The Journal Of Nephrology Social Work - Volume 36, Winter 2012

Current Issue: Volume 36, Winter 2012

Table of Contents

Changes in Dialysis Social Workers' Caseloads, Job Tasks, and Hourly Wages Since the Implementation of the 2008 Conditions for Coverage
Joseph R. Merighi, PhD, Associate Professor, Boston University School of Social Work, Boston, MA

This study examined the job-related experiences of dialysis social workers since the implementation of the 2008 Centers for Medicare and Medicaid Services Conditions for Coverage for End-Stage Renal Disease Facilities. Data were obtained from 231 part-time and 1,091 full-time dialysis social workers (N = 1,322) who responded to an online survey conducted in 2010 by the National Kidney Foundation Council of Nephrology Social Workers (NKF CNSW). Findings indicated that 41.2% of part-time and 50.1% of full-time social workers reported an increase in their patient caseloads. Similarly, 80.2% of part-time and 85.9% of full-time respondents reported an increase in job tasks, and 70.4% of the part-time and 76.6% of the full-time workers reported that they had insufficient time to provide psychosocial services to patients. Approximately one-half (49.2%) of full-time social workers indicated being somewhat or very dissatisfied with their caseloads, and more than one-half of part-time (50.4%) and full-time (52.8%) social workers indicated being somewhat or very dissatisfied with their job tasks. No differences in hourly wage changes were found between part- and full-time respondents since the implementation of the 2008 Conditions for Coverage. Implications for nephrology social work practice and research are discussed.

Patient-Centered Advance Care Planning in Dialysis: Phase One
Shiloh D. Erdley, MSW, Vonda Hetherington, RD, Evan R. Norfolk, MD, Martha Kitchen, RN, and Ion D. Bucaloiu, MD, Geisinger Medical Center, Danville, PA

Due to the high mortality rates and significant symptom burden of dialysis patients, attention to advance care planning (ACP) has grown in the nephrology community. The optimal system for addressing ACP in dialysis units is not known. We report a quality initiative project utilizing a multidisciplinary ACP team, aiming to address ACP in the outpatient dialysis unit setting in a systematic and timely manner. The results suggest that a dedicated ACP program in the dialysis unit setting is a potentially valuable tool for improving advance directive (AD) completion rates in severely ill dialysis patients. Further research of such patient-centered interventions for improving the quality of care of severely ill dialysis patients is warranted.

Social Media: Examination of Renal Professional Practices and Guiding Principles
Lisa Hall, MSSW, LICSW, Northwest Renal Network

The widespread use of technology and social networking websites, such as Facebook and Twitter, creates new avenues for renal professionals to share information. However, intentional or unintentional virtual contacts with patients and potential breaches of professional ethics are always possible. During a session at the NKF 2012 Spring Clinical Meetings in Washington, D.C., attendees discussed ethical dilemmas in this era of rapidly expanding social media, were polled regarding their practices, and expressed the need for further examination of the implications of new technologies for renal patients, professionals, and organizations. By seeking consultation with regard to ethics and reviewing professional, regulatory, and agency policies, health care professionals can stay on the safe side of social media.

Dialysis Rationing and the Just Allocation of Resources: An Historical Primer
Estes Savage, MSW, Teri Browne, PhD, MSW, NSW-C, University of South Carolina, Columbia, SC

Historically, dialysis was a rationed medical resource. Access to treatment was restricted and based on perceived medical suitability and judged social worth of the patient. With the passage of P. L. 92-603, the federal government solved the problem of access by providing dialysis to all in need. However, the federal government avoided the core issue of how to justly allocate a scarce medical resource. Today, Medicare is a major federal government expenditure vulnerable to drastic budget cuts. Given the current political climate concerning the reduction of Medicare, the purpose of this paper is to examine the early allocation of kidney dialysis, discuss the federal government's policy reaction at that time, and begin a discussion regarding the implications of the just allocation of dialysis in the event of health care rationing.

Nancy Spaeth's Story: A Little History and a Lot of Hope
Lisa Hall, MSSW, LICSW, Northwest Renal Network

The preceding historical primer by Savage and Browne documented that access to hemodialysis in the U.S. was not always available. Life-and-death decision making that occurred in Seattle no doubt affected individuals and families dramatically as the following interview illustrates. Lisa Hall, MSSW, LICSW, is the Patient Services Director at Northwest Renal Network (ESRD Network 16). Nancy Spaeth serves on the network's Patient Advisory Committee.

Transition From Pediatric to Adult Renal Care: Education, Preparation, and Collaboration for Successful Patient Outcomes
Angela Degnan, LCSW, LSCSW, NSW-C, Sarah Henderson, LMSW, Amy Nau, RN, MSN, MBA, Children's Mercy Hospital, Kansas City, MO

The transition of patients from pediatric to adult renal care is a complex process that requires careful planning and thorough execution. While the topic is popular and yields much discussion, the recommendations for best practice methods are not well defined. It is clear, however, that the published literature recognizes the importance of a successful transition program leading up to the transfer of care for adolescent/young adult patients. In response to the need for a defined transition program, the dialysis and kidney transplant program at Children's Mercy Hospital developed a transition program designed to meet the educational and developmental needs of this patient population. The program is enhanced by a city-wide collaborative group which consists of pediatric and adult renal care providers. This group meets annually to strategize ways to improve the transition program and transfer of care process in general. Ongoing evaluation will include seeking patients' input with regard to the effectiveness of the program from their perspectives. The goal of the transition program and collaborative effort is to achieve positive outcomes for this patient population.

Book Review by Wendy Funk Schrag, LMSW, ACSWB

No Good Deed: A Story of Medicine, Murder Accusations, and the Debate Over How We Die by Lewis M. Cohen, MD, ISBN-13: 9780061721779; HarperCollins; 272 pages; $14.99

National Kidney Foundation
April 2–6, 2013
Social Work Abstracts