Coping In Patients Research Articles

Analysis of Adverse Event Notifications Within the Scope of Patient and Employee Safety: An Example of a Public Hospital

This study aimed to analyze the adverse events reported in a public hospital within the scope of patient and employee safety, to develop studies aimed at learning from errors and to increase the awareness of healthcare professionals and to increase the quality of healthcare service provision. The research was designed as a descriptive, cross-sectional, and retrospective quantitative research design. Data were obtained from the Hospital Information Management System and written records with the data collection form created by the researcher. Data were obtained from the adverse events reported between 01.01.2022 and 30.12.2023. According to the findings of the research; A total of 3447 patient safety adverse event reports were made in 2022, and it was determined that 19 of them were falls, 8 were medication safety, 5 were transfusion safety, and 3415 were laboratory safety. A total of 4788 patient safety adverse event reports were made in 2023, and it was determined that 37 of them were falls, 20 were medication safety, 2 were transfusion safety, and 4729 were laboratory safety. In 2022, a total of 111 employee safety undesirable incidents were reported, of which 59 were sharp-edged injuries, 9 were blood and body fluid splashes, and 45 were legal incidents. In 2023, a total of 120 employee safety undesirable incidents were reported, of which 63 were sharp-edged injuries, 6 were blood and body fluid splashes, and 51 were legal incidents. When the 2022-2023 undesirable incident reports are compared, it is seen that the number of reports has increased over the years, which indicates that a reporting culture has been formed in the institution. As a result of the research; It was determined that the most reported undesirable incidents were laboratory safety and sharp-edged injuries.

Post‐stroke family resilience is correlated with family functioning among stroke survivors: The mediating role of patient's coping and self‐efficacy

AbstractAimFamily resilience and healthy family functioning are crucial for stroke survivors' rehabilitation. This study aimed to determine the mediating effects of self‐efficacy and confrontation coping on the relationship between family resilience and functioning among patients with first‐episode stroke.DesignA cross‐sectional design was applied.Methods288 patients with first‐episode stroke were recruited from 7 hospitals in Shangqiu and Shanghai, China, from July 2020 to October 2020. A shortened Chinese version of the Family Resilience Assessment Scale, family adaptation, partnership, growth, affection and resolve questionnaire, Medical Coping Modes Questionnaire, and Self‐efficacy for Chronic Disease 6‐item Scale were used to collect the self‐reported data. The relationships among the studied variables were studied using spearman correlation and structural equation model.ResultsThe average level of family functioning among stroke patients was 7.87 (SD = 2.32). About 26.8% (n = 76) of patients reported family dysfunction. The structural equation model showed that family resilience directly affected patients' satisfaction with family functioning (r = 0.406, p < 0.001) and indirectly affected the mediating role of patients' self‐efficacy and confrontation coping style (r = 0.119, p < 0.001). The model was with good fit (χ2/df = 2.128, RMSEA = 0.065, GFI = 0.956, AGFI = 0.919, NFI = 0.949, and TLI = 0.956).ConclusionFamily resilience and functioning among patients with first‐episode stroke are positively associated with the mediating effects of the patients' confrontation coping style and self‐efficacy between family resilience and functioning. The findings indicate that the professionals should pay special attention to families exhibiting poor family resilience or with patients who rarely use confrontation coping styles or with poor self‐efficacy since they are more likely to suffer from low functioning.

Hubungan Pemenuhan Kebutuhan Biologis Dan Sosial Dengan Tingkat Kecemasan Pada Pasien Hemodialisis Di RSUD Cibinong Tahun 2023

Kidney failure is a chronic disease where the kidneys are no longer able to remove toxic substances in the body, resulting in a buildup of toxins as a result. Patients suffering from kidney failure must undergo therapy to remove toxic substances, one of the therapies is hemodialysis. This therapy is carried out in approximately 4-5 hours to remove toxins, there are several accesses, namely with CDL and Cimino. which will cause changes in the physical, socio-economic and psychological conditions of patients undergoing Hemodialysis therapy. These changes will have an impact on the patient's coping mechanisms. Patients undergoing hemodialysis often experience several problems including psychological problems, one of which is often experienced is anxiety. Anxiety is an emotional response to a subjective individual assessment, related to feelings of uncertainty and helplessness and to overcome it is necessary family support. This study aims to determine the biological and social relationship between family support and the level of anxiety in chronic kidney failure patients undergoing hemodialysis. This research was quantitative using a correlation method involving 99 patients in the hemodialysis unit at Cibinong Hospital. To collect data, this study used prepared observation sheets, and statistical analysis was carried out using the Chi Square test. This method was carefully chosen to ensure that the data obtained could be used to evaluate the relationship between biological and social levels of anxiety in hemodialysis patients. With this approach, it is hoped that this research will provide valid and useful findings in supporting efforts to improve the quality of service in the hemodialysis unit at Cibinong Hospital.

