Health Care Social Work Treatment of Patient and Family Emotion

ABSTRACT

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.     

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.     

A standardized nutrition care process and language are essential components of a conceptual model to guide and document nutrition care and patient outcomes

Documentation of clinical services within health care systems has become increasingly significant because greater amounts of information are now required by accrediting agencies, third-party payers, researchers, and others in their evaluation of patient care and because of the increasing emphasis on patient outcomes. Given the multiple users who depend on health care information in the patient record, it is imperative that clinical nutrition practitioners implement a standardized nutrition care process and language to document comprehensively and communicate meaningful information concerning their role in improving patient outcomes. A body of work has led to the development and adoption of a standardized nutrition care process for the dietetics profession. A standardized nutrition care process consistent with the scientific method and a standardized language are two essential components required to articulate a conceptual model for clinical nutrition practice and documentation and distinguish clinical dietetics’ unique body of knowledge. The conceptual model serves as an organizing framework to standardize and guide nutrition practitioners’ clinical judgments or critical thinking processes and document information linking nutrition care to patient outcomes.     

Implementing practice management strategies to improve patient care: the EPIC project

Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.     

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.     

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.     

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.     

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 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.     

Doves and hawks: practice educators' attitudes towards interprofessional learning

The authors offer a critical account of interprofessional learning and working within the spheres of health and social care. The 'joined up' imperatives promoted by central government are compared to the somewhat contradictory findings of research exploring the effectiveness of interprofessional working. The role of practice educators in developing attitudes, learning and experiences around interprofessional working is heralded as an under-researched area while being of particular significance in the formation of professional identity. This paper uses the term 'practice educators' to capture the shared functions of nurse mentors and social work practice teachers. The authors draw on a small-scale piece of focus group-based research with professional practitioners from health and social care. The authors stress throughout the need to retain a localized approach to research in this area where differences emerged even among teams located closely to each other. The focus groups explored the experiences and attitudes of a variety of field-based practice educators within two profession-specific focus groups. The findings are coded, summarized and presented using a matrix. An analysis is offered which suggests that across both professional groups, two distinct categories of practice educators are emerging. The 'doves' appear to be more accepting of changes around professional boundaries where blurring is taking place. Although they do not ignore the potential conflict that can exist for themselves and their students, the doves largely seek to manage this conflict and look to a consensus approach. In contrast, the 'hawks' are more concerned with issues of professional erosion and look to develop more combative strategies around the maintenance of the existing boundaries and their current professional identity. It is argued that this approach has more of a conflict base.     

A career in hospital social work: do you have what it takes?

Hospitals present a variety of complex challenges for social work practitioners. Clinical social workers deal with emotionally intense and potentially draining cases in a setting where they are often faced with threats to their identity or existence. They must balance their role as patient advocates with institutional needs and be able to adjust to ever-changing models of health care delivery. Why do some social workers thrive in this environment while others struggle to survive? This article draws upon the author's twenty-year career in hospital social work to provide a "snapshot" of the clinical social work role in teaching hospitals. Included in the discussion are observations about the unique aspects of clinical practice in the hospital and strategies for surviving power struggles, turf battles and hospital "politics."     

Performance, emotion work, and transition: challenging experiences of complementary therapy student practitioners commencing clinical practice

Few researchers have explored the clinical experiences of complementary and alternative medical practitioners and students, including the emotion work they perform. In this article, using a constant comparison approach and a heuristic framework (a dramaturgical perspective), we analyze semistructured interviews with 9 undergraduate practitioners in training to examine challenges experienced when students first attend to patients. A feature of students' learning about clinical work concerned performance in a public arena and associated demands placed on the inchoate practitioner. Preliminary patient consultations represented a dramatic rite of passage and initiation into a transitional phase in professional identity. Juggling the roles of student and practitioner within an observed consultation led to anticipatory anxiety, impression management strategies, and conflict with other individuals. Of the coping strategies, participants regarded sharing and feedback from peer groups as most effective in examining and resolving the challenges of becoming a practitioner.     

Role blurring and the hospital social worker's search for a clear domain

Hospital social workers strive to define their professional domain to avoid blurring their roles with those of other health care professionals. Hospital social workers are concerned with gaining and retaining recognition by patients, families, and colleagues of their distinct professional contribution. This article reviews the evolution of social workers' roles and functions in hospitals and reflects on the frequently noted discrepancy between self-ascribed roles and those conceded to social workers by other health care professionals. Issues of collaboration in the context of interdisciplinary activity are considered, and the impact of overlapping roles on social work practice is assessed. The value and drawbacks of role ambiguity are discussed, and strategies for role clarification and development of a better-defined domain for social workers in hospitals are recommended.     

Health professionals' views of the effectiveness of nutrition care in general practice setting

Aim: The current qualitative study aimed to explore the perceptions of key health professionals relating to the effectiveness of nutrition care provided in the general practice setting. Methods: Twenty‐eight health professionals across a range of disciplines (general practitioners (n = 11), practice nurses (n = 3), dieticians (n = 5), naturopaths (n = 5) and exercise physiologists (n = 4)) individually participated in a semistructured telephone interview, guided by an inquiry logic informed by the literature. Interviews were transcribed verbatim and analysed thematically using a constant comparison approach. Results: Health professionals, including general practitioners, perceived that nutrition care provided in the general practice setting was mostly ineffective at improving patient nutrition behaviour. This was reported to be due to nutrition care competency deficits among general practitioners, a general practice reimbursement system that encourages practices inconsistent with quality nutrition care, and a low prioritisation of nutrition care in general practice. Tensions were apparent between health professional groups, which may be hindering the successful implementation of interdisciplinary nutrition care for patients with chronic disease in this setting. Conclusion: Without systematic changes to Australian primary health care model, the demand on general practitioners as primary providers of nutrition care will continue, therefore mandating support for general practitioners providing care in this context. Further research is required to identify strategies to improve nutrition care and opportunities to facilitate integrated health care provided to the general public within the general practice setting.     

