Showing papers in "Social Work in Health Care in 1985"

The Unmet Needs of Family Caregivers for Frail and Disabled Adults

Abstract: This study examines the efforts and needs associated with family care for disabled and frail adults. A survey of 117 primary caregivers focused on: the health problems associated with caregiving; the existence of informal, family support systems; the use of formal social services, and the need for additional social service programs. Most caregivers report physical and emotional problems due to caregiving ranging from hypertension and back problems to depression and mental exhaustion. The characteristics of caregivers at high risk for health problems are identified. Less than half of the caregivers have family or friends to assist them with caregiving. At least one type of social service was being used by over 80% of caregivers, with utilization patterns in male and female caregivers. Based on the study findings, several policy implications are reviewed.

Sources of strain between physicians and social workers: implications for social workers in health care settings.

Abstract: This paper analyzes the sources of strain between the professions of medicine and social work. The two professions are compared in relation to (1) the organization and socialization process of professional training; (2) perspectives on patient care, illness and role of the health care professional; (3) attitudes toward knowledge and data; (4) attitudes toward and preparation for team-work; (5) perspectives on the role of the patient; (6) perceptions of social work's function.

Women and abortion: attitudes, social networks, decision-making.

Abstract: The results of a study of 517 women seeking abortion are presented regarding attitudes about abortion in general, feelings about the specific decision to have an abortion and the social networks utilized in the decision-making process. Areas of potential conflict related to decision-making are identified along with the implications for social work practice.

The role of the social worker in the in-vitro fertilization program.

Abstract: The role of the clinical social worker in the In-Vitro fertilization Program is to help provide patients with an environment that includes realistic expectation and emphasizes the emotional spectrum of euphoria, anxiety and dysphoria that can accompany the demanding protocol. The literature supports the need for counseling and supportive psychotherapy in the infertility clinic but has not dealt specifically with the psychological demands of In-Vitro fertilization. This paper addresses the emotional stress of in-vitro fertilization and emphasizes the role of social worker as counselor, educator and guide.

Crisis intervention: a drop-in support group for cancer patients and their families.

Abstract: Cancer today presents patients and their families with an on-going series of crises. A drop-in, open ended, professionally-run support group for cancer patients and their families is described as a means of crisis intervention for the mobilization and promotion of adaptive responses and movement away from maladaptive responses to the stresses of cancer. This model is important because it can be easily generalized. As oncology units develop throughout the country in community-hospital settings, there must be concurrent development of psychosocial support systems.

Stress, adaptation and coping in a maternal-fetal intensive care unit.

Abstract: The emotional needs of 18 patients in a maternal-fetal intensive care unit wcre assessed using a semistructured interview Patients were asked to rank ordcr thc stresses they experienced while on the unit as well as the supports which they felt enabled them to cope with the hospitalization Responses were analyzed taking into account the duration of the patients' hospitalizations and the differences in two settings of the intensive care unit Being away from home and family, physical discomforts, medication side effects, and feelings of helplessness and loss of control were the cornmon stresses noted Physicians, nurses and family and friends werc the most frequently mentioncd supports

Psychosocial Responses to Traumatic Physical Disability

Abstract: Victims of traumatic physical disability experience disruptions of normal affective functioning. The sense of body image and body ego are altered in ways that are frightening or confusing to the patient. The subjective experience of time becomes present-oriented, with time moving slowly. Grief or depression, clinically distinct responses, may further debilitate the individual. Anxiety, guilt and rage are additional emotional responses. Patients use previously existing coping patterns to manage the crisis of sudden disability. It is not the nature or the severity of the injury that exclusively influences the psychological response, but rather, it is the interaction of the person and the total environment that determines behavior.

Social work with cancer patients: stresses and coping patterns.

Abstract: This article reports a study of the special stresses affecting the increasing number of social workers who work with cancer patients and their families. Related literature and research document the universally stressful effects of this chronic and life-threatening illness but offer little knowledge of the job stresses experienced by social workers providing services in hospitals. The nature of the stresses reported by social workers, the adequacy of supports to help them cope with the emotional impact of their work and the need for additional support programs are discussed.

Social work and Alzheimer's disease: psychosocial management in the absence of medical cure.

Abstract: Because the illness erodes and destroys an individual's humanness and personality, patients and families affected by Alzheimer's Disease have particularly critical needs for help with its psychosocial sequelae. This article develops a model of psychosocial management and details specific interventions to help patients and caregivers develop and maintain adaptations during the long course of the disease.

The patient has a family: reaffirming social work's domain.