Sosialisasi Pencegahan Post Partum Blues Pada Ibu Nifas

.Bobak's book review (2005) states that post partum blues is a mild affective disorder syndrome that occurs early after childbirth, with signs of sadness or dysphoria, crying, irritability, anxiety, lability of feelings, tendency to blame oneself, appetite disorders. , sleep disturbances, feelings of envy and guilt. This situation will get better and worse depending on the patient's coping mechanism. By looking at this situation, we need to look at educational factors as well as being part of the factors that encourage post partum blues. Research from Hasifah, H., Nurparisih, U. S., Maliga, I., & Lestari, A. (2024), there is a relationship between the level of maternal knowledge and the incidence of post partum blues in post partum mothers. Conclusions from other research are that age, parity, level of education, family support, sleep disorders, type of delivery, and readiness to become a mother are factors that cause postpartum blues and can be overcome by involving the husband, family and the surrounding environment through support for postpartum mothers. (Olii, N et al, 2023). The method of this community service activity is by conducting outreach to post partum mothers or postpartum mothers in the Cirebon Regency area by visiting the home once. Socialization using leaflet media, with the topic, "Socialization on the Prevention of Post Partum Blues in Postpartum Women". The target selection here is postpartum mothers who have recently given birth, around 3-5 days after giving birth, targeting postpartum mothers and their husbands. After carrying out "Socialization on the Prevention of Post Partum Blues among Postpartum Mothers" through home visits, the response from families and mothers was visible. the good one. There are also several questions such as why it is so important to support postpartum mothers, there are also those who feel that they are not aware of the importance of this support, considering that the forms of support are also complex, they also feel helped by the socialization regarding the prevention of post partum blues.

The Nurse‐Patient Relationship in Nursing Documentation: The Scope and Quality of Interactions and Prevalent Interventions in Inpatient Mental Health Units

Aims. (i) To evaluate the scope and quality of nurse‐patient interactions recorded in the clinical notes of inpatient mental health units and (ii) to identify nursing interventions recorded in the context of the nurse‐patient relationship in the clinical notes of inpatient mental health units. Design. A multimethod approach was use. Methods. Employing a quantitative cross‐sectional design for the first aim, and a qualitative content analysis design of secondary data for the second aim. In total, 1,714 clinical notes were examined from 44 randomly selected patients who were hospitalized in five mental health units over the years 2022‐2023. Results. The patient’s experience of the interaction was present in 69.9% (n = 1,198) of the notes. However, only 12.0% (n = 205) of the notes reached a sufficient standard of quality in terms of describing the nurse‐patient interactions. Specifically, more than half of the notes did not reflect any type of nursing intervention (n = 723; 60.4%). Thirty interventions compatible with the nursing intervention classification were identified, of which more than 70% corresponded to domains in the physiological area. Conclusion. This study shows that the quantity and scope of patients’ clinical notes in mental health units do not sufficiently reflect the interventions performed by nurses, nor the quality or impact of these interventions in the context of the nurse‐patient therapeutic relationship. Implications for the Profession and/or Patient Care. Improving the quality of clinical notes by integrating interventions and their impact can increase the quality of nursing care. Impact. The use of standardized nursing terminologies would contribute to the understanding of the extent and quality of nurse‐patient interactions recorded in clinical notes. Thus, standardized documentation would also help to improve these interactions and their recording, which will facilitate decision‐making. Reporting Method. Findings were reported using COREQ and STROBE guidelines. Patient or Public Contributions. There were no patient or public contributions.

