Social workers' personal death attitudes, experiences, and advance directive communication behavior

This research surveyed 29 social workers to examine their personal death attitudes and experiences in relation to their advance directives communication practice behavior. The study measured death attitudes on 5 dimensions: fear, avoidance, neutral, approach, or escape acceptance of death. Participants' personal experiences with terminal illness and death were also assessed. Advance directive communication practices were operationalized as 7 phases: initiation of the topic, disclosure of information, identification of a surrogate decision-maker, discussion of treatment options, elicitation of patient values, interaction with family members, and collaboration with other health care professionals. Findings suggest that social workers' advance directive communication behavior differs by practitioners' death attitudes and experiences. Implications for social work education and professional development are discussed.     

Advance Care Planning Throughout the End-of-Life

Abstract

Advance care planning throughout the end-of-life is an increasingly important aspect of professional practice with older adults and their families. As the nation's population continues to live longer, more and more people will experience years of functional and cognitive decline prior to death. This article discusses the growing importance of advance care planning using a long-range, holistic perspective of examining care needs throughout the end of life. End-of-life care is conceptualized by three trajectories of decline leading to death, with about two-thirds of all older adults succumbing to four key conditions: congestive heart failure, emphysema, frailty, and dementia. Research regarding the advance care planning needs of older adults with the key conditions is presented. Further research is needed to enhance social work practice in this area.     

The Attitudes of Social Work Students Toward End-of-Life Care Planning

This study examined the attitudes of social work students toward end-of-life care planning, as well as their degree of willingness to engage in this area of social work practice. Factors associated with their attitudes were measured through structured surveys completed by 102 social work students (N = 102) at a school of social work in the southeast. Results indicated that these social work students tended to have positive attitudes toward end-of-life care planning in general. Moreover, these attitudes were positively associated with preference for pain relief treatment, higher levels of comfort when discussing death, more emphasis on self-determination, and apprehension of conflicts of self-determination. The results of this study underscored the increased societal need for recognition of personal preferences in end-of-life care, higher levels of comfort when discussing death, and an increased commitment of social workers' to maintaining the ethical principle of the client's right to self-determination in end-of-life planning. While this is not surprising, it points to a continuing need to re-assess where the field stands in its preparation of social work professionals who will work closely with people who are dying and their families.     

Managing in the Trenches of Consumer Care: The Challenges of Understanding and Initiating the Advance Care Planning Process

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.     

Long-Term Planning and Decision-Making Among Midlife and Older Gay Men and Lesbians

Abstract

This article examines the issues of long-term planning and decision-making among midlife and older gay men and lesbian caregivers. Using a qualitative methodology, in-depth interviews were conducted with 19 gay men and lesbians over 50. Participants reported on their long-term planning and decision-making processes. All but four persons reported that their partners had advance directives, but the majority of caregivers did not have advance directives for themselves. Concerns about informal family dynamics and interactions with formal systems were expressed, along with financial and ownership issues. It is important for social workers to intervene across individual, organizational, and community levels in advocacy for the needs of older gay men and lesbian clients.     

Beliefs,Death Anxiety,Denial, and Treatment Preferences in End-of-Life Care

Abstract

This study examined cultural and religious beliefs, death anxiety, denial, and medical treatment preferences in end-of-life care in a sample of social work students, community residents, and medical students in a mid-western city of 49,000. Results indicated that most social work students, community residents, and medical students preferred palliative as opposed to life-prolonging care during terminal illness. The three groups differed in cultural and religious beliefs and all three reported a moderate amount of death anxiety. Students reported less denial of terminality than community residents. Implications for personal and professional preparation to provide end-of-life care are discussed.     

The Effects of South Korean Social Workers' Professional Resources on their Understanding of a Patient's Right to End‐of‐Life Care Decisions in Long‐term Care Facilities

The aims of this study were to examine South Korean social workers' understanding of a patient's right to end‐of‐life care decisions (EOLCD) in long‐term care facilities and to explore the effectiveness of their professional resources in their understanding of this issue. A survey was conducted of 297 social workers from multiple long‐term care facilities in South Korea using structured questionnaires and face‐to‐face interviews. A multiple regression model was used, controlling for gender and religion. The participants' professional resources were measured by years of work, license type, number of beds, knowledge of advanced directives, experience in the EOLCD process, and training. The results demonstrated that South Korean social workers' understanding of a patient's right to EOLCD was moderate (mean 3.46), and their general (β = 0.576, P < 0.001) and medical knowledge (β = 0.117, P < 0.001) of advance directives, experience in the EOLCD process (β = 0.222, P < 0.001), and training (β = 0.028, P < 0.001) positively and significantly increased their understanding of patient rights (R² = 0.449, P < 0.001). The findings suggested that the development of academically supported and legally enforced standards and regulations for an EOLCD practice manual for long‐term‐care social workers would be beneficial.     

