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Table of Contents
Do Not Resuscitate Orders for Adults with Developmental Disabilities: Ethical Considerations in the Dialysis Center
Renata Sledge, LCSW
Cancer Support Community of Greater St. Louis, St. Louis, MO
Each discipline in the nephrology community has a specific code of ethics with clearly defined principles, values, and standards of practice. Reconciling these often similar values and principles with differences in professional language (jargon) and perspectives is a challenge experienced by all members of the interdisciplinary team. The following is a brief discussion of four principles of medical ethics defined by Beauchamp and Childress (1994) and the relationship of these principles to those in the National Association of Social Workers (NASW) Code of Ethics (2008). A model for resolving ethical conflicts is described and a case study using the model is presented.
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Emerging Trends in Discharging Disruptive Dialysis Patients: A Case Study
Amber M. Borges, MSW, LCSW
End Stage Renal Disease Network of New England, Woodbridge, CT
At the end of the 2009 calendar year, 399,000 End-Stage Renal Disease (ESRD) patients received dialysis as their treatment method, according to the U.S. Renal Data System. In addition to the consequences of their ESRD, patients on dialysis experience many challenging emotional, physical and financial burdens. Steps need to be taken to ensure safety when a patient is a threat to the rights and safety of other patients and staff. Severe cases of threat and abuse, both verbal and physical, can lead to the offending patient being involuntarily discharged from the dialysis facility. However, the ESRD Networks, as well as the state Departments of Public Health, do not have the authority to mandate that outpatient dialysis facilities accept known disruptive patients. When patients are involuntarily discharged from a dialysis facility, and cannot find another outpatient facility to admit them, they are instructed to go to the nearest emergency room for dialysis care. The Emergency Treatment and Active Labor Act requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. This case study attempts to explore the emerging trends of discharged, disruptive dialysis patients who are denied dialysis services from outpatient dialysis facilities.
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End Stage Renal Disease and Nonadherence to Hemodialysis: Evaluation of a Psychodynamic Intervention
Anthony Mazzella, Institute for Psychoanalytic Training and Research (IPTAR), New York, NY
Cathy S. Berkman, Fordham University Graduate School of Social Service, New York, NY
Background:Skipping and shortening hemodialysis treatments are common and result in increased morbidity and mortality. Objective:The goal was to test whether a psychodynamic intervention reduced the number of skipped and the minutes of shortened hemodialysis sessions. Methods:A quasi-experiment conducted at one hemodialysis outpatient center was used to test a psychodynamic intervention. The intervention was delivered weekly for eight weeks to intervention group patients (n=13). Comparison group (n=8) patients received routine care. Results:Adherence improved for the intervention group from the Before Phase to the Treatment Phase and After Phase on all outcomes. The mean number of hemodialysis sessions skipped was 1.9 in the Before Phase and .9 in the Treatment Phase (p=.01) and .5 in the After Phase (p=.01). During the Treatment Phase the intervention group skipped less than one session while the comparison group skipped 3.5 hemodialysis sessions (p<.001). Adherence did not improve for comparison group patients. Conclusions:A psychodynamic intervention may be an acceptable and effective treatment for reducing nonadherence to hemodialysis.
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Support of Renal Patients and Families Facing End-of-Life Care Decisions: A Nephrology Social Worker's Reflection
Maureen C. O'Grady-Hamre, LCSW, NSW-C, BCD, C-ASWCM
DaVita Fair Lawn, Fair Lawn, NJ
The delivery of health care in the United States is undergoing critical change. Actualization of social work contributions to optimum healthcare is a focus. This article describes palliative care, end-of-life measures and interdisciplinary team function. The Renal Physicians Association's Ten Recommendations for Shared Decision-Making are addressed, and the recently signed Patient Protection and Affordable Care Act's section on Patient Decision Aids and Preference Sensitive Care will be referenced. A case study presentation is included with questions designed to stimulate critical thinking.
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Can a Social Work Intervention Reduce Kidney Donor Anxiety? A Pilot Test
Sujata Rajapurkar, PhD, MA, Muljibhai Patel Urological Hospital and Society for Research in Nephro-Urology, Nadiad, Gujarat, India
Teri Browne, PhD, MSW, NSW-C, University of South Carolina, Columbia, SC, USA
Tamara Estes Savage, MSW, University of South Carolina, Columbia, SC, USA
The purpose of this study is to explore the effect of social work counseling on kidney donor anxiety in Nadiad, Gujarat, India. Thirty potential kidney donors were selected to receive counseling by a nephrology social worker during the kidney donation process, and 30 potential kidney donors were selected for a control group that did not receive counseling beyond the usual course of care. Anxiety was measured using the Comprehensive Anxiety Test. The group that received counseling from a social worker had a statistically significant decrease in their comprehensive anxiety, which was measured prior to kidney donation and at six months after kidney donation, when compared to the control group. These results suggest that counseling by a nephrology social worker during the kidney donation process may lower donor anxiety. This study and future research may help more kidney disease patients receive kidney transplants from living donors in India and beyond.
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Social Work Abstracts From the National Kidney Foundation 2014 Spring Clinical Meetings - April 22–26, 2014
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