This paper looks at the case of a single woman with health and mental problems related to end stage renal disease (ESRD) facing initial hemodialysis modality without adequate family support. During the nursing care period from January 2, 2014 to March 15, 2014, an overall assessment was conducted under the Roche adaptation mode to identify several key issues through talks, physical assessments, and examination of medical records. The main nursing care problems included: fluid overload, anxiety, hyperphosphatemia, and hopelessness. For fluid overload, we used a 700ml container to control the amount of drinking water each day. For relieving the patient’s anxiety, we designed “simulation arm” to let her know what a fistula looked like. To solve hyperphosphatemia, we saved photographs of high phosphate-containing food in the patient’s smart phone to help her identify and calculate the total amount of phosphorus in her daily diet. We gave the patient strength with supportive slogans and introduced her to a hemodialysis patient support group on Facebook for sharing everyone’s life and treatment experiences. The goal was to reduce patient’s sense of hopelessness and help her plan for the future. Every hemodialysis center should consider establishing their own support group or network on Facebook to help patients discuss or share their experiences and thoughts. For similar cases in a clinical setting, we can alleviate patient anxiety and hopelessness through their family or group support systems.