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This interdisciplinary protocol is only applied to patients that fit a certain profile&#44; where the simultaneous intervention may facilitate adopting future treatments at the lowest emotional cost possible&#46; These patients have been previously identified by the nephrologist and&#47;or nursing staff as exhibiting an intense emotional state or denial attitude that might hinder the reception of important information regarding the disease and subsequent process of shared decision making&#46;</p><p class="elsevierStylePara">Given that the presence of a psychologist in these consultations is not common in nephrology departments in Spain&#44; we sought in this publication to describe the functions and objectives of psychologists within this treatment strategy&#44; as well as to present our treatment protocol&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This editorial was sent for publication to the journals led by the two scientific societies involved in our area of medicine &#40;Spanish Society of Nephrology and Spanish Society of Nephrological Nursing&#41;&#44; with the objective of reminding us that&#44; in the integrated approach to treating renal patients&#44; there is far more that unites us than that divides us&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">1&#46; FUNCTION AND OBJECTIVES OF THE PSYCHOLOGIST IN ACKD NURSING CONSULTATIONS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The primary function of the psychologist in ACKD nursing consultations is to support the nursing staff in the process of communication and shared decision making&#46; The primary objectives include&#58;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">-&#160;Detection of possible difficulties that the patient may have in understanding the information provided&#46; If such a difficulty is detected&#44; the psychologist may help regulate the passage of information from the nursing staff so that it adjusts to the patient&#8217;s cognitive rhythm&#44; to clarify content&#44; and to aid the patient in articulating doubts&#46;</p><p class="elsevierStylePara">- To evaluate the patient&#8217;s emotional state during the process of information communication&#46; The psychologist will be attentive to the patient&#8217;s non-verbal communication so as to evaluate whether his&#47;her emotional state is appropriate to continue receiving information&#44; or whether the patient needs to stop and continue later&#46;</p><p class="elsevierStylePara">-&#160;To reinforce the nursing staff in facilitating the provision of emotional support to the patient&#46; &#8220;Emotional support&#8221; in this case is the creation of a therapeutic relationship in which the patient does not feel judged&#44; but rather understood and assisted in order to confront his&#47;her doubts&#44; needs&#44; and desires in an environment of mutual respect&#46;</p><p class="elsevierStylePara">-&#160;To support the nursing staff in exploring the values and lifestyle of the patient for the sake of facilitating shared decision-making&#46; The available literature informs us that there is no single dialysis technique that is better <span class="elsevierStyleItalic">per se</span>&#44; but rather that the criteria for choosing one type of treatment or another must be based on the patient&#8217;s lifestyle and value system&#44; among other variables&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">-&#160;To intervene in moments of crisis involving difficult communication with the patient&#44; in the case that the patient exhibits intense emotional reactions that are complicated to manage &#40;sadness&#44; anxiety&#44; hostility&#44; etc&#46;&#41;&#46;</p><p class="elsevierStylePara">- To include family members in the communication process by asking open and focused questions&#46;</p><p class="elsevierStylePara">In addition to the aforementioned aspects of patient care&#44; the presence of the psychologist in these consultations facilitates the patient undergoing psychological evaluations and interventions for specific needs when appropriate&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">2&#46; JOINT NURSING-PSYCHOLOGIST PROTOCOL FOR ACKD CONSULTATIONS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This nursing-psychologist consultation is only activated through referral from the nephrologist caring for each patient&#44; who is charged with leading the communication and shared decision making process for RRT options&#46; At each step of the process&#44; we indicate the type of health care professional who can provide the best input&#44; based on the notion that in all consultations&#44; the task of providing optimal patient care is a coordinated effort&#46;</p><li>Introductions and familiarisation between health care professionals and patient&#47;family&#46; The presence of a psychologist in these consultations may incommode the patient&#44; and may even produce resistance in some cases&#44; making it imperative to introduce the psychologist as part of an interdisciplinary team&#46; This introduction is led by the nursing staff&#46;</li><li>Indicate the primary objective of the consultation &#40;information regarding different modalities of RRT for the start of a shared decision making process based on patient values&#41;&#46; This component is also headed by the nursing staff&#46;</li><li>Indicate that the process of sharing information and making decisions is gradual&#44; not a single event&#44; in which the team can stop at any point and continue at another time&#46; This information is given by the psychologist&#46;</li><li>Explain the details of the different types of RRT with the use of visual aids &#40;mannequins&#44; catheters&#44; and bags&#41; and multimedia &#40;photographs&#44; educational videos&#44; testimonies&#44; and texts&#41;&#46; This essential component of the consultation is also carried out by the nursing staff&#44; while the psychologist will be attentive to the non-verbal communication presented by the patient&#46;</li><li>Explore whether the patient or family has any doubts&#44; and resolve these by facilitating assertive communication between the patient&#47;family and health care staff&#46; This component is carried out jointly by the nursing staff and psychologist&#46;</li><li>Explore the values and priorities held by the patient&#44; along with details regarding lifestyle&#46;</li><li>Support from both nurses and psychologists in the start of the shared decision making process through a deliberation<span class="elsevierStyleSup">4</span> based on patient value systems&#46;</li><li>A summary of the consultation&#44; space for allowing emotional reactions to level off&#44; and the offer of follow-up from the psychologist&#46;</li><li>Planning and follow-up by the nursing staff&#46;</li><li>Communication of the patient&#8217;s decision to the attending nephrologist&#46;</li><p class="elsevierStylePara">Despite the fact that we have had the opportunity to observe the benefits of this joint protocol&#44; the presence of the psychologist in the ACKD consultation is not a common occurrence&#44; and requires training for both the psychologist and nursing staff&#46; It is essential that the psychologist understands the basic medical and nursing care aspects for patients with ACKD in order to provide useful support in this process&#46; It is also essential that the nurse receives information regarding therapeutic communication skills&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Nephrology in the XXI century must involve creating interdisciplinary teams for the treatment of ACKD&#44; as well as an integrated bio-psycho-social approach to the disease&#46;<span class="elsevierStyleSup">5</span> We propose going even farther&#58; we take on the challenge of creating scenarios of joint intervention on patients health&#44; in which intervention strategies are different and the objectives are complementary&#44; in order to promote greater satisfaction for renal patients and their family members&#44; as well as for the health care professionals that look after them&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Acknowledgements</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We would like to thank our patients and their families for pushing us every day to take on new challenges in health care&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">We would also like to thank Almudena Perez-Torres for reminding us for almost four years of the importance of teamwork as an element of defence against patient suffering&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p>"
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