Showing papers in "Social Work in Health Care in 2002"
TL;DR: The authors have adopted a body-mind-spirit integrated model of intervention to promote the health of their Chinese clients and shown significant improvements in their physical health, mental health, sense of control and social support.
Abstract: Under the division of labor of Western medicine, the medical physician treats the body of patients, the social worker attends to their emotions and social relations, while the pastoral counselor provides spiritual guidance. Body, mind, cognition, emotion and spirituality are seen as discrete entities. In striking contrast, Eastern philosophies of Buddhism, Taoism and traditional Chinese medicine adopt a holistic conceptualization of an individual and his or her environment. In this view, health is perceived as a harmonious equilibrium that exists between the interplay of 'yin' and 'yang': the five internal elements (metal, wood, water, fire and earth), the six environmental conditions (dry, wet, hot, cold, wind and flame), other external sources of harm (physical injury, insect bites, poison, overeat and overwork), and the seven emotions (joy, sorrow, anger, worry, panic, anxiety and fear). The authors have adopted a body-mind-spirit integrated model of intervention to promote the health of their Chinese clients. Indeed, research results on these body-mind-spirit groups for cancer patients, bereaved wives and divorced women have shown very positive intervention outcomes. There are significant improvements in their physical health, mental health, sense of control and social support.
176 citations
TL;DR: This study explored the strategies used by children to cope with abusive home environments by categorized into common patterns that emerged as five themes showing a progression of skills used by adolescents who were maltreated as children.
Abstract: Using a grounded theory qualitative research, this study explored the strategies used by children to cope with abusive home environments. Through a series of three interviews, a group of adolescents and child care professionals were asked their perceptions regarding protective factors of resilience. These were then categorized into common patterns that emerged as five themes showing a progression of skills used by adolescents who were maltreated as children. These themes are: loyalty to parents, normalizing of the abusive environment, establishing a sense of safety through a perception of invisibility to the abuser, self value, and a future view. This research adds important knowledge to the body of practice skills in working with abusing families. Those children who have developed methods to cope provide us with valuable tools to assist other children who may continue to live in abusing environments.
166 citations
TL;DR: It is asserted that available clinical information can be converted into valuable retrospective, data-bases for practice-based research studies, and examples of such studies in health and mental health settings are provided.
Abstract: SUMMARY Social workers in health and mental health settings routinely collect and record enormous quantities of clinical information about clients, psycho-social interventions and client responses to these interventions. Despite its abundance and non-intrusiveness, social work researchers generally have ignored available clinical information, claiming that it is unreliable and subject to too many threats to validity to warrant serious consideration as a data source. Instead, many researchers have advocated “gold standard” experimental studies, employing standardized instruments and prospective data-collection. As a result, the research potential of retrospective studies based on available clinical information has been relatively unexplored and untested. This paper asserts that available clinical information can be converted into valuable retrospective, data-bases for practice-based research studies. Exemplars of such studies in health and mental health settings are provided as are guidelines for their con...
130 citations
TL;DR: It is argued that support and counselling be provided not only for women who miscarry, but also for their male partner, as the men may have fewer means to express their grief due to the “social expectation” of male roles.
Abstract: This paper reports results from six women who had miscarried and their partners in Melbourne. A qualitative approach, namely in-depth semi-structured interviews, was utilised to obtain information. Several themes emerged from the data. The findings of this study show that women and men experienced a variety of feelings in reaction before, during and after the miscarriage. These feelings varied in type, intensity, and duration in which the men generally experienced less intense feelings for a shorter period of time as compared to the women. We argue that support and counselling be provided not only for women who miscarry, but also for their male partner, as the men may have fewer means to express their grief due to the "social expectation" of male roles.
125 citations
TL;DR: Relatives' needs and anxiety levels are found to be significantly related to demographic variables and type of kinship with the patient.