Abstract: Work with the family has traditionally been claimed as the domain of social work within the hospital setting. The difficulties of expanding the scope of clinical work to systematically include the family and its needs as integral to meeting the patients' psychosocial needs can be attributed in part to the absence of a conceptual model that encompasses the patient, the impact of the illness, the family and the hospital. The authors propose a paradigm to address these multiple variables with their attendant treatment implications.

Psychosocial adjustment of the family caregiver: home hemodialysis as an example.

Abstract: Chronic rcnal failure is an example of chronic illness where the family is often expcctcd to provide ongoing home health care. This paper reports the results of a study with 19 women who were trained to assist their husbands with home hemodialysis. The impact of living with a spousc with chronic renal failure is discussed, using case examples. Future research needs are addressed.

Group support for parents of high risk neonates: an interdisciplinary approach.

Abstract: Many parents are unable to develop a satisfying relationship with their sick newborn. Although data are divided over the critical nature of the attachment process, measures to assist parents and reduce socio-environmental stresses are considered desirable. Group support is one such measure which can provide parents with a commonly needed component of neonatal intensive care. In the group described, weekly sessions are informal, encouraging discussion, an understanding of neonatal care and recognition that some emotional and coping disturbance is normal. Staff involved are an interdisciplinary team (social worker, doctor and nurse). The group requires no special funding and time commitment is low considering the support provided. We have met weekly for five years with sustained attendance. No control group exists but parents appear increasingly comfortable in the nursery and able to achieve more meaningful and ongoing interaction with their infant and the staff.

Environmental management of senile dementia.

Abstract: A model is described of social activity in club settings geared to the needs of demented and cognitively impaired old people living in the community. As well as reality orientation, guided social interaction, physical activity, dance therapy and craftsmanship, important elements include transport, home assessment and follow-up visits. Parallel support groups for spouses are essential to the complete program, which coordinates planning with local authority agencies. The complex also includes educational programs for staff, professionals and the public. This design is seen as an on-going neighborhood project in which at focal points of the week, the patient enters a meaningful social environment with which he can cope.

The Use of Theoretical Constructs and Research Data to Establish a Base for Clinical Social Work in Health Settings

Abstract: This article suggests a means for organizing a base for clinical social work practice in health settings. Membership, as a theoretical construct, is used to explore the essentials of social work, to explicate its key practice concepts, and to review characteristics of the health field. Selected findings from a secondary analysis of data from the New England Regional Survey of Social Work Practice are considered with reference to theory and essential concepts of health social work practice. Questions are raised and implications drawn for the practice of clinical social work in health settings and for education for that practice.

The impact of illness on patients and families: social workers teach medical students.

Abstract: An elective is described which teaches medical students the psychosocial components of illness. The course is taught by social work tutors who utilize their empathetic and enabling skills to provide the students experiential and didactic instruction drawn from interviews with patients. Course content is exemplified by an in-depth description of material taught by a social worker assigned to the gynecology oncology service. A course evaluation is provided as well as the rationale for linking this elective with the medical school philosophy which stresses a biopsychosocial approach to clinical problems. The course structure derives directly from the day to day practice of hospital social work and thus lends itself to replication in a variety of health care settings.

The concept of responsibility in a health model of social work.

Abstract: The current lifestyle reform movement places a central emphasis on individual's responsibility for their health status. Such focus provides a useful corrective for the traditional preoccupation with physician-centered techniques but it poses some difficulties as well. This paper analyzes the hidden consequences of holding people responsible for their own health and suggests ways in which the concept of responsibility can be repatterned. This enhanced perspective is seen to be more compatible with a social work perspective which values human capacity for health and positive change.

Good health: whose responsibility?

Abstract: The individual responsibility ideology with respect to health is examined. First the concept of health is discussed, then the factors that determine health are analyzed and finally questions are raised regarding the impact of this ideology on health and the provision of health care services. Implications for social work are also considered.

Bipolar disorder and social work practice.

Abstract: With the introduction of lithium and increasing evidence that bipolar disorder is a biogenetic condition, changes have occurred in the diagnosis and treatment of bipolar disorder. Cross-cultural studies indicate that in the United States there is a tendency to overuse the diagnosis of schizophrenia when bipolar may be indicated. Both disorders have psychotic symptoms, rendering diagnostic confusion possible. This paper describes the characteristics of bipolar disorder, explanatory theories and treatment. A medical model of treatment is preferred. Issues of concern to social workers are addressed.

Myocardial infarction patients in the acute care hospital: a conceptual framework for social work intervention.

Abstract: This paper describes a conceptual framework for identifying myocardial infarction patients in the acute care hospital who are at risk for medical and psychosocial complications that may impede recovery. Because of their precarious medical status, these patients present special issues for social work practice. Psychosocial factors affecting outcomes are reviewed and interventive strategies are outlined. The crucial role of adaptive denial in recovery is highlighted.

