Research Critiques and PICOT Question

People diagnosed with chronic kidney disease are highly prone to psychological and emotional difficulties, which often go unnoticed by their clinicians. As Taylor and Combes (2014) inform, a range of national guidelines highlight the importance of appropriate and effective response to the emotional needs of chronic kidney disease patients. Moreover, supporting these patients emotionally and psychologically is deemed integral in appropriate management of these long-term diseases among other chronic conditions. Since patients with chronic kidney disease are prone to emotional and psychological challenges, it is important to analyze critically studies that detail how appropriate intervention can help to create a better platform for health care practitioners and patients to connect emotionally, leading to better management of patients emotions.

Summary of Studies

Chronic kidney disease is attributed to various emotional, psychological, cultural, social, and spiritual challenges. In their study, Shahgholian and Yousefi (2015) believed on the importance of overcoming the challenges as the key to providing holistic patients care. Nonetheless, they also indicate that irrespective of the support provided by consultants to the patients, some clients continue to feel dissatisfied with the emotional and psychological support provided. To deliver a comprehensive recommendation on the issue, the researchers designed a phenomenological study with a primary objective of examining the concept of dissatisfaction with emotional, psychological, social, spiritual, and cultural support from the patient viewpoint. Correspondingly, the study by Combes et al. (2019) emotional distress among patients. In their belief, the emotional connection between practitioners and patients was important in providing relevant emotional support to the latter. The objective of their study was to explore the opinions of staffs regarding obstacles to identification of emotional distress and in the provision of relevant support to clients with chronic kidney disease. Importantly, these studies address the emotional needs from the perspective of the patient and that of the healthcare practitioners, which makes the studies crucial in unveiling an appropriate measure to meeting the psychological and emotional needs of patients.

PICOT Question

In End Stage Kidney Disease clients, what is the effect of Palliative Care Educational Intervention compared to regular practices on patient outcome, such as mental health status and death rates, within a span of three months?

How Articles Support Nurse Practice Issues

The article by Shahgholian and Yousefi (2015) and the article by Combes et al. (2019) are crucial to the completion of this research. The researchers from both studies appreciate the importance of emotions among patients and practitioners. However, Combes et al. (2019) indicates that a gap exists in the level of confidence portrayed by healthcare professionals who should be providing relevant psychological and emotional support to patients with chronic renal disease. As the study reveals, medical practitioners are the people who should be on the forefront in helping patients with chronic illnesses to address their emotional distress. However, barriers, such as those related to fear, role perception, and lack of knowledge on how to handle emotionally distressed patients become a setback in providing quality services. However, they propose approaches such as formulation of training programs that make responding to patient’s emotional challenges a priority for all rather than a solution for the few. Similarly, the article by Shahgholian and Yousefi (2015) offers an ideal perspective of support needed by patients with chronic kidney disease. Their study is primarily based on the patient’s perspective regarding the type of support they need. The study reveals that patients need support, whether emotional, social, cultural, or psychological, from practitioners, family, and society. Further, their study reveals appropriate interventions appropriate to responding to the needs of these patients to foster better patient outcomes. When combined, the two articles are pivotal to answering the PICOT question for this research.

Method of Study

In their research, Shahgholian and Yousefi (2015) take a descriptive phenomenological research approach on end-stage renal disease patients undergoing hemodialysis. A purposive sampling approach was employed since their intention was to address the emotional needs of ESRD patients undergoing hemodialysis. Further, the researchers used unstructured face-to-face interviews that lasted 30-40 minutes, which were later analyzed using Collaizi’s Method. On the other hand, Combes et al. (2019), in their study used qualitative semi-structured interviews with hospital staffs. For analysis, they used thematic analysis and grounded theory.

The descriptive phenomenological approach utilized by Shahgholian and Yousafi in their research. According to Bhar (2019), a phenomenological approach involves studying subjects who have experienced a certain phenomenon of interest to a researcher. The advantage of this approach is that it gathers natural data rather than artificial data. However, it has a major drawback in that it is time intensive, which is attributed to challenges such as ability to control pace and endpoints. On the other hand, Combes et al. (2019) utilizes qualitative approach that takes the form of a grounded theory study. According to. El Hussein et al. (2014), a grounded theory involves generating a theory based on gathered data. One benefit of using a grounded theory approach is that a researcher does not predetermine their findings. Instead, it allows the researcher to assess the phenomena as it is, ensuring a neutral perspective of the perspective. However, it has a significant challenge since it fails to acknowledge the importance of a researcher as an agent of data construction and interpretation since they rely on already collected data (El Hussein et al., 2014).

