<![CDATA[Anxiety is common among patients with chronic kidney disease (CKD) undergoing hemodialysis, particularly during therapy initiation. It may affect hemodynamic stability and quality of life, requiring safe and effective nonpharmacological nursing interventions. Spiritual Guided Imagery and Music (SGIM) integrates guided imagery, relaxation music, and spiritual approaches to reduce anxiety. To analyze nursing care for a patient with CKD during hemodialysis initiation, focusing on SGIM to manage anxiety at Persahabatan Hospital, Jakarta. A descriptive single-patient case report using a comprehensive nursing care approach, including assessment, diagnosis, planning, implementation, and evaluation. The case involved a 54-year-old man with stage 5 CKD initiating hemodialysis. SGIM was administered in three 10–15-minute sessions during hemodialysis. Data were collected from medical and nursing records, HARS assessments, vital-sign observations, and patient subjective reports before and after each session. Data were analyzed descriptively by comparing pre- and post-intervention HARS scores and examining changes across sessions. HARS scores decreased across sessions from 28 to 21, 21 to 15, and 14 to 10. Overall, the baseline score decreased from 29 to 10, representing a 19-point reduction (65.5%). The patient reported feeling calmer, more relaxed, nearly falling asleep, more accepting of his condition, and more optimistic about treatment. Blood pressure, pulse rate, and respiratory rate also decreased. The patient subsequently used water-flow sounds as an independent coping strategy at home. The implementation of non-pharmacological nursing interventions, such as Spiritual Guided Imagery and Music (SGIM), is effective in reducing anxiety and supporting hemodynamic stability in patients with chronic kidney disease undergoing hemodialysis initiation.]]>
