"Everybody puts a lot into it!" Single session contacts in hospital social work

For the most part, social casework literature is based on the assumption that social workers have on-going contacts with clients over a period of time. However, the experience of social workers in a number of fields of practice suggests that it is common for social workers to see clients only once. This paper reports on a qualitative study of hospital social workers' experiences of single session contacts with clients. Analysis of the data from focus groups with hospital social workers indicated that they do not always give single session work the significance it deserves, although a high level of skill is seen to be required to do such brief work well. A number of distinctive characteristics of single session work were identified including setting clear goals and parameters, establishing rapport quickly and adhering to the social work principle of self determination at the same time as working quite directively. The implications of these findings for future research are discussed.     

Working with children with autism and their families: pediatric hospital social worker perceptions of family needs and the role of social work

ABSTRACT

Social workers with knowledge of autism can be valuable contributors to client- and family-centered healthcare services. This study utilized a qualitative design to explore pediatric hospital social workers’ experiences and perceptions when working with children and youth with autism and their families. Interviews with 14 social workers in a Canadian urban pediatric hospital highlighted perceptions of the needs of families of children with autism in the hospital and challenges and benefits related to the role of social work with these families. Results suggest that pediatric social workers may benefit from opportunities to develop autism-relevant knowledge and skills.     

The experiences of pediatric social workers providing end-of-life care

Pediatric social workers working in acute care hospital settings may care for children and their families in end-of-life circumstances. This qualitative study is part of a larger study focusing on the experiences of health care providers working with dying children. This study consisted of 9 semi-structured interviews of acute care pediatric social workers who work with dying children and their families. Themes included the role of social work with dying children, the impact of their work and coping strategies. Authors suggest a hospital-worker partnership in supporting staff and promotion of supportive resources.     

Levers and barriers to patient-centred care with children: findings from a synthesis of studies of the experiences of children living with type 1 diabetes or asthma

Background The last 50 years have seen a sea change in approaches to health care with children, from a time when children were routinely separated from parents while in hospital, to current recognition of the importance of placing the experiences of children and their families at the heart of care. Yet, there is a gap in the evidence about how children's involvement might be best achieved.This study aimed to synthesize findings of children's experiences of long‐term illness and, from this, to identify levers and barriers to patient‐centred care with children. Methods A synthesis of studies of the experiences of children living with type 1 diabetes or asthma. Data sources Eight health and social care databases, bibliography searches and consultation with field experts and first authors of included studies. Eligibility criteria Qualitative studies with children 10 years (mean) and younger on their experiences of living with type 1 diabetes or asthma. Main results Findings suggest key ‘levers’ to patient‐centred care with children include: (1) engagement with children's expertise about their own lives: their personal and social experiences of their care, including how these are affected by their relative lack of power in some settings; (2) exploring children's understandings and preferences in terms of their physical sensations and day‐to‐day experiences; (3) willingness to find resources to engage with even the youngest children; (4) avoiding age‐based assumptions about children's contributions to their care. Discussion and conclusions Action on the above ‘levers’ may present a range of challenges in healthcare settings not least because it represents a move away from medicine's historical focus on children's developing competencies to engage rather with children's social realities from the earliest ages.     

A Pilot Study of Fieldwork Rotations vs. Year Long Placements for Social Work Students in a Public Hospital

A comparison of two types of fieldwork was undertaken with 26 social work students in a large urban hospital. The first group was assigned to a traditional, year long placement. the second group was assigned to three successive placements of approximately 10 weeks each. The impact of these two types of placement on students' general sense of self-efficacy, self-efficacy regarding specific hospital social work activities and perceptions of the work environment, was assesed. Initial results suggest that both groups produce virtually no change in students' general sense of self-efficacy, yet produce positive changes in students' self-efficacy regarding hospital social work. In addition, results suggest that the fieldwork rotation used in the second group may produce somewhat more positive views of the work environment.     