Results of the Study

The study by Combes et al. (2019) found that practitioners were cognizant of the distress that patients with ESRD underwent since they were responsible for rendering their routine medical services. However, irrespective of the challenges underwent by patients, the study reveals that there are different practices regarding how to address the emotional needs of patients. Importantly, the study reveals that there are no specific guidelines to help consultants in rendering appropriate emotional support to renal patients. Moreover, the study points that the dissatisfaction experienced across many patients regarding the level of emotional support results from six crucial factors.

First, Combes et al. (2019) report that healthcare providers indicated that the cause for emotional challenges varied across patients. As a result, practitioners addressing their emotional needs experienced varying challenges owing to the fact that there are no explicit guidelines on how to offer emotional and psychological support to their clients. Second, practitioners indicated that the perception of patient emotional needs across practitioners might result in health care providers overlooking these needs since some assumed some groups were in need of more attention than others. Another important factor identified in their research includes varying perception of staff roles, with many recounting feeling uncomfortable handling some situations. Furthermore, the research indicated that fear among staff members that the emotional burden might overload them when they share the emotional distress of the patients. Another important factor is that consultants lacked appropriate training, skills, and confidence to handle emotional interactions with their clients. Finally, practitioners claimed that work overload denied them sufficient time to address the emotional and psychological distress of patients, and there lacked appropriate or sufficient support services they could refer when they found their patients needed such.

The second article by Shahgholian and Yousefi (2015) found four themes relevant to meeting the emotional needs of patients with chronic kidney disease, including psychological support, social support, accompaniment, and spiritual support. The study prioritizes the mental wellbeing of both the patient and consultants. Notably, there exists a string connection between mental wellness and an individual’s physical health. In their research, Shahgholian and Yousefi (2015) found that psychological support is delivered by both family and practitioners. Consequently, it is crucial for these parties to be fully oriented with appropriate approaches to delivering emotional and psychological support. An important factor they found ideal for achieving this objective was improvement in communication between the patient and the practitioner or family. Better connection between the patient and healthcare provider resulted in quick adaptation to the treatment process, and consequently, positive outcomes.

Outcomes Comparison

The studies are expected to have a positive outcome on the PICOT question. The revelation acquired from the studies show that emotional or psychological support is crucial for positive outcomes. Importantly, the study by Shahgholian and Yousefi (2015) indicate that patients show an explicit need for emotional and psychological support from practitioners. For example, in their study, Shahgholian and Yousefi (2015) found that patients worry about a plethora of things, including their health, their job, salary, and family, among others. In solving these emotional and psychological problems, they need support from practitioners and their family. From the practitioner’s side, they need assurance that the medication will help them recuperate. Similarly, family needs to offer appropriate support, including accompaniment and devoting more time to attending to their sick family member or relative. On the other hand, the study by Combes et al. (2019) reveals that practitioners are focal to providing emotional support. However, the study indicates that very few practitioners are fully equipped for that role. Moreover, many do not consider that role as their own. For this reason, they recommend the need for practitioners to undergo training on how to handle the emotional needs of the patients. In this perspective, the two studies indicated the need to ensure a balance between the emotional support provided by practitioners and family, since some patients barely know any relatives to offer the required emotional support.


Research remains instrumental to understanding different phenomena in vast fields. The qualitative studies identified above play a very instrumental role in understanding the psychological or emotional needs of patients dealing with chronic kidney disease. Moreover, they provide ideal options regarding appropriate interventions. Particularly, they identify appropriate training for practitioners as a key measure to addressing the emotional needs of the patients. Through training, practitioners can manage both the patients’ emotional needs and their own emotional needs. Combined with other studies, the two researches can help provide effective solutions to improve patient outcome.


Bhar, S. (2019). Introducing phenomenological research methodology in sustainable consumption literature: illustrations from India. International Journal of Qualitative Methods.

Combes, G., Damery, S., Sein, K., Allen, K., Nicholas, J., & Baharani, J. (2019). Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support. PLoS ONE 14(11): e0225269.

El Hussein, M. T., Hirst, S., & Salyers, V. (2014). Using grounded theory as a method of inquiry: advantages and disadvantages. The Qualitative Report, 19, 1-15.

Shahgholian, N., & Yousefi, H. (2015). Supporting hemodialysis patients: A phenomenological study. Iranian journal of nursing and midwifery research20(5), 626–633.

Taylor, F. & Combes, G. (2014). Supporting the emotional and psychological needs of end-stage renal disease patients. University of Birmingham: Study Report. Retrieved from

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