Abstract: Introduction: This study explores the needs and anxiety levels of relatives faced with the stress of a family member's critical care hospitalization in relation to the relatives' age, gender, educational level and type of kinship with the patient and in relationship to the characteris- tics of the admission and the condition of the patient. Methods: Participants were 200 relatives of 120 different critical care patients. Family needs were measured by means of the Critical Care Family Needs Inventory. Anxiety was measured by means of the State version of the State-Trait Anxiety Inventory. Results and conclusion: Relatives' needs and anxiety levels are found to be significantly related to demographic variables and type of kinship with the patient. The implications for clinical practice are discussed.
89 citations
TL;DR: An 18 month follow-up study of 26 women who were treated for various types of cancer at a major medical center in the United States revealed that the women's psychosocial well-being changed for the better between Time 1 and Time 2, indicating that relational factors continue to play a significant role in the sample's Psychosocial adjustment.
Abstract: The psychological and social consequences of having a diagnosis of cancer can continue beyond the initial year of diagnosis. However, very few empirical studies examine the long-term adjustment of cancer survivors and the factors that promote survivors' well-being. This paper presents an 18 month follow-up study of 26 women who were treated for various types of cancer at a major medical center in the United States. They completed questionnaires during the initial treatment phase of the illness and 18 months later. The questionnaire consisted of standardized scales measuring relationship factors (i.e., mutuality, silencing-the-self schemas, and relationship-focused coping) and psychosocial well-being (i.e., quality of life, depression, self-care agency). The results of the follow-up study revealed that the women's psychosocial well-being changed for the better between Time 1 and Time 2, while their relationship factors remained constant. Only one relational factor, silencing-the-self beliefs, at Time 1, was significantly correlated with a well-being variable at Time 2. However, relationship factors at Time 2 were significantly correlated with psychosocial well-being at Time 2, indicating that relational factors continue to play a significant role in the sample's psychosocial adjustment.
76 citations
TL;DR: Assessment of the practical and psychosocial needs of rural women with early breast cancer in Australia revealed that only 47% of the women who had to travel for treatment received financial assistance, and 13% of these women had difficulty organizing or claiming financial assistance.
Abstract: The purpose of the current study was to assess the practical and psychosocial needs of rural women with early breast cancer in Australia and recommend strategies to ensure equity in availability and access to cancer treatment for all women. A random sample of 204 rural women diagnosed with early breast cancer was recruited to participate in a telephone survey via state and territory cancer registries. Although the majority of women were satisfied with their provision of information overall, less than a third of participants were provided with specific information on assistance for rural women. Findings also revealed that only 47% of the women who had to travel for treatment received financial assistance, and 13% of these women had difficulty organizing or claiming financial assistance. Furthermore, only 10% of women found social workers to be a source of support.
68 citations
TL;DR: It is suggested that efforts at both the systems and individual levels, including changes in social work education, can be made to enhance mind-body interventions use in traditional health settings, as well in other types of settings.
Abstract: In the past decade, we have seen an increase in the popularity of mind-body medicine as an alternative or complement to traditional health care interventions. This paper explores the history of mind-body medicine and how particular mind-body interventions focusing on stress reduction and relaxation can be useful complements to social work practice. Four types of mind-body interventions are described, research on their effectiveness is reviewed, conclusions are drawn, and the applicability to social work practice is discussed. Given existing empirical support for the effectiveness of these interventions, the authors suggest that efforts at both the systems and individual levels, including changes in social work education, can be made to enhance their use in traditional health settings, as well in other types of settings.
66 citations
TL;DR: It is revealed that Arab women utilize psychiatric services less than Arab men, and Arab patients significantly underutilize mental health services, compared to Jewish patients.
Abstract: National hospitalization records (1995, 1986, N = 15,698) reveal that Arab women utilize psychiatric services less than Arab men. The exact reverse occurs among Jewish patients. Moreover, Arab patients significantly underutilize mental health services, compared to Jewish patients. Possible reasons for these utilization patterns include: Arab health care utilization patterns in general; the availability of mental health services in Arab communities; the influence of the "cultural" over the "professional" in Arab mental health utilization; the lack of Arab mental health practitioners; Arab attitudes towards mental health; and gendered role constructions within Arab society. Findings emphasize the need for a policy of developing infrastructure and trained personnel that can provide services adapted to the special cultural characteristics of the Arab population.
