Abstract
Though renal transplantation is considered as a complete therapy for renal failure, there are sometimes patients who have to undergo hemodialysis again due to rejection.
Here we report a patient whose transplanted kidney had totally lost its function and who refused to undergo hemodialysis, but eventually came to accept this therapy by means of our approach based on psychiatric nursing.
The patient is a 29-year-old, unmarried female office worker. In May, 1978, she was diagnosed as renal failure, and hemodialysis was begun in August. In November, 1979, she underwent renal transplantation as well as an operation for duodenum perforation a month later. Six months after the transplantation, the patient began to show chronic rejection. We treated her with plasma exchange and some other therapies, but we couldn't achieve good results. So we decided to perform hemodialysis therapy irregularly. As a patient kept rejecting us and refusing hemodialysis, CAPD was tried in June, 1982. But after one month, peritonitis arose as a complication, so we abandoned this therapy. We tried a second CAPD in November, 1982, according to the patient's strong desire, but we had to give it up, as it caused stomach aches and ileus. The patient still refused to undergo hemodialysis and stuck to CAPD. Our decision was to accept, support and communicate with the patient as warmly as possible. Six months after starting hemodialysis against the patient's will, the relationship between the patient and us turned for the better, and good communication with each other was established. The patient gradually came to accept hemodialysis.
Through this case, we have renewed our understanding that, in psychiatric nursing, it is very important for the medical staff to try to grasp the patient's personality, to seek for a frank relationship with the patient and to establish good communication based on sympathy with the patient.
