The psychiatry-integrated nurse practitioner role in hemodialysis: An opportunity to provide nurse practitioner care between the interface of psychiatry and hemodialysis.

The mental health of patients living with end-stage kidney disease (ESKD) is an important aspect of their care. According to national survey data, depressive disorders affect about 9% of the North American population (Kessler, Chiu, Demler, Merikangas, & Walters, 2005). A review of psychological distress and depression across the spectrum of chronic kidney disease indicates that the prevalence of depression in ESKD is reported to be about four times that of the general population and it is associated with adverse outcomes including low quality-of-life ratings, graft failure, and death after renal transplantation (Zalai, Szeifert, & Novak, 2012). At St. Michael’s Hospital (SMH), patients on hemodialysis (HD) requiring psychiatry consultation had traditionally been referred to a dedicated outpatient psychiatrist. This presented challenges around access to psychiatry assessment and follow-up, as patients were reluctant to attend appointments outside of HD visits. The team recognized these challenges and addressed them through the introduction of the Medical Psychiatry NP (MP NP) role, as the point-of-care consultant in HD.