Health care social work treatment of patient and family emotion: a synthesis and comparison across patient populations and practice settings

Health care practitioners and researchers alike are beginning to acknowledge the importance of emotion in health. Nevertheless, health care social workers continue to assume most of the responsibility for actually dealing with the emotions of patients and families. Literature exploring social work interventions with emotion are restricted to a single patient population and practice setting. This study conducted a content analysis of pertinent literature, systematically codifying strategies across patient populations and practice settings according to a pragmatic conceptual foundation of the professional emotion treatment process. Analysis yielded a comprehensive conceptually clustered matrix of 45 strategies, establishing an objective and systematic basis for identifying and understanding this professional emotion treatment process for social work educators, practitioners, and researchers alike.     

Changing Practice

Abstract

Changes to professional work now ensure that social care and health care workers should be accountable to service users, and not only to their professional colleagues. This paper seeks to explore how this may eventually be realised in new working relationships that will profoundly affect mental health social work.

These changes are driven by factors that are external to the social work profession-in policy initiatives that introduce measures of performance that incorporate the service user in both evaluating and planning services, in efforts to build new relationships, and in a breakdown of barriers between social work practitioners and service managers. While these changes are sometimes likely to be resisted by practitioners and service users alike, the demands of policy makers for a new professional accountability to service users can be used to pave the way for effective dialogue. The paper outlines the steps necessary to build confidence among both service users and service providers. This requires sensitive management and leadership. It also requires that action demonstrably follows from such dialogue. The paper uses evidence from Community Mental Health Teams in Swansea, over a three-year period, to demonstrate how the policy and management imperatives faced by service providers can be reconciled with the expressed desires of mental health service users.     

The Effects of Gender and Race on Physician Treatment of Patient Emotion

This study explored the effects of physician gender and patient gender and race on physician treatment of patient emotion. Physicians were randomly assigned to one of four conditions: receiving a White-male, White-female, Black-male, or Black-female patient case vignette. Analysis based on data from 225 physician respondents showed that female physicians were more likely to treat patient emotion and use strategies which approached rather than avoided emotion than male colleagues. However, an interaction effect among physician gender, type of practice, and practice setting revealed that male generalists practicing in institutional settings were more likely to treat patient emotion than female practitioners. When patients were White, emotion was considered more important and the client was more likely to receive treatment. Specifically, an interaction effect between patient gender and race indicated that physicians were least likely to avoid and most likely to treat the emotions of White females followed by White males.     

Academic-Practice Partnerships in Practice Research

Summary

Academic-practice partnerships in practice research support health social workers in engaging in research that is embedded within their practice. This shift in culture enables social workers to join in a health service discourse that is increasingly data-driven and focused on effective practice and demonstrated quality of care for patients. The mentoring model is described as enabling practitioners to superimpose research skills onto existing practice skills. An academic-practice research collaboration can reduce the distance between research and practice, contribute to a body of knowledge for health social work and promote health social workers as “research focused practitioners.”     

Identifying subgroups of persons with multimorbidity based on their needs for care and support

Background

Health care-related harm is an internationally recognized threat to public health. The United Kingdom’s national health services demonstrate that upwards of 90% of health care encounters can be delivered in ambulatory settings. Other countries are transitioning to more family practice-based health care systems, and efforts to understand avoidable harm in these settings is needed.

Methods

We developed 100 scenarios reflecting a range of diseases and informed by the World Health Organization definition of ‘significant harm’. Scenarios included different types of patient safety incidents occurring by commission and omission, demonstrated variation in timeliness of intervention, and conditions where evidence-based guidelines are available or absent. We conducted a two-round RAND / UCLA Appropriateness Method consensus study with a panel of family practitioners in England to define “avoidable harm” within family practice. Panelists rated their perceptions of avoidability for each scenario. We ran a k-means cluster analysis of avoidability ratings.