56 citations
TL;DR: Analysis of three-stage empirical secondary data analysis of seven specific types of social support, psychological history and stage of illness variables, and sociodemographics and their connection to medication compliance ratings revealed that having emotional support and being employed seemed to be predictive of being a “Good Complier.”
Abstract: Social work practitioners and researchers have greatly understudied the idea of how social support correlates with combination therapy medication compliance, in people living with HIV disease. Meanwhile, such data could help health social workers better assist HIV-infected people who want to cope well, live long, and avoid drug resistance. Therefore, this article presents findings from a three-stage empirical secondary data analysis that examined seven specific types of social support, psychological history and stage of illness variables, and sociodemographics and their connection to medication compliance ratings. A sub-sample of 179 HIV-infected clinical trial study participants enrolled in a federally funded combination therapy treatment study and a nested compliance study were analyzed. Analysis of 14 bivariate hypotheses and 20 predictor variables at the multivariate level revealed that having emotional support and being employed seemed to be predictive of being a "Good Complier." Also, having higher levels of HIV symptoms appeared to be associated with being a "Poor Complier."
49 citations
TL;DR: The experience of hospital work is explored and the identification of social workers'‘tolerance’ of the hospital environment is identified as a way of explaining staying, informing and challenges existing theories of retention and turnover of workers.
Abstract: Hospitals have traditionally been large employers of social workers. As workplaces they are often identified as being challenging and ambiguous environments for social work practice. In this study the experience of hospital work is explored. Social workers'‘tolerance’ of the hospital environment is identified as a way of explaining‘staying.’ Staying has both positive and negative features which arise from the interaction between workers' tolerance of the environment and their qualities of‘self-ac-tualisation.’ The identification of this relationship informs and challenges existing theories of retention and turnover of workers.
TL;DR: In this article, the authors report qualitative findings from a larger study that investigated, in part, illness perspectives of 96 women with hyperemesis gravidarum (HG) and reveal women view HG as biologically determined and that it has substantial impact on their daily functioning.
Abstract: There is a multiplicity of proposed causes, yet a scarcity of research regarding the pregnancy complication, hyperemesis gravidarum (HG), severe nausea and vomiting. This is not unlike other female medical conditions that have been underinvestigated, and perhaps as a result, erroneous assumptions about them persist. This is a report of qualitative findings from a larger study that investigated, in part, illness perspectives of 96 women with HG. Results reveal women view HG as biologically determined and that it has substantial impact on their daily functioning. The study challenges commonly held notions that HG is a psychosomatic disorder.
TL;DR: The perceptions of young adults with CF regarding the impact the disease has had on their lives, especially during the transition from adolescence to adulthood, indicate concerns about health insurance and finances, as well as the achievement of independence and optimism for the future.
Abstract: Cystic fibrosis (CF) has long been thought of as a childhood disease but the life expectancy for those with CF has been steadily on the rise and now reaches well into adulthood. There has been little or no research on the psychosocial impact of CF on becoming an adult. This exploratory, qualitative study examined the perceptions of young adults with CF regarding the impact the disease has had on their lives, especially during the transition from adolescence to adulthood. The findings indicate concerns about health insurance and finances, as well as the achievement of independence and optimism for the future.
TL;DR: The roles HIV/AIDS social workers will play in the next wave of the epidemic are described, and the implications of these changing roles for social work education and training are discussed.
Abstract: HIV/AIDS social work was changed fundamentally by the introduction of more effective medications to combat the disease, and by the spread of HIV/AIDS beyond the gay community to intravenous drug users and their sexual partners, women, children, adolescents, and people of color. This paper describes the professional challenges HIV/AIDS social workers now face at this stage in the history of the disease as a result of improved medications, and the spread of the disease to newer groups. We describe the roles HIV/AIDS social workers will play in the next wave of the epidemic, and discuss the implications of these changing roles for social work education and training.
TL;DR: Emotion-focused coping of acceptance and avoidance strategies were culture-specific, and were useful in reducing the stress associated with the resettlement difficulties encountered, and it was found that strategies such as acceptance, compromise and avoidance might have deleterious effects on the longer-term adjustment of immigrants.
