Towards Customized Deliberations

ABSTRACT

The profession of social work has important contributions to make in the rapidly developing dialog about medical care decision making and to the evolution of hospitals as systems that engage with people as patients, for whom illnesses create increased vulnerability (Gruber, 1998). Professional ethics clearly states that the individual professional social worker has a responsibility to influence processes involving vulnerable populations. Articulating social work's responsibility and potential contributions in the area of medical care decision making begins with an application of social work's mission and values, and then continues with consideration of the profession's evolving role in hospitals. Pertinent aspects of the health care industry, including current models for continuum of care and for provider-patient relationships, are discussed in terms of opportunities to modify the models used to guide interactions with patients. Finally, the impact of a growing number of distinct treatment options is also considered. The objective of the article is to offer social workers in health care settings a conceptual framework for considering professional ethical obligations and for participating in the contemporary dialog regarding medical care decision-making.     

An analysis of dyadic dominance in family decision‐making among older adults

Growth of the population aged sixty‐five and over is a significant trend in the sociodemographic structure of society. As a result, this age group is receiving increased attention from governmental and business decision‐makers. Little is known, however, about intra‐family decision‐making among members of this group. This paper presents an analysis of the determinants of husband and wife dominance in family decision‐making. The data indicate that dominance by the wife in decision‐making is related to the wife's positive self‐concept concerning the ability to make decisions as well as a “rub‐off” effect on the wife by the husband's self‐concept. Work history of the husband, in turn, contributes to his self‐concept. There were, however, no significant relationships between educational levels of either spouse and decision‐making dominance.     

Factors Influencing Family-Member Perception of “Homelikeness” in Long-Term Care Homes

Background: A number of long-term care homes in Nova Scotia, Canada, have been built or redesigned with new models of care with expanded care aide scope of practice and neighborhood-style layouts. Our objective was to examine what physical characteristics (bed size, owner-operator), model of care, and relational (family–staff relationship, perceived staff–resident relationship) factors were associated with increased family-member perception of homelikeness in long-term care homes.

Methods: We analyzed surveys collected from 273 family members from 23 long-term care homes in Nova Scotia, Canada. We conducted a multivariate linear regression to assess variables associated with increased family-member perception of homelikeness.

Results: We found that relationships between family and staff, perceived resident-to-resident relationships, and family involvement in decision making were positively associated with increased family perception of homelikeness. We found no significant associations between model of care or physical characteristics and increased family perception of homelikeness.

Conclusion: Relationships among family members, residents, and staff are integral to family members feeling at home in their loved one's long-term care home. Feeling at home in long-term care is largely related to family-member perception of meaningful social interactions between family and staff, and between residents.     

A Typology of Source of Information About the Continuing Care Retirement Community and Older Adults’ Living Arrangement

Abstract

A continuing care retirement community (CCRC) represents a residential alternative for older adults. It offers a variety of social and health care services to meet older adults’ needs and preferences. Using the theory of innovation as a theoretical basis, the overall goal of the study was to use the source of information about the CCRC as a potential predictor of the decision to move. In total, 76 older adults responded to a question about the source of information on the CCRC. Of these, 40 were CCRC residents and 36 were community dwellers, who expressed an interest in the CCRC but decided to remain in their community. Based on their responses, respondents were classified into one of five clusters (e.g., spouse, friends, children, nonhuman sources, mixed human and nonhuman sources). Those classified into the spouse or adult children as sources of information were more likely to live in a CCRC. Results show that information about the CCRC should be conveyed to additional members in the family, such as adult children, as they often take a major role in the decision to relocated. The findings have implications for administrators as they clearly point to potential sources of greater influence on older adults’ decision to relocate.     

