Have you shown them photos of bones eaten away by excess phosph? That's what did it for me.
I am going to preface what I am about to write by saying that I realize what I am about to propose will increase your workload exponentially. If you are like most social workers I have read about, you are stretched to the breaking point already so I am sure this is pie in the sky talk but Iím going to share it anyhow.Hereís my idea from my time both in-center and doing home hemo: for each patient, identify the top clinical goal. For Patient A, maybe itís transitioning them from catheter to fistula. For Patient B, maybe itís getting their albumin to a reasonable level. For Patient C, maybe itís getting their phosphorus down. Then have a discussion with each patient, letting them know what the benefits TO THEM would be for achieving the clinical goal. Hopefully you can tie the benefits to a problem they are actually experiencing Ė make it real for them. Then work TOGETHER to come up with 1-2 action items for the month. Maybe for Patient A, an action item would be scheduling a vein mapping and then helping them get transportation to the doctorís office to keep the appointment. For Patient B, it might be asking them to add extra protein to breakfast each day and working with them to identify protein based foods they would like to include in their breakfasts. Maybe for Patient C, it would be finding out what high-phos food or beverage they like and identifying accessible substitutes and where to find them locally. Document the action items and both of you sign that the patient will work on the action item and you will be there to help them break down barriers to success. While this might seem daunting, what I am trying to describe is two-fold: individualizing the goals by person (not something that is clinic-wide that is too generic to make a difference) and having the conversation be private and adult.
We do initial, 90 day and yearly assessment and care plans, but I love the idea of having each patient to commit to something they can change, Cattlekid! Maybe we can do a lobby day doing that and ask each patient to write it down. We have a program call "Support a Patient" where techs are assigned patients to check with twice a month to address concerns and make sure patients are happy with their care. That could be something we incorporate in that program. I am going to bring that up with management and see what we can do! Thanks for all the ideas!