Possibilities for Intervention in Domestic Violence: Frame Analysis of Health Care Professionals’ Attitudes

ABSTRACT. Violence is a serious problem, and social and health care providers are in a key position for implementing successful interventions. This qualitative study of 6 focus groups with professionals (n = 30) examines the health care professionals’ ways of framing a domestic violence intervention. Of special interest here is how professionals see their own roles in the process of recognizing and helping victims of domestic violence. By using Erving Goffman's frame analysis, this study identifies several frames that either: a) emphasize the obstacles to intervention and justify nonintervention, or on the contrary, b) question these obstacles and find justifications for intervention. The possibilities for intervention are further explored by analyzing the ways in which the dynamics between the different frames allow redefinition of domestic violence interventions. Despite the challenges involved in a domestic violence intervention, there seems to be potential for change in personal attitudes and reform of professional practices. The research findings underline the role of social and health care professionals as members of a larger chain of service providers working collaboratively against domestic violence. Implications for practice and directions in policy and future research are suggested.     

Advance Directives Among Korean American Older Adults: Knowledge,Attitudes, and Behavior

The study objective was to explore knowledge, attitudes, and behavior about advance directives and how cultural values influence these beliefs. Three focus groups with 23 Korean American older adults were conducted. Advance directives were seen as helpful for ensuring that preferences for unwanted end-of-life treatment are honored and for relieving the decision-making burden on family members. However, some viewed completing advance directives as contrary to focusing on living. Culturally competent education about advance directives for Korean American older adults is necessary to help them make informed decisions about end-of-life care and informing family and health care providers of these preferences.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Learning Experiences of Older Volunteers in a Community-based Social Program for People with Dementia

Abstract

This qualitative study aimed to explore older adults’ perspectives on volunteering in an activity-based social program for community-dwelling people with dementia called Stepping Stones. Semi-structured interviews were individually conducted with eight older adults who had volunteered in Stepping Stones. Interpretative phenomenological analysis was used to analyze interview data. Four themes related to learning experiences of older volunteers in Stepping Stones emerged. These themes include (a) self-growth and confidence in working with people with dementia; (b) understanding dementia, people with dementia, and needed support for people with dementia and their families; (c) desire not to develop dementia, while recognizing that anything can happen in old age; and (d) exercising person-centered approaches and taking on advocacy roles. Findings suggest that older volunteers gain feelings of personal growth and confidence in working with people with dementia, better understanding, and enhanced attitudes toward people with dementia through volunteering in an activity-based social program for people with dementia. Older adults will be able to fill the needs of community programs for people with dementia, while experiencing benefits from volunteering and learning in later life. Further research is needed to examine to what extent having previous dementia experiences make their experiences and learning different.     

Perceptions of Preparedness to Assist Elders with End-of-Life Care Preferences

Abstract

Using a systematic sample of Florida licensed clinical social workers (N = 272), this study found that respondents perceived themselves capable of assisting elders with end-of-life care decisions and considered themselves moderately knowledgeable of resources available to elder clients. Respondents indicated slightly positive attitudes for work with elders and elders with Alzheimer's disease, and most respondents believed that elders should have the right of physician-assisted suicide. Using multivariate analysis, four predictor variables were identified that account for 61.3% of the adjusted variance of the dependent variable of preparedness to assist elders with end-of-life care preferences. These predictor variables were (a) knowledge of resources available to elders, (b) desirability of working with elders, (c) desirability of working with elders with Alzheimer's disease, and (d) attitude toward assisted suicide.     

Facilitating Forgiveness and Peaceful Closure

Abstract

The importance of addressing psychosocial concerns with dying patients is pivotal to facilitating peaceful closure in end-of-life care. The social worker's role in recognizing and providing skilled, psychosocial intervention with patients and families in hospice programs is significant. In this article, the literature in this area is examined and a case example of a hospice patient's need for closure and the responsive social work intervention for the patient in his moment of death is provided. The case offers social work knowledge and skills and demonstrates the therapeutic benefit of addressing psychosocial needs in end-of-life care. The importance of targeted training and continued skill development for social workers in end-of-life treatment settings is emphasized.     

