Showing papers in "Social Work in Health Care in 2001"

Globalisation and social policy.

Abstract: This paper discusses six major themes: that economic and social issues are closely interdependent and that the appropriate stance is to work on both together, simultaneously; that though the threats from globalisation have been exaggerated, there can be substantial costs as well as considerable benefits; that constraints on national policy are significant but are less severe than is commonly considered; that the vitality-the vigour-of national and international political processes must be increased to cope effectively with the changes which are underway; that the private sector, unions and civil society have crucial roles in the provision of services and in advocating socially responsible values, standards and policies; and that one of the most effective means of addressing the erosion of national autonomy from globalisation is for countries to cooperate in setting and implementing shared objectives and international standards and establishing more global public goods

Experience and Covariates of Depressive Symptoms Among a Cohort of HIV Infected Women

Abstract: Objectives: The objectives of this study are to assess (a) the level of depressive symptoms among a cohort of HIV infected women and comparable controls and (b) the relationship with covariates including socioeconomic status, substance use, social relations, disease status. Methods: Participants were enrolled in the Women's Interagency HIV Study (WIHS). Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CESD). Data from 1993 HIV seropositive and 551 seronegative women are presented. Results: Of HIV positive women 57.7% of HIV positive women scored 16 or higher on the CESD (ns) as compared to 55.0% of HIV negative women; at a cutoff of 23, the percents were 40.4% and 35.9% respectively (p = .06). The mean score was high 19.8 but not significantly different between groups. Scores were higher among women who had less education, lower income, were of Hispanic ethnicity, used alcohol or drugs, experienced domestic abuse, had more than one partner, or had l...

Health Care Social Workers' Views of Ethical Issues, Practice, and Policy in End-of-Life Care

Abstract: End-of-life care decision making is perhaps the most difficult practice situation faced by health care social workers. Complex ethical issues arise from decisions regarding use of advancing medical technologies and/or other artificial treatments that may prolong life and/or compromise its quality. NASW has set forth a policy to help guide social workers dealing with end-of-life care decisions and the preservation of client self-determination in these situations. However, the present study (N = 63) revealed that a majority (57%) of social workers were not aware of the existence of, or were only somewhat familiar with the policy. Ethical dilemmas most often faced in end-of-life care situations related primarily to issues of communication between and among patients, families, and professionals. Practitioners indicated that more specific practice guidelines and increased education regarding bioethics and issues of end-of-life care are needed to be effective in assisting patients and families in end-of-life decision making.

The cost of caring for patients with an illness: contagion to the social worker.

Abstract: This article will examine the effects of hospital work on social workers. It will highlight the events of a focus group that was used to gather data in an attempt to begin to understand the stressors faced by the worker. The Self-Constructivist Model (McCann & Pearlman, 1990b) is utilized in relation to trauma experienced by the social worker, while working with patients diagnosed with an acute, chronic or life-threatening illness. Findings are summarized and recommendations are made to assist hospital social workers in coping with the aftermath of secondary trauma.

Impact of social support, diversity, and poverty on nursing home utilization in a nationally representative sample of older Americans.

Abstract: This study examined the effects of social support, poverty, functional status, and demographic variables (age, race, gender) on nursing home admission using Cox proportional hazard models with time varying covariates on the Longitudinal Study on Aging (1984-1990). The Behavioral Model of Health Care Utilization was used to organize the study. Living with a spouse or children reduced the risk as did being socially active. High income reduced the risk but there were problems in the measurement of income. Higher levels of functional disability predicted higher risk. Being Black or being female reduced the risk of admission. Age was a predictor of increased risk. Beyond these findings this paper provides support for the importance of gathering and utilizing data that allows for predictor variables to vary with time.

Educational approaches for preparing social work students for interdisciplinary teamwork on geriatric health care teams.

Abstract: Interest in teamwork has fluctuated over the last several decades, with recent renewed interest. As social workers become more involved in working with older people in the coming years, their success will hinge on collaboration with other health providers. Schools of social work and clinical sites must address this through the development of educational curricula and clinical programs which prepare social workers to work on interdisciplinary geriatric health care teams. Based on the experience of the national Geriatric Interdisciplinary Team Training (GITT) Program, this article presents an overview of the necessary team skills for social workers, educational methods for teaching teamwork developed at the GITT sites, and some teaching challenges.