Gender and sexual vulnerability of young women in Africa: experiences of young girls in secondary schools in Uganda

Sexuality is part and parcel of students' experiences of schooling manifested in personal friendships, relations and social interaction. These encounters constitute sites within which sexual identities are developed, practiced and actively produced through processes of negotiation. Drawing on qualitative research conducted in 14 selected secondary schools in Central and Western Uganda, the study illuminates gendered sexual vulnerability within patterns of social interaction and young girls gendered experiences and negotiation of their sexuality. The study reveals that through social and discursive practices, students construct complex gendered relations of domination and subordination that position boys and girls differently, often creating gender inequalities and sexual vulnerability for those gendered as girls. Girls' vulnerability is characterised by confusing and traumatic experiences fraught with double standards and silences. Typical of these experiences are complex tensions and contradictions surrounding constructions of sexuality that are predicated upon unequal power and gender relations characterised by homophobia, misogyny, control of female sexuality and sexual abuse and exploitation, all which work against girls' expression of sexuality. Gender sensitive sexuality education is identified as a valuable site of intervention to address such vulnerabilities and promote gender equality and equity in society.     

MSW student perceptions of sexual health as relevant to the profession: Do social work educational experiences matter?

Many social work clients are at an increased risk for negative outcomes related to sexual behavior, including unwanted pregnancies and sexually transmitted infections (STIs). However, there is a dearth of literature on social work student experiences with these topics in social work classrooms and their perceptions about the topic’s relevance to their practice. The purpose of this study is to explore relationships between experiences with STIs and contraception as topics in social work education and practica experiences on student perceptions toward sexual health as a relevant topic for social work. Among a national sample of MSW students (N = 443), experiences with STIs and contraception as topics in practica was significantly related to perceptions toward sexual health’s relevance to social work. Findings and implications are discussed.     

Privilege as a Social Determinant of Health in Medical Education: A Single Class Session Can Change Privilege Perspective

Accredited medical schools are required to prepare students to recognize the social determinants of health, such as privilege, yet privilege education has been overlooked in medical school curricula. The purpose of this study is to determine whether a single class session on privilege, within a social justice elective offered to first and second year medical students, is sufficient to change the perspective of medical students concerning their own personal privilege. A pre-class survey, followed by a class session on privilege, and post-class survey were conducted. Thirteen of the 18 students enrolled in the elective completed the pre-class survey. Ten students completed the post-class survey, although only 9 completed both the pre- and post-class surveys. The demographic profile of the participants was 93% Asian and 7% White ethnicity, with 57% identifying as being culturally American. There was no significant difference between average male and female or between age groups'' self-assessed privilege amounts. For all characteristics tested, except hair color, participants had an increased self-assessed privilege perspective following the class. Three participants had an overall positive difference in privilege perspective, three participants had an overall negative difference in privilege perspective, and three participants had only a minimal change in privilege perspective. The absolute total difference in privilege perspective was 25 units of change. The single class session on privilege was sufficient to change significantly the perspective of medical students on their own personal privilege; however, future studies with larger groups of medical students are needed to elucidate other findings suggested by this study.     

St Joseph's Community Health Centre model of community-based interdisciplinary health care team education

As our reliance on interdisciplinary health care teams for meeting the multidimensional needs of the community becomes greater, new interdisciplinary education programmes and learning experiences are needed to educate students and health care professionals to become better team players. The St Joseph's Community Health Centre (SJCHC) model of community-based interdisciplinary health care team education was developed with support from McMaster University and the Educational Centre for Aging and Health's Clinical Teaching Unit Without Walls. The SJCHC model is structured as one 3-h session each week for eight consecutive weeks and is an elective learning experience for students. Six to eight senior health, social science and other health-related students work with two group facilitators as a team on discussion theme topics: team dynamics; role issues and professional values; collaboration and conflict; communication, leadership and power; client-centred goal-oriented care; and consumerism issues. The success and impact of the SJCHC model has been measured by several primary and secondary outcomes outlined in the Charting the Outcomes of Educational and Clinical Approaches (COECA) model.     

The social worker's role in the hospital: seen through the eyes of other healthcare professionals

Social workers in hospitals necessarily work alongside other healthcare professionals, and the perspectives on social work held by doctors and senior nurses are relevant both to their relationship with social workers and to the smooth running of the hospital. An exploratory investigation in the East Anglian Region has produced profiles of perceived social work practice in six different patient-care categories: surgical and orthopaedic, accident and emergency, medicine for the elderly, psychogeriatric medicine, psychiatry and paediatrics. The social worker's functions are recognized as including statutory responsibilities in child protection and mental health, and there are some secondary roles that often reflect a social worker's personal interest or sphere of expertise. The social worker's primary role, however, is deemed to be that of discharge planning - a task which has been given statutory force under the National Health Service (NHS) and Community Care Act 1990. The nurses and doctors interviewed rated the quality of social work practice predominantly by the extent to which the social worker was seen to identify unambiguously with the hospital and its ethos; but they also set great store by the presence and easy accessibility of a social worker, and they preferred regular contact with the same person. They saw the social worker as a key agent within the health care framework, and acknowledged that the social care role and the social worker's link with the community were crucial components of good hospital practice.     

