The Forgotten Aspects in Managing Chronic Kidney Disease

written by Karunia Valeriani Japar

foto nia

Chronic Disease does not develop spontaneously and the patients rarely have total recovery. But thanks to the progress of medical science, many chronic disease patients can live longer, but it is still uncertain whether such patients have a good quality of life. The survivors usually have the emotional baggage. They need special care and attention to lighten their emotional burden. These psychological aspects are often forgotten by the health service officers. The most common emotional burden is depression. Researchers found that patient with chronic disease would be stressed and depressed and the depression will trigger patient to suffer from the chronic disease. It is just like an evil cycle.

The main cause of mental health disorders is still unknown but there are several factors that can increase the risk of mental health disorders. The Center for Chronic Disease (CDC) found the following factors that may trigger mental disorders in chronic disease patients :

Mental Health	Chronic Disease
Risk Factors	Modified Risk Factors	Unmodified Risk Factors
Family Medical History	Bad eating style	Age
Stressed Life	Less physical activities	Family Medical History
Suffer from Chronic disease	Smokers
Traumatic Experience	Excessive alcohol consumption
Drugs User	Social Surroundings
Child Abuse	Financial Status
No social support

It might seem very serious, but in fact mental health can be maintained. Health officers, families and patients can use many strategies to physically and mentally support the better work environment so that patients can have a better quality of life. The main target of better quality life program can be on the Modified Risk Factors such as smoking, less physical activities, poor nutrition.

Health officer should pay attention to the patients’ mental health. According to the Indian Journal of Nephrology, there are some psychological guidelines for health workers to deal with patients with chronic kidney disease.

First patient has to be informed all the medical procedures. It is important to clearly explain the information to the patients since the medical procedures might trigger the negative feelings such as fear, anxiety, bewilderment and irritation. Being well informed patients can get more involved in the treatment from the very beginning.

Second, according to The Indian Society of Nephrology, the diagnose of chronic kidney d can cause some emotional reaction that raise the following impacts :

Third, the medical officer should educate patients about the disease and its treatment, facilitate them with anything according to their tradition and culture, get social support from their families and friends, and also motivate patients; so they could be independent to take care, manage, monitor and encourage themselves.

The next step is to deal with the changes of the disease. When the disease gets worse, the health officer should help patients to take option of medical procedures, so that patients are able to adapt to the new procedures and integrate the disease into their life style.

The sixth step is to regularly check the patients’ psychological condition, especially when patients complain about the increased frequency or severity, worse impacts of the kidney disease, initial hemodialysis therapy, new place for hemodialysis treatment, both modalities, changes in clinical intervention or rehabilitation (such as counselling, peer support, education, physical therapy). It is important to do the psychological examination because impact of poor mental health will give bad impact to the chronic kidney disease such as deteriorating kidney function and other complications. But the examination of patients’ psychological conditions should be done carefully. Survey must use the standardized instruments so that the result is valid, reliable, and can be easily done and interpreted as well. Some examples are WHOQOL-BREF, Dialysis Symptom Index (DSI), Beck Depression Inventory (BDI), Generalized Anxiety Disorder (GAD-7) and Pittsburg Sleep Quality Index (PSQI) quality.

The seventh step is to organize the educational program for the patients. Some supportive activities given by The Indian Society of Nephrology are as follows:

Provide information about medical history, its treatment and also diet
Provide alternative options about medication and treatment
Help patients with their daily problems such as medication and nutrition
Help patients to state their feeling and communicate it effectively.
Help patients to be more self confident
Be the informal support for the patients and their families.

According to the researches with the above mentioned program, patients will not suffer a serious complications. The programs can also give good impact for the betterment of behavior and emotions of the patients and encourage them to be responsible so that they become aware to regularly do the treatment.

In conclusion, to deal with chronic kidney disease patients, we need a full team from various fields – nephrolog, internist, GP, nurse, technician, nutritionist, psycholog or psychiatric, social worker, families and friends. Everyone can be patients’ educator depending on the knowledge and the communication skills he or she has. Although the psychological aspect is not the main field but it should be taken seriously because if it is done properly, it will give very good result for the patients, the families and the health officers.

REFERENCES :

CDC Workplace Health Promotion Depression (http://www.cdc.gov/workplacehealthpromotion/implementation/topics/depression.html)

CDC Mental Health Overview (http://www.cdc.gov/mentalhealth/)

National Institute for Occupational Safety and Health (NIOSH) Stress at Work (http://www.cdc.gov/niosh/topics/stress/)

Substance Abuse and Mental Health Services Administration (SAMHSA) - Workplaces That Thrive: A Resource for Creating Mental Health-Friendly Work Environments by the Substance Abuse and Mental Health Services Administration (http://www.promoteacceptance.samhsa.gov/publications/business_resource.aspx)

Baum A, Taylor S.E, & Singer JE (Eds). Handbook of psychology and health. Vol 4 Social psychological aspects of health. 1984. Hillsdale NJ: Earlbaum

Brannon L, Feist J. Health Psychology. An introduction to behaviour and health. 4th edition. 2000. Wadsworth Australia.

Edwards, S, Davis, P.(1997) Counseling children with chronic medical conditions. Communication and Counseling in Health Care Series.130:56-79.

Grumke J, King K. Missouri Kidney Program. Patient Education Program – a 10 year review. Dialysis and Transplantation 1994;9:978-87

Hoeger WWK, Turner LW, Hafen BQ. Wellness guidelines for a healthy life-style.3rd Edition, 2002, Wadsworth, Australia.

K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. 2002;39(2), Suppl 1: 161-9.

Taylor S. Health Psychology. 1995 McGraw-Hill Inc. New York

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