There are no Answers,Only Choices: Teaching Ethical Decision Making in Social Work

Abstract

In teaching students about ethical decision making in social work, it is essential that the students are able to recognise the moral implications of their work and develop a deep understanding about ethical issues and their personal responsibility for making ethical choices. Thus, more than a “how to do it” approach is needed and teaching students about values and ethics is an essential thread that runs through our experience-based social work education program. The present paper describes a learning unit that sought to teach students about ethical decision making as a critical thinking process and, in so doing, to integrate students’ knowledge and experience of values, ethics, policy, and research in the final year of study. The relationship between values, ethics, policy, research, and social work practice provided an ideal context within which students could learn to integrate their knowledge and experience and apply it directly to their fieldwork practice. The paper ends with our critical reflection on this teaching experience and a critique of decisionist ethical frameworks.     

Problematic Integration and Family Communication about Decisions at the End of Life

Making a decision on behalf of a family member at the end of life (EOL) is a highly uncertain and anxiety-ridden experience. To examine how families navigate this complex, emotionally stressful situation, Problematic Integration theory was applied as a lens for understanding EOL decision experiences managed in the context of the family. Drawing on qualitative data from interviews with 22 family members who participated in family conversations about an end-of-life decision, this study demonstrated that family members encounter multiple sources of uncertainty and divergence, including questions regarding whether or not a family member’s life is ending, what the decision should be, and who should make or participate in the decision. Family members’ stories also identified ways in which medical professionals and communication about the wishes of the patient helped family members manage problematic integration. Finally, findings revealed experiences where problematic orientations were not transformed after family members made an EOL decision.     

Traumatic Brain Injury

Abstract

Traumatic Brain Injury (TBI) is a devastating medical condition mat can happen to anyone at anytime, despite precautions. This paper provides details regarding etiology, symptoms, prognosis, and treatment of TBI. Patients and families usually require assistance and direction from several healthcare professionals, including social workers, both during and after the initial period of hospitalization and rehabilitation. After a brief discussion of interventions at several levels, the paper concludes with a focus on both the individual and the family, and how social workers in the hospital or rehabilitation clinic can intervene to assist the patient and family members in learning and using more effective methods of coping. Implications for social work practice are included.     

Family Law and Foster Care

Abstract

There are challenges associated with teaching family law and public policy; however, cooperative learning, a recognized teaching strategy that serves to enhance students' overall development, including academic, cognitive, and social growth, can be used successfully to teach this subject matter. In this paper, we describe how we taught students about some aspects of qualitative research methods, foster care policies, and pertinent family law concepts and practices; this was done through the initiation of a research team of undergraduate and graduate students. We explain the development of a cooperative research team, and the methods used to teach family law, using foster care as a context. The observed outcomes for students and faculty members are offered to readers.     

An Analysis of the Patient Self-Determination Act of 1990

Advance directives (ADs) provide a way to express medical care preferences at the end of life, yet they are underutilized. This article analyzes the effect of the Patient Self-Determination Act and presents recommendations for the improvement of AD legislation. Although the Patient Self-Determination Act was intended to educate patients, clinicians, and the public about ADs, more work is needed to improve involvement in end-of-life care decision making for individuals who may be disenfranchised in this process.     

Social work students’ professional and personal exposure to social work: an Australian experience

General career research suggests that many factors may influence how people select a career, including information about or exposure to the career. The focus of this paper is upon how exposure to a social worker personally (e.g. friend or family) or in a therapeutic capacity (e.g. received social work therapy) may influence the decision to become a social worker, when compared to other disciplines. The results showed that 63% of 64 social work students had personal and/or professional exposure to social work prior to making a career decision. When compared to other students (n?=?447) the social work students were significantly more likely to have accessed social work services (themselves or a family member). The influence of a friend who was a social worker and working with a social worker was noteworthy for mature-aged students. These results highlight that every interaction social workers have with the community provides valuable information about the profession and gives insight into social work as a career. Additionally, the results suggest that the increase in numbers of social workers and the influence of that exposure to a social worker have resulted in an increase in the use of social work services by students, and may continue to rise in the future.     

