Understanding the Critical Role of Social Work in Safety Net Medical Settings: Framework for Research and Practice in the Emergency Department

Social workers in Emergency Departments (ED) provide counseling, community resource linkage, and discharge planning. The ED is a critical intervention point for patients with multiple unmet medical, psychological, and social needs, and little or no other contact with service providers. In part because of its role as a medical safety net for underserved populations, use of the ED has steadily increased over time. There is limited research examining the utility of social services in the ED. This article provides a brief history of hospital social work and a literature review of ED social work research with the goal of advancing current research and practice agendas.     

The Complexity of Cancer in Multiple Family Members: Dynamics of Social Work Collaboration

This article presents a case study of one family affected by a cancer diagnosis in both the father and the daughter, who were diagnosed within the same time interval and who underwent treatment at the same time. The article examines the relationship between the caregivers and the oncology patient as well as with one another when the stress of diagnosis is compounded by multiple, simultaneous, and similar diagnoses in a highly condensed period of time. A thorough examination of the literature reveals that there are significant gaps regarding how multiple cancer diagnoses in one family affect the family dynamic, individual and collective coping styles, and caregiver burden. The diagnoses can also dramatically exacerbate economic stressors in a family. The coordination of psychosocial care from the perspectives of the adult and pediatric oncology social workers at an urban academic medical center will be discussed. The social work role, importance of collaboration, and family centered care perspective will be discussed as a method of easing the treatment experience for families in psychosocial distress.     

Impact of nutrition on quality of life during cancer

PURPOSE OF REVIEW: This review addresses the relationship between nutritional intervention and quality of life in oncology patients. RECENT FINDINGS: Nutrition related symptoms, such as anorexia and weight loss, reflect impaired nutritional status, which is often associated with reduced quality of life. Malnutrition can be related to reduced response or tolerance to cancer treatment. Early nutritional intervention may positively impact on quality of life and enhance clinical response in oncology patients. SUMMARY: Nutritional intervention should be considered as a supportive measure within the global oncology strategy. In curative oncology care, it contributes to reduced postoperative infection rate, better control of cancer-related symptoms, shortened length of hospital stay and improved tolerance to treatment. In palliative care, the nutritional intervention focuses on controlling symptoms, thus improving quality of life. The evaluation of nutritional status should include an assessment of quality of life in order to optimize nutritional treatment for patients' individual requirements. Because of the potentially clinically relevant impact of nutritional intervention on quality of life, nutritional care should be included in any antineoplastic strategy.     

Organizing social work services with adult cancer patients: integrating empirical research.

Today only half of those diagnosed with cancer will die of the disease, leaving enormous room for psychosocial interventions to improve the psychological or functional status of those coping with the disease. Therefore, social workers in oncology must be current with empirical research. In an effort to integrate current research into social work practice, we reviewed empirical studies with sound research designs to answer the following questions: (1) What portion of cancer patients are likely to need social work services? (2) What types of services do social workers provide to meet these needs? and (3) Who is likely to be (or not to be) the recipient of these services. Does intervention research include diverse (non-traditional, non-white and non-middle class) clients? The results show about one third of patients will be judged at high-risk for psychosocial problems but that only 15-25% of those who are diagnosed with cancer will eventually use psychosocial oncology services. Some have mainly instrumental, concrete needs, and others will use psychosocial counseling. A review of the inclusion of minorities and non-traditional, non-middle-class groups, shows that they are not adequately represented in current intervention research in psychosocial oncology. Methods for enlarging their access and participation are suggested.     

The Role of the Social Worker in the Adult Critical Care Unit: A Systematic Review of the Literature

Social workers provide care to patients and families in the adult critical care unit. We conducted a systematic review of the literature to more clearly identify the role of the social worker practicing in the intensive care unit. We conducted a comprehensive search of the literature using the Pubmed, Embase, ISI, Scopus, and Social Work Abstracts databases using the terms “intensive care,” “critical care,” and “social work.” Articles were selected for review if they met the following criteria: formal studies or opinion papers whose primary focus was the role or scope of practice of the social worker in the adult critical care unit. Articles were selected and reviewed independently by two social work investigators. Our search retrieved 550 potentially relevant articles. Twelve full-text articles were deemed eligible for abstracting. Three of the articles were studies that examined different aspects of social work practice including implementation of a family assistance program, social work response to anxiety levels of families in critical care and common activities of critical care social workers. Nine articles were primarily opinion pieces. All of the opinion articles described psychosocial support and counseling as a primary role of critical care social work. Other frequently identified roles were crisis intervention, psychosocial assessment, facilitating communication, end-of-life care, and practical assistance. There is little empiric data describing the role of the critical care social worker. Consistent themes from the articles identified include the role of social workers as counseling professionals, facilitators of communication, and resource agents. Further research to identify formal assessment tools and outcome studies of specific counseling techniques will provide important information for best practice guidelines in this area.     

