CNSW – OR – WA
Council of Nephrology Social Workers OR/WA Chapter		6/11/2004 – 12 Noon – lunch provided St. George's Episcopal Church, Parish Hall 1024 SE Cass Street Roseburg, Oregon
** 3 CEUs **
Meeting called by: Donald Prebus, Chair		Type of meeting: Quarterly Meeting	**For 3 CEUs - $10 for Members - $20 for Non-members; payable at the door; NASW approval pending.
		Note taker: Donald Prebus
Please bring:	Print out this agenda and bring it to the meeting. Membership Renewal/Application and Dues $20 for 2004-2005 (form included here)
Agenda
12-1:00 Lunch (provided) & Business Meeting		All	60
1:00 – 2:00 Nephrologist – Social Worker Collaboration: What the Nephrologist Expects		Neil Kumar, M.D. – Medical Director Gambro HealthCare	60
2:00 – 3:00 Psychologist as Participant Observer In The Dialysis Process		Dr. Benjamin Nolan, Ph. D. Roseburg VA Hospital	60
3:00 – 4:00 Presentation on the DOPPS Study		Deborah Hayslip, RN Amgen, Inc.	60
Adjourn		All	5
Directions
Take Interstate 5 to Roseburg Oregon - Exit 124 "City Center" and go east toward downtown. Take a right on Pine Street (one way street) and go one block south to Cass Street - take a left. It is several city blocks to St. George Episcopal Church, which will be on the left before you get to the intersection with Kane Street. Parking is on the street (some free and some parking meters) and in the lot across the street (see Map on last page) Contact Regina Eckles for carpooling (503) 493-3322.

Business Meeting - Annual Election of Officers and Renewal of Membership; Planning Coming Year’s Activities; Donald’s Chicago Diary (NKF – 2004 Clinical Meetings).		All		60
	Main Discussion Item: We need to elect new officers and plan program and activities for the coming year. Donald will lead a discussion of ideas for sharing the strengths of our organization – we have a lot to offer and more could benefit from participating with us. What are we good at? What has worked in the past? How can we play a more active role in the renal community? What challenges do we face? How can we increase our membership? What do we want to accomplish in the next year? What’s our potential?
	Notes from Discussion: 1. Use of funds. Astrid called into question the use of funds for speakers and for transportation. It was there is concern for inequality when chapter funds are devoted to hiring or paying for transportation services to get to and from meetings. There is concern also that money is spent on speakers unnecessarily. Plan: After discussion, Don asked Regina to give a treasurer's report at our next meeting where we can more fully deliberate on these concerns. 2. Annual meeting outside Portland-Salem area. Heidi suggested that we make it a matter of policy to hold at least one meeting closer to where those who live in Southern Oregon can attend. Plan: After discussion and general consensus about this it was decided to make it more formal at our next meeting. We discussed other meeting formats and tentatively decided to hold our Fall meeting as a retreat in Bend. Jan Goodwin volunteered to assist with the arrangements. 3. Election of Officers. Donald and Regina are willing to stand for office again this coming year. Also Adrianne Miller volunteered to serve as Secretary on condition that she be permitted to be absent from the December meetings. Plan: Astrid proposed that the elections be held as in past years by mail process since not everyone attends meetings. Donald will mail out a nominations form to be followed by ballots. 4. Discussion of chapter activities in coming year. Donald suggested that we devote some energy to reaching out to all Nephrology Social Workers in Oregon and SW Washington. We have a strong program to offer other Social Workers in our field of practice. Adrianne suggested that a list be distributed with the names of each unit and that we divide it geographically among a committee of people to make calls the Social Workers. Astrid suggested that this call be followed up by a request to complete a written survey to reflect what people want from our organization. Donald suggested that following these contacts we mail a letter of introduction to the supervisors of all Social Workers describing out program and asking them to encourage their Social Worker to be members and attend meetings, suggesting that they give time off to attend quarterly meetings and pay membership dues. Donald also suggested that we continue our efforts to coordinate with our local NKF affiliate, noting that Tina Ford had volunteered to come the Roseburg meeting and is committed to attending all our quarterly meetings. He noted also that Patty Salve-Sundy has now been appointed to the Board of Directors of the Oregon Chapter of NKF. He will be in contact with her. It was also pointed out by Astrid that we have had a representative to the Patient Services Committee. Donald also will describe at our next meeting what our relationship is (formally and informally) with the national CNSW group is. We will endeavor to have more communication with them about what is happening at the national level. Donald also suggested that we have an annual meeting together with the Seattle "NW Chapter" CNSW. 5. Report on the NKF CNSW: Donald reported on his meeting with members of the CNSW Executive committee about his NSW Archive project. He noted that our web site needs to have approval of the national organization, and even though we obtained permission for the CNSW-OR-WA mailing list, he will follow through on getting permission for the web site itself.
	Conclusions: See Plan sections above
	Action items:		Person responsible:		Deadline:
			various		Nxt Mtg.

