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«  Октябрь 2007  »

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Главная » 2007 » Октябрь » 1 » Психосоциальные компоненты помощи больным ХПН

Психосоциальные компоненты помощи больным ХПН

Известно, что в США в диализных отделениях работают так называемые "социальные работники"
в 2002 в Орландо было обсуждение их роли. Если кто либо переведет это обсуждение для наших сестер, то я буду очень признателен.

Sally Campoy:And certainly last, but not least, a critical member of that multidisciplinary team in the management of patients with chronic kidney disease is the social worker. And believe it or not they've got a host of problems in the chronic kidney disease clinic as well. I'm pleased to introduce Renee Bova-Collis. She is a Nephrology Social Worker at GAMBRO Health Care in Richmond, Virginia. She received her bachelor of science degree in psychology from Radford University in Radford, Virginia, and a master of science degree in social work from Virginia Commonwealth University in Richmond, Virginia. She is also a licensed clinical social worker. She's been involved in numerous organizations including the National Kidney Foundation and has served on the board. And she's here to tell us how she manages the social issues of these very complex patients. Renee?

Далее Рени Бова-Коллис сделала короткое собщение на тему:
Психосоциальные компоненты помощи больным

Renee Bova-Collis
Thank you Sally. Good evening everyone. Basically my role as a social worker is to clean up the mess after these guys have come through. Just like this evening I've got about five minutes to do it in.

There's really no set time for me to come in and visit with the patient. Generally, I see the patient in the clinic setting, in the classroom setting, and that's like once every eight weeks the class comes up. But it never fails that there's somebody along the way that's got questions that really are directed towards me. And I'll get that phone call and Ann will say, "This person needs to talk to you," and just hand the phone over. One particular thing that really kind of sticks out in my mind when I think about that is one patient had called and there were issues with her refusing to get her access placed. And really it was because she was working and had no insurance, and how was she going to pay her rent if she stopped working to have the surgery done, and then the healing process that went along with that? So I had to have a conversation with her about the resources available to her to help her meet her responsibilities, and get the health care that she needed.

  • Когда лучше всего привлекать социального работника?
  • Цель - "не живи для диализа"
  • Первый класс - обзор
  • Система поддержки - вовлечение семьи
  • Система поддержки - транспортировка
  • Система поддержки - финансовое покрытие
  • Отказ
  • Заключение: Системы поддержки - ключевые моменты

The social workers tasks and issues:
So the goal actually, I want to call this: "don't live for the disease," because of tonight's topic. And really what I want to do is foster a mindset in the patient where they're more positive with what's happening to them, to recognize that they have choices, and that they have some control in the decision-making, and to empower them to make good decisions. So, in the classroom what I'm doing is assessing where they're at now. What are they hung up on that's keeping them from getting involved in their care; that's keeping them from doing the things that we know that they need to do to keep them from starting dialysis, to prolong that process as much as possible? I also want to give them a picture of what's normal to expect in the adjustment process, in the treatment process, in the disease process, so that it's not so scary, and so that it provides a more positive way for them to transition from the predialysis setting to the initiation of the treatment.

So we're looking at support systems really. And with the family, that's the biggest key indicator of success with these patients, having good family support. I want to know who these family members are, what their involvement is, and is it a quality involvement, because we all know we've got family members that are not going to be very helpful to us. They're going to hinder our ability to move on with things.

Also in the support system, I'm going to add this other one too, transportation ... Transportation and financial coverage. These are the worst things I have to deal with. I hate these parts of my job. With the transportation issue, if the patient can drive or a family member can drive them to their appointments, I am really very pleased with that. But oftentimes, I have to deal with insurance companies that have their own way of doing things, especially with the HMOs now where we've got a million different vendors we've got to deal with. And then if the patient has an HMO where they've got to go through getting a referral, this is a nightmare if they're stuck with an insurance company that I can't work with, because I'm not one of their preferred people.

As far as financial matters go, I want to know where their income's coming from. Are they the sole provider for their family, or is there another family member that's involved that can assist them in supporting them and continuing on with their responsibilities? I want to know do they have insurance and what kind of insurance? How much coverage do they have? How much are they responsible for? Co-payments, out-of-pocket expenses? And then, do they have a disability already that's going to qualify them for Medicare or Medicaid, and the resources that can come along with those? The biggest obstacle, of course, in regards to all of that would be the medications and the medical costs. Oftentimes our patients, the ones that we see, don't have coverage. They've got nothing coming in because as a predialysis patient, they often don't meet a disability category where they can get coverage. So it's a real hurdle to get over, and oftentimes when we're talking about medications, it's not uncommon for me to look up manufacturing companies and try and see what kind of assistance the manufacturers can provide. Maybe we have to get a medication that's cheaper. The family may have to jump in there.

Denial. The big 'D' word. This is the biggest challenge for predialysis patients. It's a maladaptive coping mechanism, and really time is our biggest ally. Early intervention and consistent education are what are going to buy us the time we need. And that's going to get the patients involved and take the heat off them so that they can focus on what they need to do to make informed decisions. So really the goal with that would be to get them to a gradual adjustment to what lays ahead for them versus the shock of being thrown into it.

So the support systems really are the key thing to successful adjustment to our patients. They facilitate positive coping and adjustment, and the collaborative team is the big part of that support system. Thank you.
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