Social work at the heart of the medical team

This paper proposes one model of hospital social work delivery services that places social work in a facilitative role within the medical team, and describes a pilot project designed to evaluate these services. Social work's role in this teaching hospital setting was tailored to provide patients and medical staff access to social work services upon admission, rather than at the time of discharge. This change places social work at the pivotal juncture to improve medical care and addresses the social, cultural and environmental concerns as they surface during patient stay. Unique to this demonstration model is the added advantage of placing the social worker at the hub of the physician-led medical team. Medical students, residents, and attending physicians all learn, observe, and experience the advantages social workers bring to the process. Educating medical students on teams with social workers bodes well for the profession. The authors summarize the program design, results and implications for social work practice in a teaching hospital setting.     

Social Work in the Academic Medical Center:

Although the total number of social workers within the academic medical center will probably decrease because of decreasing hospital bed usage, the role for those who remain will be that of a clinical specialist, a sophisticated and adaptable practitioner who can work flexibly under minimal supervision. The valued social work practitioner will be an independent player on the health care team who assumes a significant role which no other member of that team is equipped to take. Advanced training is more important today than ever before in the evolution of social work practice in academic health care. However, this training is not now available within the parameters of the two year master's program.     

Social work practice and chronic pediatric illness.

The role of social workers in a pediatric chronic illness setting is presented. The difference between acute and chronic illness is explored, with emphasis on the ramifications of these differences for social work practice. Early assessment of patients and families provides the social worker with a data base from which to select an appropriate intervention with families. Of primary importance is the amelioration of feelings of helplessness, dependency, and isolation. This may be accomplished by helping families anticipate problems, mobilizing resources to help, and encouraging families to share their experiences with other families. Because the medical system, particularly in a teaching hospital, may not provide continuity of care for patients, the relationship of the social worker to patient and family, and resulting knowledge of the family, becomes an important resource in the provision of high-quality care.     

ATTITUDES TOWARD SOCIAL WORK IN FAMILY MEDICINE

An initial survey of attitudes among Family Medical Center staff rated social work as highly consistent with the values of family medicine, capable of competently addressing difficult problems, and contributing valuably to a team approach to continuous and comprehensive family medical care. After integration of a social worker into the practice, a repeat survey documented significant attitude changes, rating social work as more competent, passive, and difficult, and lowering the estimate of patients potentially helped by a social worker from 38 percent to 31 percent. Such attitudes may influence the evolution of the social worker's role in the family medicine patient care team.     

Using Theory to Explore Health,Medicine and Society,by Peter Kennedy and Carole Ann Kennedy

This paper, based on questionnaire data gathered in the summer of 1975, analyzes the ways in which social workers in the pediatrics departments of twenty-eight teaching hospitals define their roles and describe their activities. Data on the overall social work coverage in these hospitals is briefly described, with emphasis on hospital size, professional preparation of staff, academic rank, and staffing patterns. Within this context, data analysis focuses on the extent to which pediatric social workers exercise autonomy in direct service, teaching, and research. Areas on the pediatric service which are examined include worker-bed ratios, direct practice coverage, and participation in grand rounds, medical rounds, policy-level committees, teaching, and research. Social work role priorities and obstacles to quality role performance are also discussed.     

Group care workers as parent educators

Using a model of group care practice that identifies seven areas of child care worker activity and skill, this paper shows how these skills can be used in work with parents and other family members of children in placement. The emphasis is on the child care worker’s role as parent educator. This approach transforms the 24-hour-per day group care environment, and the living unit in particular, into a classroom for teaching and learning parenting skills. The educational, policy, and resource consequences of this proposal are then discussed. Finally, this model of practice is linked to psychoeducational, family resource, and competency-based approaches to family intervention and social work practice. All of these models de-emphasize family pathology in favor of practice that views parents and family members as partners in the care and treatment process. The author thanks Karen Kayser of Boston College and Henry Maier of the University of Washington, Seattle, for their comments on an earlier draft of this article.     

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.     

Applying Ideas from Learning and Teaching in Higher Education to Develop Professional Identity: The Case of the M.Sc. in Advanced Residential Child Care

Residential child care in Scotland is located, professionally, within social work. However, the very specific expertise required to work in the field is rarely accommodated in social work training or within wider social work discourses. The literature on learning and teaching in higher education helps illuminate some of the differences between the two disciplines. Within this literature, expertise is located in the practice experience of those who work in a particular field. Accordingly, the role of the M.Sc. could not be, merely, to transmit existing “formal” knowledge. Rather, it needed to contest much of this as that formal knowledge had not served residential child care well. It had to draw out the situated knowledge of students on the course and to synthesise this with understandings from the child and youth care tradition so that the course might begin to generate a discourse for residential child care that reflected and resonated with the experiences of practitioners.     

Attitudes toward social work in family medicine: a before and after survey

An initial survey of attitudes among Family Medical Center staff rated social work as highly consistent with the values of family medicine, capable of competently addressing difficult problems, and contributing valuably to a team approach to continuous and comprehensive family medical care. After integration of a social worker into the practice, a repeat survey documented significant attitude changes, rating social work as more competent, passive, and difficult, and lowering the estimate of patients potentially helped by a social worker from 38 percent to 31 percent. Such attitudes may influence the evolution of the social worker's role in the family medicine patient care team.     

