Volume 28, Spring 2008
Table of Contents
Rates and Correlates of Therapy Non-Adherence in Adult Hemodialysis Patients
Cynthia L. Russell, PhD, RN; Robert Whitlock, MSSW, MHA, LCSW; Norma Knowles MSW, LCSW; .Leanne Peace, MSW, LCSW; Barb Tanner, RN, BSN; and Barry A. Hong, PhD, FAACP
This article examines the rate of non-adherence (NA) and the relationship of demographic and psychosocial variables on NA with treatment, fluid, diet and medications in adult hemodialysis patients. We used a cross-sectional, longitudinal design, and included 107 adult hemodialysis patients. NA rates were variable depending on the outcome examined. Fluid NA rate was the highest, with 40% of participants categorized into this group. Significant differences and correlations were found between race and albumin, months on dialysis and Kt/V, and skipped treatments and Kt/V. No significant differences were found between sex, smoking, locus of control, depression, social support, general health, self-efficacy and co-morbid conditions. The influence of environmental factors, such as health care team and system factors, on adherence should be considered in future research.
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Relationships in Transition: Young Couples Facing Renal Failure and Transplant
Staci Simmelink-Johnson, PhD
Young people are not the typical population one might imagine when thinking of chronic illness, yet many young people encounter major health issues. The current literature neglects to adequately examine the impact serious health concerns might have on young couples. This study seeks to examine the impact of End Stage Renal Disease (ESRD) and its treatments on relationships between the ill spouse and partner. In an exploratory, phenomenological fashion, six couples shared details of their experiences with ESRD and its impact on their relationships. This research presents a complex picture of the disease experience itself, and indicates that the experience of illness is not always negative for couples. The conclusion contains suggestions for those working with couples facing ESRD.
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The Critical Renal Challenge: Finding Godot, Not Waiting for Him: Screening, Early Detection and Treatment of Precursors of Chronic Kidney Disease
Robert W. Whitlock, MSSW, MHA, LCSW
U.S. demographic, social and medical trends are converging and threaten to reach a crescendo in the incidence and prevalence of chronic kidney disease (CKD), particularly affecting those in the later years of life. Government and medical resources are ill prepared to deal with the implications of this phenomenon and demographic population changes. It is imperative that existing programs be expanded and new approaches be developed to intervene earlier in the disease processes that precede CKD. Early childhood education, early screening and treatment of chronic conditions and more effective interventions in minority communities are critically needed. Waiting for kidneys to fail is not an option; there is no choice but to intervene sooner and better than ever before.
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Assessing Readiness for Change: A Novel Application of the Transtheoretical Model of Health Behavior Changes in a Pre-Renal Insufficiency Clinic
Stephen Giles, MS, RSW and Jamie Garrett, MSW, RSW
The transtheoretical model of health behavior change was applied by a social worker in a Canadian pre-renal insufficiency clinic as a method to facilitate and support the behavior change required by patients to initiate renal replacement therapy. A chart review of 102 patients was undertaken to determine the ratio of patients in various stages of change and determine the statistical relationship between stages of change, activities of daily living and demographic characteristics. Major findings revealed a significant correlation between stages of change and activities of daily living and stages of change and age. Future research should focus on developing a standardized staging tool for this population. Implications for social work practice are discussed.
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Dialysis Social Worker Training and Knowledge Regarding Kidney Transplantation
Steven A. Iacono, LMSW
Social workers are often a primary source of education for patients in the outpatient dialysis setting, requiring these professionals to have a broad knowledge base regarding many aspects of dialysis and the various treatment modalities. Social workers are expected to be able to competently educate their patients, yet this can only be done if they themselves have been properly trained. An investigation regarding the training social workers receive and their overall knowledge about transplantation was conducted. The findings noted that formal training was almost nonexistent and exceptionally brief. Many social workers had knowledge deficits and were unable to answer basic questions regarding the kidney transplantation process
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End-of-Life Care Discussions: A Survey of Dialysis Patients and Professionals
Sheila Weiner, MSW, LCSW
Bearing in mind the high mortality rate among individuals with kidney failure-in 2005, of the 485,013 individuals with End Stage Renal Disease in the United States, there were 85,790 deaths (17.6%; U.S. Renal Data System, 2007)-coupled with the confluence of complex psychological, medical, emotional, spiritual, ethical, cultural, legal and familial factors involved with the dying process, the National Kidney Foundation conducted patient and professional surveys to advance understanding of end-of-life discussions. One-hundred and eighty-two in-center hemodialysis patients and 1,202 professionals responded to surveys distributed on e-mail lists and in a clinical meeting session. Most professionals (86%) reported having end-of-life discussions with patients; however, discrepancies associated with the topics they discussed as well as with the professionals responsible for discussions were found. Of patients, 75% were receptive to having end-of-life care discussions, with more interest in talking about advance directives and pain management than other topics. Current practices are insufficient in providing patients with the necessary information to empower them to make difficult decisions about the dying process.
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