Nephrologist – Social Worker Collaboration: What the Nephrologist Expects		Neil Kumar, M.D. – Medical Director		60
	Learning Objectives: Identify main areas of social work involvement of which most Nephrologists are aware: including social and family issues; financial needs; mental health needs and transportation problems. How to collaborate with Nephrologist to identify and work together on these individual patient issues. Teamwork with dietician (and others) to strengthen teaching methods best suited to obtain patient adherence with dietary and fluid guidelines. The development of financial assistance at all levels (from national to local) for meeting dialysis patients’ needs. What can we do together in regards the latter at our local level? Notes from Presentation: Dr. Kumar presented on the expectations he holds for the Social Workers he works with. Many specific suggestions were given in the following areas: · Insurance, · Transportation, · Patient Education, including medical advance directives. · Work with the dietician in helping patients maintain optimal; dietary and fluid intake, · Financial assistance with medications (particularly the renal medications), · Assistance with assessment of depression and medications for that, patient education - including advance medical directives, · How the Social Worker functions as a member of the team coordinating with other disciplines and with the physician’s office, · Special needs of patients and finding and/or creating resources in the community. He stressed the need for innovating solutions to problems patients are having at the local level with these issues as part of “going the extra mile” for our patients. He gave illustrations of creative solutions: · In the area of transportation - where volunteer drivers were recruited from the community, · In the area of renal medications – where patients are systematically screened for their financial access to these medications. · In the area of raising funds for patient activities.
	Conclusions:
	Action items:		Person responsible:		Deadline:

Psychologist as Participant Observer In The Dialysis Process		Dr. Benjamin Nolan, Ph. D Clinical Psychologist - Roseburg Oregon Veteran's Administration Hospital	60
	Discussion: For three days a week I participate in a process as a dialysis patient and though as a patient I try not to acknowledge the behavior and emotional issues going on around me and inside me.   However, I find it difficult to avoid reflections that involve making clinical observations and judgments. I will try and share a somewhat clinical view from the dialysis chair. Learning Objectives: Social Workers are the front line Clinicians treating the psychosocial issues that confronting dialysis patient. The purpose of this discussion is to provide some thoughts about possible interventions from the clinical participant observer point of view.  It is the hope of the presenter that this presentation will be helpful to the Social Worker in formulating their treatment plans.
	Notes from Presentation: Dr. Nolan began his presentation by describing how he feels about the dichotomy of being at the same time a care giver, concerned about the healing of others and a patient. He stressed the contrast between the acute awareness of one's own vulnerability as a dialysis patient and the relative unawareness of this when acting in the role of caregiver. The feelings of vulnerability are often locked away and defended against until one is in a situation where they are unavoidable. Recommendations to Social Workers: He emphasized the overriding need for patients to have support and suggested various ways that we as Social Workers can enhance what is available in our clinics for patient support. Allowing patients to have contact with each other is very important. Support groups, waiting rooms and treatment areas that are conducive to patient-patient interaction, taking time and adopting the attitude when talking with patients to give our undivided attention. He suggests that we as therapists learn each patient's philosophy of life and its associated metaphors to build and strengthen a therapeutic alliance. He suggests that we prioritize the time we spend with patients by first figuring out who needs the most support. We should recognize that patients needs change over time and that their participation in treatment is an on-going developing process. He suggests that we initially make a psychosocial assessment and then check in with patients at least every few months to not changes taking place. Patients should know that getting to dry weight is a process that should involve empowering the patient to negotiate their own treatment. He characterized the culture of each individual unit and based on his experience in six different dialysis units he has visited, he described the culture of three different units as a means of illustrating what some of the important underlying determinants of how much support there is for patients in each one. The first culture he termed "Dry to the Bone". The staff rigidly enforces the quantitative aspects of treatment and the uniform application of policy. Getting the patient dry is the chief concern of all staff; treatment is delivered "by the book". Patients are disempowered in all aspects of the treatment process. There are severe restrictions on visiting. He noted that as he experienced this, the unit director rarely appeared in the treatment area and then only as an Administrator, not participating in patient care. The second he characterized as "Family". The staff greeted each new patient with an attitude that said, "You have come here for treatment. Don't worry. We will take care of you." Patients are supported (as described above) and empowered. They actively participate, for examply, by weighing themselves and receive education and explanations for the complex aspects of treatment. Patients not getting the kind of emotional support available here tend to give up earlier and he has observed that the death of several patients in his experience was attributable to their giving up on themselves in their isolation from support. The third culture he terms the "L-Shaped Culture". He emphasizes that the physical layout of the treatment area will have strong influence on how patients experience treatment, because so much of it is involved in the psychosocial aspect. In the treatment center he illustrated here, patients in the "far end" of the treatment area were abandonned to their fearfulness by staff spending most of their time and attention on the other area of the room. He found the overall effect of this as seeming to incorporate aspects of both the former culture types. Other than physical layout of waiting rooms and treatment areas, by far the biggest determinant was: how are policies and procedures put into effect by the administrator of the unit? If the administrator is not a participant in direct treatment the support for the patient will be reduced. This is so, he reasons, because institutions always work against the theraputic effects of treatment.