The geriatric social worker and his self-awareness

Abstract

Hospice and palliative care services have become an established part of Australian health care in the last decade. Multi-disciplinary teams are usually a feature of such services and social workers are common members of such teams. Yet the exact extent of their use and role in these programs has not been investigated previously. The author conducted a survey of 53 social workers working in such programs and at the same time, another questionnaire was also sent to service directors in all 134 Australian programs about their utilisation and perception of social workers. This article reports the results of both surveys. The results show that a third of the programs employed social workers, but the social workers themselves reported a number of difficulties: nurses are often the dominant occupational group and role-blurring amongst team members is common. The findings are discussed in terms of their implications for the social work profession.     

Food: Sustenance and Symbol

Abstract

College students often delay or avoid seeking testing for sexually transmitted infections (STIs), even if the services are readily available. We used in-depth, semistructured interviews to survey 41 college students aged 18 to 23 years about factors that influence decisions about STI testing. We grouped statements into 9 themes that represent influences on the decision. The most frequently mentioned factors were negative consequences of testing and perceived vulnerability to infection; other issues that influenced decision making included perceived benefits, perceived severity of diseases, public knowledge and opinion, social norms, provider characteristics, test-site characteristics, and personal considerations. Social stigmas and negative consequences appear to represent significant barriers to college students' being tested, which could increase the risk of spreading infections to others. Clinicians and health educators should raise students' awareness of the need for screening and should work to reduce the barriers to screening, including social stigmas and negative consequences.     

Using Student Course Evaluations: Findings,Issues, and Recommendations

Abstract

Although university administrators widely use student course evaluations (SCEs) in evaluating faculty performance, faculty members are skeptical about what SCEs actually measure. Faculty lack information about SCE reliability and validity and whether administrators use them fairly in making personnel decisions. This article reports research findings on factors that threaten the reliability and validity of SCEs. It provides recommendations for minimizing these threats. It reports findings of a recent survey of social work deans on their opinions about and use of SCEs. The article also presents recommendations to enhance the use of SCEs.     

Language Reversion among People with Dementia from Culturally and Linguistically Diverse Backgrounds: The Family Experience

Abstract

Culturally and linguistically diverse (CALD) older people with dementia, along with their families, face many unique challenges and have unique needs. One such challenge is language reversion, an issue that has received little research attention. This paper presents the findings of an exploratory study of the experiences of family members of people with language reversion emanating from dementia. Using a qualitative, phenomenological approach, in-depth interviews were conducted with seven participants. The study found that the presence of language reversion created additional challenges for family members of someone with dementia, particularly if the family member did not share the person's first language. Community-based aged care services have the potential to offer valuable support, but barriers of negative past experiences, lack of communication, stigma, cultural understanding, and locality need to be overcome. While further research is recommended, these findings have implications for both policy and social work practice in community-based aged care with CALD populations.     

Shit is good: Mental health social work with lives of squalor

This paper investigates the phenomenon of three clients living in squalor, all of whom have severe and enduring mental health problems, and are on the caseload of a mental health social work team. By thinking about the clients both individually and as a group, within a psychoanalytic framework, it attempts to understand their squalor in a new way, with particular regard to the transference and countertransference experienced by the practitioner. By making use of social work literature as well as that concerning organisations and community care, it also discusses the impact these clients make on the wider community around them, and examines some of the dilemmas faced by the practitioner. The implications for social work are serious and far-reaching and these are discussed with regard to long-term intervention as well as professional and personal scrutiny.     

Supporting the Well-Being of People with Mobility Disabilities Through Social Work Practice

ABSTRACT

The purpose of this insight generating study was to explore the viewpoints of people with mobility disabilities (PWMD) about ways for social workers to promote their well-being through social work practice. A qualitative participant action style methodology encouraged PWMD to voice their concerns and recommendations. Eighteen PWMD were interviewed, including nine consumers and nine social workers. Participants indicated from their experiences that social workers commonly are not sufficiently cognizant of the personal goals, perspectives, and health potentials of PWMD. Overall, they suggested that the social work practice approach for people with disabilities should become more holistic and proactive. Their recommendations are consistent with current ideas about best practice in the social work and disabilities literature and they reinforce the importance of making these ideas more widely practiced.     

