The Role of Renal Social Worker in Introducing
the Advanced Directives -
Renal Program, Penticton Regional Hospital
by Zhila Schofield
Talking with all Renal Program Clients:
The intent of the Advanced Directives initiative is that, if possible,
every client in the Renal Program Penticton Regional Hospital completes
and signs the advanced directives form. The title of this form is
“Patient Directive for Life Support”.
The role of the Renal Social Worker is to prepare the clients for
this process. The social worker approaches each client with the
principle of respect for autonomy, and assists them to achieve a
sense of control amidst managing their chronic condition.
The Renal Social Worker does the following:
- Introduction regarding the advanced directives by showing
the client a copy of the form, explaining what it is for and
why it needs to be done. The client becomes aware that the Nephrologist
will speak to them in more detail about filling
out this form.
- Informing the client that he/she can change his/her
mind at any time, and the form will be changed accordingly.
- Inviting questions and clarifying misunderstanding or
misconceptions.
- Giving the option to bring along a partner, relative
or a friend to the session with the Nephrologist to fi ll out
the form.
- Explaining to the clients that after the form is signed,
the Nephrologist will witness the signature. A copy of the form
will be given to the client, a copy will be faxed to their family
physician, and the original will become part of the Health
Record.
- Validating the psycho-emotional impact of what had been
discussed.
- Suggesting longer individual appointments if client
becomes quite distressed and needs further counselling.
- Making follow up personal calls to touch base with more
distressed clients.
- Giving the client the option of not discussing the advanced
directives, if the timing is not right because expression of
frustration being too great, crisis in the family, etc.
Process Feedback thus far:
At this point all the Hemodialysis, Home Hemodialysis, and Peritoneal
Dialysis clients have been introduced to this form.
We are now in the process of having it introduced to all the Renal
Health Clinic clients. Client reactions thus far have ranged from expressing indifference
to feelings of depression, becoming quite upset, and not willing
to be introduced to the concept, never mind discussing it with
the MD or signing the form. Although I do not have any statistics
to show, I can say that the majority of the clients have not expressed
diffi culty with the process, and have not shown any symptoms
of distress or expressions of sadness. Some of the positive expressions
of clients regarding the process have been in the form of giving
compliments to Penticton Regional Hospital Renal Program stating
that this would make things easier for them, that they had already
done their living will and this was similar and they did appreciate
doing it specifically for Renal Program too. Some clients have
been so ready for such a process that would start giving their
Answers to the Renal Social Worker before even meeting with the
MD.
