[Incorporation of a psychologist into a nephrology service: criteria and process]

Chronic kidney disease is associated with a wide range of stressful situations causing important physical and psychological repercussions. It is not usual that psychology professionals are active members of the nephrology teams. In consequence, these alterations are not properly assisted. Our aim is to present the introduction process of a psychologist in a nephrology department and its preliminary results. We designed a clearly defined introduction process, starting with a therapeutic communication training program for all the staff. In the model we have priorized pre-emptive interventions in order to promote the adaptation process, far from simple psychological symptom control. It is assumed the binomial patient-family as the major objective for care, choosing an interdisciplinary approach. We worked more from a health psychology perspective than from a mental health perspective. Over the year 2008 the number of patients assisted by the psychologist were 571 (mean 48 patients/month). The total number of interventions was 1,022. Majority of cases (45.2%) were derived from the advanced chronic kidney disease program, mostly related to demands about emotional impact of renal replacement therapy commencement. Others were: suspect of depression episode, adherence, primary caregiver emotional overwhelming, bereavement, anxiety and support in decision making process. This experience is a stimulus for the integral approach of the renal patient.