Discharge planning and social work practice.

Abstract: Current health care practice discharge planning has emerged as a major professional function in hospital settings. To examine the tasks involved in discharge planning and how frequently they are being performed, 124 Alabama hospitals were contacted with a 72% rcsponse rate. Of the 178 surveys returned by discharge planners the core tasks were identified and ranked in terms of performance frequency. The results revealed that the tasks performed typically resembled that of generalist social workers. When specialization occurred, it was related to the populations served and not the specialized tasks or methods utilized. From this data recommendations are made for linking advanced generalist social work practice to discharge planning activities.

An evolving paradigm of supervision within a changing health care environment.

Abstract: As hospitals attempt to decrease their costs to survive in today's health care market, they are implementing resizing strategies that promise greater efficiency. A by-product has been the elimination of many management and supervisory positions. A self-administered questionnaire was sent to a stratified random sample of 750 hospitals (yielding a 46% return rate) to study the types of supervisory models being utilized and the factors associated with their differential use. While concern is expressed about the erosion of clinical supervision, the data suggests that the majority of social workers are receiving supervision from a social worker.

Social Work Practice with People with Disabilities in the Era of Disability Rights

Abstract: Social workers, especially those in health care and rehabilitation systems, must consider practice changes necessitated by recent legislation and the growing activism of disability rights groups. The authors review essential elements of the emerging sense of both oppression and empowerment that is occurring for many people with disabilities and groups; consider key aspects of ADA and other perti nent legislation that place new emphases on the self-determination of people with disabilities; and discuss what implications changing practice roles might have for social workers' relationships and patterns of interaction with other professionals in medical, health care and rehabilitation settings. The authors outline a beginning effort at designing a conceptual framework that promotes practice that: (1) maximizes clients' involvement in exploring an expanded range of options and choices; (2) prepares clients to be more effective in dealings with professionals, bureaucrats and agencies that often do not understand nor appreciate their need for self-determination; and (3) at the organizing level, mobilizes and helps to empower groups of people with disabilities to consider policy and program alternatives that can improve their situation. This framework may also be useful in work with people who have other long term care needs, chronic conditions.

Young women with PD: a group work experience.

Abstract: Parkinson's Disease (PD) prior to the age of 40 affects between 5-10% of the PD population. The psychosocial changes that patients with early PD encounter, may be more devastating and disabling than the actual motor disability. The paper describes a unique experience in groupwork with young female PD patients treated in the Movement Disorders Unit of the Tel Aviv Sourasky Medical Center. The paper focuses on the special issues which characterized this group's experience: stigma, body and sexual image, and personality traits.

Predicting length of stay in an acute care hospital: the role of psychosocial problems.

Abstract: In an acute care hospital, a major performance indicator is patient length of stay. This study, in a large university teaching acute care hospital in Canada, examined the effect of psychosocial problems on length of stay, controlling for patient demographics and medical condition. Average days stay for Diagnostic Related Groups (DRGs) was used as a proxy variable for severity of medical condition, and the Person-in-Environment (PIE) classification system was used to measure psychosocial problems. Data were collected on a sample of 160 patients; 78 in psychiatry and 82 in medical/surgical wards. In a regression analysis, the severity of the patient's psychosocial problem was a more significant predictor of length of stay than the DRG variable. The identification of psychosocial problems and their severity add an important and complementary dimension to research into the effectiveness of social workers in reducing length of stay. Workers found clients had significantly more problems related to their social role functioning than problems in the environment.

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

Abstract: 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.

Knowledge and attitudes of health care social workers regarding advance directives.

Abstract: This cross sectional investigation describes the knowledge and attitudes of health care social workers regarding advance directives and explores factors that influence them. As major contributors to quality patient care, the level of knowledge and attitudes held by health care social workers regarding health care policy mandates are important. Mail survey methods were used to collect data from a systematic random sample (n = 324) of social workers throughout one mid-western state. Results indicate that the majority of health care social workers have high to moderate levels of knowledge about advance directives and hold positive attitudes regarding the policy. Social workers with more experience working with the elderly had higher levels of knowledge. Those employed in nursing homes and hospice settings had more positive attitudes than did those working in other health care facilities.