Presentation on the DOPPS Studies on Nonadherence in Hemodialysis

Deborah Hayslip, RN
Amgen, Inc.
mailto:dhayslip@amgen.com

(805) 313-8176 w

60

Learning Objectives: Review the outcomes of the Dialysis outcome practice pattern study as it relates to non-adherence and compliance. Identify the impact of non-adherence to patient outcomes. The impact of non-adherence/compliance in the hemodialysis setting creates increased opportunity for negative outcomes. Quantifying the impact and identifying common factors provides and opportunity to address and potentially modify patterns that negatively impact patients.

Notes from Presentation: Deborah Hayslip, RN described and presented some of the findings from the Saran Nonadherence study (see below) based on data from the Dialysis Outcomes Patterns and Practices (DOPPS) study. The ongoing DOPPS Study gathers statistics from participating units located all over the world. The patient subjects number in the tens of thousands. It is the largest sample of any study of dialysis patient and allows for comparisons along a multitude of dimensions. Results related patient adherence behaviors and behavioral indicators of nonadherence (missed and shortened treatments, inter-dialytic weight gains and high phosphorus and potassium levels) to effects in morbidity and mortality. The most striking result was the degree to which missing one or more treatments a month increases risk of fatality and hospitalization. The degree to which patients in the USA miss and shorten treatments is also remarkably higher than in other countries. Overall conclusions point to the need to reduce this phenomenon together with the need to increase education from dialysis staff members as the physician who did this previously has no time any longer to educate their patients. Our speaker referred us to the DOPPS web site and to the URREA website for slides showing the major features of the study. To view slides simply input your e-mail address and press “go”. She can also furnish you the full text articles for the Saran and Leggat studies upon request.

From NSW Archive:

Title	Content	Topic	Source	Applies to:	Type	Date	Contributor
Dialysis Outcomes & Practice Patterns Study DOPPS	an on-going observational study of hemodialysis patients in twelve countries, seeking to identify dialysis practices that contribute to improved mortality rates, hospitalization rates, health related quality of life, and vascular access outcomes.	Education - Professional Renal	University Renal Research	INTERNATL		3/27/2002	Donald Prebus
Nonadherence in hemodialysis:…	…Associations with mortality, hospitalization and practice patterns in the DOPPS" see also Study Slides from URREA	Education - Professional Renal	Saran, R, Bragg-Gresham JL, Rayner HC et al. Kidney Int. 2003;64:254-262	INTERNATL	Article Summary	6/14/2004	Donald Prebus
Noncompliance in Hemodialysis:…	…Predictors and Survival Analysis" This article lays the methodological foundation for a widely cited subsequent study by Saran, Gragg-Gresham, Rayner et al using the more extensive data from DOPPS	Education - Professional Renal	Leggat Je Jr, Orzol SM, Hulbert-Shearon TE, et al. Am J Kidney Dis. 1998;32:139-145	INTERNATL	Abstract	6/14/2004	Donald Prebus

Adjourn		All	5
	Discussion:
	See Notes from Discussion of Business meeting (above) Tentatively, we will have a retreat meeting in Bend on Friday and (briefly) Saturday, September 10-11, 2004 . Jan Goodwin will explore a meeting venue to host the meeting.
Additional Information
Resource persons:
Special notes:

Application/Renewal
for membership with CNSW-OR

Dues for the full year 2004-2005 are $20.00 from July thru June. If joining at a different time of year dues will be pro-rated by calendar quarters.

Please complete the form below with your check payable to CNSW, Oregon Chapter, and mail to:

Regina Eckles, MSW

FMC – NE Portland

703 NE Hancock

Portland, OR 97212

If you have any questions, please call Regina Eckles at (503) 493-3322.

Thank you.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Enclosed is my payment of $20.00 for the 2004-2005 CNSW, Oregon Chapter dues. (Check #: _________)

Name:

Dialysis unit name and address:

Phone number(s):

Email address:

I prefer to be notified of CNSW Meetings by: ( ) regular mail ( ) e-mail only ( ) both

How Many Years in Dialysis?

Ideas for CNSW Activities?

Please list areas of Professional Interest:

Please list areas of Previous Activities/ Expertise You Can Share with Other Members:

Are you a member of CNSW National Chapter? Yes ___ No ___

http://www.kidney.org/professionals/cnsw/member.cfm

Would you like to join the CNSW Listserve? Yes ___ No ___

This is a nationwide mailing list discussion of matters of interest to Nephrology Social Workers.

http://www.kidney.org/professionals/CNSW/listserv.cfm

Thank you!

Please keep a copy of this form as your receipt for tax purposes.