Results

Panelists reached consensus for 95 out of 100 scenarios. The panel agreed avoidable harm occurs when a patient safety incident could have been probably, or totally, avoided by the timely intervention of a health care professional in family practice (e.g. investigations, treatment) and / or an administrative process (e.g. referrals, alerts in electronic health records, procedures for following up results) in accordance with accepted evidence-based practice and clinical governance. Fifty-four scenarios were deemed avoidable, whilst 31 scenarios were rated unavoidable and reflected outcomes deemed inevitable regardless of family practice intervention. Scenarios with low avoidability ratings (1 s or 2 s) were not represented by the categories that were used to generate scenarios, whereas scenarios with high avoidability ratings (7 s 8 s or 9 s) were represented by these a priori categories.

Discussion

The findings from this RAND/UCLA Appropriateness Method study define the characteristics and conditions that can be used to standardize measurement of outcomes for primary care patient safety.

Conclusion

We have developed a definition of avoidable harm that has potential for researchers and practitioners to apply across primary care settings, and bolster international efforts to design interventions to target avoidable patient safety incidents that cause the most significant harm to patients.

     

The role of emotion in patient safety: Are we brave enough to scratch beneath the surface?

Healthcare professionals work in emotionally charged settings; yet, little is known about the role of emotion in ensuring safe patient care. This article presents current knowledge in this field, drawing upon psychological approaches and evidence from clinical settings. We explore the emotions that health professionals experience in relation to making a medical error and describe the impact on healthcare professionals and on their professional and patient relationships. We also explore how positive and negative emotions can contribute to clinical decision making and affect responses to clinical situations. Evidence to date suggests that emotion plays an integral role in patient safety. Implications for training, practice and research are discussed in addition to strategies to facilitate health services to understand and respond to the influence of emotion in clinical practice.     

Shared Decision Making in Health Care Settings: A Role for Social Work

Shared decision making (SDM) is a process integral to social work practice, one where the provider/professional and the consumer/patient discuss treatment alternatives based on patient values and life circumstances and make a shared decision about whether and how to proceed with treatment. Evidence-based medicine suggests that for many health conditions, having the choice of several effective treatment options is not uncommon. In these cases treatment should be based on what is best for the individual, since many factors influence an individual's treatment preference, including the psychological, social, cultural, and spiritual history she/he brings to the medical encounter; a history that has long been ignored in somatic health care. This article develops the argument that medical social workers possess the professional knowledge and skill base to provide decisional coaching, and implementing SDM in primary care settings. Of particular importance are the values that guide professional social work practice, including client self-determination, which is the basis of SDM, and the ability to maintain neutrality.     

Knowledge and Social Work in Health Care—The Case of Finland

Abstract

Studies carried out in different countries have shown that there is a lack of a common and up-dated knowledge base in social work, and that social workers make use of research in their everyday practice only to a very limited extent. On the other hand it has been shown that social workers feel they need knowledge but not necessarily in the form it is produced by the researchers.

This paper explores issues of knowledge and competence in health social work based on the results of a survey and a focus group interview conducted among social workers in Finland. According to the results, social workers in health care do feel they need new knowledge. Some significant differences were found in the way health social workers view the acquisition and maintenance of professional competence and in the way they seek knowledge, when compared to social workers working in the municipal social services.     

Changing practice: involving mental health service users in planning service provision

Changes to professional work now ensure that social care and health care workers should be accountable to service users, and not only to their professional colleagues. This paper seeks to explore how this may eventually be realised in new working relationships that will profoundly affect mental health social work. These changes are driven by factors that are external to the social work profession-in policy initiatives that introduce measures of performance that incorporate the service user in both evaluating and planning services, in efforts to build new relationships, and in a breakdown of barriers between social work practitioners and service managers. While these changes are sometimes likely to be resisted by practitioners and service users alike, the demands of policy makers for a new professional accountability to service users can be used to pave the way for effective dialogue. The paper outlines the steps necessary to build confidence among both service users and service providers. This requires sensitive management and leadership. It also requires that action demonstrably follows from such dialogue. The paper uses evidence from Community Mental Health Teams in Swansea, over a three-year period, to demonstrate how the policy and management imperatives faced by service providers can be reconciled with the expressed desires of mental health service users.     