The influence of religious and personal values on nursing home residents' attitudes toward life-sustaining treatments.

Abstract: A cross-sectional survey design was used to interview 133 Jewish, Catholic and Protestant residents from 13 nursing homes to examine the influence of religious and personal values on attitudes toward life-sustaining treatments. Subjects on average were 83 years old, Caucasian and female, with more than half having Advance Directives (ADs). Jewish subjects, as well as those who relied on God, were better educated and more anxious about death, had significantly more positive attitudes toward life-sustaining treatments at the end-of-life. On the other hand, those who had implemented ADs desired fewer life-sustaining treatments. Findings demonstrate that understanding individual desires for life-sustaining treatments is complex. Practitioners who provide education on end-of-life decisions need to discuss a myriad of issues including individual religious and personal values and other characteristics in an effort to understand and respect treatment choices.

An evaluation of a psychotherapeutic group intervention for persons having difficulty coping with musculoskeletal disorders.

Abstract: This study evaluated an 8-9 week psychotherapeutic group program designed to help people cope with the difficulties and changes that arise when living with musculoskeletal (MSK) disorders. Also examined were individual differences in client expectations about the benefits of the groups. Participants were 64 community-dwelling adults who completed questionnaires at the beginning, end, and three months after their final group session. Outcomes were mastery, coping efficacy, helplessness, self-acceptance and depression. Significant changes from pre- to post-intervention were found in mastery, depression, and coping-efficacy with effect sizes of .50 or greater. Individuals who had concerns or reservations about participating in the groups gained from the intervention in the same ways as others who were more positive at the outset of the groups.

Health problems and long‐term unemployment

Abstract: The article deals with the relation between unemployment and health problems using as a case a local support project for long-term unemployed in northern Finland. Mass unemployment has increased competition on the labor market, and successful job-seekers must have a wider range of qualifications than before. As demands have intensified on the labor market, health has become a salient criterion in the recruitment process. At the same time the incidence of illness among long-term unemployed is surprisingly high. The situations of the project clients strongly indicate that health-related difficulties are one distinct risk factor for the long-term unemployed in finding work. We need new means for health promotion, more extensive psychosocial rehabilitation and local solutions for people who are unemployed.

Health care and social work education in a changing world

Abstract: This article examines two major challenges that beset contemporary social work education, namely, rapid and dramatic macro-level changes that are occurring in the social, political, economic and demographic realms and, also, the slow speed at which curriculum changes occur in institutions of higher education. Primarily employing managed care as an example, a series of recommendations are offered to improve social work education concerning health care. Among them are more efficient mechanisms for introducing curriculum changes, greater emphasis on research and evaluations skills, systematic monitoring of health care programs, preparation of public impact reports, better utilization of modern information technologies, and the introduction of mini-courses that can be adapted readily to emerging health care and educational needs.

Mental quality of life: an indicator of unmet needs in patients with diabetes.

Abstract: This exploratory study investigates the quality of life needs of 173 individuals being treated for type 2 diabetes over a six month period of time. It samples patients whose primary care providers practice the most current model for delivering care, diabetes disease management. These physicians utilized a multidisciplinary diabetes education program to facilitate the patient-provider knowledge-based partnership essential in discase management. Patient quality of life changes were measured by the SF-36. A paired samples t-test showed significant diminishment in patients' mental quality of life indicating diminished overall emotional functioning, negatively impacting quality of life; possibly due to the effects of time. Multiple regression results also indicated that patients at risk for major depression and at risk for major depression superimposed on dysthymia experienced significantly diminished mental quality of life. These findings suggest that enhanced mental health assessment and mental health services provided by social workers in diabetes education programs and/or primary care settings would improve patient mental quality of life.

A description of inappropriate hospital stays in selected in-patient services: a study of cases receiving social work services.

