This article explores the harmful certainties and uncertainties caused by hopelessness and depression alongside complications resulting from myocardial infarction while undergoing hemodialysis in a patient with diabetic end-stage renal disease. These feelings resulted in the patient being indecisive regarding visiting a surgery department for examination of the poor flow rate of a fistula during treatment. Between December 8, 2016, and March 31, 2017, the author of this article cared for the patient and utilized the“ Certainty and Uncertainty Evaluation Guide” by Wu (2000) and the four sources of uncertain feelings in patients as defined by Mishel, namely symptoms, hospital routines, treatments, and communication, between patients and the medical team. Data were collected through direct care, conversation, telephone follow-up, and a review of medical charts. The causes of the patient's detrimental levels of certainty were established as the predictable deterioration of the illness and hopelessness and depression resulting from undergoing hemodialysis. In addition, the causes of uncertainty were established as the treatment outcome not reaching the patient's expectation, a lack of complete information regarding the disease's symptoms, unclear communication between the patient and the medical team, and indecisiveness toward decision making. Regarding the patient's concern of myocardial infarction recurrence, the author provided positive support and encouragement, as well as health education on hemodialysis and myocardial infarction, to enhance the patient's self-care ability. Cognitive reappraisal was used to improve the patient's harmful certainty, and three different self-control strategies were used to improve the high degree of uncertainty. With a well-coordinated support system, the patient was able to accept and adapt to the disease with a positive attitude. On March 21, 2017, the patient underwent a fistula dilatation procedure at the department of cardiovascular surgery and continued to receive hemodialysis treatment.