Surgical treatment of aortic root abscess: 10-year single center experience

The issue of optimal surgical scope in patients with aortic root abscess due to infective endocarditis remains open, since there are different strategies and interventional methods. In addition, the guidelines do not give preference to any particular type of surgical intervention and recommend an individual approach to each situation. The study included 25 patients with aortic root abscess due to aortic valve infective endocarditis. The most frequently performed surgical intervention in patients was the Ross procedure (n=12, 48%). Eight (32%) patients of the center underwent aortic homograft root replacement. Combined surgery was performed in 7 (28%) patients as follows: 3 (12%) patients — interventions on the mitral valve (all patients underwent mitral valve repair due to mitral valve involvement in abscess), 3 (12%) — coronary artery bypass grafting, 1 (4%) — ascending aortic replacement due to dilatation. Five- and ten-year survival after surgical treatment of patients with aortic root abscess was 86,9% and 78,6%, respectively. There was no reintervention and recurrence of infective endocarditis in the long-term period.

Surgical treatment of aortic root abscess: 10-year single center experience

The issue of optimal surgical scope in patients with aortic root abscess due to infective endocarditis remains open, since there are different strategies and interventional methods. In addition, the guidelines do not give preference to any particular type of surgical intervention and recommend an individual approach to each situation. The study included 25 patients with aortic root abscess due to aortic valve infective endocarditis. The most frequently performed surgical intervention in patients was the Ross procedure (n=12, 48%). Eight (32%) patients of the center underwent aortic homograft root replacement. Combined surgery was performed in 7 (28%) patients as follows: 3 (12%) patients — interventions on the mitral valve (all patients underwent mitral valve repair due to mitral valve involvement in abscess), 3 (12%) — coronary artery bypass grafting, 1 (4%) — ascending aortic replacement due to dilatation. Five- and ten-year survival after surgical treatment of patients with aortic root abscess was 86,9% and 78,6%, respectively. There was no reintervention and recurrence of infective endocarditis in the long-term period.

Knowledge and perception regarding adverse drug reactions among undergraduate medical students of Bihar, Eastern India.

Adverse drug reactions (ADRs) have national and international monitoring and are part of teaching-learning of undergraduate medical course and curriculum. To find the knowledge and perception of ADRs among undergraduate medical students in a tertiary care teaching institute in eastern India. This was an observational cross-sectional study conducted among the MBBS medical students by administration of pre-designed, pre-tested, semi-structured questionnaires. The data on their knowledge and candid reflections on ADRs were analyzed question by question using software and compared with peers. The responses from the participants on knowledge and perception of ADRs varied widely. Final-year students had the most precise response on classification, filing an ADR report, national reporting centers, and the first step in monitoring ADRs; the majority accepted their first- hand experience and legal and professional responsibilities on ADRs. Third-year students responded well on objectives, methods, and scope of patients on direct reporting or drug overdose and monitoring; respect patient confidentiality while reporting; and expect feedback from monitoring centers, with special training on ADR. Second-year students responded well on definitions, pharmacovigilance programs in India, alertness of banned drugs because of ADR, and related capacity building. The awareness and insight on ADRs of the undergraduate medical students were quite reasonable. However, further reinforcement is needed in future to be updated to relevant issues to their practice as primary care physicians.

A Quality Improvement Project to Gain Insight Into What Helps Cancer Patients Cope During Outpatient Radiation Therapy Treatments.

Psychosocial support in cancer care has not been researched or published to the degree of physical support. This type of support includes the mental, emotional, social, and spiritual needs of patients and loved ones. This quality improvement project provides insight for those seeking understanding of what exactly helps cancer patients cope during outpatient radiation therapy treatments. The purpose of this project was to learn what practices benefit patient's coping during outpatient external radiation therapy treatments in order to increase attention given to psychosocial support of future cancer patients receiving outpatient external radiation therapy treatments. Insight from this project was used to create a resource handout for Novant Health Cancer Institute to help increase awareness, discussion, and attention to supporting outpatient radiation therapy patients emotionally and spiritually.