Abstract: The number of discharges (63,303) from a university-affiliated medical center in Israel were reviewed. Eight percent of cases in three departments received social work services. Patients experiencing inappropriate hospital stay (discharge delay) and who received social work services were characterized and compared with social work clients not experiencing delay. Discharge delay patients differed from other social work clients on key sociodemographic variables. Patients admitted because of “injury” were significantly more likely to experience delay than patients admitted because of “illness.” “Waiting for community/institutional resources” was the most common reason for delay and discharge to an institutional setting increased the likelihood of delayed discharge. High risk factors were department-specific and should be studied in context. Results suggested the limited but positive impact of hospital-community collaborative strategies in reducing the incidence of delay over time.

Selecting a measure of health related quality of life.

Abstract: Quality of life is becoming recognized increasingly as an important outcome measure which needs to be considered by social workers. However, there does not appear to be a clear consensus about the definition of quality of life. In addition, social workers are likely to experience difficulties choosing and applying an appropriate instrument with which to measure quality of life because of the many available instruments purporting to assess quality of life. This paper discusses the definition of health-related quality of life and explains the main measurement properties of an instrument that must be appraised when considering whether or not an instrument is appropriate. The paper will assist social workers to make an informed choice about measures of health-related quality of life.

Employment and health among older bereaved men in the normative aging study: one year and three years following a bereavement event.

Abstract: Research has indicated that the negative effects of bereavement on health among elderly men occur within the first six to twelve months following a bereavement event while other studies indicate that the death of a loved one can have long-term effects on social functioning and mental health (Arbuckle & DeVries, 1995; Vinick, 1983a). However, employment has been found to buffer the strain produced by stressful life events. The purpose of this study was to examine the differential effects of employment on physical and mental health between elderly men bereaved for one year and elderly men bereaved for two to three years. We selected two groups of men from the Normative Aging Study: those bereaved within the past year (N = 248) and those bereaved from two to three years (N = 262). Ordinary least squares multiple regression analyses examined the direct effect of employment, controlling for age, education, income, marital status, and stress, on physical and mental health among the two groups of men. A...

The impact of ethnic identity upon the adjustment and satisfaction of Jewish and African American residents in a long-term care facility.

Abstract: The role of ethnicity in shaping the adjustment process and satisfaction level of cognitively intact older adults with nursing home living is examined in two predominant ethnic groups in an 816 bed long-term care facility. A convenience sample was used to select 71 Jewish and 21 African American residents age 65 and older. Face-to-face interviews were conducted at a single point in time and incorporated four scales that measure strength of ethnic identity, adjustment and satisfaction with residency. Ethnic behavior was the only ethnic identity measure that was significantly associated with resident adjustment and with satisfaction. The two ethnic groups did not differ significantly in the association of ethnic identity with adjustment and satisfaction. Additional research will be necessary to establish the generalizability of these results to other ethnic and racial groups.

A Department of Social Work uses data to prove its case [corrected].

Abstract: The introductions of managed care with its emphasis on cost containment has led a Department of Social Work Services at a large urban teaching center to better document and justify its roles. A concrete result was the saving of social work positions during budget cutbacks and downsizing. There is also information in these data to help clarify the differential roles of social workers and utilization review nurses in the hospital case management/discharge planning processes. The system came about because of concerns around cost containment, the need for more systematic discharge planning and the advent of the Prospective Payment System and Diagnosis Related Groups (DRG's) as a means of reimbursement to hospitals.

HIV/AIDS case management tasks and activities: the results of a functional analysis study.

Abstract: Functional analysis, a variation of the time study technique, was used to examine how HIV/AIDS case managers in the tri-county region of New York State spend their time-the actual tasks and activities they choose to perform relative to the total universe of activities and tasks subsumed in the general category of case management. The picture developed was of a system operating primarily in a crisis mode, spending relatively brief amounts of time completing a range of activities and providing an extensive scope of services for or on behalf of clients. The bulk of the work was client centered, not administrative, and involved providing disease management and essential services (e.g., family and mental health). The implications of these findings are discussed, with particular attention paid to the potential influence of client profiles and worker demographics.

