Akriti Kafle Baral ¹ Ruixing Zhang ^1* Dzifa Kodzo Lalit ¹ Sirjana Pandit Pahari ² Manthar Mallah Ali ³ Kamala Dhakal ⁴ Suraj Baral ⁵ Rajina Shakya ⁶ Mikiyas Amare Getu ^7,8

• ¹ School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan Province, China
• ² Department of Nursing, Charak Academy, Pokhara, Nepal
• ³ College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
• ⁴ Maharagunj Nursing Campus, Kathmandu, Nepal
• ⁵ Department of Medicine, Charak Memorial Hospital, Pokhara, Nepal
• ⁶ Nepal Health Research Council, Kathmandu, Nepal
• ⁷ Shenzhen university, Shenzhen, China
• ⁸ Woldia University, Woldiya, Amhara, Ethiopia

Introduction: Hemodialysis is the most common type of dialysis globally; approximately 3 million people are reported to receive this type of dialysis. Psychosocial issues in hemodialysis are the psychological and socioeconomic burdens emanating from the initiation and course of treatment and have the potential for gross deterioration in the quality of life and general wellbeing of patients. Understanding the psychosocial issues and needs of patients undergoing hemodialysis could pave the way for comprehensive support and therapies designed to reduce stress, improve social support, and foster mental resilience.The aim of this study was to explore the psychosocial issues and support needs of patients undergoing hemodialysis at a tertiary care center in Nepal.Methods: A qualitative descriptive study was conducted among 20 purposefully selected patients attending hemodialysis treatment at Pokhara Academy of Health Sciences, Nepal. Data were analyzed via thematic analysis.The study resulted in three major themes which included Emotional, psychological, and spiritual struggles, Social and economic impacts, and Support and information needs. Moreover, 16 sub-themes emerged which are Frustration with daily life, Constant fear of death, Thoughts of self-harm, Perceived Burden on Family, Sense of Divine Punishment, Sense of Unfairness, Fear about future uncertainties, Social avoidance, Social stigmatization, Loss of employment, Financial strain, Transportation challenges, Need for early, clear and comprehensive information, Need for support and reassurance from family, Support through peer connections, and Reassurance from healthcare providers. Conclusion: The findings of this study indicate patients undergoing hemodialysis in Nepal experience numerous hardships and multifaceted struggles that require support from different dimensions. Establishing robust support systems that include family involvement, peer networks, and effective communication from healthcare professionals can significantly mitigate feelings of anxiety and isolation.