, which in turn may affect other family
members adversely. Non-adherence on the part of the c) talk to those who have
patient is not uncommon. Decrease in sexual activity successfully adjusted to the
between the couple may occur. treatment process.
Psychological Assessment of the patients should be 3) conditions that cause chronic disease (diabetes or
conducted periodically hypertension) or complications of decreased GFR
(anemia, malnutrition, bone disease, neuropathy),
Psychologists should assess the functional status and
well-being as soon as possible, after referral, in order to 4) level of GFR that is below a GFR of approximately
obtain baseline data and to allow early intervention to 60 ml/min/1.73 m2.
improve functioning and well-being. Psychologists should Reduced kidney functioning is associated with increasing
regularly reassess functioning and well-being to ascertain symptoms, such as tiring easily, weakness, low energy,
the patients current status and the effectiveness of
care) as well as enter into new relationships, to Brannon L, Feist J. Health Psychology. An introduction to
accommodate the needs of the child. Helping families to behaviour and health. 4th edition. 2000. Wadsworth
Australia.
make these transitions is therefore imperative. End-note:
Edwards, S, Davis, P.(1997) Counseling children with
A multidisciplinary team is required to look after the chronic medical conditions. Communication and
welfare of the patients, namely the nephrologist, nurse, Counseling in Health Care Series.130:56-79.
dialysis technician, dietician, medical social worker, health Grumke J, King K. Missouri Kidney Program. Patient
psychologist/ human development specialist. Any or all Education Program a 10 year review. Dialysis and
Transplantation 1994;9:978-87
of these personnel can function as patient educators
Hoeger WWK, Turner LW, Hafen BQ. Wellness
depending on their knowledge in the field and their
guidelines for a healthy life-style.3rd Edition, 2002,
communication skills. However, psychological counselling Wadsworth, Australia.
can be undertaken only by those trained in the field. K/DOQI Clinical Practice Guidelines for Chronic Kidney
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