I Cancervive: Exploring the Modern Travails of Cancer-Stricken Adolescents in the Pandemic New Normal

Currently, the world faces two critical challenges: the COVID-19 pandemic and surging cancer cases. Healthcare systems worldwide, including the Philippines, struggle to cope with rising cancer patient mortality. Urgent action and innovative solutions are vital to managing cancer care amidst the ongoing pandemic. Hence, this study explored the journey of adolescent cancer patients who are receiving treatment during the pandemic particularly the present challenges with cancer treatment, its holistic repercussions, the patient's coping mechanisms, and their significant life breakthroughs. It employed a qualitative multiple-case study, utilizing semi-structured interviews to collect data from four (4) pediatric hematology-oncology cases. The data was analyzed using content analysis wherein the narratives of the participants were compared. The findings of the study revealed themes that represent the challenges experienced by cancer patients namely, (1) treatment and other medical services disruption; (2) reduced social support; and (3) increased contamination-related anxieties. The immediate repercussions included (1) psychological disturbance, stress, and depression; (2) uncertainty and emotional distress; (3) stronger behavioral adherence to COVID-19 prevention measures; (4) increased gadget usage/gadget dependence, and (5) decreased scholastic involvement. Further, the participants’ coping mechanisms include (1) active coping strategies via engaging activities; (2) awareness and acceptance of the current situation; (3) strong social and spiritual support, and (4) positive and active mind setting. The insights gathered from the analysis are (1) the need for better access to cancer-related services and assistance, and (2) the call for more psychological health intervention programs. The findings showed that the insights and realizations of participants emphasized the need for better access to cancer-related services and assistance and a calling for psycho-oncological therapeutic interventions for fellow cancer patients.

Patient's Coping of Anxiety Level of Dialysis Patients

This study aims to determine the effect of coping with anxiety levels. The research method used is descriptive correlative using Cross-Sectional. The results showed moderate anxiety levels in the hemodialysis installation at Advent Bandung Hospital with 86 people (96.63%). In conclusion, coping mechanisms influence the patient's anxiety levels.
 
 Keywords: Anxiety, Dialysis, Patient Coping

Perioperative Health Education Improves Coping Mechanisms in Preoperative Cataract Patients

Patients with cataracts can experience psychological and physiological impacts; the physiological impact caused is discomfort in sight, while the psychological impact on patients is anxiety because they will have surgery on the eye. This study aims to analyze the effect of providing perioperative health education on the coping mechanisms of preoperative cataract patients. This study used a quasi-experimental research design with a pre-test and post-test research approach with a control group design. The research sampling technique used is consecutive. The sample in this study were cataract patients who were going to perform cataract surgery as many as 30 respondents. Analysis of the data used using the dependent t-test and independent t-test. This study's results indicate differences in coping mechanisms in the measurement of the treatment and control groups, with a p-value = 0.001. This study concluded that there were significant differences in coping mechanisms after being given perioperative health education in the treatment group and the control group. Nurses are expected to be able to apply health education to preoperative cataract patients so that the patient's coping becomes adaptive and ready for surgery

Everybody Copes: An Interprofessional Workshop on Stress, Coping, and Helping Primary Care Patients Manage Medical Stressors.

The value of psychological principles has become apparent in medical settings, especially with the rise of patient-centered care. We aimed to provide a curriculum informing medical providers about the theoretical basis and clinical utility of the social-cognitive model of stress and coping. This workshop was delivered to an interprofessional team of faculty and trainees. Our initial pedagogical approach was to relate the concepts of cognitive appraisals and coping strategies to participants' own stress responses. We then used didactic presentation and small-group activities to explore ways to promote adaptive coping with patients to improve health outcomes. Learners participated in a mindfulness exercise, conceptualized coping strategies given a hypothetical case scenario, and, in small groups, role-played a patient encounter to construct an effective coping repertoire for the patient. Participants completed a prework self-assessment and workshop evaluation form. The 2.5-hour workshop had 48 participants from five professions (medicine, education, physician assistant, pharmacology, psychology). We received 35 evaluations (73% response rate). Learners reported increased real-world skills (M = 8.0 out of 10) and feeling better prepared for working in interprofessional settings (M = 7.6 out of 10). Qualitative feedback suggested that participants recognized the importance of individual differences in coping with stress and felt they could categorize strategies into emotion- or problem-focused coping. This workshop provided participants with basic knowledge about the social-cognitive model of stress and coping and allowed them to practice newly learned skills in a role-play as an interprofessional medical care team.

Association of Coping Strategies and Medication Adherence: A Systematic Review.

