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.     

"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.     

Ethical dilemmas in general hospitals: social workers' contribution to ethical decision-making

Thirty-two hospital social workers, fourteen of them directors of social work services and eighteen direct practitioners, were interviewed about their perception of the factors influencing social workers' contribution to the resolution of ethical dilemmas in general hospitals in Israel. Findings revealed that while ethical decision-making in hospitals is an interdisciplinary process, social workers' contribution to the process is affected by rivalry between social workers and other members of the health team, personality differences, type of ward and the nature of the ethical dilemma. Participants of the study had quite a clear perception of their role and of the unique knowledge-base social work can offer, including knowledge of the individual and family life course, understanding and skills in coping with diseases, and systems thinking. In order to increase their influence in ethical decision-making, the hospital social workers felt they must put more effort into developing their relationships with the other professionals involved in ethical decision-making both by making themselves more indispensable and by making their contribution explicit through greater documentation of their activities. The findings also implied that in order to gain more power and be accepted as equal partners in multidisciplinary teams, hospital social workers should improve their communication skills when interacting with representatives of other heath care professions.     

Key factors impeding discharge planning in hospital social work: an exploratory study

Despite its long historical tradition in Northern Ireland, there is a dearth of research studies on the role of hospital social work and the professional challenges involved at the health and social care interface. This is the first small-scale exploratory study in Northern Ireland that sought to identify the key factors that hospital social workers perceive as impeding their practice in the discharge planning process. A 15-item postal questionnaire was developed and distributed to 30 hospital social workers from four hospital social work departments in a city in Northern Ireland. The study group comprised social workers based in a range of hospital directorates who had differing levels of hospital social work experience. Data generated from the questionnaires suggested that deficits in community resources impacted most negatively on social workers' practice in discharge planning. The length of time respondents had been in their current post was also shown to influence their responses to the perceived impediments in their discharge planning role. The implications of the study and recommendations are discussed in relation to in-service training, social work practice and continuing education in Northern Ireland.     

Commitment of licensed social workers to aging practice

This study sought to identify client, professional, and employment characteristics that enhance licensed social workers' commitment to aging practice. A series of binary logistic regressions were performed using data from 181 licensed, full-time social workers who reported aging as their primary specialty area as part of the 2004 NASW's national study of licensed social workers. Several variables were identified as being significant predictors of commitment to aging, including clients' source of insurance, practitioners' years of experience in social work and gerontology, perceived adequacy of training, number of social work colleagues in the work environment, perceived appropriateness of delegated tasks, and annual income. This study illuminates critical areas of need to promote professional commitment to aging practice. Promotion of training and competency-based education and the need for sufficient job challenge and appropriate assignment of roles (that is, those that are consistent with practitioners' skills and abilities) will encourage commitment to working in the field ofgerontology.     

The lives of female sex workers in Vietnam: Findings from a qualitative study

To facilitate better understanding of the environment and power structures in which sex work in Vietnam takes place, this study examined the sex workers' social and economic lives, their working environment, social relationships and presentation of self in everyday social contacts and interactions. Thirty in-depth interviews and 14 focus groups were conducted with street-based and venue-based sex workers in the cities of Da Nang and Hanoi. Results show that sex workers live and work within a complex system involving multiple relationships. In any of these relations, women have limited power to protect their personal security and secure payment for services rendered. Economic hardship is a major problem facing street-level sex workers and contributes to unsafe sexual practices. Venue-based sex workers worry less about economic hardships as such, but frequently incur gambling debts. Women also reported incidents of abuse and experiences of social stigma. Although many women exhibited a strong desire to leave sex work, they found themselves trapped in the sex industry by the lack of alternative employment options. This study provides evidence that socio-psychological factors must be addressed along with risky behaviours to promote women's well-being and social integration.     

Recommendations in relation to shift work]

The purpose of the recommendations is to decrease as much as possible physiological, psychological and social problems connected with shift work. To achieve this goal working hours should be organized to take account of shift workers' tolerance to shift work. When recruiting new shift workers certain personal characteristics that make work in any shift work system inadvisable should be checked. As shift work can be considered to be an additional load, shift workers' health requires regular checking-up. If there are signs of health impairment, the workers should be removed from night shift work permanently or at least temporarily. The shift workers' free time should be arranged so as to facilitate recovery from shift work, especially after night shift. To decrease the workload during the night shift, if possible, workers should be given opportunity to take naps during work.     