Abstract: A qualitative study was undertaken to explore the stage-specific and culture-specific coping strategies used by Mainland Chinese immigrants in Hong Kong to handle psychosocial stressors experienced during the resettlement stage of the migration process. While direct action coping strategies of problem-solving and compromise were used by immigrants to deal with recurring, daily resettlement difficulties, cognitive strategies of positive comparisons and positive and optimistic thinking were utilized to change the meanings of these difficulties. Emotion-focused coping of acceptance and avoidance strategies were culture-specific, and were useful in reducing the stress associated with the resettlement difficulties encountered. It was also found that strategies such as acceptance, compromise and avoidance might have deleterious effects on the longer-term adjustment of immigrants. Implications for services and counseling for the immigrants were suggested.
TL;DR: The efforts of a large urban hospital to provide hospital-based comprehensive services to pregnant and parenting teens to reduce the negative consequences to them and their children, and to help them to become effective parents and lead healthy, productive lives are described.
Abstract: The impact of early pregnancy and parenting on adolescents is well documented, with its negative effects on achieving adequate education, job skills training, gainful employment and economic independence duly recognized. While current interest and resources focus on abstinence only programs as major pregnancy prevention initiatives, we are increasingly failing those young women who have chosen early parenthood as a life option. This article will describe the efforts of a large urban hospital to provide hospital-based comprehensive services to pregnant and parenting teens to reduce the negative consequences to them and their children, and to help them to become effective parents and lead healthy, productive lives.
TL;DR: In this article, the authors describe a demonstration project designed to explore psychosocial risk and resiliency factors, social work interventions and health-related outcomes with dialysis patients.
Abstract: SUMMARY This article describes a demonstration project designed to explore psychosocial risk and resiliency factors, social work interventions and health-related outcomes with dialysis patients. The study is unique in including an interdisciplinary research team to guide the process, using available data contained within the medical record and focusing on interventions and outcomes over time rather than at one or two points in patients' treatment histories. It demonstrates the complexity of practice with dialysis patients and the crucial role for social workers in enhancing patient outcomes. Secondary benefits of this methodology and implications for social work practice and research are discussed.
TL;DR: Adaptive skills needed for the restructured acute care context are focused on, including the creation of key roles for social work on the multidisciplinary team, pre-admission high-risk screening and discharge planning, high volume recording, and the development of community partnerships.
Abstract: SUMMARY The re-engineered acute care environment that emphasizes managed care, reduced costs per case and shorter lengths of stay also demands innovative approaches to the delivery of social work service. As departments disappear and other professions compete for roles in counselling, discharge planning and community liaison, there is a real threat to the viability of the acute hospital as a setting for social work. This paper focuses on the adaptive skills needed for the restructured acute care context, including (1) the creation of key roles for social work on the multidisciplinary team, (2) pre-admission high-risk screening and discharge planning, (3) high volume recording, (4) solution-focused brief interventions, and (5) the development of community partnerships. These conceptual strategies are implemented differently in examples drawn from three distinct high-volume patient groups: reconstructive orthopaedics, high-risk fetal assessment and thoracic oncology.
TL;DR: In this article, the authors present an approach to ethical decision-making at the end of life that is more inclusive of the patient's family and has the potential to advance social work practice in end-of-life care.
Abstract: A large number of Americans would rather rely on family and friends more than their physicians about end-of-life care and decisions. Moving beyond traditional clinical ethics and its dyadic focus on the physician-patient relationship, this article presents an approach to ethical decision-making at the end of life that is more inclusive of the patient's family and has the potential to advance social work practice in end-of-life care. Initial attention is given to how psychosocial and bioethical perspectives and practices interact to shape understanding of moral issues in end-of-life decisions. Morally relevant principles are then adapted from contextual therapy as being useful for including more of a family focus and viewing ethical decision-making at the end of life as a family process. Specifically, focus is on exploring the ethical dynamics of family systems that impact the decision-making process and translating psychosocial insight into ethical discussions that are supportive of families. The case of a patient with sudden and unexpected brain death and without advance directives demonstrates one family's unresolved grief and illustrates how its members were helped to reason morally about end-of-life choices. Contributions of a social worker and bioethicist are illustrated.
