Nursing Care for a Patient with Chronic Kidney Disease During Hemodialysis Initiation
DOI:
https://doi.org/10.37287/ijghr.v8i6.2717Keywords:
anxiety, chronic kidney disease, guided imagery, hemodialysis, music, nursing, spiritualityAbstract
Anxiety is common among patients with chronic kidney disease (CKD) undergoing hemodialysis, particularly during therapy initiation. It may affect hemodynamic stability and quality of life, requiring safe and effective nonpharmacological nursing interventions. Spiritual Guided Imagery and Music (SGIM) integrates guided imagery, relaxation music, and spiritual approaches to reduce anxiety. To analyze nursing care for a patient with CKD during hemodialysis initiation, focusing on SGIM to manage anxiety at Persahabatan Hospital, Jakarta. A descriptive single-patient case report using a comprehensive nursing care approach, including assessment, diagnosis, planning, implementation, and evaluation. The case involved a 54-year-old man with stage 5 CKD initiating hemodialysis. SGIM was administered in three 10–15-minute sessions during hemodialysis. Data were collected from medical and nursing records, HARS assessments, vital-sign observations, and patient subjective reports before and after each session. Data were analyzed descriptively by comparing pre- and post-intervention HARS scores and examining changes across sessions. HARS scores decreased across sessions from 28 to 21, 21 to 15, and 14 to 10. Overall, the baseline score decreased from 29 to 10, representing a 19-point reduction (65.5%). The patient reported feeling calmer, more relaxed, nearly falling asleep, more accepting of his condition, and more optimistic about treatment. Blood pressure, pulse rate, and respiratory rate also decreased. The patient subsequently used water-flow sounds as an independent coping strategy at home. The implementation of non-pharmacological nursing interventions, such as Spiritual Guided Imagery and Music (SGIM), is effective in reducing anxiety and supporting hemodynamic stability in patients with chronic kidney disease undergoing hemodialysis initiation.
References
Gagnier, J. J., Kienle, G., Altman, D. G., Moher, D., Sox, H., Riley, D., & CARE Group. (2013). The CARE guidelines: Consensus-based clinical case reporting guideline development. Global Advances in Health and Medicine, 2(5), 38–43. https://doi.org/10.7453/gahmj.2013.008
Riley, D. S., Barber, M. S., Kienle, G. S., Aronson, J. K., von Schoen-Angerer, T., Tugwell, P., Kiene, H., Helfand, M., Altman, D. G., Sox, H., Werthmann, P. G., Moher, D., Rison, R. A., Shamseer, L., Koch, C. A., Carpenter, J. E., & Gagnier, J. J. (2017). CARE guidelines for case reports: Explanation and elaboration document. Journal of Clinical Epidemiology, 89, 218–235. https://doi.org/10.1016/j.jclinepi.2017.04.026
Kidney Disease: Improving Global Outcomes (KDIGO). (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International, 105(4S), S117–S314. https://kdigo.org/guidelines/ckd-evaluation-and-management/
Huang, C. W., Wee, P. H., Low, L. L., Koong, Y. L. A., Htay, H., Fan, Q., Foo, W. Y. M., & Seng, J. J. B. (2021). Prevalence and risk factors for elevated anxiety symptoms and anxiety disorders in chronic kidney disease: A systematic review and meta-analysis. General Hospital Psychiatry, 69, 27–40. https://doi.org/10.1016/j.genhosppsych.2020.12.003
Nagy, E., Tharwat, S., Elsayed, A. M., Shabaka, S. A. E.-G., & Nassar, M. K. (2023). Anxiety and depression in maintenance hemodialysis patients: Prevalence and their effects on health-related quality of life. International Urology and Nephrology, 55(11), 2905–2914. https://doi.org/10.1007/s11255-023-03556-7
