New employee in dialysis and looking for advice...

[just_me]

I'm glad to be here because I think I have found a place I can come and get some real answers to questions I have. First of all, I am 26 years old and a recent college grad with a Masters Degree in Social Work. I am scheduled to take my exam to become licensed in October. I got my first "real" job as a social worker in a dialysis center in my small little town. In the past, I have worked and/or interned for seven years as 1. a crisis interventionist in a youth detention center and 2. in an alternative school for kids behavior disorders and emotional disorders. After graduation, I decided to "broaden my horizons". I feel very blessed to have got a job in the dialysis center because doing medical social work was another "goal". ANYWAYS, I am very passionate and take my job very seriously. I want to serve, respect, and assist each and every patient the best way I can. Here's where I have the questions.....I am following the social worker who retired. She has been there for almost 12 years so I have big shoes to fill. All the patients love her. It was a very emotional good-bye for many of them. I worked with her for a month and now I am on my own but while I was with her, I noticed a few things. Long story short, I am coming in and want to make a few changes...First off, a lot of patients pretend they are asleep when she would come around.  I thought it was pretty funny because she had no clue and I didn't say anything. So question #1: Instead of walking around trying to speak with every person in every chair, should I put something on the table by their chair to let me know they need something. I noticed that MANY of them just want to sleep and be left alone. (I know one thing: I will NEVER wake a sleeping patient!!!) anyways, I know I will make myself available by being in the treatment room as much as possible but I don't want people to see me and dread me coming because they feel like they HAVE to talk to me. ANY ideas/advice on this would be greatly appreciated.

Another thing I noticed, when you walk into a treatment for the first time ever, its a little depressing. I have admitted twelve patients since I have been there (eight under the age of 30) and when they walked in, they freaked. Three ladies cried their whole treatment time. Can anything be done that won't be annoying to make the place look soo...(I don't know the right word)...depressing and scary for first timers?

I am also considering starting support groups but thats a whole different thing.....

I'm sorry its so long but I would be so very grateful for any pointers, advice, suggestions, anything to meet their needs the most comfortable way possible and to make it as easy as a treatment time as possible.

THANKS!!!

[Joe Paul]

Welcome just me, good to have you aboard.

[Wallyz]

It is depressing , and scary.  I would start by finding resources to help people with adjustment and Post traumatic disorders.  Try to have conversations with people where you build a relationship before trying to fix stuff. 

And work to get a nocturnal program going.  The real issue for so many people is that they are under dialyzed.

[willieandwinnie]

  just_me. We are a great group and I'm sure you will get lots of suggestions. Dialysis is scary and depressing and I don't think you can change that. It is what it is. We hope to hear more from you and Good Luck with your position. 

[RichardMEL]

G'day just_me and welcome! Thanks for coming and asking us what we think as part of the kidney community. It sounds like you already have empathy for your charges and their siituation and I love that you don't want to wake sleeping patients and recognise some would pretend to sleep because they don't want to talk to the SW (which is sad in its own way). I have to admit I've had no interaction with the SW in my own unit... but our setup (a hospital unit) is more that they get involved if you need them rather than doing regular visits. I am not sure what would or wouldn't be worse. In a way it may help to foster a sense of community rather than a "us and them"attitude.

The hardest part may well be to do what your patients actually want or would be comfortable with. Doing a questionaire might be an idea, but I know for myself I loathe such things... and if a lot of the patients may not want to talk much it forms a bit of a barrier... It sounds like you want to try to do the right thing by everyone - maybe asking the staff who work with the patients daily for some thoughts or even a few patients who might be receptive to your thoughts and ideas.

Regarding dialysis centres being scary for first timers I often see this myself and have thought about this issue. One idea I always thought might be a good idea is that it might be a good idea to have an introduction of sorts to dialysis for new patients. Obviously for acute patients that's not going to happen.. but others have fair warning what's coming up. In my own case I went to a seminar organised by the hospital some months before I started - where they had a machine, showed us the needles, went through how it is and that sort of thing. They even had some dialysis patients along to show us you can live with it, and so on. That was pretty good. Another idea might be to say walk a patient through before their first session.. maybe if there's some patients in the unit that are chatty/lively that perhaps could talk to the newbie.. so they(the new one) can see sort of what its about. When I had my first session I understood the theory and what in general would go on, but I didn't know anything about the specific procedures and so on. It was all a bit eye opening.

Oh and our unit is grim too.. I've often wondered about that.. it's a little hard I guess with limited budgets etc to mix form and function.

I think it is great you want to be appropriate and sympathetic to your charges... I hope it goes well for you!!

[monrein]

First, I want to wish you well in your career and hope that you never lose your passion (although it may wane a bit at times) and your genuine concern for us, your patients.