TL;DR: As the patient's initial PES condition was found to be the best predictor of involuntary return and duration of post-PES hospi-talization seemed to lose its prophylactic effect, it seems the authors have gone too far in reducing lengths of inpatient stays.
Abstract: Objective. Under managed care, there is pressure to shorten hospital stays. Yet, previous investigations have shown longer hospitalizations following a psychiatric emergency service (PES) evaluation reduce recidivism. This study examines the relationship between post-PES hospitalization, patient characteristics and involuntary PES return within 12 months. It is done in a context where average duration of post-PES hospitalizations are 6 days, approximately 1/4 the duration of previous studies reporting positive effects of such hospitalization. Method. Structured observations of PES evaluations of 417 patients were completed at 7 California county general hospitals. Follow-ups were conducted at 12 months after initial evaluation. Study objectives are evaluated using multivariate modeling. Results. Subsequent to the initial evaluation, 121 of the 417 patients (29.0%) were involuntarily returned to the PES. The likelihood of involuntary return was increased by a psychotic diagnosis and the seriousnes...
TL;DR: Gender differences were apparent in the type of disorders managed, in the perceived severity of caregiving duties provided and in the total range of activities engaged in, which challenges the myths of a close-knit migrant community looking after its own.
Abstract: SUMMARY Family-based caregiving refers to the daily provision of help to a co-resident family relative with the usual activities of daily living, custody and protection of a dependent relative at risk of self-injury, and support of a person with physical, developmental and/or mental disability or frailty due to ageing. Many reports from western studies refer to the caregiving burdens, stress and strains. A common view of migrant peoples is that they ‘look after their own’ to a greater extent than do English-speaking groups and that their closer connections with ethno-spe-cific community organisations and with their extended family networks provides more opportunities for assistance and support so that caregiving is shared and the burdens are reduced. A study was carried out with 300 Australian-Greek families in Melbourne where 150 were providing family-based caregiving, and these were age and gender matched with friends or acquaintances who had no such duties. Most care was provided bywomen, although almo...
TL;DR: Although children experienced slightly less pain intensity, pain aversiveness, and anxiety in the SBW condition, these results did not achieve statistical significance.
Abstract: This was the third randomized controlled clinical trial (RCCT) of Starbright World (SBW)-a private, interactive computer network for hospitalized children. The present randomized controlled clinical trial (RCCT) consisted of a series of 39 replicated single system designs (SSDs) that compared children's self-reports of pain intensity, pain aversiveness and anxiety in the SBW condition with those in a standard clinical practice condition. Findings from the SSDs were aggregated using meta-analysis. Although children experienced slightly less pain intensity, pain aversiveness, and anxiety in the SBW condition, these results did not achieve statistical significance. The relationship of these findings to the two prior studies of the effectiveness of SBW is discussed.
TL;DR: The role of practice-based research in enhancing worker reflectiveness is described and an array of administrative strategies employed in one hospital social work department to promote reflective social work practice are discussed.
Abstract: Promoting and sustaining a staff of reflective social work practitioners requires a supportive departmental structure and culture. Providing such support is a particular yet necessary challenge to social work administrators in the current health care environment. This article discusses an array of administrative strategies employed in one hospital social work department to promote reflective social work practice. More specifically, it describes the role of practice-based research in enhancing worker reflectiveness.
TL;DR: The role of the social work profession in the mental health service arena is discussed, stressing that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons.
Abstract: The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons. Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served. Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.
TL;DR: A subset of data from a larger study that explored the impact of the legal choice of physician assisted suicide on hospice providers revealed the dilemmas that arise from the hospice philosophy and the conflicts that emerge between the choice of PAS and social works' cardinal values and practice principles.
Abstract: This article presents a subset of data from a larger study that explored the impact of the legal choice of physician assisted suicide (PAS) on hospice providers. Eight social workers shared their personal and professional voices about a very controversial and difficult issue. Oregon is the only place in the country where PAS is legal and these social workers practice in an environment where the choice of PAS has been an option for two years. Three overarching themes emerged from the data: (1) the dilemmas that arise from the hospice philosophy; (2) the conflicts that emerge between the choice of PAS and social works' cardinal values and practice principles; and (3) the struggles with personal values and PAS.