Burrai, F., Magavern, E. F., Micheluzzi, V., Magnaghi, C., Apuzzo, L., & Brioni, E. (2020). Effectiveness of music to improve anxiety in hemodialysis patients: A systematic review and meta-analysis. Holistic Nursing Practice, 34(6), 324–333. https://doi.org/10.1097/HNP.0000000000000411
Yangöz, Ş. T., & Özer, Z. (2022). Effects of music intervention on physical and psychological problems in adults receiving haemodialysis treatment: A systematic review and meta-analysis. Journal of Clinical Nursing, 31(23–24), 3305–3326. https://doi.org/10.1111/jocn.16199
Melo, G. A. A., Rodrigues, A. B., Firmeza, M. A., Grangeiro, A. S. de M., Oliveira, P. P., & Caetano, J. Á. (2018). Musical intervention on anxiety and vital parameters of chronic renal patients: A randomized clinical trial. Revista Latino-Americana de Enfermagem, 26, e2978. https://doi.org/10.1590/1518-8345.2123.2978
Yangöz, Ş. T., Kavradim, S. T., & Özer, Z. (2025). Spiritual interventions on physical and psychological outcomes in adults receiving haemodialysis: A systematic review and meta-analysis of randomized controlled studies. Applied Nursing Research, 83, 151918. https://doi.org/10.1016/j.apnr.2025.151918
Şanli, M. E., Dinç, M., Öner, U., Buluş, M., Çiçek, İ., & Doğan, İ. (2023). The role of spirituality in anxiety and psychological resilience of hemodialysis patients in Turkey. Journal of Religion and Health, 62(6), 4297–4315. https://doi.org/10.1007/s10943-023-01855-y
Barello, S., Anderson, G., Acampora, M., Bosio, C., Guida, E., Irace, V., Guastoni, C. M., Bertani, B., & Graffigna, G. (2023). The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: A systematic review and a meta-analysis. International Urology and Nephrology, 55(4), 897–912. https://doi.org/10.1007/s11255-022-03374-3
Zahra, Z., Effendy, E., Mawarpury, M., Marthoenis, & Jaya, I. (2023). Psychotherapies for chronic kidney disease patients with hemodialysis: A systematic review of randomized control trials and quasi-experiments. Narra X, 3(3), e215. https://doi.org/10.52225/narra.v3i3.215
Nuwa, M. S., & Kiik, S. M. (2020). Pengaruh spiritual guided imagery and music terhadap kecemasan pasien kanker yang menjalani kemoterapi. Jurnal Ners dan Kebidanan, 7(1), 95–106. https://doi.org/10.26699/jnk.v7i1.ART.p095-106
Simamora, A. Y., Zahwa, P. N., Sari, N., Laia, R., & Nurhayati, E. L. (2024). Efektivitas spiritual guided imagery and music terhadap kecemasan pasien kanker yang menjalani kemoterapi di RSU Royal Prima Medan. MAHESA: Malahayati Health Student Journal, 4(8), 3166–3179. https://doi.org/10.33024/mahesa.v4i8.14971
Toding, D., & Masfuri. (2021). Efektivitas penerapan intervensi berbasis adaptasi dan guided imagery pada pasien gagal ginjal kronik yang menjalani hemodialisis. Jurnal Penelitian Kesehatan Suara Forikes, 12.
Zees, R. F., & Lapradja, L. (2021). Efektifitas terapi guide imagery terhadap kecemasan pasien hemodialisa. Jambura Health and Sport Journal, 3(1).
Tim Pokja SDKI DPP PPNI. (2017). Standar diagnosis keperawatan Indonesia: Definisi dan indikator diagnostik. Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.
Tim Pokja SIKI DPP PPNI. (2018). Standar intervensi keperawatan Indonesia: Definisi dan tindakan keperawatan. Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.
Tim Pokja SLKI DPP PPNI. (2019). Standar luaran keperawatan Indonesia: Definisi dan kriteria hasil keperawatan. Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.
Yuwono, T., & Ellina, A. D. (2025). Mengatasi kecemasan pada pasien hemodialisis dengan terapi guided imagery berbasis spiritual di rumah sakit: Overcoming anxiety in hemodialysis patients with therapy spiritually based guided imagery in hospitals. Jurnal Abdi Kesehatan dan Kedokteran, 4(1), 38–45. https://doi.org/10.55018/jakk.v4i1.70
Widiyono. (2021). Betapa menakjubkannya terapi musik bagi kesehatan. Lima Aksara.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