It's always tough to take over from someone who's been in the job a while but now you must carve out your own role within the unit.  I would introduce myself to all the patients and explain what you can provide in the way of services.  I'd also be very sure to tell them that there is no obligation or expectation that they must speak with you.  In fact I'd tell the patients that I encourage them to let me know that they don't want to talk if ever I drop by and that's the case.  Give explicit permission for them to say "Not today".  I'd also let them know that you can make space for them outside the unit in a more private space because the lack of privacy can be a huge barrier.  If people were in private rooms things would be different.
I'd also follow up your in person intro  with a typed outline of the common issues that may arise when dealing with a chronic illness, how counseling might be helpful and be sure to include all the instrumental things you can help with, form filling, travel arrangements etc.  Many people have little or no experience with counseling, with good counseling at any rate and social workers often end up being viewed as overly cheerful, chatty types who come in, aren't seen to be doing much and are seen as a bit of an irritant.  Don't be afraid to address some of the common issues with people.  Ask Mrs. Smith "How are you REALLY coping with this runaway train that's smacked into your life?  I can't say I know what it's like because I don't have to do it, but I am available to you if you ever need or want someone to talk to.  And if you don't want to talk about it, that's fine too."

I'd perhaps start getting to know patients by talking with them about the atmosphere of the unit and see if they have any ideas.  It's non-threatening and concrete.  Get them involved and see if there's anything that isn't too expensive to make the place more pleasant.
Whatever you do, try to avoid getting stuck with organizing silly games or things that infantilize patients.  In general we hate it as much as being woken up. It's also a waste of good SW skills.

I have to run to D now but if I think of anything else I'll let you know.   

[okarol]

The only social worker who was ever helpful was one who followed through with what she said she would do. She made navigating the Medicare maze a little easier, assisting with forms and making contact with the office. She also helped Jenna get a handicap placard through the DMV and completed the waiver for jury duty. Beyond that no social worker has been very knowledgable or available or competent, in my experience. I admire you for trying to become more educated. Good luck!

[TynyWonder]

Just me,

My first thought to your post was aaaaawwww she sounds great and she is really trying hard to get involved with her patients and to me, that is great!   GOOD LUCK girl!!!!      Anywho, let me tell you first of all, I am at my 2nd dialysis clinic as I have just recently moved from AL to TN and at the clinic in AL, the SW there was just that *there* and I never even knew that SWs could even be different (get really involved) until I got to TN.  The SWs & staff here put together functions such as "get togethers", cook-outs and I know, that not every patient would participate but I, personally am looking forward to *my* first cook-out with my clinic this weekend, October 4th.    Also, this is not something I am suggesting you to do but it is something else that goes on in the clinic here in TN that did not happen in AL but there is a patient at this clinic that takes it upon herself to find out each month, each patient's birthday and she fixes up a "birthday basket" for each patient's birthday for that month.   I have yet to meet this lady but hopefully, she will be at the cook-out and she and I can meet then.  That is another plus for cook-outs, you get to meet others that comes to *D* on a different shift that you might not otherwise ever meet.  Also, you get to talk w/ them & their families on a more personal level.  Anywho, like I said, the cook-outs/get togethers aren't for everybody but I am told that here they usually have a pretty good turn out.   Well, you asked for suggestions & that is my      

Again, good luck and please do keep us posted on how things are going in your new job and tell us what you come up with for your patients......it might give us new ideas for our clinics.    

[thegrammalady]

glad you have joined us.

the problem with your new people is probably no one told them anything about what to expect at a dialysis clinic. i had 3 days of dialysis in the hospital but that's totally different from a clinic. and it's something you can't do much about, it has to come from the hospital, doctor or tech doing inpatient dialysis and they really don't say anything. in the hospital you are in your own room, at my center there are 24 people on my shift. no one said it would be cold or that centers usually don't have pillows and blankets. and okarol is right follow through with what you say you will do. if i had waited for the social worker who was there when i first started, i'd still be waiting.

good luck, and welcome aboard.

[just_me]

  I got better answers than I thought I would! Thank you all so much for all the wonderful answers and if anyone else has any suggestions, I would love to here them. Seriously, I am printing each answer off so I can jot down some off my own ideas. Cheesy maybe I know but I do thank you again!

[flip]

Good luck. I see our social worker about twice a month when she comes around asking who wants to play bingo. Few takers....I'm holding out for karoke. My singing is painful anyway.

[paris]

Thank you,  just_me, for wanting to hear honest answers from patients.  This is a very open, caring group and will give you the best answers you will find.  One suggestion is to refer patients to this site.  It has been a life saver for many of us.   As you can tell, not many are happy with silly games,etc.  It reminds me of my Mom in an Alzheimers facility and the aides trying to engage them in games.   Your patients are real people dealing with life altering diagnosis.  It seems like you have a good attitude and are ready to be a real help to your patients.  Keep posting and let us know how you are doing.  We really are glad when professionals in the field come here to learn and to share.   






Paris,moderator

[pelagia]

My husband began dialysis in the hospital and then went to the clinic.  no orientation, no explanations until after he was already in the midst of it all.  I agree that helping folks with information at the beginning would be very helpful.

[Ang]

   jst  me


in  answer  to  your  questions,  a  bit  of  all  of  the  above.


information  is power,