Depression and decreased perception of social support are associated with mortality in several studies of ESRD patients (Cukor, Cohen, Peterson, & Kimmel, 2007). Decreased marital satisfaction, lower socioeconomic status, and disturbances in family dynamic can affect how a patient perceives social support (Cukor et al., 2007). Social support is intended to benefit the patient and their ability to cope with stress of having ESRD (Cukor et al., 2007). Support is divided into three types: instrumental, informational, and emotional (Cukor et al., 2007). Instrumental support provides material aid, such as financial assistance (Cukor et al., 2007). Since Medicare supports all renal dialysis patients of any age, this is an example of instrumental support for Amanda. Informational support refers to providing helpful information such as guidance (Cukor et al., 2007). Studies show that religious and spiritual beliefs are associated with decreased perception of burden of illness, decreased depression, and increased perception of social support, and better satisfaction with life (Spinale et al., 2008). The social worker can help bring a Chaplin to speak to Amanda about her spirituality. Another form of guidance is having a patient who had similar experiences with End Stage Renal Disease talk to the patient through a mentor program. Emotional support involves expressing empathy and providing encouragement of emotional expression (Cukor et al., 2007). Health-care professionals can intervene to strengthen the patient’s personal network (Rounds & Israel, 1985). A common intervention is counseling provided by the social worker and group interventions that are usually facilitated by a member of the health-care team (Rounds & Israel, 1985). Social integration is another concept that involves participation in social relationships by actively engaging in a wide range of social activities or relationships and cognitively understanding one’s identification with his or her social role (Cukor et al., 2007). An example for Amanda would be to partake in church events or attend prayer meetings. The con to that is this idea is that she would have to depend on someone for rides or pay for taxis as she cannot drive. Social support has been linked to improved health outcomes in a variety or chronic illnesses through numerous studies (Cukor et al., 2007).

References
Cukor, D., Cohen, S.D., Peterson, R.A., Kimmel, P.L. (2007). Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. Journal of the American Society of Nephrology, (12):3042-55. doi:10.1681/ASN.2007030345.
Rounds, K.A., Israel, B.A. (1985). Social networks and social support: living with chronic renal disease. Patient Education and Counseling, 7(3) 227-247. Retrieved from http://www.sciencedirect.com.proxy.library.emory.edu/science/article/pii/0738399185900321
Spinale, J., Cohen, S.D., Khetpal, P., Peterson, R.A., Clougherty, B., Puchalski, C.M.,…Kimmel, P.L. (2008). Spirituality, social support, and survival in hemodialysis patients. Clinical Journal of the American Society of Nephrology, 3(6):1620-7. Retrieved from http://cjasn.asnjournals.org/content/3/6/1620.long