Hospital social work and discharge planning: an exploratory study in East Anglia

An exploratory research study in one district health authority demonstrates the significant impact of the NHS and Community Care Act 1990 on hospital-based social workers. Their work is overwhelmingly concerned with the discharge planning process, in which they have developed patterns of collaboration with a range of other professional groups while retaining a specific commitment to the interests of the patient and carers. The social workers interviewed differ in the degree to which they feel a sense of corporate identity with the hospital and the healthcare system. The study identifies five practice elements in the social worker's range of responsibilities: interdisciplinary collaboration, assessment, providing a link between hospital and community, networking and negotiation, and the use of financial acumen. Two areas of debate and dissonance are identified: counselling is not now something that looms large in the social worker's daily round; while the defence of patient rights sometimes involved the social worker in conflicting relationships with other professional groups.     

Using the photovoice method to understand experiences of people with physical disabilities working in social enterprises

BackgroundSocial enterprises can be an alternative option for people with disabilities to build confidence in the job market, where unemployment and difficulty securing a decent job is a social issue for this population. However, limited studies have examined these experiences from the participants’ perspectives.ObjectiveThis study explored the life experiences of people with disabilities working in social enterprises, using the photovoice method.MethodsFive employees with physical disabilities working in a social enterprise participated in five sessions of photovoice in South Korea. They took photos for each session on four themes and participated in group discussions.ResultsThis paper draws from narrations and photos shared during group discussions regarding four themes selected by participants: my current state, life changes after being employed in a social enterprise, feeling frustrated, and my future. The participants reported better quality of life both financially and socially, but also felt frustration facing interpersonal, health, or workload problems while working at a social enterprise. They expressed hope to continue working in their social enterprise, and thus ultimately experience better quality of life and a sense of contributing to society.ConclusionsEmployers can create more supportive and sustainable workplaces to secure decent job opportunities for persons with disabilities at a social enterprise and contribute social value. Social work professionals should provide professional support to employees with disabilities who are struggling with health and psychosocial problems that often occur in social enterprises.     

“Old friend and powerful cadre”: Doctor-patient relationships and multi-dimensional therapeutic landscapes in China's primary hospitals

A positive doctor-patient relationship is believed to play a key role in the healing process in clinics. While challenges to the doctor-patient relationship are a global concern, complex social contexts which introduce familial collectivism and totalitarian bureaucracy to maintain a doctor's authority have complicated doctor-patient relationships in China. This study delineates a multi-dimensional therapeutic landscape of hospitals in China, focusing on the doctor-patient relationship performances used to improve patients' healing experiences. Based on fieldwork in two primary hospitals in Eastern China, we find that primary hospitals in China are not only professional spaces, but hybrids of professional and non-professional spaces. In these spaces, both professional and other discourses in various forms of social-environmental engagement affect therapeutic experiences. Varying time and space in hospitals allow doctors to construct multi-dimensional therapeutic landscapes vis-a-vis patients to secure patients' compliance with their recommendations, and thus improve health outcomes. We argue that these dimensions may also cause negative therapeutic experience such as unnecessary health care. This study contributes to the literature on therapeutic landscapes of health care by providing a critical view on the construction of multi-dimensional therapeutic hospital landscapes. Furthermore, it links the critical health geographies literature with China's broader social context to explicate the cultural and social transformation of health care spaces in contemporary China. Findings from this study inform both theoretical and empirical debates regarding therapeutic landscapes of health care by embedding the professional spaces of health care into broader geographical discourses. This calls for health professionals to reflect on ethical concerns in multi-dimensional health care landscapes.     