The perils and promises of the health practice domain.

Abstract: The domain of social work in the health field is recognized as prominent among the fields of practice. However, this accomplishment could generate problems in the relationship between the health field and the profession itself. An unfortunate outcome would be the over-determination of health (or illness) in the psychosocial definitions of problems. Owing to the effectiveness of the work done in health, it could blur its boundaries with other fields, and in so diminishing the notion of domain altogether, the profession could tilt toward a health rather than a social work identification. Definition of domain will require more than adherence to methods, skills and values; mastery of a well-defined field-specific knowledge base would appear to be the most significant distinguishing characteristic of this and other fields of practice.

The Psychiatric Emergency Service As a Setting for Social Work Training

Abstract: The psychiatric emergency service can provide rich training opportunities for social work students. It is a site where they can learn to function in clinically autonomous, independent roles as primary care providers who are responsible for the evaluation, treatment, and disposition of psychiatric emergencies. Assuming responsibility for evaluating and intervening with a w3ide variety of people in acute distress prepares the student to enter professional practice with self-confidence. The abundant educational opportunities available on the psychiatric emergency service are discussed, teaching strategies to facilitate learning are suggested, and the unique professional growth experiences which derive from training are identified.

Families, transitions, and health: another look.

Abstract: This paper critically reviews the Caroff-Mailick classification of families seen around health care crises, and of reciprocal roles suggested for health social workers depending on severity and trajectory of illness and on family's functioning levels. As balance, transitional crisis theory, holistic health concepts, and team approaches to the mobilized family as the nit of caregiver attention are discussed. Newer alternative family styles are reviewed which challenge middle class caregiver mores and practices. Family forces which may prejudice worker assessment are reviewed, and the need to mitigate unhealthy and constricting environmental conditions is stressed.

Family treatment in the health setting: the need for innovation.

Abstract: While the important role families play vis-a-vis illness is generally recognized, there are relatively few clinical encounters with entire families reported by social workers in health settings. Some of the possible explanations for this are examined, with a recommendation for the design of interventions based on a family systems perspective. Two areas requiring further investigation are highlighted: the element of uncertainty which confronts families coping with chronic life-threatening illness and the impact of serious illness on children. By conceptualizing new ways to help families adapt, social workers can make a significant contribution clinically and reaffirm their position in this domain.

Research agenda for discharge planning.

Abstract: With increased competition over diminishing resources in health care today, discharge planning has become a key element for hospital survival The sudden high status now attached to this traditional social work function has caused major power struggles for control over discharge planning Social workers have up to now succeeded in being undisputed leaders in this area because of tradition and demonstrations of clinical competence Continued success and status in the future will require arguments and organizational design based on scientific research and hard data This paper describes the main questions that need to be examined and proposes manageable approaches for conducting practice field studies

Family practice social work: a new area of specialization.

Abstract: Many physical problems presented to family physicians by their patients often involve psychosocial variables with stress being a major one. Though family medicine advocates a biopsychosocial focus, one that is compatible with social work, the psychosocial aspects of health are often ignored. The involvement of social workers in the private practices of family physicians to deal with such problems is discussed in this paper as a new area of specialization. Issues such as the medicine-social work gap and the financing of social work services in private family medical practice are also addressed. It is concluded that this should be considered a new area of specialization. However, social workers must take the initiative in its development.

Social Work in Family Practice

Abstract: In a study by Frangos and Chase of thirty-nine family practice residents, it was found that the majority had positive attitudes toward having a social worker associated with their future medical practice. Their findings, however, could have been positively skewed since their sample was small and from residents in only one program. This paper reports the findings of 159 board certified family practitioners surveyed in a national sample. This study also yielded positive findings but much less than those in Frangos and Chase's study. These and other findings related to family practitioners' attitudes and practices regarding social work involvement in their practices are reported and discussed.

The health care social worker's role in facilitating grief work: an empirical study.

Abstract: In this research. 155 people who had recently experienced the loss of someone they cared about rated the extent to which diffcrcnt social work activities would or would not havc bccn hclpful to them at the time of their loss. Discussion of the data, focuses on how social workers in a health setting can assist individuals who are grieving.

The geriatric worker in a community-based out-patient geropsychiatry clinic: a conceptual model.

Abstract: This paper dcscribes the role of the geriatric worker as a member of the service provider team in a community-based geropsychiatry out-patient program using the bio-psycho-social model. Three major components are identified: (1) the functional role, (2) the affective role, and (3) the community-integrative role. The contribution of the worker is shown to be significant in thc attainment of the goal of outpatient geropsychiatry: that being the resocialization and maintenance of the elderly person with special needs in the community.