Mild Traumatic Brain Injury: Implications for Social Work Research and Practice With Civilian and Military Populations

Over one million mild traumatic brain injuries (mTBI) are treated in U.S. hospitals each year. In addition, mTBI has affected thousands of soldiers returning from the Iraq and Afghanistan wars. Many individuals experience post-concussive symptoms immediately after mTBI; some experience severe and prolonged symptoms. Symptom etiology is not well understood, and effective psychosocial interventions have not been well developed. Because of the high incidence of mTBI, many social workers in health care settings will come in contact with mTBI patients and need specialized knowledge to provide appropriate services. Social work researchers can contribute to improved services by elucidating symptom course, and developing and testing effective interventions aimed at preventing or alleviating symptoms. This article provides an overview of civilian- and military-related mTBI outcomes and psychosocial interventions. Recommendations for current social work practice and research are made with the goal of improving the care of persons with mTBI.     

Measuring Satisfaction with Social Work Services

For various reasons, the role of the medical social worker is often unclear to persons seeking medical treatment. Allied health professionals, such as nursing staff, tend to have a better understanding of the medical social worker's role and of whether services are being provided to best meet each patient's needs. We aimed to illustrate the abilities of nursing staff to provide patient satisfaction feedback to medical social workers in such areas as responsiveness to patient requests and the satisfaction of patients and their family members with the social services provided. Use of this satisfaction measurement technique will hopefully resolve any confusion that patients, and others not familiar with the role of the medical social worker, may have. This method provides accurate measurement of patients' evaluation of medical social work services.     

The use of hypnosis to improve pain management during voluntary interruption of pregnancy: an open randomized preliminary study

OBJECTIVE: This report describes an open randomized study that aims to determine whether a brief hypnotic intervention during first-trimester surgical abortion reduces requests for pain medication. METHODS: Thirty women undergoing first-trimester surgical abortion at the family planning clinics of a large hospital in Quebec City were randomized into a control group that received standard care and a hypnosis group that received, in addition to standard care, an intervention of hypnosis, including analgesia suggestions 20 min before and throughout the surgical procedure. Patients in both groups were given the option to control their pain with nitrous oxide (N(2)O) sedation administered through a nose mask as often and for as long as they wanted during the procedure. N(2)O sedation as the primary outcome was assessed at each step of the procedure. The patient's self-reported anxiety and pain were also assessed during the procedure as secondary outcomes. RESULTS: Thirty-six percent of patients in the hypnosis group requested N(2)O sedation during the procedure versus 87% in the control group (p<.01). No differences between the groups were found in reports of pain and anxiety during the procedure. CONCLUSION: These results suggest that hypnosis can be integrated into standard care and reduces the need for N(2)O in patients undergoing first-trimester surgical abortion. This reduction in N(2)O consumption did not lead to significant changes in pain or anxiety, and a larger sample size is required to assess the possible effects of hypnosis on those variables.     

Cancer at the crossroads.

A number of elements are transforming cancer care in hospitals. First is ongoing, rapid technological advance: Experts contend that biotechnology therapies will shift the site of cancer treatment from external, systemic treatments like radiation and chemotherapy, to targeted, tumor-specific drugs that boost the immune system. That change alone holds many implications for oncology management. In addition, an aging population, longer cancer survival rates, reimbursement concerns, and the increasing involvement of patients and their families in treatment decision making, will all have an impact on the way cancer care is designed and delivered. The time to plan, say experts, is now. Meanwhile, innovative treatment plans, patient care approaches, and collaborative efforts among institutions are moving hospital oncology into the 1990s in a dramatic way.     

