Table of Contents
REPORT
The Festering Crisis of Inadequate Nephrology Social Work Staffing: What are the Options for Improvement?
William A. Wolfe, MSW
Women's Institute for Family Health of Philadelphia, Philadelphia, PA
Staffing has long been identified as a structural measure of quality in healthcare. In spite of this, it has not been accorded prominence in the CMS End-Stage Renal Disease (ESRD) program. Among the major consequences has been the absence of research on dialysis clinic staffing which could serve as a basis for developing evidence-based standards. In lieu of such standards, there has been a widespread arbitrariness in decision making about staffing, which has contributed to adverse patient outcomes and distress among the different disciplines trying to provide care. Largely ignored in these evolving developments has been the festering crisis in nephrology social work staffing, its ramifications for patients' psychosocial concerns not being addressed, and concomitant potential for the exacerbation of medical issues. This study provides a broad overview of these issues with social work staffing, and also suggests some pragmatic alternatives that could help mitigate the problem.
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ORIGINAL RESEARCH
The Experience of Mothering a Child with a Kidney Transplant and the Implications of Illness-Related Uncertainty
Andrew Mantulak, MSW, PhD, RSW
Assistant Professor, King's University College at Western University, London, ON, Canada
Advances in the surgical and immunological aspects of organ transplantation have resulted in significant improvements in long-term outcomes and survival rates, making kidney transplantation the optimal therapy for children with chronic kidney disease (CKD). This study examines the phenomenon of sustained uncertainty as an element of the burden of care for maternal caregivers of children who have undergone kidney transplantation. This study indicates these mothers experience uncertainty in two prominent ways: 1) in their subjective sense of time, and 2) in their ongoing fear that their child will experience rejection of the transplanted kidney. Ultimately, this study advocates for nephrology social workers to begin addressing the social and emotional implications of uncertainty in the experience of illness for caregivers.
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REVIEW
Nonadherence in Individuals on Hemodialysis: A Discussion of Three Theories to Improve Adherence
R. Lee Phillips, LCSW
The University of Georgia, Athens, GA
This paper explores three theories that can guide practice when working to improve the compliance of individuals on hemodialysis. The Theory of Planned Behavior (TPB), the Common-Sense Model (CSM), and Motivational Interviewing (MI) each offer insight into behavioral change and the internal processes of individuals. Each theory seeks to empower the individual and sees client involvement as critical to patient care and improved health-related outcomes. Understanding the tenants of these three theories can guide social work practice beyond education and the dissemination of health-related information in order to improve compliance.
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