Volume 27, Winter 2007-08
Table of Contents
Prevalence, Predictors and Correlates of Non-Adherence to a Hemodialysis Regimen: A Review of the Literature
Cynthia L. Russell, PhD, RN, University of Missouri-Columbia, Sinclair School of Nursing Columbia, MO*;
Norma Knowles, MSW, LCSW, Dialysis Clinics, Inc., Columbia, MO;
Leanne Peace, MSW, LCSW, University of Missouri Health Care, Columbia, MO
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Mastering Hemodialysis to Reverse Patterns of Missed and Shortened Treatments
Jessica Cabness, PhD, LCSW, University of South Florida School of Social Work, Tampa, FL;
Cindy Miller, MSW, LCSW, USF Dialysis Center, Tampa, FL;
Kristin Martina, MSW, USF Dialysis Center, Tampa, FL
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Volunteering Improves Adherence to Dietary Regimens and Outlook of People With Chronic Kidney Disease
Bonnie G. Orlins, MSW, LISW, Fresenius Medical Center, Sidney, OH;
Susan T. Davis, PhD, University of Dayton, Dayton, OH;
Dee Ann Roman, RD, CDE, Pinehurst, NC
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New Legislation and Old Solutions: Employment Following Renal Transplantation Revisited
Lisa Raiz, PhD, College of Social Work, The Ohio State University, Columbus, Ohio
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Kidney Community Emergency Response (KCER) Coalition: Partnering to Improve Prepardness and Outcomes in Disasters
Lisa M. Hall, MSSW, LCSW, FMQAI: The Florida ESRD Network (Network 7), Tampa, FL
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Book Review: Handbook of Health Social Work, Edited by Gehlert, S. and Arthur-Browne, T. (John Wiley & Sons, Hoboken, NJ, 2006) ISBN: 978-0-471-7143-6. U.S. $80.00
Reviewed by Wayne Walter, MSW, Renal Social Worker
Abstracts From Original Articles
Prevalence, Predictors and Correlates of Non-Adherence to a Hemodialysis Regimen: A Review of the Literature
Cynthia L. Russell, PhD, RN, University of Missouri-Columbia, Sinclair School of Nursing Columbia, MO*;
Norma Knowles, MSW, LCSW, Dialysis Clinics, Inc., Columbia, MO;
Leanne Peace, MSW, LCSW, University of Missouri Health Care, Columbia, MO
A review was conducted of the literature on prevalence, predictors and correlates of adherence to the therapeutic regimen in adults receiving hemodialysis (HD). Searches were conducted on Medline, PsycINFO and CINAHL from the years 1950 to 2007. Articles selected for this review met the following inclusion criteria: subjects were adult HD patients, at least one predictor or correlate of adherence was studied and at least one adherence outcome was included. Sixty-nine articles were included in the review. Rates, predictors and correlates of non-adherence (NA) varied widely. Young age and smoking were the only variables that consistently predicted NA. Suggestions for practice and future research are described.
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Mastering Hemodialysis to Reverse Patterns of Missed and Shortened Treatments
Jessica Cabness, PhD, LCSW, University of South Florida School of Social Work, Tampa, FL;
Cindy Miller, MSW, LCSW, USF Dialysis Center, Tampa, FL;
Kristin Martina, MSW, USF Dialysis Center, Tampa, FL
Missed and shortened treatments have potentially grave health consequences for dialysis patients, placing them at higher risk for fluid overload and increased hospitalizations. Missed treatments further negatively impact dialysis center revenues. Mindful of the social worker's dual ethical responsibility to patients and employing agencies, the investigators proposed a research study aimed at reversing patterns of missed and shortened treatments. Drawing on the pioneering work of Prochaska and DiClemente, a transtheoretical model of behavioral change was adapted for nephrology social work with treatment-resistant dialysis patients in a comparative study involving three treatment approaches. The findings suggest improved motivation for treatment adherence, fewer hospitalizations and a decrease in missed and shortened treatments for patients in the social work intervention group.
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Volunteering Improves Adherence to Dietary Regimens and Outlook of People With Chronic Kidney Disease
Bonnie G. Orlins, MSW, LISW, Fresenius Medical Center, Sidney, OH;
Susan T. Davis, PhD, University of Dayton, Dayton, OH;
Dee Ann Roman, RD, CDE, Pinehurst, NC
The research reported here builds on a corpus of studies that have found strong positive effects of volunteering on depression, self-esteem and adherence to medical regimens. Patients with chronic kidney disease at a community hemodialysis facility volunteered to act as participants in a control condition or an experimental (volunteer) condition that involved 1 hour/week volunteer service. The patients were matched with a volunteer activity from possibilities identified by the hemodialysis unit social worker and showed reliable increases in adherence as measured by control of fluid weight gain and potassium levels. In addition, qualitative analysis of pre- and post-experiment interviews with participants correlated well with measures of depression and self-esteem. Depression indicators declined for those in the volunteer condition but not for those in the control condition. Our discussion includes strong recommendations that volunteer opportunities developed and facilitated by the unit social worker for patients on dialysis are an investment of resources that produce a significant payoff in patient physical and psychological health.
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New Legislation and Old Solutions: Employment Following Renal Transplantation Revisited
Lisa Raiz, PhD, College of Social Work, The Ohio State University, Columbus, Ohio
Employment (i.e., return to work) and renal replacement therapy have been linked since the original discussions for the 1972 Social Security Amendment. This legislation deemed individuals with end-stage renal disease disabled for the purpose of Medicare eligibility and access to treatment. Proponents of the legislation suggested that 60% of those who received renal replacement therapy would resume employment following vocational rehabilitation, and the majority of the remaining 40% would return to work with no intervention (Kutner & Brogan, 1985; Rettig, 1984). Achieving this optimistic prediction has been elusive, and post-transplant employment outcomes have been disappointing. Nevertheless, the number of renal transplants has risen yearly, with 17,094 transplants being performed during 2006, 80.8% for individuals ages 18 to 64 (Organ Procurement and Transplantation Network, n.d.[a]). Thus, the majority of patients who undergo renal transplantation are working-age adults and many do not return to the labor force.
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Kidney Community Emergency Response (KCER) Coalition: Partnering to Improve Prepardness and Outcomes in Disasters
Lisa M. Hall, MSSW, LCSW, FMQAI: The Florida ESRD Network (Network 7), Tampa, FL
Emergency events that could occur nationwide and affect the renal community include earthquakes, fires, floods, blizzards, hurricanes, tornados, ice storms, chemical spills, pandemic disease and acts of terror. Each emergency has the potential to affect access to care. Facilities should be prepared to address concerns such as lack of power, water, food, housing and communications; dangerous conditions; flooding; fuel shortages; patient tracking issues; mass zone evacuations; rapidly changing weather; road closures and patient transportation issues; curfews; hospital closures and limited staff resources. Providers should be prepared to assist patients with little or no notice. The Kidney Community Emergency Response Coalition is working together to minimize disruption to life-sustaining dialysis and transplant services in emergencies.
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