The development of an Australian National classification system for social work practice in health care

Abstract: Summary Australian Social Work, over recent years, has been challenged to develop a standardised and accurate classification system for social work interventions. The need for such a system arose through changes in funding arrangements based on the Diagnosis Related Groups (DRGs) treated within hospitals. In Australian hospitals, the mix of DRGs treated became known as its ‘casemix.’ These new funding arrangements made it necessary for Social Work to classify and measure activity with each patient to ensure continuing resource allocation to social work services in hospitals. A national Casemix Network was formed under the auspice of the Australian Association of Social Workers to develop a classification system. The Network worked collaboratively with other allied health professions to produce a generic framework for professional activities and also developed a classification of social work interventions. These activity classifications have been incorporated into procedure coding in Australian hospitals. ...

Physicians' perceptions and responses to patient emotion: implications for social work practice in health care.

Abstract: Physicians serve a pivotal role in today's health systems, as they are often the first professional patients must contact for emotion problems. This study surveyed 225 practicing physicians to understand how they perceive patient emotion and the actio“emotion complaints” from a patient vignette, these physicians perceived the patient as experiencing anxiety, followed by fear, anger and sadness. Physicians had distinct preferences for psychosocial oriented responses (e.g., explore, reassure, and rationalize) and were least likely to avoid, distract, and ignore. Overall, anxiety and fear generated the greatest number of possible responses from physicians, anger and sadness the fewest.

Delivering health care services in the community: a multidisciplinary perspective.

Abstract: Summary The Canadian health care system has shifted away from its traditional emphasis on acute care in‐patient services, to increasing dependence on community‐based services. A major implication is that education for work in this new environment will need to be reconceptualized, and those already in the system will have to examine their assumptions and alter their approach to patient care. This paper reports the results of a study which examines the attitudes, educational preparation, skills sets, and perceptions of “community” among social workers, occupational therapists, nurses and physiotherapists. The results should inform social work and other health educators about relevant theoretical and practical preparation for work in an environment which increasingly emphasizes multiple skills, community partnerships and coordinated care.

The buck stops where? Contracting, service delivery and the challenge to provide responsive services.

Abstract: Summary This paper discusses the impact of contract‐based purchasing on the delivery of social and health services to families in New Zealand. The paper arose out of research conducted by the authors into the effectiveness of certain human service interventions. It begins with an outline of the agency in which the research took place. It presents a brief overview of the development of contracting and then considers four key issues raised by this development from both the international literature and from the authors’ experience of researching a social service agency. These issues are: defining what is to be purchased, accountability mechanisms, specificity/fragmentation and partial funding. The paper identifies that central components of the first two issues are informational, the third is about control and the fourth is about reducing government spending and extending state control over the activities of the not‐for‐profit sector.

Analyzing end-of-life care legislation: a social work perspective.

Abstract: SUMMARY Several policy approaches are currently being considered in an attempt to organize a national response to the crisis surrounding quality end-of-life care. Recent healthcare efforts aimed at supporting individuals facing advanced illness are marked by debate over assisted suicide, untimely referrals to hospice care, inconsistent adherence to advance directives, and substantive amounts of unrelieved pain in end-of-life. Social workers require a clear understanding of the current political and social climate if they are to navigate the ethical dilemmas as they are presented in end-of-life care. This article discusses recently proposed policy responses to the various political and social controversies surrounding end-of-life care for individuals facing advanced illness. The analysis will suggest criteria for evaluating end-of-life policy in general and offer a framework for evaluating proposed legislation. Suggestions for making end-of-life policy more effective and areas for future research will be p...

Help-seeking patterns in HIV/AIDS outpatients.

Abstract: This study investigates factors associated with requests for professional services, made by newly registered HIV/AIDS Clinic outpatients, referred by general practice physicians to a large urban hospital serving a broad metropolitan/rural area in Canada. Professional service requests were divided into two primary help-seeking categories: practical support (assistance with financial aid, housing, medication costs, etc.) and emotional support (i.e., psychological counselling). Slightly more than half of the sample (51%) of people living with HIV/AIDS (PHA) requested professional services. Service requesters are indistinguishable from non-requesters on a large number of variables, including age, gender, family awareness of HIV/AIDS diagnosis, time elapsed since diagnosis, employment status, spousal status, overall support network size, physical health indicators (Karnofsky Performance Status, CD4 count, symptoms, opportunistic infections) and receipt of community support services elsewhere. Similarl...