The role of social work in the ICU: reducing family distress and facilitating end-of-life decision-making

The costs associated with Intensive Care Units (ICUs) are high and at times invasive ICU care may not be beneficial, particularly for those patients admitted to ICUs who have little hope of recovery. The process of clarifying medical goals for these patients is often facilitated by addressing psychosocial factors. Social workers in the ICU are uniquely qualified to assess and address many of the complex psychosocial circumstances and can clarify potential misperceptions, enhancing communication among patients (if capacitated), their families, and the medical team members. This can not only help improve quality of life for very sick and dying patients in the ICU and their families, but may also reduce the likelihood of decision-making conflicts from arising. Further studies need to be done to investigate the effectiveness of social work interventions in reducing family distress, avoiding care that is unwanted by patients, and demonstrating cost-saving benefits.     

Calling the question of "possible dying" among nursing home residents: triggers, barriers, and facilitators

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as "dying" can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of "possible dying" by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Facilitating forgiveness and peaceful closure: the therapeutic value of psychosocial intervention in end-of-life care

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.     

Pediatric palliative and end-of-life care: the role of social work in pediatric oncology

Pediatric oncology social workers are often engaged in the psychosocial care of dying children and their families. Despite their participation on the interdisciplinary team, the role for social work in pediatric palliative and end-of-life care has not been clearly defined. This survey of 131 pediatric oncology social workers identified current and best social work practices for care of children and their families at the end of life. Implications for practice, education, and research are discussed.     

HIV/AIDS treatments

Although fewer people are being diagnosed with AIDS in the U.S. and deaths continue to decline, the number of adults age 50 and older who are living with HIV/AIDS is larger than ever. It is likely that older people will continue to comprise an increasingly larger proportion of individuals diagnosed with HIV/AIDS, reflecting both the ineffective prevention efforts targeting older adults and the highly effective antiretroviral therapies that allow many people to live for significantly longer periods of time. These recent trends have created two distinct populations of older persons with HIV/AIDS: those who were infected later in life and those infected earlier and now aging with HIV disease. Aging with HIV/AIDS presents unique psychosocial challenges that may be exacerbated by the aging process. HIV-related stigma, social support and coping issues and evidence-based psychosocial interventions for older adults with HIV/AIDS are reviewed in this paper and suggestions for future research are discussed.     

Pediatric Palliative and End-of-Life Care

Abstract

Pediatric oncology social workers are often engaged in the psychosocial care of dying children and their families. Despite their participation on the interdisciplinary team, the role for social work in pe-diatric palliative and end-of-life care has not been clearly defined. This survey of 131 pediatric oncology social workers identified current and best social work practices for care of children and their families at the end of life. Implications for practice, education, and research are discussed.     

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.     

Calling the Question of “Possible Dying” Among Nursing Home Residents

Abstract

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as “dying” can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of “possible dying” by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Hospice care for the child with AIDS

Hospice care was established to provide palliative (i.e., noncurative) services for the dying and their families. The advent of the AIDS epidemic has posed a challenge to hospice care, particularly for the child dying of the disease, and has adapted to modified palliative services. Parents, with a child dying of AIDS, must deal with many issues of disclosing the disease status to the child, coping with the emotions of losing a child, and when and where to incorporate hospice services into the dying process. Optimizing home based hospice care involves; (1) Nutritional management, (2) Prevention of opportunistic infections, (3) Pain management, and (4) Protection of Non-HIV positive members of hospice care. For the dying, hospice strives to achieve a peaceful death and provide supportive intervention for the survivors.     

Beneath the Mask: A Group Therapy Model Supporting Children Infected With and Affected by HIV/AIDS

In 2007 a study was conducted to identify the outcomes of an activity-based psychosocial intervention called Leading the Way, a program designed for children infected with and/or affected by HIV/AIDS, based in Toronto, Canada. Qualitative and quantitative data showed that children who were unaware of the HIV status of their families experienced heightened anxiety and depression when compared to children who were aware of the presence of HIV in their families. Furthermore, data indicated that though the intervention positively influenced children's senses of self and their ability to cope and problem solve, deep social stigma surrounding HIV continued to profoundly affect the lives of these children. The ethical dilemmas involved in serving populations of children who have not been disclosed to regarding their own or a family members' HIV status came to light in the development of the program and are discussed in the analysis of data.     

Crisis as challenge: counselling counsellors,persons living with HIV / AIDS and survivors

Although the AIDS pandemic has catastrophic implications for all levels of South African society, it can be viewed as an opportunity to face the inevitability of human mortality with dignity rather than fear and denial and to rebuild shattered communities. This article discusses issues pertaining to counseling HIV-infected persons, the counselors themselves, and families and social groups affected by AIDS-related deaths. Counseling of HIV/AIDS patients is supportive in nature, with a focus on here-and-now issues such as unfinished business, reconciliation with family members, finding meaning in daily activities, and preserving a sense of personal control. This process can be obstructed, however, by distrust of authority figures, anger at experts who fail to cure the disease, and an internalized sense of shame and inferiority. The effectiveness of AIDS counselors depends on their ability to recognize and resolve personal conflicts triggered by HIV-positive clients, including feelings about death, helplessness, overidentification, and discomfort with sexual issues. Most South Africans will face bereavement and have to go through a mourning process for friends and relatives. Complicated and delayed grief reactions triggered by new and continuous losses can be expected. Involvement of community members in the grieving process, whether as helpers, volunteers, professionals, or recipients of service, offers South African society an opportunity for development of a new culture of compassion.     

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.     

