Volume 33, Summer 2010
Table of Contents
Assessing the Effect of a Technology-Based Peer-Mentoring Intervention on Renal Teams' Perceived Knowledge and Comfort Level Working With Young Adults on Dialysis
Erica E. Perry, MSW; Kai Zheng, PhD; Andrew Grogan-Kaylor, PhD; Mark W. Newman, PhD; Tiffany C. E. Veinot, PhD
The study presented in this article was part of a larger project to develop and evaluate a technology-based peer-mentoring program for empowering young adults (YAs) on dialysis and their renal teams. In this article, we focus on how the program has influenced the renal team members' perceived knowledge of, and comfort levels with, working with YAs, and their perceptions of YA behavior. We conducted surveys with 110 renal team staff members (not including the renal social workers who served as study coordinators) from 16 dialysis units in a midwestern state. The overall intervention included: (1) staff viewing a DVD of other staff discussing how to work with YAs; (2) YAs viewing a DVD of peer mentors discussing life with CKD; and (3) an opportunity for YAs to virtually “meet” with peers via a website we developed called ktalk.org. We found that the staff inter¬vention led to improved staff perceptions of knowledge, YAs' behavioral adherence and comfort talking with the team. However, our results also revealed that staff experienced decreased comfort levels working with the young patients on dialysis.
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Central Line Dissent and Fatal Dialysis Fear: The Story of Florence
M. Gilda Dacanay Dumasal, BSW, MSW, RSW; Nishardi Wijeratne, MBBS, MHSc; Bob Parke, MSW, MHSc
This case study focuses on an incapable patient requiring life-saving medical intervention to which she does not assent and the ethical challenges that stem from this refusal. This article discusses the law's limitations in managing such situations as well as the difficulties for substitute decision makers (SDMs) and the clinical team when SDMs consent to treatment that cannot proceed without patient cooperation. The moral distress that befalls the clinical team and caregivers in these unique situations lead one to conclude that resources should be made available to support families who are suffering when loved ones deny needed therapies. From an ethics point of view, one can conclude that organizational support should be available to clinical teams to effectively manage these challenging cases.
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The Renal Caregiver Burden Scale: Phase One
Robert A. Schneider, PhD, LISW
Caregiver burden is becoming more important as the aging population becomes larger. This growth applies to caregivers involved in chronic illness management in general, and chronic renal disease in particular. The purpose of the present study was to create the Renal Caregiver Burden Scale (RCBS) and establish basic measures of its reliability and validity. In a pre¬liminary test for the new measure, seven master's level renal social workers from various clinical settings across the country interviewed 52 voluntary dialysis patient caregivers. The measures used were thought to be associated with the construct of burden. A Cronbach alpha analysis yielded a reasonably high internal consistency reliability of 0.84 for the 16-item RCBS. The measure also correlated highly with the Zarit Burden Interview at 0.72 and the Center for Epidemiologic Studies Depression Scale depression scale at 0.70. Recommendations for further refining and validation of the measure with a larger sample are discussed. The relatively high degrees of reliability and validity for the first outing are encouraging, although 2 of the 16 items need restating due to ceiling and basement effects.
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Case Study: Handling the $5,993 Hemodialysis Treatment
Steve Bogatz, MBA, MSW, LCSW
Thanks to Medicare and private insurance, citizens and residents in the United States seldom have to worry about going bankrupt when they need renal replacement therapy. This case, however, describes what could have been an exception. When an uninsured, low-income patient with significant assets landed at an outpatient dialysis center, he was charged thousands of dollars per treatment. The nephrology social worker struggled with the dilemma of how best to advise the patient regarding his financial options. His advocacy interventions resulted in the patient receiving a substantially reduced rate. This article discusses this case and the national system of funding dialysis, which consistently puts financial pressure on providers and the uninsured.
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CROWNWeb: Transforming How Nephrology Social Workers Access Patient-Centric Data
Oniel Delva
In February 2009, the Centers for Medicare & Medicaid Services (CMS) launched a web-based data-collection system in an effort to transform the way End-Stage Renal Disease (ESRD) facilities report care provided for their patients. This system, dubbed CROWNWeb, gives Medicare-certified dialysis providers a central database in which clinical and administrative information can be entered. This system is a universal resource that social workers, patient services coordinators (PSCs) and other ESRD Network personnel can use to access near real-time data pertaining to a patient's course of treatment. This key element will also aid CMS and the renal community in their ongoing commitment to improving quality of life for people with chronic kidney disease. This article focuses on the CROWNWeb system's impact as it relates to the duties of social workers and the interdisciplinary team that are outlined by CMS' updated Conditions for Coverage for ESRD Facilities, published April 15, 2008. It analyzes how the system can help the ESRD community as a whole to boost patient care efforts, quality of life and satisfaction with care. In addition, this article delves into how the system is designed to reduce the barriers that social workers and PSCs may face in obtaining key data regarding their patients.
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Dialysis Patient-Provider Conflict Reduction: An ESRD Network Quality Improvement Project
Renée Bova-Collis, MSW, LCSW
Trending of complaints and grievances in End Stage Renal Disease (ESRD) Network 5 revealed that a cluster of dialysis units consistently had complaints/grievances in consecutive years. A conflict reduction project aimed at improving conflict management was initiated. Soon after implementation, it became apparent that facilities were struggling with basic quality improvement (QI) concepts, applications and tools. The project's primary focus shifted to assisting facilities in building those skills. Despite variations in competency, each facility improved its QI skill level and all but one experienced a decrease in complaints to the Network. More training and guidance is needed to ensure that facilities are meeting the Quality Assessment and Performance Improvement requirements of the Medicare Conditions for Coverage, thereby potentially increasing satisfac¬tion among patients and staff
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CNSW Research Grants Program
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