Conflicting professional values in social work and medicine

The professional relationship between social workers and physicians historically has been somewhat strained. Social workers have been quick to blame the medical model for problems in health care and consequently have overlooked useful lessons from this model that could improve social work practice. To work effectively with physicians, social workers must be aware of physicians' professional values and be able to identify conflicts with social work values. Conflicting values in social work and medicine are identified in five areas: (1) saving life versus quality of life, (2) patient autonomy in setting treatment goals, (3) attitudes toward objective versus subjective data, (4) responses to patients with emotional problems, and (5) differing perspectives on interdisciplinary team roles. Case illustrations based on the author's experiences as director of behavioral science training for resident family practice physicians are included. Although different value orientations may produce conflict, the differences also can catalyze successful collaboration between the two professions, which ultimately will benefit patients who receive care.     

Discourse(s) of emotion within medical education: the ever‐present absence

Context Emotion in medical education rests between the idealised and the invisible, sitting uneasily at the intersection between objective fact and subjective values. Examining the different ways in which emotion is theorised within medical education is important for a number of reasons. Most significant is the possibility that ideas about emotion can inform a broader understanding of issues related to competency and professionalism. Objectives The current paper provides an overview of three prevailing discourses of emotion in medical education and the ways in which they activate particular professional expectations about emotion in practice. Methods A Foucauldian critical discourse analysis of the medical education literature was carried out. Keywords, phrases and metaphors related to emotion were examined for their effects in shaping medical socialisation processes. Discussion Despite the increasing recognition over the last two decades of emotion as ‘socially constructed’, the view of emotion as individualised is deeply embedded in our language and conceptual frameworks. The discourses that inform our emotion talk and practice as teachers and health care professionals are important to consider for the effects they have on competence and professional identity, as well as on practitioner and patient well‐being. Expanded knowledge of how emotion is ‘put to work’ within medical education can make visible the invisible and unexamined emotion schemas that serve to reproduce problematic professional behaviours. For this discussion, three main discourses of emotion will be identified: a physiological discourse in which emotion is described as located inside the individual as bodily states which are universally experienced; emotion as a form of competence related to skills and abilities, and a socio‐cultural discourse which calls on conceptions from the humanities and social sciences and directs our attention to emotion’s function in social exchanges and its role as a social, political and cultural mediator.     

Towards holistic social work practice in general medical settings

This paper describes the development by field educators and social work students of a generalist model of practice related to work with general medical practitioners. The model developed outlines the values, knowledge and skills required to respond to the problems presented by intervening in a wide range of social systems. Effective social work practice is related to successful collaboration with the doctors. This is facilitated when there are close administrative links and when both groups are aware of the different perceptions on client/patient care. Conflict resolution is facilitated when the social worker encourages a focus on what is best for the client/patient and can articulate and demonstrate a practice perspective that links interaction among social, economic, political and health factors in people's lives.     

Introduction: promoting and maintaining a reflective professional staff in a hospital-based social work department

Promoting and sustaining a staff of reflective social work practitioners requires a supportive departmental structure and culture. Providing such support is a particular yet necessary challenge to social work administrators in the current health care environment. This article discusses an array of administrative strategies employed in one hospital social work department to promote reflective social work practice. More specifically, it describes the role of practice-based research in enhancing worker reflectiveness.     

"Villagers": differential treatment in a Ghanaian hospital

Differential treatment of patients by health workers in African medical institutions is acknowledged by patients, health workers and policy-makers alike to be an obstacle in the realization of government objectives of equity in health care. This qualitative study understands the production and legitimization of differential treatment from the perspective of health workers. On the basis of qualitative field material from a hospital in Northern Ghana the relation between socio-cultural, biomedical and bureaucratic aspects of hospital practice is explored through a focus on categorizations of patients. It is concluded that to blame the "bad attitudes" of health workers for differential treatment is not an adequate explanation. It is important to acknowledge that differential treatment can be understood as a form of agency, and is related to the conditions of hospital work and to the professional and social identities of health workers.     

Toward a communicative perspective of collaborating in research: the case of the researcher-decision-maker partnership

In the shift to a post-industrial order, the production and use of knowledge is gaining greater importance in a world beyond science. Particularly in the health sciences, research foundations are emphasising the importance of translating research results into practice and are experimenting with various strategies to achieve this outcome, including requiring practitioners to become part of funded research teams. In this paper, we present a case of a partnership between researchers and decision-makers in Canada who collaborated on an investigation of implementing change in health care organisations. Grounded in this case and recent empirical work, we propose that such research collaborations can be best understood from a communicative perspective and as involving four key elements: relational stance that researchers and decision-makers assume toward each other; purpose at hand that situates occasions for developing and using knowledge; knowledge-sharing practices for translating knowledge; and forums in which researchers and practitioners access knowledge. Our analyses suggest that partnerships are most effective when researchers see the value of contextualising their work and decision-makers see how this work can help them accomplish their purpose at hand.