Background: Medication adherence is difficult for most patients who take at least one medication. Poor drug adherence is a developing problem since it contributes to negative outcomes, prescription waste, increased healthcare expenses, and disease progression. Coping strategies are an important tool for managing a patient's condition because a patient's coping method influences how he or she perceives the situation and deals with the stress that comes with it, which can eventually affect adherence. Coping strategies are classified into five categories: problem-focused, emotion-focused, seeking understanding, support seeking, and problem avoidance. Objective: The goal of this study is to examine and illustrate the association of coping strategies on medication adherence. Method: A systematic review of PubMed/MEDLINE database was conducted in order to screen and select articles. A total of 15 studies were included where they were classified by endpoints. Endpoints that were considered are medication adherence, problem-solving/active coping strategy, emotion-focused coping strategy, seeking understanding coping strategy, support seeking coping strategy and problem avoidance coping strategy. The association of each coping strategy on medication adherence was then evaluated from each article assigned to every category of coping strategies to determine if it had a favorable, negative, or no impact on medication adherence. Results: Most studies which measured problem-solving/active coping strategy (78%) had a positive association on medication adherence, followed by studies which measured emotion-focused coping strategy (69%). Majority of the studies that evaluated for problem avoidance coping strategy (50%) showed a negative association on medication adherence and a small proportion of studies (30%) showed a positive association. Four(4) of the 5 coping strategies (problem-solving/active, emotion-focused, seeking understanding and support seeking) were found to have a greater number of studies showing positive association to medication adherence as opposed to problem avoidance. Conclusion: The findings may suggest that problem-solving and emotion-focused coping strategies can be useful to help people with chronic conditions improve their medication adherence. More study is needed to establish a link between coping strategies and medication adherence in patients, which will allow pharmacists and other healthcare professionals to deliver better interventions to patients and assess for medication nonadherence due to poor coping skills.

Persisting symptoms after concussion: Time for a paradigm shift.

Persisting symptoms after concussion: Time for a paradigm shift.

DIAGNOSTIC UTILITY OF THORACOSCOPY IN UNDIAGNOSED AND MISDIAGNOSED PLEURAL EFFUSION AT A TERTIARY CARE CENTRE

Background Pleural effusion results from accumulation of abnormal volumes ->( 10-20) ml of uid in pleural space . Signicant number of cases of pleural effusion remains undiagnosed after simple diagnostic pleural aspiration. Thoracoscopy allows direct visual assessment of the pleura and subsequent biopsy of visually abnormal areas, hence maximising diagnostic yield. A retrospective study of all Thoracoscopic Methods procedure performed with rigid and semi- rigid scope in patients admitted in Respiratory department of SRMS, Bareilly. Post-procedural diagnoses were obtained from the clinical records and using relevant hospital databases. A total of 40 patients underwent Thoracoscopy in Results time span of 2020-2021 to diagnose a wide spectrum of benign and malignant conditions. The diagnosis of 23 malignant conditions - 13 Adeno Carcinoma, 3 Non – small cell carcinoma and 7 cases of other malignancies , along with 17 benign cases were made . Conclusion Thoracoscopy can be used as a diagnostic tool for investigation of various pathologies of undiagnosed pleural effusion . In our study the sensitivity of thoracoscopy was more than 90%

An Ethical Analysis of the AI Values / Principles in “Turkey’s AI Strategy Plan” for Improving Patients’ Access to Health Care

The Turkish National Artificial Intelligence Strategy (TNAIS) has been prepared in line with the 11th Development Plan and the Presidential Annual Programs of the Republic of Turkey. The purpose of this strategy report is to describe the methods of determining national strategic AI priorities and set these priorities. In this report, according to the patent applications between 1980 and 2016, it is stated that the fields in which AI technologies are applied the most are: communication (24%), transportation (24%), and health sciences (19%). Therefore, it is seen that almost 1/5 of all AI technologies are applied in the field of health science. It can be concluded that AI technologies used in the field of health have a special place in the scope of the TNAIS report. The report covers four ethical values including: respect for human rights, democracy and the rule of law, improving the environment and biological ecosystem, ensuring diversity and inclusion, and living in peaceful, just and cohesive societies; and eight ethical principles including (1) proportionality, (2) safety and security, (3) fairness, (4) privacy, (5) transparency and explainability, (6) responsibility and accountability, (7) data sovereignty, and (8) multi-stakeholder governance. Consequently, in this study, the TNAIS report will be analyzed based on the ethical values and principles it contains within the scope of patients' access to healthcare. Then the current or prospective ethical issues emerging from the existence of AI technology used in healthcare will be addressed. Finally, the suggestions about the perspectives for approaching ethical issues when these values and principles are in conflict will be shared.