Social Group Work

Abstract

Deconstruction of traditional social work departments can isolate social workers from their primary source of professional affiliation, leaving them without the support to take stands on controversial patient care issues. This paper describes an alternative: the building of a powerful social work collective based on social group work theory that potentiates professional practice while transcending management forms. The model includes group supervision, but moves beyond it to utilize the social work group as a central organizing principle. At the heart of the collective are the elements of professional accountability, support, autonomy, and collaborative decision-making within democratic peer group structures. The authors highlight current management theory, distinctions that create an authentic social work value-based practice, and outcomes for social workers, their clients, and colleagues.     

Exploring UK medical and social work students’ legal literacy: comparisons,contrasts and implications

To ensure acceptable practice standards both doctors and social workers should draw on relevant legal rules when reaching professional judgements concerning, for instance, children requiring protection, people with severe mental distress and adults at risk, information sharing, consent to intervention and service user involvement in their care and treatment. Many practitioners use the law to maintain high standards of professionalism. However, research has uncovered limited awareness of legal rules and poor standards of health and social care. Academic benchmarks and practice requirements for health and social care professions centrally position legal knowledge for secure decision‐making. Model curricula exist. However, the outcomes of the taught curriculum on students’ confidence in their legal knowledge and skills have been relatively overlooked. This article introduces the concept of legal literacy, a distillation of knowledge, understanding, skills and values that enables practitioners to connect relevant legal rules with their professional practice, to appreciate the roles and duties of other practitioners and to communicate effectively across organisational boundaries. It presents the outcomes for a 2006–2009 study of 1154 UK medical and 638 social work students of their law learning for practice, response rates of 46% and 68%. Significant differences were found between medical and social work students’ attitudes towards the law, and in their self‐ratings of legal knowledge and skills. Confidence levels were low and anxiety high, especially among medical students, although law teaching had some positive outcomes on knowledge and skill development. Social work and medical students associated different themes with the law, the latter especially foregrounding ethics, negligence and liability, which could affect inter‐professional working. Students are not fully prepared for legally literate practice, with a consequent need to review the time allocated for, and the content of law learning and the subsequent availability of continuing professional development.     

Hospital Social Work and Community Care

SUMMARY

This paper presents the findings of an exploratory research study which considers the effect of organisational change on social work practice in hospitals in four local authorities in England. Its aims were (1) to obtain the views of hospital social workers and their managers about the effect of implementing the NHS (National Health Service) and Community Care Act of 1990 and policies for Care in the Community on the practice of social work and (2) to elicit issues of concern to form the basis of a national study.

Semi-structured interviews were carried out in hospital social work departments which were providing a service to adults with health needs. Interviews with a representative sample of 85 workers and 36 managers (including Assistant Directors and Principal Training Officers) in 11 hospitals were held between June-December 1993, three months after the introduction of the policies. The interviews were tape-recorded and transcribed, A questionnaire provided some quantitative data, and additional information was obtained through non-participant observation at team meetings.

The interviews covered four topic areas: the nature of social work in hospitals; the changes introduced by implementing the legislation; the management ofthat change; and the effect of the new policies on practice.

Results show an increase in the volume of referrals particularly in assessment for nursing home care; and an overwhelming amount of administrative work to process the new procedures for providing community care. Most relates to filling in forms, duplication of assessments and repetitive bureaucracy. Workers struggle to meet their expectation of professional practice with organisational demands.

The discussion centres on three issues raised by practitioners: the changing nature of social work due to the alternative models of service being imposed by local authorities; the lack of consultation and involvement by management of the frontline workers in the management of this change; the dissonance felt by hardworking and committed practitioners to whom the increasing paper work is yet another obstacle to user involvement.

This may have clear implications for management, for the degree of stress and perceived pressure resulting from these organisational changes is counterproductive to job satisfaction. If the reforms are not to be undermined, they need proactive management. This requires a sensitivity to workers¹ needs, investment in training and working together to integrate the care management role into social work practice.     

