PROCEEDINGS OF THE FIRST ASIAN CHAPTER MEETING— ISPD
DECEMBER 2003 – VOL. 23, SUPPL 2
disease is a consequence of overwork,” “Chronic ill-ness is the penalty imposed by supernatural forcesfor having broken moral codes,” “The role of ‘patient’is a burden to family and to self,” “The role of ‘patient’denotes inferiority among peers,” “Laypeople can’tpractice self-care in health matters.” Health beliefsand culture influence how a patient adapts to treat-ment requirements. For example, perceptions aboutnutrition play an important role in patients on PD.Nutritionists can provide good advice about a low-phosphate diet; however, the patient may believe that“food is the greatest gift” and that there should be norestrictions. Perceptions about the body, ideas aboutself and about illness, and social attitudes toward ill-ness vary and may be very different between ethnicgroups, countries, or even families.Care should focus on the patient’s personal andcultural realities and should not impose beliefs andculture from outside. Nurses require the sensitivityto avoid poor interpersonal contacts, distorted social-ization, and negative influences on the patient’s mo-tivation that will cause grief in the patient about self or others. The establishment of supportive social en-vironments has been shown to have a positiveimpact (7).
Renal disease may affect sexualperformance in both men and women. The cause orcauses may be organic (hormonal change attributableto uremia, or vascular insufficiency in diabetes), psy-chosocial (changes in self-esteem from alteration inbody image due to the presence of the PD catheter,leading to feelings of sexual unattractiveness), orphysical (distention and discomfort due to intraperi-toneal fluid, uremic symptoms that decondition thepatient on PD treatment). The role of “patient” andthe accompanying stress on the partner can furtheralter role perceptions and affect sexual performancein some patients. The effects of drugs prescribed aspart of the treatment regime can cause sexualdysfunction.The knowledge that help is available if problemsoccur is all that is needed until a specific problemarises. The patient may reflect sexual difficulties in aloss of physical function. Referral to a sex therapistor counselor is appropriate so that specific strategiescan be developed to improve sexual function and toallay the frustrations of the patient and the partner.
End-stage renal disease is progressive, and the dis-turbances it brings are progressive. Any interventionhas to be tailored to the progress of the disease itself,with the individual’s level of physical, psychological,and social functioning as the central focus. The con-current physiologic, psychological, and social stressesdemand cognitive effort from the patient in coping.Researchers suggest that patient adherence to a medi-cal regime is significantly related to high social de-sirability and a shorter length of time on dialysis (8).Patients with ESRD are empowered for self-care inmatters of drug administration and PD management,but adherence to treatment requirements must be avoluntary act of submission, with consent for the ad- justment and adaptation to the illness and treatment.Psychosocial intervention is best started as early (atdiagnosis) and demands continuous effort.
End-stage renal disease hasa characteristically downward trajectory. Patientshave to come to terms with their current physical con-dition. Psychosocial nursing interventions should at-tempt to facilitate adjustment to changes in the courseof the illness and to normalize social interaction andlifestyle by preventing medical crises, controllingsymptoms, and incorporating the PD treatment re-gimes into daily living (9). Knowledge can significantlyminimize a patient’s anxiety. It is crucial that nurseshave the skills to provide clear information, to helppatients identify their goals in the course of treat-ment, and to assist with problem-solving for optimalphysical functioning.
Assessment determines the patient’sneeds, identifies problems and potential problems,and collects information for a treatment plan so thatappropriate support can be rendered. The assessmenttherefore focuses on the effect of the illness on thepatient. Useful information includes the patient’slifestyle, patterns of daily living, personality,strengths and interests, normal coping patterns, un-derstanding of the current illness, perception of treat-ment regimes, recent life stresses or changes, andmajor issues raised by the disease. By listening tothe patient and the family in the course of discus-sion, nurses can identify the observable psychoso-cial interferences consequent to the disease and theneeds for assistance. At the same time, informationon the expected course and likely outcome of the dis-ease can be provided.
The role of the health care profes-sional is to encourage and, where possible, to enablepatients to accept responsibility for their health andwell-being and to fulfill their obligations within thefamily and society. As well as providing knowledgeand clarifying misconceptions, nurses can encouragepatients to accept the personal limitations consequentto the illness and its treatment. When a patient isencouraged to perform self-care, better self-esteemand power to maintain health are established. Whenopen discussion and awareness of the mutual situa-tion is encouraged between patients and their part-ners, positive and understanding attitudes arereinforced. The perception of emotional support has
LEUNGPSYCHOSOCIAL ASPECTS IN RENAL PATIENTS