Optimizing the role of social workers in advance care planning within an academic hospital: an educational intervention program

Advance Care Planning (ACP) promotes communication to help patients express future health-care preferences and goals for their medical care. Social workers (SWs) are trained to facilitate complex conversations and assist in various ACP tasks across clinical settings. This three-part mixed-method interventional study implemented a comprehensive education and training program for SWs of a large academic hospital, which used pre- and post-training evaluations, chart review, and qualitative data from debrief sessions to examine ACP skills and confidence, and assess the number of ACP conversations initiated with patients. Self-reported level of preparation to facilitate ACP conversations improved significantly (n = 26; pre 36% versus post 82%; p < .05). A 4-month post-intervention chart audit showed an 8.69 fold increase in the number of initiated ACP conversations. Qualitative analysis identified key themes regarding barriers and enablers of initiating ACP conversations during standard care from the perspective of SWs.     

Towards More Effective Intervention in Natural Helping Networks

Fiscal constrains which are promoting a retreat from social welfare programming place increasing responsibility for care on natural helping networks of family and friends. Research hsa identified several characteristics of informal networks which are associated with support such as density, reciprocity, homogeneity, and multiplexity. Professional interventions have also responded to the potential supports available in networks. Professional practice concentrates primarily on self-help groups and the use of key persons in networks. There is, however, little correspondence between research findings and professional approaches to intervention. Little has been done to determine the possible impact of formal service provision on the dynamics of informal networks. More effective intervention in informal networks must consider the limitations of current practice, the development of assessment instruments, and the changes in network structures and processes over time.     

Conducting an advance care planning group among older adults living in residential care homes: An initiative of social workers in Hong Kong

This study aimed to examine the effects of an advance care planning (ACP) group which was developed by social workers in Hong Kong for older adults. A quasi-experimental study was conducted. Participants were recruited from 14 residential care homes. The ACP intervention group included 59 participants for analyses, and the control group 58. Three major outcomes were measured at two time points: (a) Quality-of-life concerns, (b) End-of-life preference and (c) Advance directive (AD)-related outcomes (awareness of AD, AD completion, willingness to complete AD and communication with family members about AD). Findings indicate that the ACP group enhanced participants’ awareness of AD compared with the control group. Participants were also more willing to complete AD, and more participants communicated with family members about AD after participating in the ACP group. No significant difference was found in other outcomes. This study demonstrates the efforts of social workers in promoting ACP in Hong Kong and the effectiveness of an ACP group for enhancing older adults’ awareness of AD. Findings support the role of social workers in promoting ACP for deprived groups, like frail older adults. The ACP group could be considered a first step in enhancing older adults’ awareness of and willingness to discuss end-of-life issues. Further follow-up is required to develop individualised ACP for older adults.     

Role changes of hospital social workers in South Korea

The roles of social workers in hospitals have changed in accordance with the environmental changes in the healthcare system. Since 1958, hospital social workers have performed important roles in providing care services in South Korea. Providing psychosocial services was considered to be the most important for more than 30 years from the 1970s to the 1990s. The healthcare system has since undergone major environmental changes, yet there has been little study on the role of hospital social workers in South Korea. In order to address this research gap, this study aims to explore how the roles of hospital social workers have changed since the 2000s. We recruited 198 hospital social workers who were active members of the Korean Association of Medical Social Workers as study participants. The average age of participants was 35.36 years old (SD = 8.27), and they had an average of 8.24 years in hospital social work experience (SD = 6.35). The results indicated that the roles of financial support and community resource linkage, which were regarded to be relatively less important until the 1990s, were recognized as the most important. Given the role changes of hospital social workers in South Korea, implications are discussed.     