Investigating the Readiness of Hospital Social Workers to Respond to Domestic and Family Violence

ABSTRACT

Domestic and family violence (DFV) is recognised as a health care priority. Women experiencing DFV use health services at a higher rate than the general population. Hospital social workers are an important component of a public hospital response to domestic and family violence but how prepared are they for this role? This research study explored the readiness of social workers in a Melbourne metropolitan hospital setting to respond to DFV. Results indicated that although the social workers had a knowledge base highly relevant for responding to DFV, many lacked specific knowledge of risk assessment, safety planning, legislative responsibilities, and referral pathways for support, including legal support. As a result, it was likely that they were not adequately responding, either by not recognising when they needed to, or with knowledge and confidence when they did. They also identified a range of organisational enablers, including policy, time, and safe conversation spaces.

IMPLICATIONS

• Hospital social workers have a central role to play in responding to domestic and family violence.

• Hospital social workers need to be better prepared for domestic and family violence responses.

• Social workers require ongoing training and organisational support including practice protocols and guidelines, and the provision of time and private, safe spaces for sensitive conversations to occur.

• Universities should ensure that the role of hospital social workers is considered within curriculum addressing the area of domestic and family violence (DFV).

     

Foster Care to Kinship Adoption: The Road Less Traveled

ABSTRACT

Although a rather extensive literature concerning informal kinship care and kinship foster care has emerged over the past 30 years, much less is known about the children and families involved in kinship adoption. This article pays particular attention to recent research that investigates placement decisions and outcomes for former foster children adopted by relatives. This review suggests conclusions similar to broader reviews, in that kinship placement tends to show some consistently favorable outcomes across a range of study populations and methods. Financial need may be the greatest concern for relatives who adopt. The Fostering Connections to Success and Increasing Adoptions Act of 2008 expands adoption subsidies and provides states with the option of providing ongoing subsidies to certain relatives who take guardianship of family members from the foster care system. However, relative caregivers often are not well informed about financial supports afforded them by federal and state policies. Specialized programs for kinship adoptive families are still limited. Much of the growth of kinship placement has been due to the absence of other placement options for many children and value-based decision making that places a premium on kinship, rather than on evidence of the advantages of kinship adoption.     

Family Functioning and Satisfaction of Former Residents of a Non-Therapeutic Residential Care Facility: An Exploratory Study

ABSTRACT

Recently there has been a resurgence in discussions among government policy-makers regarding the use of non-therapeutic residential care as an alternative to kinship and family foster care. If informed decisions are to be made regarding foster care alternatives, evaluation is needed of how children fare in residential care facilities. This study looks at the family relationships and life satisfaction of 76 adults who resided in a residential care facility as children. The overall positive results suggest that the negative reputation of non-therapeutic residential care facilities may not be wholly deserved. The authors hope that this information can assist social workers and policy-makers in making important decisions about the appropriate use of residential care with our country's future population of foster care children.     

Child protection decision-making: social workers’ perceptions

ABSTRACT

Decision-making is located at the heart of social work as a core professional activity, because much of what social workers do concerns decisions about future courses of action. Drawing on elements of the learning together systems model and Falkov’s Systemic Family Model, this study investigated social workers’ perceptions regarding how child protection decisions are made. Evidence was drawn from a constructivist–-interpretivist qualitative research design, involving 16 semi-structured interviews with qualified and experienced social workers and 20 direct, non-participant observations of child protection meetings. Evidence from the study suggests that professionals and family members do not rely entirely on the guidance on the threshold criterion of the likelihood and significance of risk of harm when making decisions. Instead, they use discretionary intuition and analytical judgement, involving multidimensional criteria which includes consensus between professionals and with family members; individual professional’s state of mind; other agencies and professionals’ priorities as well as external factors such as the availability of resources. Conclusion can be drawn that existing guidance on decision-making is inadequate, hence the discretionary use of a combination of intuitive heuristics and analytical thinking in a complementary manner. This study, therefore, contributes to considerable conceptual clarity regarding the complex child protection decision-making process.