Recently, I was on a call with a young mom of five kids who has chronic kidney disease (CKD). Her husband also had CKD and in the last year his condition had progressed to end-stage kidney disease and he was now visiting a dialysis center multiple times a week to receive treatment. After seeing her husband’s experience, the woman was concerned about her treatment options and adamant her own treatment couldn’t impact her time with her kids and her quality of life.

Prior to our conversation, she wasn’t aware of any options for receiving dialysis treatment at home. When I told her about home dialysis, she was open, engaged, and asked great questions. We discussed pros and cons and how she could prepare her schedule if she chose home dialysis. She ended the call feeling ready to speak to her nephrologist about her options, including referral for transplant.

Stories like this reinforce the importance of getting to know our patients beyond what we can read in their charts and labs. As nurses, we must start with understanding our patient’s health narrative, which is how they view their health in the context of their life. Do they comprehend the nature of their sickness? Are they aware of the treatment options available? Do they have the resources and support they need at home to manage their illness? And how does all of this affect their day-to-day lives, responsibilities, and personal goals?

Regardless of title or specialty, the medical professionals I’ve had the privilege to work with all do an amazing job meeting our patients where they are to provide them with the best care possible. But as nurses, we frequently have a unique opportunity to build deeper relationships with patients and caregivers. We’re just a phone call away between appointments, and often we’re the ones calling to check in. We offer a listening ear and endless empathy in moments of fear, sadness, and anger. We answer questions and explain things in a way our patients can understand. We do our best not to judge and, over time, we earn our patients’ trust.

Why building trust matters

Many patients I care for at Interwell Health have recently been diagnosed with CKD and are digesting a lot of information as they embark on their kidney health journey. I approach these early conversations without assumptions. Some of my patients are highly educated, or even from a medical background, yet know very little about CKD. Some of my patients are dealing with other health issues and struggle to comprehend the full nature of their diagnosis. And some have preconceived notions of the disease, perhaps from a family member or something they read online, which may or may not be accurate.

Building trust is the first step toward filling gaps in knowledge and addressing misperceptions. When patients understand their health condition, they’re more likely to feel empowered to make informed choices about their care. When the opposite is true and patients lack understanding of their health, they’re less likely to follow treatment plans and make decisions that reflect and support their individual health goals.

Having tough conversations, such as dialysis planning, and making sure patients understand their treatment options frequently requires using clinical language. Terms such as “creatinine” and “GFR” may be helpful to explain how CKD affects the body and how we can slow disease progression. Yet simply dropping these phrases into the conversation only creates confusion and causes many patients to feel overwhelmed or even frightened. I start with explaining these terms as simply as I can and then build on that education in future conversations. I strive to ensure my patients feel confident that they understand all of the options available and can have informed conversations with their providers about their choices.

Recently, I was on a call with a patient in his 30s who was skeptical of his diagnosis and believed his doctor was rushing him into dialysis. He was at a stage where we needed to discuss dialysis soon, but I knew we wouldn’t get very far if I couldn’t earn his trust first. I took the time to listen and understand his concerns before jumping into education. We ended the call with the patient requesting more information over email and scheduling a follow-up call—a small step toward helping this patient make more informed decisions about his care.

Our privilege to ensure patients feel heard

As long as I’ve been caring for patients, I always get a twinge in my belly right before I call someone to talk to them about their treatment options. I always wonder how they’ll react and whether what I say will resonate. But most of the time, before I know it, we’re having a conversation, and they’re engaged and open and asking all the right questions. Maybe we even get in a few laughs.

Sometimes, the best thing we can do for our patients is listen. Simply letting them tell you their story can be eye opening. We might surface a gap in understanding that we can fill with education and help our patients make empowered decisions about their health. Or we might help patients acknowledge long-held concerns that they’d been too scared to say aloud. And sometimes all they need is for that fear to be acknowledged as valid. We all want our concerns and fears to be acknowledged. As nurses, we have the opportunity and privilege to serve in that role for our patients.

Bianca Blanco MSN, APRN, FNP-BC, CNN, is a nurse practitioner at Interwell Health, a value-based kidney care provider. She brings more than 20 years of nephrology experience to her role on Interwell’s telehealth patient care team, empowering individuals with chronic kidney disease and end-stage kidney disease to live their best lives.