Gender differences among Canadian spousal caregivers at the end of life

The purpose of this study was to examine gender differences in spousal caregiving at the end of life. The primary research question was to determine gender differences in caregiver strain among spousal caregivers. Secondary research questions investigated included (i) the presence of gender differences among spousal caregivers in the duration of care provided; (ii) gender differences among spousal caregivers in formal service use and unmet service needs; and (iii) whether support to care recipients in activities of daily living varied according to the gender of the spousal caregiver. The study was conducted over a 2‐year period (2000–2002) in south‐central Ontario, Canada. The study sample included 283 informal spousal caregivers (198 females, 85 males) each of whom were caring for a terminally ill spouse at the time they participated in a cross‐sectional telephone survey. The analysis showed that females reported a significantly greater level of caregiving strain than males (t = –2.12, d.f. = 281, P = 0.035). When considering source of support in activities of daily living for the care recipient, differential assistance was noted on the basis of caregiver gender. Female caregivers had almost twice the odds of providing support in toileting‐related tasks than male caregivers (odds ratio (OR) = 1.98, 95% confidence interval (CI) = 1.01–3.85, P = 0.044), while male caregivers had approximately twice the odds of providing support in mobility‐related tasks (OR = 0.41, 95% CI = 0.21–0.81, P = 0.011). Care recipients who had a female caregiver had lower odds of receiving support from family and friends in tasks associated with personal care (OR = 0.17, 95% CI = 0.05–0.53, P = 0.002). To address gender differences in caregiving, a realistic home‐based palliative care approach must take into account the importance of informal caregivers.     

Job satisfaction and turnover intent among hospital social workers in the United States

Feelings of job satisfaction and turnover intentions among social workers affect work quality for both social workers and the people for whom they provide services. Existing literature on job satisfaction among hospital social workers is limited, and is overly focused on issues of compensation. There is job satisfaction research with hospital nurses available for comparison. Other informative social work research on job satisfaction and turnover exists in mental health and generally, across settings. Research on turnover intent in social work is primarily from child welfare settings and may not generalize. The literature notes gaps and contradictions about predictors of job satisfaction and turnover intent. Using a large national dataset of hospital social workers, this research clarifies and fills gaps regarding hospital social workers, and explores how Herzberg’s theory of work can clarify the difference between sources of job dissatisfaction and job satisfaction. Findings include hospital social workers reporting high job satisfaction and that demographics do not contribute to the predictive models. The findings do support centralized social work departments and variety in the job functions of hospital social workers, and are consistent with the theoretical framework.     

医院社会工作者的战略地位和卫生经济学贡献

医院社会工作者是跨学科、跨专业、跨领域医疗团队的重要成员,在卫生保健体系和医院质量管理中处于战略地位。更为重要的是,医院社会工作者通过健康教育宣传、社会资源动员、预防和缓解医疗纠纷等专业服务,可为医院做出难以估量的卫生经济学贡献。     

Documenting the contributions of palliative care social work: testing the feasibility and utility of tracking clinical activities using medical records

ABSTRACT

Access to data on quality metrics can better equip palliative care social workers to identify and address gaps in patient care, establish standards and accountability for social work functions on the interdisciplinary team, and evaluate the impact of interventions. The objective of this demonstration project was to create and pilot a data collection format in the patient electronic medical record (Epic) for documentation of social work metrics at each inpatient consultation, and to build corresponding pilot reports relevant to quality improvement goals. The successful implementation and initial pilot reports were reviewed for the feasibility of longer-term applications.     

Health social workers sources of knowledge for decision making in practice

This article presents findings from research examining knowledge social workers in a health network in Victoria, Australia identified as informing their decision-making. Data for 13 patients, and in-depth interviews with six social workers who worked with these patients, were studied. A thematic analysis of interviews revealed that participants identified reliance on past experience and contextual/situational information as underpinning their decisions, demonstrating their commitment to person-in-environment perspectives. However, despite the availability of a repository of empirical evidence, no respondent made use of this. This study provided insight into health practitioners’ sources of knowledge, highlighting gaps and areas for further exploration.     

Community nurses and social workers learning together: a report of an interprofessional education initiative in South Wales

Collaboration between different professional groups and agencies is an essential element in the provision of high quality community care for people with complex health and social needs. There are, however, a number of barriers to effective interprofessional working. These include: the differing structures and operational philosophies of organizations; the differing languages and values of professional groups; professional and agency rivalries; and the fact that professional groups are, still, largely educated and trained in isolation. Interprofessional learning has been advocated as a possible solution to some of these problems. In this paper the rationale, planning, delivery and evaluation of one interprofessional education initiative are presented. Twelve months of planning between a team of three university teachers working in South Wales, United Kingdom, led to a combined group of community nursing and social work students following post-qualifying courses at undergraduate diploma and first degree level participating in two shared learning sessions. Using an interactive approach the student group explored, first, professional roles and responsibilities and secondly, engaged in group work focused on the discussion of case studies. Student evaluation of the sessions indicated an overwhelming appreciation of the importance of interprofessional education in unidisciplinary education programmes.     