Le social à l’épreuve,l’épreuve du social. Ou l’art d’accommoder la position sociale des patients dans le travail préventif en médecine générale

AimThis article examines the way in which private general practitioners take into account the social position of their patients in their preventive work.MethodsAfter a review of the main normative constructs supposed to equip the general practitioners to grasp the social dimension of their practice, the article used two surveys on the provision of preventive care, one epidemiological (PrevQuanti) and the other sociological (PrevQuali).ResultsDeontology, training and recommendations make it difficult to shape the social dimensions of health that pratitioners have to deal with. The PrevQuanti survey, however, revealed that the provision of preventive care is subject to almost systematic but variable social gradients. The analysis, based on the PrevQuali interview study, makes the ways in which pratitioners mobilise the social position of their patients and whether or not they adapt to it.ConclusionThe positionings of general practitioners can be modelled in a typology of six postures between which some oscillate.     

Médicos de familia y psiquiatras ante el paciente con depresión: la necesidad de readecuar enfoques asistenciales y dinámicas organizativas

ObjectivesTo find out the perceptions of family doctors (FD) and psychiatrists (PS) on their inter-relationships in the health care of patients with depression.DesignQualitative methodology. Exploratory design based on FD and PS discussion groups (DG).SettingPrimary health care centres (PHCC) and mental health centres (MHC) of the Basque Country Health Service in Vizcaya.Participants and contextA total of 29 FD from 20 PHCC, and 13 PS from 11 MHC, distributed according to the socioeconomic level of the reference population. The meetings were arranged and held in the PC research unit.MethodsAn intentional sample to configure 4 DG of FD and 2 of PS, homogenous as regards socioeconomic level, and heterogeneous as regards the centres they came from, work experience and gender. The meetings were recorded and transcribed and a sociological discourse analysis was made. Triangulation between researchers and results comparison with the participants was carried out.ResultsThe perceptions and attitudes of the FD and PS differed, in their connections with the patient, expectations and health care context. In both cases they perceived the unsuitability of the real patient as regards the prefixed perceptions of the professional. The increase of the problem and its management seemed to be conditioned by a social medium which was uncontrolled, and due to increasing deficiencies in the collaboration between health care levels.ConclusionsCare of the patient with depression requires diagnostic and treatment approaches centred on the patient and shared by FD and PS.     

The clinical challenge of hospital-based social work practice

This paper describes and analyzes the complexity, intensity and variety of hospital-based social work practice in the rapidly changing, fiscally driven climate of acute health care in the United States. The professional guidelines which enable workers to master this challenging environment are enumerated and discussed. It is suggested that hospital-based social work calls for highly skilled, creative clinical practitioners who can be recruited to the field through a balanced, accurate portrayal, both in schools of social work and the media, of acute health care as a field of practice.     

Out-of-hours co-operatives: General practitioner satisfaction with governance and working arrangements

Objective. General practice co-operatives have led to significant improvements in quality of life for general practitioners. Little is known about general practitioners’ own experiences with the working arrangements and governance of co-operatives. This study investigates GP satisfaction, the working environment, governance and future developments in co-operatives. Methods. A questionnaire was sent to GPs in two co-operatives in the Republic of Ireland, covering mixed urban and rural areas. Results. Of 221 GPs in the co-operatives, 82% responded and confirmed the co-operatives’ positive effects on their lives. However, 57% still received requests for out-of-hours care while off duty, most commonly from patients who preferred to see their own doctor. Half felt overburdened by out-of-hours work, especially those over 40 y of age. Twenty-five per cent were dissatisfied with the GP complaints mechanism. The majority (63%) would prefer a GP/health board partnership for the organization of out of hours, while 23% wanted sole responsibility. GPs indicated a strong need for better ancillary services such as nursing, mental health, dentistry, pharmacy and social work. Access to records is an important issue in terminal care and mental illness. Conclusion. While GP co-operatives are a success story for general practice, they will work better for general practitioners and their patients if nursing, mental health, dentistry, pharmacy and social services are improved. Support and training is needed in mental health, palliative and emergency care to increase competence and reduce stress. GPs are willing to work with health authorities in further co-operative development. More attention needs to be paid to the complaints and suggestions of GPs in the running and governance of their co-operatives.     