Paruresis (Shy Bladder Syndrome): A Cognitive-Behavioral Treatment Approach

The oncology social worker is a core profession in the psychosocial care of cancer patients, and has been scrutinised according to its role, function, and delivery of care, primarily from an Anglo-Saxon perspective. There is, however, a lack of studies outside this context, and empirical studies based on individual data. This study is a contribution by exploring the variability in clinical practice from a Swedish perspective. It is based on documentation from one oncology social worker’s (OSW’s) patient contacts over the course of one year. The essence of the majority of contacts was counseling and the patients displayed a wide variety of motives for seeing an OSW. The function of the OSW is thus multifaceted, and the findings suggest that the OSW, in addition to guiding patients in social legislation issues, also should be prepared to act as an anchor in an acute crisis, contain despair in different phases of the trajectory, and facilitate the ‘carrying on as before’ or finding a ‘new normal’. The paper discusses the importance of the OSW being acquainted with different counseling/psychotherapy perspectives in the illness context, but primarily the importance of having the ability to establish a ‘working alliance’ with their patients.     

社会工作视阈下癌症患者心理支持服务模式

为了帮助癌症患者及其家属应对在癌症治疗和康复过程中容易出现的焦虑、无力感等心理困扰,减轻医务工作者的压力,某三甲肿瘤医院率先开展针对患者及家属的心理支持服务.逐步建立由医院心理咨询师和社会心理咨询师共同参与,集电话咨询、集体辅导、"1+1"面询等服务为一体的心理援助体系,以心理援助中心为研究对象,总结运行机制并分析在运作过程中的优势和不足,并提出建设性意见和建议.     

Impact of brief communication training among hospital social workers

Hospital social workers are often the fulcrum of communication between physicians, patients, and families especially when patients are facing life-threatening illness. This study aims to understand the impact of a brief training for hospital social workers. The training is designed to improve communication skills and self-efficacy, as well as lessen fears of death and dying. Repeated-measures tests were used to assess outcomes across three time points. Twenty-nine university-based hospital social workers participated. Results trended in the desired directions. Communication self-efficacy improved immediately following the training, and this was sustained 1 month following training completion. Although participants were relatively experienced, improvement was still demonstrated and maintained suggesting brief communication training is promising for hospital social workers across the career.     

Transforming the Legacies of Childhood Trauma in Couple and Family Therapy

Abstract

A multi-theoretical couple/family therapy clinical social work practice model synthesizes various social, family, trauma, and psychodynamic theories to inform a biopsychosocial assessment that guides clinical interventions. The client population involves adult partners who have negotiated the impact of childhood trauma, i.e., physical, sexual, and emotional abuses, including culturally sanctioned trauma. Couples may also be dealing with the aftermath of acute trauma related to interpersonal violence, political conflict, and/or the dislocations related to refugee or new immigrant status. Clinical examples demonstrate the usefulness of the model as well as contraindications when active physical violence is present. The construct of resilience remains a central focus in assessment and treatment. Specific attention to cultural and racial diversity enriches both assessment and treatment interventions with these high-risk couples and families. This practice model will be explicated in depth in an upcoming publication from Columbia University Press titled Transforming the Legacies of Trauma in Couple Therapy     

A randomized trial to measure the optimal role of the pharmacist in promoting evidence-based antibiotic use in acute care hospitals.

BACKGROUND: There is a considerable gap between randomized clinical trials and implementing the results into practice. This is particularly relevant in the use of broad-spectrum antibiotics in hospitals. Hospital pharmacists can be effective vehicles for bridging this gap and promoting evidence-based medicine. To determine the most effective way of using the pharmacist in this role, a prospective cefotaxime intervention study was conducted with randomization incorporated into the design as well as patient-related therapeutic outcomes. METHODS: A total of 323 patients who were prescribed cefotaxime were randomized into an intervention or nonintervention group where only the former was challenged by pharmacists for inappropriate cefotaxime usage relative to hospital guidelines. The primary outcome was the appropriateness of cefotaxime prescribing between groups. Logistic regression analysis was then used to identify factors that were associated with successful clinical response. RESULTS: Overall, 94% of orders in the intervention group met cefotaxime dosage criteria compared with 86% in the control group (p = .018). However, there was no impact with respect to promoting cefotaxime use for an appropriate indication (81% vs. 80%; p = .67). There was a trend for improved clinical outcomes in patients who received cefotaxime within hospital guidelines (OR = 1.73; p = .31). CONCLUSIONS: The pharmacist as a vehicle for promoting the appropriate use of broad-spectrum antibiotics in the acute care hospital setting can improve the dosing of such agents. However, several barriers to optimizing the impact of the pharmacist were implied by the data. Removing these barriers could increase the pharmacists' utility as an agent for improved patient care.     