Related factors to the coping style of patients with sudden sensorineural hearing loss.

Coping style can affect the patient's physical and mental health management. Therefore this study aimed to identify factors related to the coping style of young and middle-aged sudden sensorineural hearing loss (SSNHL) patients to provide reference for clinical nursing practice. A cross-sectional study was conducted on young and middle-aged SSNHL patients hospitalized in the otolaryngology departments of four hospitals in Suzhou City, China. A paper-based self-administered questionnaire investigated the patient's coping style and related factors. Multiple linear stepwise regression analysed the effective related factors in patients' coping styles. Among 872 patients, 866 completed the survey, with an average age of 37.27y. Factors related to the coping style of these patients included gender, chronic diseases, history of trauma, social support and type D personality (p<0.05). Female patients adopt more negative coping styles than male patients. Patients with chronic diseases or a history of trauma had more positive coping styles. Higher social support scores were related to improvements in coping style. Patients with type D personality were more likely to adopt negative coping styles. This study suggests that psychological assessment of patients, chronic diseases, history of trauma, social support and type D personality may benefit the understanding of these patients' coping styles and, as a consequence, may improve their stress management.

PEMBERIAN EDUKASI DAN TEKNIK RELAKSASI PROGRESIF TERHADAP TINGKAT KECEMASAN PASIEN INFARK MIOCARD DI RSUD DR. PIRNGADI MEDAN TAHUN 2022

Acute Myocardial Infarction (AMI) also known as cardiac arrest, coronary occlusion, or simply coronary, is a life-threatening condition characterized by the formation of localized necrotic areas within the myocardium. Anxiety is the strongest predictor of disease. To reduce one's anxiety, it is necessary to have the ability to accept a process of change. A person in a conscious and not anxious state is able to make someone accept what is experienced. Acceptance will make a good psychological change, so good acceptance will make a positive change of mind. One that is very influential on the psychological state of patients with heart disorders so that they will be able to change the patient's coping patterns in dealing with illness and living their lives is the emergence of anxiety. All clients are prone to feelings of anxiety when they seek help with health problems. Easy and appropriate nursing interventions are needed in AMI patients to help reduce anxiety in supporting patient recovery. Community service providing education and progressive relaxation techniques to the level of anxiety of myocardial infarction patients are patients who are treated at RSUD Dr. Pirngadi Medan. Anxiety is closely related to feelings of uncertainty and helplessness, this emotional state has no specific object. Anxiety is different from fear. From the analysis of five articles on independent nursing interventions to reduce anxiety in AMI patients, it is concluded that aromatherapy interventions are very effective in helping reduce anxiety in AMI patients. The results of the study can be considered nursing interventions to reduce anxiety in AMI patients by providing education and progressive relaxation techniques

The Relationship of Duration of Hemodialysis with Coping Mechanisms of Chronic Kidney Disease Patients Underwent Hemodialysis

Chronic Kidney Disease patients undergoing hemodialysis can cause stress to the patient. The longer the patient suffers from Chronic Kidney Disease, the more the patient has a variety of experiences with stressors due to the disease. These experiences can be used as an anticipatory effort in dealing with stressors experienced by patients. The purpose of this was the relationship between the duration of hemodialysis and the coping mechanism of patients with chronic kidney disease undergoing hemodialysis. This study used descriptive quantitative, with a correlation design and a cross-sectional approach. The sample was 111 patients with chronic kidney disease undergoing hemodialysis. Sampling technique used the purposive sampling technique. The data collection instrument used a jalowiec coping scale questionnaire and length of underwent hemodialysis. The results showed that most respondents underwent hemodialysis in the category &lt;8 months (70.3%). The coping mechanisms in most patients were categorized as adaptive (55%). It was concluded that there was a relationship between the duration of hemodialysis and the coping mechanism in patients with chronic kidney disease undergoing hemodialysis (p = 0,000). The correlation strength value is 0.402 (moderate strength), and the direction of the correlation is negative, it shows that if the length of time is more than eight months, then the patient's coping mechanism becomes adaptive. The patient has accepted the situation he was undergoing, which is due to routine hemodialysis, which causes the patient to often meet other patients with the same problem so that by often telling each other they can share experiences and problems and encourage each other.