Development of a research agenda for general practice based on knowledge gaps identified in Dutch guidelines and input from 48 stakeholders

Background: Several funding organizations using different agendas support research in general practice. Topic selection and prioritization are often not coordinated, which may lead to duplication and research waste.

Objectives: To develop systematically a national research agenda for general practice involving general practitioners, researchers, patients and other relevant stakeholders in healthcare.

Methods: We reviewed knowledge gaps from 90 Dutch general practice guidelines and formulated research questions based on these gaps. In addition, we asked 96 healthcare stakeholders to add research questions relevant for general practice. All research questions were prioritized by practising general practitioners in an online survey (n?=?232) and by participants of an invitational conference including general practitioners (n?=?48) and representatives of other stakeholders in healthcare (n?=?16), e.g. patient organizations and medical specialists.

Results: We identified 787 research questions. These were categorized in two ways: according to the chapters of the International Classification for Primary Care (ICPC) and in 12 themes such as common conditions, person-centred care and patient education, collaboration and organization of care. The prioritizing procedure resulted in top 10 lists of research questions for each ICPC chapter and each theme.

Conclusion: The process resulted in a widely supported National Research Agenda for General Practice. We encourage both researchers and funding organizations to use this agenda to focus their research on the most relevant issues in general practice and to generate new evidence for the next generation of guidelines and the future of general practice.     

Improvisation as an Adaptive Strategy for Occupational Therapy Practice

ABSTRACT

As health care environments become increasingly complex, practitioners must develop new adaptive skills to master practice. The idea of using theatrical improvisation (improv) in health care is relatively new. Occupational therapy students were taught a module of improvisational techniques as part of an academic seminar, learning improvisation rules, and enacting solutions to typical daily professional challenges. The purpose of this article is to recommend improvisational techniques as an adaptive skill to effectively blend art and science for occupational therapy practice in fast-paced and unpredictable health care environments.     

Les pratiques de repérage de la situation sociale des patients. Analyse anthropologique de discours de praticiens libéraux

BackgroundA number of studies have highlighted differences and even discrimination in health care offer according to social category, and shown that they contribute to the production of inequality. On the other hand, when the health care system treats every patient equally, and does not take personal difficulties into consideration, some authors have suggested inequality “by omission”. That is why public health actors at different levels have recommended systematic collection of information on patients’ social status. The objective of this article is to analyze data gathering on patients’ socio-economic condition and its repercussions.MethodsThe survey is based on more than 50 semi-structured face-to-face interviews with doctors and dentists in private practice. Their answers were subjected to socio-anthropological analysis.ResultsWhile some practitioners collect information on patients’ social status proactively by systematic interrogation, others proceed indirectly and in accordance with subjective criteria. Quite often, patient status remains ignored, usually due to lack of interest, and less frequently because practitioners wish to guard against any risk of stigmatizing underprivileged patients. Different rationales may explain these attitudes: need to prioritize relevant information, wish to observe equity and equality, determination to refrain from social labeling, desire to protect patient self-esteem and to reinforce the practitioner-patient relationship. When identification does occur, it is essentially justified by a desire to adapt the care pathway to potential socio-economic obstacles.ConclusionWhen a patient's social situation is sought out by private doctors and dentists, they are mainly concerned with customizing care pathways by taking financial impediments into close consideration. In most cases, their justifications for asking questions are subjective; by doing so, they inadvertently introduce arbitrariness in an area where the French state endeavors to produce social justice via provisions such as “CMU” (“universal”, across the board health coverage). Systematic questioning on a patient's social status can represent a form of supplementary if unconscious symbolic violence toward frequently disqualified persons; what is more, it runs the risk of inducing stereotypes and manifesting prejudice. Only when contextualized does such questioning seem appropriate. On the other hand, when a practitioner misses out on social issues liable to impede care and treatment, he will probably have no “second chance” to address these concerns. Some practitioners have emphasized a need for suitable timing and contextualizing of questions on a patient's social status, and for putting them forward in a climate of trust.