论医院医务社工在医疗纠纷中的职责

目的：医疗纠纷逐渐增多,使得医患关系日趋紧张,成为社会关注的焦点,有学者提出医院中的医务社工应该介入医疗纠纷,本文就医院医务社工在医疗纠纷中的职责进行探讨。方法通过文献回顾的方法,了解我国医务社工的职责以及在医疗纠纷中发挥的作用。结果在医疗行为进行过程中,医务社工的职责主要体现在,针对医患之间信息不对称的情况,通过调查、谈话等活动,弥补双方的信息不对称,预防可能发生的矛盾冲突,缓解医患关系。结论医务社工在医疗纠纷处理过程中,从专业的角度,运用个案工作、小组工作、社区工作等工作方法,在中间起到的是调和、缓冲的作用。医务社工坚持价值中立原则,理清自身的角色,明确自己的立场,从第三方的角度出发,不介入医学专业问题,使纠纷能得到合理合法的解决。     

Outbreak of Listeria monocytogenes in an oncology unit associated with sandwiches consumed in hospital

In May 2003, two adult patients in an oncology unit were diagnosed with listeriosis, and sandwiches consumed in the hospital were identified as a common risk factor. Both patients were infected by the same strain of Listeria monocytogenes. Sandwiches collected from the hospital and external sandwich producer, as well as sites within the manufacturing environment, were contaminated by the same strain of L. monocytogenes. Sandwiches consumed in other hospitals have been associated with small clusters of listeriosis patients in the UK. This report describes the investigations following diagnosis of the two infections, and highlights a more general problem with sandwiches sold in hospitals.     

Adolescents with cancer. Hypnosis for the reduction of the acute pain and anxiety associated with medical procedures

Eighteen adolescents with cancer were trained in hypnosis to ameliorate the discomfort and anxiety associated with bone marrow aspirations, lumbar punctures, and chemotherapeutic injections. Two patients rejected hypnosis. The remaining 16 adolescents achieved significant reductions in multiple measures of distress after hypnosis training. Preintervention data showed no pattern of spontaneous remission or habituation, and, in fact, an increasing anticipatory anxiety was observed before hypnotic treatment. Group reductions in pain and anxiety were significant at levels ranging from p less than 0.02 to p less than 0.002 (two-tailed t-tests). Significant reductions were also found in Trait Anxiety. A non-significant trend toward greater self-esteem was present. The predicted changes in the Locus of Control and General Illness Impact were not found. Comparisons between hypnosis rejectors and successful users unusually showed higher levels of pretreatment anxiety in the former. The pragmatic nature of hypnosis as part of comprehensive medical care in oncology is noted.     

Re‐structuring the negotiated order of the hospital

Researchers continue to lament the lack of organisational focus in the sociology of health and illness. Although studies have increasingly focused on boundaries between organizations, little such research has focused on the formal boundaries within the hospital itself. Given its dramatic compartmentalisation, and continuing prevalence in health systems, the lack of organisational perspective in hospital research limits insights into the effects (as well as the construction) of the order of health work and care. With a greater emphasis on ‘ordering’ in the concept of negotiated order, the aim of this study is to examine the manifestation and consequences of the formal boundaries of hospital departments. Fieldwork featured 12 months of ethnography, including formal and informal observations, 80 audio‐recorded, semi‐structured interviews, and 56 field interviews, in the Emergency Departments (EDs) of two tertiary referral hospitals. Compared with in‐patient hospital departments, the ED has limited legitimacy claims of organ‐specific knowledge to transfer patients out of the ED. The manifestation of specialised knowledge hierarchies in organisational structures disadvantages patients who are older and who have chronic conditions, underpinning the argument that effects as well as the negotiation of stable organisational orders deserve increased attention in the sociology of health and illness.     

The Challenges of Health Care Reform for Hospital Social Work in the United States

This article examines the potential impact of the Patient Protection and Affordable Care Act (ACA) of 2010 on the practice of hospital social work in the United States and its implications for social work education and training. It briefly traces the history of hospital social work, outlines some contemporary issues in the health care field, particularly those that create persistent health disparities, summarizes the major provisions of the Act that have implications for social work practice, and discusses how social workers in hospital settings might respond effectively to the changes produced by the legislation.