TL;DR: In this paper, the authors analyse the difficulties faced in the importation of this urban-developed treatment model into a rural setting and suggest that group leaders in rural PND programs face more resistance to the idea of groups for therapeutic intervention, need to draw different lines betw...
Abstract: SUMMARY The treatment of postnatal depression (PND) via group therapy is an accepted practice in Sydney and other metropolitan areas throughout Australia. This article analyses the difficulties faced in the importation of this urban-developed treatment model into a rural setting. In 1995, this program was established in a major rural centre of New South Wales (NSW) and drew participants from the regional centre, surrounding rural properties, towns and villages. Participation in the program resulted in significant lowering or absences of depressive episodes following treatment. But beyond this significant aspect of a positive response to this treatment program is a fascinating aspect of differences between the rural and urban groups in this population. The differences occurred in group formation, group process and attitudes of the participants. We would suggest that group leaders in rural PND programs face more resistance to the idea of groups for therapeutic intervention, need to draw different lines betw...
TL;DR: The study underscored the importance of both spirituality and family in the lives of aging minority women and suggests an agenda for public policy advocates in the new millennium.
Abstract: The purpose of this study was to identify and describe perceived barriers to seeking health care, determine perceptions of confidence in health care practitioners, and explore strategies to enhance, promote, and improve early health care intervention among low income minority women. Focus group methodology was used to collect data and content analysis was used to analyze the data. Results revealed four broad categories for discussion: (a) confidence in the physician, (b) frequency of engaging in screening procedures, (c) barriers and influences in seeking health care, and (d) a wish list for covered health care services. The study underscored the importance of both spirituality and family in the lives of aging minority women. The paper includes implications for public policy and suggests an agenda for public policy advocates in the new millennium.
TL;DR: A policy analysis framework is used to compare recent developments in the mental health sector in Canada, the United States, Britain and Australia and identify the challenges for social work in the field of mental health in the 21st century.
Abstract: In recent years many countries have embarked on various types of health and mental health reform. These reforms have in large part been driven by governments' concerns for cost containment which has, in turn, been driven by an increasing process of global marketization and the need to control national deficits. A critical issue in these reforms is the increased emphasis on the use of "market mechanisms" in the delivery of health and mental health services. This paper uses a policy analysis framework to compare recent developments in the mental health sector in Canada, the United States, Britain and Australia. The common framework to be used for this will focus on: the defining characteristics of the society; legislative mandate; sectorial location (within or separate from health sector); funding streams; organising values of the system; locus of service delivery; service technologies; the role of social work; interprofessional dynamics; the role of consumers; and evaluation of outcomes at multiple levels. This analysis provides an opportunity to explore similarities and differences in mental system reform and in particular identify the challenges for social work in the field of mental health in the 21st century.
TL;DR: A retrospective, practice-based research study of social work interventions with liver transplant candidates and recipients based on a retrospective chart review to examine psychosocial risk factors, interventions and medical outcomes.
Abstract: This paper describes a retrospective, practice-based research study of social work interventions with liver transplant candidates and recipients. This study is based on a retrospective chart review conducted to examine psychosocial risk factors, interventions and medical outcomes. Psychosocial interventions provided to patients and families before and after transplant will be described as well as their relationship to medical outcomes. Research Findings and practice implications will be discussed.
TL;DR: This qualitative study examined several ecological aspects of medical social work practice that affect social workers' emotional well-being, with emotional dissonance emerging as a central theme.
Abstract: This qualitative study examined several ecological aspects of medical social work practice that affect social workers' emotional well-being. Forty-seven medical social workers from seven hospitals participated in small group interviews in which practice experiences were explored. A grounded theory approach was used to analyze the data, with emotional dissonance emerging as a central theme. Community, family, and individual factors contributing to emotional dissonance are presented, and the effect of social support is examined. Implications for social work practice are discussed.