The Psychological Effects of Unplanned Initiation of Dialysis

Dallas—Patients with end-stage renal failure who have to initiate dialysis without prior planning are at increased risk for morbidity, mortality, and have increased use of healthcare resources. Eva-Lena Nilsson, MSN, RN, at the Skanes University Hospital, Malmo, Sweden, conducted a study to describe the meaning of the phenomenon described as “initiating hemodialysis in an unplanned fashion.” The study design was described at the 2019 ANNA National Symposium in a presentation titled Patients’ Experiences of Initiating Unplanned Hemodialysis.

The study involved five patients (four men, one woman) who experienced initiation of unplanned hemodialysis; patients were recruited from two dialysis units in southern Sweden. Individual in-depth interviews were conducted, recorded, and transcribed. The texts were analyzed according to Giorgi’s method.

The essence of the phenomenon was described as a “life situation characterized by a rapid decline in health and kidney function leading to unplanned initiation of hemodialysis, which resulted in not really being able to understand what happened.”

The patients were affected in different ways by the sudden initiation of hemodialysis. Participants said they relied on support from others, acceptance of the situation, and inner strength; they wished for more in-depth conversations with healthcare professionals.

In summary, Ms. Nilsson said, “Psychological support is critical. Healthcare professionals need to have the time and the necessary skills in communications and empathetic listening to understand the psychological trauma each patient goes through in the unplanned setting, even if otherwise seemingly well prepared for dialysis.”

Source: Nilsson E-L. Patients’ experiences of initiating unplanned hemodialysis. Abstract of a presentation at the 2019 American Nephrology Nurses Association National Symposium, April 14-17, 2019, Dallas Texas.