How to provide emotional support to patients with CKD?
We spoke with psychologist Yésica Paola Velasco Gutiérrez, who gave us her point of view on some of the most common questions regarding the emotional state of patients with CKD.
The low or no functionality of an organ is a duel.
When one of the patients loses the health of an organ as important as the kidney, one must prepare psychologically to accept and confront that loss and what comes with it.
"We are all different human beings, and we react differently to situations. Patients' reactions to RCD are diverse; there are patients who often do not understand the process they are going through, and many refer to phrases such as "I do not understand why this happens if I took care of myself", or "I was already in the nephroprotection program and I knew I could reach this point" and others say "I felt good all my life and from one moment to the next my tension rose and I resulted in CKD," explains the psychologist.
Faced with this situation, patients enter a state of emotional shock. They have feelings of sadness, anguish, and anxiety. "The process of acceptance and commitment to the disease begins, but we also work on the grieving process in the face of the loss of the functionality of your kidney or kidneys, and like any grieving process, it is characterized by stages (1. Denial 2. Anger/anger 3. Negotiation 4. Depression 5. Acceptance)," she adds.
Support Network
Since each case is different, family and friends must patiently accompany each stage of grief and accompany the patient in his process, which must be guided by a psychologist. “Having a support network will be the patient’s staff throughout the acceptance and dialysis process. It is important that this support network be prepared for crisis situations, as emotional and physical wasting occurs for the patient, and it is not easy to cope with these changes. This support network must be characterized mainly by tolerance and empathy. Similarly, this network is characterized by having a primary caregiver, however it is ideal that this role be assumed by more than two people in order to reduce symptoms of fatigue or depression."
Furthermore, in the day-to-day normality is important, and this psychologist recommends maintaining the routines of the activities that generate physical and emotional satisfaction.
What things should we not say to a patient with CKD?
The choice of words is key in the message that is given to a person going through a Chronic Kidney Disease. For this reason, Velasco suggests maintaining a realistic stance. Phrases such as "do not worry, everything will pass" should be avoided, since this phrase is reinforcing the idea of denial of the process, and it will be more difficult for the patient to face dialysis therapy. Another phrase to avoid is: "keep calm, it is not that bad", because it can be misunderstood as minimizing the pain, feelings and anguish generated by having CKD.
Warning signs: Acting in a decaying mood
This psychologist reminds us that from the physiological point of view there are normal processes, like feeling inappetence for certain foods. However, from the emotional point of view, it is important to be aware that self-care behaviors are maintained, such as bathing daily, changing clothes, brushing teeth, and worrying about physical appearance. "There are changes on an emotional level, and there will be moments where the patient is stable, but there will also be moments of crisis, where the patient can manifest things like 'I'm tired of all this, I don't want to go back to dialysis anymore' or 'I won't reconnect anymore,'" she says. Changes in self-care behaviours or the mention of these phrases may be signs that psychological help is required.
The expectation of a possible kidney transplant: patient and donor
For many patients, this idea can become a big illusion. Even so, expectations should remain realistic considering that the transplant may not be given or may not give the expected results. “The idea of having the transplant is highly motivated for the patient by the change in lifestyle, but the viability of the probability of this event should be emphasized. More work needs to be done in the care around CKD (diet, adequate intake of medications and emotional management),” says Velasco.
As for the donor, who in many cases can be a family member or close person, there are also a series of emotional guidelines to take into account, in addition to the physical care of rigor. "We must bear in mind that it is a single delivery and therefore controls with psychology will be received. Emotional support is important before (doing an anticipated grieving process in order to prepare you for a loss), during (accompanying the postoperative process), and after (accompanying the process of adapting to your new lifestyle)," she explains.
What to do when optimism seems not to be enough?
- It is important to keep in mind from the beginning the normal progression of the disease and its possibilities so as not to generate false expectations.
- When we seek from the beginning the acceptance of the diagnosis with psychological help we can work from the beginning in the mourning of the disease.
- Be an unconditional support network be present at every stage of the disease and offer our support in difficult times to ease the emotional burden.