Impact of an Infusion Model on Social Work Students' Aging Knowledge,Attitudes, and Interests

Abstract

This study sought to provide data regarding the use of infusion of gerontological materials throughout curriculums to enhance students' attitudes toward older adults, their knowledge of aging-related issues, and their perceptions of gerontological social work. A quasi-experimental design was used to compare outcomes for graduate social work students who were and those who were not exposed to gerontological infusion. Results indicated that exposed students experienced a greater improvement in their view of aging-related career opportunities and in their belief in the importance of gerontological social work. Treatment group students also showed greater gains in self-rated aging knowledge. Both treatment and control group students had significant gains in a test of aging-related knowledge. Pedagogical implications are discussed.     

Zelda Foster and Her Contributions to Social Work in End-of-Life Care

ABSTRACT

This article is both a memoir of one social worker's professional collaboration with Zelda Foster and a tribute to Zelda's legacy in the form of an educational resource on end-of-life care. It reviews achievements of Zelda Foster in social work practice and teaching related to death and dying. Resources presented in this article were supported by the Soros Foundation's Project on Death in America, a funded grant project to which Zelda contributed. The end-of-life care education, training and informational tools discussed in this article are examples of ongoing efforts in the social work profession to improve the lives of the dying and bereaved.     

A Qualitative Case Study on Recovery and Personal Growth in Korean Drug Addicts

ABSTRACT

In recent years, crimes related to drug smuggling and production have gradually increased in Korea. This qualitative case study explores the experiences of Koreans recovering from drug addiction and identifies specific details and mechanisms of recovery. For this purpose, participants were selected based on criteria such as engaging in social activities after recovery from addiction for 3 years or more. Next, one-on-one in-depth interviews were conducted with five voluntarily consenting participants. Data were analyzed using the within-/cross-case analysis suggested by Creswell. Substantial personal growth took place in the recovery process for drug addicts. Nineteen themes were identified as manifestations of personal growth through within-case analysis. Four common themes were then derived through cross-case analysis. These four common themes were “reconnection with reality,” “embracing the essence of one's own existence,” “reconstructing oneself in social relations,” and “self-love.” The study's results suggest that a recovery program needs to be developed wherein the program not only enables drug addicts to reflect on their current existence but also allows them to develop their specific coping skills. Future research should be broadened to consider the social support mechanism and viewpoints of people including family and local community members in close contact with drug addicts.     

Emotionally supportive counselling for health care personnel led by social welfare officers: effects on well-being

The aim of this study was to evalute an emotionally supportive counselling program for health care personnel that can be led by social welfare officers. The program consisted of 1-hour sessions conducted every second week for 7 months. The meetings were devoted to talks about personal stress experiences related to patients and their relatives. Nurses and nursing aides (n = 51) in counselling groups showed significant changes in a favourable direction on the following variables: fewer perceived daily hassles; fewer self-reported physical and psychological symptoms; and improved subjective well-being. No effects were noted on sense of coherence and subjective physical health status. Interviews with program participants, the group leaders (social welfare officers), and their supervisor (a psychotherapist) indicated how the counselling program may be affected by the personality and competence of the group leader, the working conditions of the wards in general and the attitudes of the head nurse in particular. The results were discussed as promising.     

Social Support for Mothers of Children With Disabilities in China

ABSTRACT.

This article analyzes the gendered parenting experiences of mothers of children with disabilities in China. These mothers struggle to meet their children's needs, including daily care, financial security, and child development. In the context of China's social welfare development, are social services responding to their needs, so that mothers can share responsibility for the needs of their children with disabilities? The research analyzed qualitative data about 6 case-study children in rural and urban China. The data were derived from observation and interviews with their parents and other family and community members. The analysis revealed that the capacity of the mother, community, and local social services had an impact on the rights of the children and mothers. They experienced social discrimination, insufficient social support, and local failure to implement central policy social services and income support. These findings are consistent with international research about disability rights. They reinforce the importance of economic redistribution to enable local implementation of the national disability rights policies, rather than merely relying on ephemeral concepts of cultural change. Further research about the comparative impact of economic and social change in China on mothers and children with disabilities would extend these findings.     

Transport related social exclusion in New Zealand: Evidence and challenges

Abstract

People without functional access to a car in countries where private vehicles are the predominant form of transport are at a disadvantage. Alternative modes of travel in such settings often do not meet people's mobility needs, creating barriers to participation in work, education, social activities, sport and leisure, and to accessing basic goods and services. In New Zealand, private vehicles have long been prioritised as the mode of personal transport in land transport planning policy. However, this is beginning to change with policy objectives now including improvement of access and mobility for all, and reduction of social exclusion. Despite this there is very little evidence of the experiences of those with mobility or access problems in New Zealand. This article seeks to provide qualitative data about experiences of transport related social exclusion, the efficacy of alternative modes for people's mobility needs, the impacts of these difficulties on people's lives, and the policy implications of these findings.