Attitudes Toward Euthanasia: Implications for Social Work Practice

This article reports the findings of a randomized general household survey that examined the attitudes of 618 Chinese respondents toward different types of euthanasia. The general public is found to agree with active euthanasia and non-voluntary euthanasia, but is neutral about passive euthanasia. Support for euthanasia is predicted by decreasing importance of religious belief, higher family income, experiences in taking care of terminally ill family members, being non-Protestants, and increasing age. Patients were percieved as the chief decision makers in euthanasian decisions. Finally, suggestions on social work practice and professional training are made.     

An exploratory study of spiritual care at the end of life

PURPOSE Although spiritual care is a core element of palliative care, it remains unclear how this care is perceived and delivered at the end of life. We explored how clinicians and other health care workers understand and view spiritual care provided to dying patients and their family members.     

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.     

Bio-psycho-social-spiritual needs of adolescents and young adults with life-threatening illnesses: Implications for social work practice

ABSTRACT

This paper explores the biopsychosocial and spiritual needs of adolescents and young adults (AYA) with life-threatening or terminal illnesses. AYA are situated between childhood and adulthood (ages 15–25) and have distinct biopsychosocial and spiritual needs unique to their developmental stage. Having a life-threatening or terminal illness directly challenges normal AYA developmental tasks and identity formation. AYA experience more troubling physical symptoms during the dying process compared to other age groups, which leads to significant psychological distress and an increased need for pharmacological treatments. In general, AYA desire to be fully informed and involved in the health care decision-making process, leading to ethical dilemmas when the AYA is a minor and their wishes differ from the wishes of their legal guardian(s). Social workers are especially well-equipped to serve this population due to aligning professional standards and ability to advocate for holistic care within interdisciplinary teams. Additional research is needed to tailor holistic interventions to meet the needs of this population.     

Moral distress as experienced by hospital social workers in South Korea and Australia

This exploratory, qualitative research explored the ethical problems faced by hospital social workers in South Korea and Australia, and what and who influenced their decision making using a focus group design. Although dilemmas of boundaries, confidentiality, self-determination, and other complex scenarios found in practice were identified, moral distress, a consequence of the unresolvable conflicts, dominated participants’ narratives. This was particularly the case for the Korean social workers in this sample. A thematic analysis of the data yielded three main themes: ‘Under pressure—“It’s very uncomfortable”’; ‘Failing our patients’; and ‘Coping and codes’.     

Chronic Cancer: Bringing Palliative Care Into the Conversation

Palliative care is a treatment model that aims to relieve patient suffering and improve quality of life, and is essential for those living with chronic cancer. However, most palliative care referrals are made as a last resort when all other treatment options have failed. This article argues that social workers have an important role in early palliative care discussions because of their unique skill set. Techniques for early introduction of palliative care are addressed, as are ways for empowering patient advocacy. A case narrative of a young woman with chronic cancer is included as an example of the need for ongoing palliative care conversations.     

Professional and practice characteristics associated with self-efficacy in assessment and intervention among social workers in aging

This study examined professional and practice characteristics associated with assessment and intervention self-efficacy among gerontological social workers in Ontario, Canada who participated in online surveys. Results from multivariate analyses indicated that higher client acuity, longer duration of practice experience, smaller caseloads, and a greater proportion of clients 85 and over were significantly associated with greater assessment self-efficacy. Greater client acuity and smaller caseloads were also significantly associated with greater intervention self-efficacy. Implications for education include the importance of providing practical experience with the oldest old and with clients with greater biopsychosocial complexity. Also recommended is the need for manageable caseloads, especially when older adults with complex needs are part of the practice milieu.     

Complex families,the social determinants of health and psychosocial interventions: Deconstruction of a day in the life of hospital social workers

The roles of hospital social workers are delineated in the literature; however, their daily interventions have only been described anecdotally. This study analyzes the daily work of social workers in a pediatric hospital through a survey completed which examined factors related to interventions utilized and time spent per case over a 1-day period. Length and types of interventions were associated with the social determinants of health, time since diagnosis, biopsychosocial issues, and perception of complexity. The study offers a snapshot of the personalized expertise, provided by social workers that addresses complex contextual and biopsychosocial concerns of patient and families