Treatment at the end of life

End-of-life care has gained recognition as an important interdisciplinary clinical domain during the past three decades largely because scientific and medical advances have changed the nature of dying in the US. Advances in the treatment of life-limiting ilness have typically focused on medical issues and on treating the physical symptoms that accompany the final stage of a terminal illness. However, because the lengthening life span has made more choices available at the end of life, there is also greater need for evidence-based psychosocial treatment to diminish some of the prolonged emotional, psychological treatment to diminish some of the prolonged emotional, psychological, social, and spiritual distress that accompanies dying. Both terminally ill older adults and their caregivers can be helped by interventions that address the need for information, education, preparation, communication, emotional support, and advocacy. This paper preents a review of evidence-based psychosocial treatments at the end of life for both older adults and their caregivers.     

The Capacity to Care

The social work profession has demonstrated a commitment to assisting the disabled elderly to maintain an independent life style within the community. The dual focus of the profession has led to the development of a variety of instrumental and psychosocial approaches to assist elders and their families. This paper addresses the conceptual basis for social work practices with elderly persons in non-institution settings. It involves a discussion of family caretaking process and an examination of the relevance of family theory to social work practice. A model is presented which would assist the practitioner in integrating instrumental and psychosocial approaches to serving the aged.     

Ageism,Death Anxiety and the Caseworker

ABSTRACT

This paper presents the results of an exploratory research study designed to identify some of the attitudes and socio-cultural characteristics of social workers practicing in the field of aging. Data were collected from two groups of caseworkers-one group with a geriatric caseload, the other with a non-geriatric caseload. There were striking and significant differences between the two groups in their preferences for working with particular client populations. The geriatric caseworkers indicated a preference for working with the frail elderly and cancer patients and negative preference for working with younger clients (either disturbed children or adolescent offenders). The non-geriatric caseworkers generally expressed a negative preference for the frail elderly or cancer patients and a preference for young married couples. No single factor seemed to differentiate the two groups as clearly as their levels of death anxiety. Those practicing in the field of aging revealed a significantly greater level of death anxiety as indicated by their higher levels of fear of the dying of others. Results also pointed to a relationship between death anxiety and the number of years of social work practice with the aging. In general, the greater number of years in the field of aging, the greater the level of anxiety tended to be, leveling off at about six or seven years. When the age of the social worker was held constant longevity in the field of aging affected levels of anxiety about the death of others, the dying of self, as well as the dying of others.     

Paternal involvement in fragile,African American families: Implications for clinical social work practice

Abstract

Changes in family formation and structure mandate reassessment and realignment of traditional parenting roles and arrangements. Adaptation to these changes has been truncated along racial and socioeconomic status lines. Poor African American families and especially fathers in fragile families are most vulnerable and are in need of individual and structural assistance to achieve expected personal and societal role development. The “person‐in‐environment” perspective of clinical social work offers an organizing framework for interventions designed to improve paternal role and family functioning.     

Supporting HIV/AIDS affected families and children: the case of four Chinese counties

This article focuses on the impact that HIV/AIDS has on children in China and the social support provided to these children. The research finds that the consequences of HIV/AIDS are serious: the entire environment in which children develop is adversely affected by the disease. These negative socio-economic effects are due not only to HIV/AIDS, but also to the social discrimination and exclusion experienced by affected communities and families. Local governments and societies have started to provide support to HIV/AIDS-affected children and work to reduce the social exclusion they suffer. However, many challenges and problems still lie ahead.     

Clinical Case Management

Case management is a vital service in gerontological social work-perhaps the most essential service. Extreme variation in the definition and implementation has detracted from the core functions of case management. When these functions are placed in a clinical context, case management becomes the treatment of choice for many frail elderly and their families. There have been many forces operating against the development of professional case management, yet gerontological social work must take the lead in clinical case management practice. Social work educators must play a key role in preparing social workers for case management and promoting this treatment model as the hallmark of gerontological social work.     

Resilience among older caregivers in rural Namibia: The role of financial status,social support and health

Background: Namibia has one of the highest human immunodeficiency virus (HIV) prevalence rates and one of the highest rates of orphanhood in the world, and older caregivers provide much of the care to Namibians living with HIV and acquired immune deficiency syndrome (AIDS) (UNAIDS, 2014). In this study, the authors explore how financial status, social support, and health were related to the resilience of caregivers caring for people affected by HIV and AIDS in rural northern Namibia, Africa. Method: Data were collected through a structured interview from (N = 147) caregivers from the Zambezi region. Results: Findings from this study show that employment and physical health were significantly associated with increased resilience in older caregivers. Discussion: Our findings point to the need for employment assistance and health services to improve the resilience of caregivers caring for people living with HIV and AIDS. We conclude that there is a need for more vigorous concerted efforts from public and private sector practitioners and policy makers to create more sustained formal employment opportunities and intervention programs aimed at improving the overall health of older HIV caregivers, especially those residing in rural HIV endemic communities in developing countries.     

Social work in South Africa at the dawn of the new millennium

The article examines recent developments in social policy and its implications for social work education and practice in South Africa. It traces the changes from the birth of democracy in South Africa to the dawn of the new millennium as these crucial years marked the beginning of a new era in South Africa's welfare history. It examines the challenges to social work and provides an example of the integrated, holistic developmental interventions, which are needed to combat social problems such as crime, AIDS and poverty. It ends with an examination of the implications of developmental welfare policy for social–work education as social workers are called to address mass poverty, unemployment and social deprivation through greater use of diverse social work methods, such as advocacy, community development, empowerment, consultation, networking, action research and policy analysis.