Creating ‘therapeutic landscapes’ for mental health carers in inpatient settings: A dynamic perspective on permeability and inclusivity

Although there has been a shift toward treatment in the home and the community, in the UK, inpatient facilities are still important in modern mental health care. ‘Informal carers’, including family members, often play an essential role, not only in providing care in the community but also in care of patients during periods of hospitalisation. UK National Health Service policies increasingly consider the position of these carers as ‘partners’ in the care process, but relatively little attention has been paid to their position within the hospital settings where treatment is provided for inpatients. This paper contributes to geographical work on carers experiences, by reporting how this issue emerged through a study focused on perceptions of a newly built hospital, compared with the inpatient facilities it replaced. We draw on qualitative research findings from discussion groups and interviews with informal carers. The material considered here focused especially on carers' views of aspects of the hospital environment that were important for wellbeing of carers and the people they look after. The carers' views were supplemented by relevant material drawn from other interviews from our wider study, which included service users and members of hospital staff. These accounts revealed how informal carers experienced the hospital environment; we interpret our findings through a conceptual framework that emphasises carers' experiences of a ‘journey’ along a ‘caring pathway’ to and through the hospital space. This perspective allows us to make a connection between three bodies of literature. The first relates to phenomenological interpretations of one's environmental perception, formed as one moves through the world. The second derives from the literature concerning ‘permeability’ of hospital institutions. Bringing these ideas together provides an innovative, dynamic perspective on a third strand of literature from health geography that examines hospitals as ‘therapeutic landscapes’. The analysis helps to explore the extent to which carers in this study were positioned as ‘outsiders’ in the hospital space.     

Experiences and implications of social workers practicing in a pediatric hospital environment affected by SARS

This phenomenological study's purpose was threefold: to detail the experiences of social workers practicing in a hospital environment affected by severe acute respiratory syndrome (SARS), to describe essential themes and structures of social work practices within this crisis environment, and to explore recommendations for better preparedness to meet similar crises in the future.The sudden onset of SARS in hospital settings created an immediate necessity to study this phenomenon as hospitals and health care professionals struggle to adapt to this new epidemic environment. This study is the first using qualitative research to investigate the unique perspective of social workers in an epidemic environment.The results reflect the social workers' subjective experience of their interventions with patients and families and indicate that a number of professional tenets, such as advocacy, family-centered approach, knowledge of systems, open communication, and ethics effectively supported social work practice in a crisis environment.     

解读第二周期医院评审重点

医院评审是政府管理医院的重要手段。第二周期医院评审工作主要有以下特点：强调公立医院的公益性;安全、质量、服务、管理绩效是核心内容;医疗质量安全管理与持续改进是重点章节;全面检查前一评审周期的日常工作是重点考核内容;特别增加社会评价环节;评审方法有创新等。     

The Value of the Presence of Social Work in Emergency Departments

The value of the presence of social work in emergency rooms is supported by directly examining the hospitalization rates of patients seen by social workers. It utilizes a 3-year-long data set of social work self-reports on medical emergency room outcomes at a large, teaching hospital in the New York Metropolitan area with a sample size of 3370. The study findings suggest that social workers in this acute care hospital's emergency room often are referred the most complex cases. The data on this site indicate that the majority of social work dispositions were to home (54%) or a nursing facility (8.4%). Only 16% of the patients seen by social work were admitted to the hospital. These findings support the cost-effective nature of social work in the emergency room setting and the importance of finding alternatives to hospital admissions. The results of a logistic regression suggest that the criteria used by social workers to assess patients are based on sound psychosocial factors. Patients who were assessed as having “Environmental” (p = .00) or “Relationship” problems (p = .00) were much less likely to be admitted. Conversely, patients with “Care/ADL” problems (p = .00) and behavior problems (p = .00) had a heightened chance of being admitted. Being African American has less effect but was still relevant.     

PATIENT REPRESENTATIVE PROGRAMS

Patient Representatives are one of the fastest growing new human service occupations functioning in hospital settings. The patient representative's role and function bears certain similarities to social work and hs the potential for being seen as pre-empting part of its domain. This article describes the role of patient representatives, reports on a survey of hospitals with patient representative and social work programs and examines some of the issues that this new occupational group may pose for social workers in hospital settings.     

Experiences of social work intervention among mothers with perinatal mental health needs

Perinatal mental health difficulties are prevalent among women, and the vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. This study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi‐structured interviews were carried out with 18 women with 6‐ to 9‐month‐old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children's social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother's own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers’ mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of ‘turning points’ where initially negative interactions stabilised and child protection concerns lessened. Women's accounts highlighted the importance of feeling ‘known’ by social workers who understood and respected them. The findings also suggested there may be value in improving collaboration between social workers and mental health professionals to create more space for representation of women's needs as well as those of their babies.