Volume 31, Summer 2009
Table of Contents
Post-Transplant Employment and its Relationship to Physical Status in Kidney Transplant Recipients
Mary Beth Callahan, ACSW/LCSW, and Wayne Paris, PhD, LCSW
Post-transplant employment has long been considered an indication of functional benefit to the recipient and social benefit to the community. Some studies suggest that the majority of transplant recipients are physically able but remain unemployed and continue to draw disability post-transplant. In this article, the employment status and perception of 110 kidney transplant recipients from a specialty kidney transplant clinic that follows recipients from three hospital programs were compared by use of The American Medical Association’s Guide to Physical Impairment (AMAGPI) and creatinine clearance. Overall, there was approximately the same number of males and females (54% vs 46%, respectively), in middle adulthood (mean = 43 years), well-educated (mean = 14 years of schooling), Caucasian (55%) and married (57%). Of those surveyed, 77% (n = 85/110) were classified as employed and 23% (n = 25/110) were disabled. After excluding those who were disabled and using AMAGPI criteria as the basis for comparison, it was found that 80% (n = 68/85) with kidney impairment ranging from 0 to 14% were employed compared with 64% (n = 16/25) for all other impairment classifications combined. When broken down by AMAGPI groups, no significant differences were found between mean creatinine clearances with regard to employment status and employment perception.
When employment status and patient employment perception are compared by traditional means (i.e., creatinine clearance), there is only minimal change in employment rates observed even as the lab values continue to decline and impairment level increases. Thus, use of criteria accounting for issues specifically related to kidney recipients (e.g., medication reactions, chronic pain) suggest that, unlike other solid organ transplantation, the reason for unemployment and continued perception of inability to work remains a complex phenomenon and is not directly related to organ functioning or physical impairment. These findings clearly conflict with earlier reports and indicate the need for additional study to help determine whether other physical limitations specific to the patient’s continued perception of inability to work in the kidney transplant population exist or strategic rehabilitation interventions and case management (such as a structured rehabilitation program specific to outcomes) could improve employment results.
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Early and Preemptive Transplant: Helping Patients and Providers Consider the Whole Picture
Mary Beth Callahan, ACSW/LCSW
This article briefly reviews a March 2007 KDOQI conference convened in 2007 to review information available regarding preemptive transplantation. Psychosocial implications as they relate to preemptive transplant are discussed. Social work assessment and psychoeduation is essential in identifying barriers in preemptive transplant that may differ from patients already on dialysis. Transplant social workers can provide collaboration and case management to improve patient outcomes through preparation.
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Framing the Gift of Life: An Empirical Examination of Altruism, Social Distance and Material Incentives in Non-Directed Kidney Donor Motivation
Harry L. Humphries, PhD; Browyn K. Conrad, PhD; Rimal Berry, BA; Shelli Reed; and
Clara Michelle Jennings, BA
This study utilizes frame theory to examine the persuasiveness of the National Kidney Foundation’s altruistic “gift of life” frame in improving the number of living kidney donations. We surveyed a sample of 73 individuals to assess the relationship between social distance, increasing material incentives and donor motivation. Our results suggest that altruism is significantly related to donor motivation only for donations to immediate family members and that limited material incentives, as well as strategic “re-framings” that address the social distance between donor and recipient, may be important in enhancing donations among individuals unrelated to kidney transplant recipients.
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Dialysis Dogs Program Implementation at Saint Joseph Hospital’s Outpatient Dialysis Clinic: Animal-Assisted Activity in the Dialysis Environment
Megan R. Prescott, MSW, LCSW, and Melissa Milne Ogata, MSW, LCSW
In recent years, interventions with animals in medical environments have become more prevalent and accepted as a unique approach to improving patient outcomes. Hospitals, rehabilitation centers and nursing homes often use animals as part of the therapeutic milieu. A wealth of benefits to patient well-being has been explored in the literature, as have the relative safety of animal activities in medical settings. In spite of these benefits and documented safety of such interventions, therapeutic activities with animals in dialysis settings have not become common, nor have such programs been explored in the literature as a therapeutic adjunct for dialysis patient care. In 2006 and 2007, following parameters developed by and in partnership with volunteer teams trained through the Delta Society, the social workers at the outpatient dialysis clinic at St. Joseph Hospital in Orange, CA, successfully implemented a dog visitation program with 22 patients in the outpatient adult hemodialysis clinic. This article explores the design and implementation of this pilot program, as well as the impact of this unique approach for both patients and staff at the St. Joseph Hospital Renal Center.
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CNSW Research Grants Program
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