Transforming general practice: the redistribution of medical work in primary care

The paper focuses on the redistribution of medical work within primary health care teams. It reports the results of the analysis of interviews with general practitioners, practice nurses and managers, undertaken as part of an ethnographic study of primary care organisation and practice during a period of rapid organisational change. By examining the ways in which the respondents account for how work is being redefined and redistributed, we explore how current government policy and professional discourses combine to reconfigure both the identities of those who work in primary care and the nature of patienthood. In particular, we show how general practitioners are being reconfigured as medical specialists or consultants in ways that seem to depart radically from earlier claims that general practice is a distinctive field of social or biographical medicine. Within this new discourse medical work is distributed between doctors, nurses and unqualified staff in ways which make explicit the reduction of general practice work to sets of biomedical problems or tasks. At the same time, the devolution of much general practice work to less qualified and cheaper personnel is justified by drawing on a discourse of person-centred medicine.     

医务社会工作的基本意涵、角色定位与实务体系

目的:了解我国医务社会工作发展现状,分析存在的问题并提出可能的发展路径。方法:以"医务社会工作"为主题词检索知网数据库,收集2000~2018年相关文献,运用Citespace软件进行分析。结果:共纳入610篇文献,文献表明医学院校是医务社会工作研究的主要阵地。目前医务社会工作领域的研究主要集中在医务社会工作基本内涵、实务模式与实习督导、社会角色、服务领域、医患关系、临终关怀、各地经验等。结论:在医务社会工作中,工作者需要处理好与患者、医疗体系、社区及家庭的关系。医务社会工作的实务体系可以分为以政府为主导的模式和医院、学校、社会合作的模式。医务社会工作在发展中面临的问题主要是角色不清晰与制度依附。发展路径在于发展医务社会工作教育,以实现专业嵌入;营造医务社会工作发展环境,以实现制度嵌入。     

Medical social work positions: BSW or MSW?

Acute care social work positions face budgetary scrutiny in the current climate of fiscal restraint in Canadian health care. Managers may be faced with the question of whether a new or vacant medical social work position should be filled by a BSW social worker or an MSW social worker. This question is further complicated when experienced and less costly BSW social workers are available while MSW social workers with medical or hospital experience may be limited in supply. This paper reviews the literature relevant to medical social work practice and hiring. A small scale survey was conducted with inter­professional managers responsible for the hiring of medical social workers. The purpose of this research was to examine the current hiring practices and considerations for hospital medical social workers.     

Video and qualitative research: analysing medical practice and interaction

CONTEXT: Video has long been recognised as providing an important resource within medical education, particularly, perhaps, for training in primary health care. As a resource for research, and more specifically within qualitative social science studies of medical practice, video has proved less pervasive, despite its obvious advantages. METHODS: In this paper, we sketch an approach to using video to inform the analysis of medical practice and the ways in which health care is accomplished through social interaction and collaboration. Drawing on our own research, we discuss two brief examples: the first involves the use of computing technology in primary health care and the second concerns informal instruction during surgery. The examples illustrate the multimodal character of medical work, how activities are accomplished through the interplay of talk, the visual and the use of material artefacts. They also illustrate the ways in which video provides access to the complex forms of social interaction and collaboration that underpin health care. DISCUSSION: We reflect upon the research opportunities afforded by video and the ways in which video-based studies of interaction can contribute to the practice and practicalities of medicine.     

Goodness of fit: social work education and practice in health care

This study addresses the fit between social work education and practice in health care. A random sample of NASW members identifying with health care (N = 179) responded to a mail survey about the utility of core knowledge and roles that we had identified by reviewing seven commonly used health care social work texts. Quantitative data revealed knowledge and roles most frequently used in health care settings as well as differences in roles used dependent upon department name; and different professionals supervising social workers. Qualitative data from four open-ended questions provided suggestions for what knowledge and skills should be taught in social work programs, the best forums/methods for teaching this content, and topics for continuing education. Findings are discussed in relation to six key areas of the peer-reviewed literature: vulnerable populations/diversity, ethical dilemmas, interdisciplinary collaboration, mental health, managed care/accountability, and advocacy. Implications for social work practice, education, and research are discussed.     

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.     

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.     

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."     

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.     

The Americanization of family medicine: contradictions, challenges, and change, 1969-2000

Family practice became the 20th medical specialty in 1969, identified by its leaders as a harbinger of health care reform, as well as practice excellence, and with expectations of continuing government support of its purpose and role. Since that time, the cultural and political environments have changed significantly in some ways, and not changed in others as initially expected, thus challenging the new specialty with pressures for reinvention with respect to its identity, function, and prestige. The most important impediment to a clear-cut role for family practice has been the lack of a formal administrative structure for primary care practice on a nationwide basis in the United States. Differentiation of the field from all other parts of medicine was also difficult because of the identification of family practice with the professional accoutrements of a specialty, parallel to other specialist fields. Family practice moved from an outsider role in medicine to a position of entrenchment in the medical establishment, including hospitals and academic medical centers. And, family practice became one of several overlapping and competing primary care fields. The role of family practice in US culture is now less clear than the potential role envisioned for it in 1969. Its multiple and not always well-defined roles in medicine may make it difficult to establish a clear identity for the specialty in the future. If it is to be successful, family practice must develop allies and work aggressively to establish its role in primary care. It must also work to institute primary care in the US medical system and act politically (as in the 1960s), taking advantage of current cultural trends, notably the information revolution and the growth of biomedical research.