Evidence that supports the value of social work in hospitals

The value of hospital social work is supported by one hospital's tracking system that monitored social work discharge services and compared outcome with non-social work discharges. The sample consisted of a total of 64,722 patients admitted to the "med-surg" hospital unit over a two and one-half year time period from 2002 to 2004. Of the total patients in the sample, 15.7% (n = 10,156) had social work involvement. Sixty percent of the social worker patients were age 70 or over compared with the mean age of the sample of 56.2 years. The mean length of stay for social work served patients was 11.4 days (sd = 13.9) compared to 4.3 days (sd = 6.3) non-social work patients, a difference that was significant (t =-68.3; p = .000). The authors attribute the longer lengths of stay to social workers' receiving older and more difficult-to-place patients. An evidence-based case is made for the cost-containment value of social workers in hospitals and for the creation of a tracking infrastructure to aid in monitoring the daily achievements of medical/surgical social workers.     

The stress and coping of Israeli emergency room social workers following terrorist attacks

The authors of this qualitative study analyze Israeli hospital social workers' emotional responses to working with civilian casualties in the wake of an unprecedented surge of terrorist violence. Data are based on four focus groups conducted with 38 hospital social workers in relation to their experience with clients in the emergency room. Three themes were identified: (a) Restoring a lost sense of personal security as a necessary stepping-stone toward resuming professional performance, (b) Meeting the families'pain and responding to it, and (c) Disconnecting emotionally in the service of the professional self. The authors discuss the findings in light of the literature on peritraumatic dissociation among helpers.     

Status inequality in the social worker-nurse collaboration in hospitals.

An Israeli pilot study among 34 social worker-nurse teams (team members working in the same hospital ward) was aimed at elucidating the conditions for promoting a milieu of collaboration between them. The data suggest that this collaboration is characterized by status-inequality, the nurse's dominance prevailing with respect to meeting the patient's psychosocial needs. Nurses view social workers mainly as fulfilling chores relating to the patients' instrumental needs that emanate from outside the hospital, while social workers, though overtly objecting to the nurses' dominance, still view the milieu as collaborative. Explanations are offered for this apparent contradiction. Possible implications are suggested regarding the consequences both for effectively meeting the patients' psychosocial needs and for the social workers' professional status in hospitals.     

The impact of clients' mental illness on social workers' job satisfaction and burnout.

The study discussed in this article examined the relationship between the degree of involvement with clients with severe mental illness and social workers' job satisfaction and burnout. A total of 128 social workers were administered a questionnaire that included three scales: an involvement scale, a job satisfaction measure, and the Maslach Burnout Inventory. Greater involvement was related significantly to higher levels of emotional exhaustion and depersonalization. Overall, results suggest that social workers are affected negatively by this type of work. The implications for the social work profession are discussed as well as the importance of social support systems at the work setting that will help social workers cope more effectively with stressful work situations.     

Ethical activism: strategies for empowering medical social workers

Little empirical research examines the extent medical social workers try to change attitudes, norms, expectations, and protocols to create a hospital environment that encourages their participation in ethical deliberations. The researchers developed an ethical activism scale that measured the extent medical social workers engaged in such ethical activism, confirming its reliability from data obtained from a sample of 162 medical social workers in 37 hospitals in the Los Angeles basin. They tested seven hypotheses that probed the extent specific ethics-training, organizational, and demographic variables influence the extent social workers engage in ethical activism. Data strongly suggest the need to expand ethics training to include tactics of ethical activism, since many social workers do not engage in ethical activism. Data also suggest the need to target such training to social workers in hospitals that are relatively unreceptive to social workers' participation in ethical deliberations, since social workers are least likely to engage in ethical activism in such settings.     

Perceptions of the Hospital Ethical Environment Among Hospital Social Workers in the United States

Hospital social workers are in a unique context of practice, and one where the ethical environment has a profound influence on the ethical behavior. This study determined the ratings of ethical environment by hospital social workers in large nationwide sample. Correlates suggest by and compared to studies of ethical environment with nurses are explored. Positive ratings of the ethical environment are primarily associated with job satisfaction, as well as working in a centralized social work department and for a non-profit hospital. Religiosity and MSW education were not predictive. Implications and suggestions for managing the hospital ethical environment are provided.     

Constructing resilience: social workers' understandings and practice

Concepts and constructions of resilience have assumed a significant position in contributing to understandings of the psychosocial development of children and young people. This paper examines how concepts of resilience are constructed within the literature, and then explores social workers' perceptions and use of resilience with young people who were 'looked after' or at risk of becoming 'looked after'. It addresses the interface between social workers' views and understandings of the emotional health needs of their clients, and the responsiveness of accompanying service interventions. Using the Framework for Assessment as a platform for discussion, 32 semistructured interviews were conducted with 19 social workers relating to a purposive sample of 52 children and young people (31 boys and 21 girls). Social workers experienced difficulty in conceptualizing resilience, often providing cursory, general or non-expert explanations. Furthermore, social workers described all children and young people within the sample as being resilient, drawing only upon face-value observations to evidence this. Related to this was the low frequency of social workers' reports of children and young people's mental health difficulties and the concomitant low referral rate to secondary tier services. The authors argue that social workers' optimistic perceptions of the resilience of children and young people within this sample, alongside their positive appraisal of their emotional needs, impact on the interventions that are put in place. The paper concludes that the tendency of social workers to project optimism onto their client base calls our attention to a possible transference of the collective need for the social work department itself to be resilient within that local authority.     

Violence, dignity and HIV vulnerability: street sex work in Serbia

Sex work can be contextualised by violence, social and material inequality, and HIV vulnerability. We undertook a qualitative study to explore female and transvestite sex workers' accounts ( n  = 31) of HIV risk environment in Belgrade and Pančevo, Serbia. Violence emerged as a key theme. Accounts emphasise the ubiquity of multiple forms of everyday violence – physical, emotional, social – in street sex work scenes, linked to police as much as clients. We highlight the salience of emotions in sex work risk management, in which the preservation of dignity is of prime importance. Accounts draw upon narratives of hygiene and responsibility which, we argue, seek to resist portrayals, normative to this setting, of sex workers as contaminated and irresponsible. Findings highlight how the ubiquity of the risk of violence in street sex work scenes reflects institutionalised social inequalities and injustices. Sex workers are inevitably participant in the cycle of symbolic violence they seek to resist. The challenges for HIV prevention are therefore considerable, and require interventions which not only seek to foster safer micro-environments of sex work but structural changes in the welfare, criminal justice and other social institutions which reproduce the cycle of violence faced by sex workers day to day.     

Social work in the veterans administration hospital system: impact of the work

Social workers in the Veterans Administration (VA) hospital system are faced with numerous challenges to best address the ongoing health and mental health needs of those who serve in the military. Social workers in the VA system serve diverse roles on the multidisciplinary medical teams and mental health services and are integral to the VA hospital environment. Most social workers feel positive about their work and their contributions to the care of the military. Despite positive feelings about their work, social workers are also prone to compassion fatigue and burnout as the work, especially with returning veterans from Afghanistan/Iraq, often extracts a toll. This article details the experience of social workers in the VA hospital system; it describes the impact of the work on the social workers, noting levels of compassion satisfaction, compassion fatigue, and burnout.     

Social Work in the Veterans Administration Hospital System: Impact of the Work

Social workers in the Veterans Administration (VA) hospital system are faced with numerous challenges to best address the ongoing health and mental health needs of those who serve in the military. Social workers in the VA system serve diverse roles on the multidisciplinary medical teams and mental health services and are integral to the VA hospital environment. Most social workers feel positive about their work and their contributions to the care of the military. Despite positive feelings about their work, social workers are also prone to compassion fatigue and burnout as the work, especially with returning veterans from Afghanistan/Iraq, often extracts a toll. This article details the experience of social workers in the VA hospital system; it describes the impact of the work on the social workers, noting levels of compassion satisfaction, compassion fatigue, and burnout.     

A Prospective Study of the Effectiveness of Early Intervention with High-risk Back-injured Workers—A Pilot Study

INTRODUCTION: It was postulated that workers, at the sub-acute stage after injury, respond differently to clinical and occupational interventions offered in a workers' compensation environment. Individual worker risk of disability, it was further believed, would influence the effectiveness of early intervention. The objective of the current pilot study was to evaluate return to work (RTW) outcomes following proactive, combined clinical, occupational and case management-based interdisciplinary early intervention, provided in a workers' compensation environment 4-10 weeks of onset of back pain, to workers with medium and high risk for disability. METHODS: The project was a controlled study comparing conventional workers' compensation case management with integrated, interdisciplinary and multimodal early intervention (hereinafter referred to as "EI"). At baseline, risk status was determined by a validated Risk for Disability Questionnaire by Carragee et al. (Spine 5(1):24-35, 2005). Seventeen workers at high risk of protracted disability and 20 workers at moderate risk of disability received conventional case management, and 17 workers assessed at high risk of protracted disability and 18 workers at moderate risk of disability received the Early Intervention. RESULTS: At 3 months post back pain onset, no statistically significant differences were identified in RTW outcomes between conventional case management and the Early Intervention. However, by 6 months post back pain onset, workers at high risk of work disability who received the Early Intervention were significantly more likely to RTW than high risk workers who received conventional case management. In contrast, moderate risk workers continued to exhibit no statistically significant differences in RTW outcomes. CONCLUSION: Multimodal Early Intervention in the workers' compensation case management context is likely effective for workers with sub-acute back pain who are at high risk of occupational disability. The comprehensive Early Intervention is, however, likely redundant for workers who are not at high risk for disability and should not be applied indiscriminately. Further studies are required to determine longer-term Early Intervention outcomes, and to replicate the findings using a randomized control design. Also, with a larger sample size, it will be possible to determine predictors of occupational outcomes.     

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."