Moral distress among social workers: The role of insufficient resources

The present study examined moral distress among Finnish social workers and the role of perceived resource insufficiencies in explaining it. The aim was to shed light on this understudied phenomenon in the field of social welfare. The study focused on work‐related moral distress, defined as impaired wellbeing that is connected to the continual inability to implement actions that one considers morally appropriate. The survey data were collected with an electronic questionnaire between the years 2011 and 2012. The respondents (n = 817) were social workers in the public social welfare services and the overall response rate was 46.5 per cent. Nearly 11 per cent of the respondents reported experiencing moral distress and perceived resource insufficiencies strongly explained this experience. Moreover, social workers with moral distress reported that they were less willing to continue in their post, were more frequently on sick leave and had positive work‐related experiences less often than their colleagues who did not experience moral distress. Key Practitioner Message: ● The concept of moral distress is useful in describing the experiences of social welfare workers when they are unable to practise their profession according to their moral code and the emotional burden related to this inability; ● Perceived resource insufficiencies are strongly associated with experiences of moral distress among frontline social workers; ● Social workers experiencing moral distress are less willing to continue in their work, take sick leave more often and less frequently have positive experiences related to their work.     

Comfort and Confidence Levels of Health Care Professionals Providing Pediatric Palliative Care in the Intensive Care Unit

ABSTRACT

Most childhood deaths that occur in the hospital happen in the pediatric intensive care unit. Providing pediatric palliative care in the intensive care unit comes with unique challenges due to the acute care, curative and often medically aggressive focus of these settings. In this study, 190 PICU health care professionals reported on their comfort and confidence in providing palliative care. Findings indicate that professionals report only a moderate level of comfort and confidence in this type of care in the pediatric ICU. For physicians and nurses, comfort and confidence was significantly higher for those who had practiced 8 years or more. Practitioners reported less comfort in providing psychosocial care. Implications for the social work role on the interdisciplinary team and suggestions for future research are discussed.     

Webster‐Stratton Incredible Years Basic Parent Programme (IY) in child care placements: residential staff carers' satisfaction results

The aim of the present study was to investigate residential child care staff satisfaction with their involvement in the Webster‐Stratton Incredible Years Basic Parent Programme (IY). In an exploratory, not randomized study, 27 professionals from two different short‐term Portuguese residential child care centres (IG1, n = 15; IG2; n = 12) completed weekly IY evaluations and an overall satisfaction questionnaire at the end of their participation in the IY intervention. The weekly level of satisfaction was assessed with regard to each of the programme's components (content, DVDs, group leaders, group discussion). At the last session, they filled out a questionnaire aimed to evaluate the levels of satisfaction regarding the programme overall, the teaching format, the group leader(s) and the usefulness of specific educational techniques they learned. Data indicated that residential staff carers were highly satisfied with the weekly sessions and with the overall usefulness of the intervention programme. Results are discussed in terms of implications and future research directions.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

Unmet Needs at the End of Life

Abstract

Among persons at the end of life, it is important to understand whether the needs of patients are being adequately addressed. In particular, in hospice settings where the emphasis is on comfort care and quality of life, we know little about the presence of unmet needs. The purpose of this study was to examine the experiences of hospice social workers in working with hospice patients who had unmet needs at the end of life. Surveys were mailed to hospice social workers (N = 212) in two Southeastern states with a response rate of 36%. Results revealed that hospice social workers perceived patients to experience a wide variety of unmet needs-more commonly at the time of admission than during subsequent patient interactions. The most common unmet need reported at both times was a decreased ability to participate in activities that make life enjoyable. In situations where unmet needs exist, social workers reported that the most common perceived reasons were patient-related psychosocial issues and family conflict/issues. Additionally, a variety of interventions were used to address unmet needs, but a large number of barriers appear to impact outcomes in the cases. Results suggest that hospice patients experience a number of unmet needs, many of which are potentially treatable problems and concerns. Hospice professionals must continue to seek ways to assess and intervene effectively with patients who have unmet needs.     

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.     

A secure base? The adolescent–staff relationship in secure residential youth care

The client–therapist relationship is recognized as an important factor contributing to outcomes of child and youth care. Particularly in secure residential youth care, in which adolescents with mainly externalizing behaviour problems are often placed coercively, the client–staff relationship seems to be important for the achievement of positive outcomes. The present study aims to assess the client–staff relationship for a group of 135 adolescents in secure residential care and factors associated with a positive relationship. The results show that adolescents, group care workers and teachers experience a limited affective bond in their relationship 2 months after the adolescents were admitted to the secure care centre. Adolescents do tend to use care workers and teachers as a secure attachment figure, which suggests that an affective bond is no precondition for the adolescents to experience staff as a secure base. Main predictors of a good relationship are the positive treatment skills of both group care workers and teachers. These findings point to the need for training of care workers and teachers so that they are better prepared for working with these adolescents.     

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.     

Managing behaviour in child residential group care: unique tensions

Residential group care workers are frequently required to support children with extremely challenging and aggressive behaviour. Our knowledge about the tensions that may exist for workers that manage difficult behaviour is theoretically and empirically underdeveloped. The aim of this exploratory study was to contribute to our understanding of the dynamics of behaviour management in the residential environment by identifying the worker‐reported tensions involved in the management of challenging and disruptive behaviour. Seventeen South Australian residential group care workers participated in semi‐structured interviews in which they were asked to describe their management of behaviour. These interviews were subjected to thematic analysis. The analysis revealed several dynamics that influence workers' management of challenging behaviour: the sense of parenting at a distance, the pressure for consistency, the desire for balance between control and connection, the desire for normality and the inconsistent nature of relationships. These findings contribute to our knowledge about the interpersonal context in which behaviour is addressed in the residential group home and enhance our understanding of the unique tensions that workers' experience in managing behaviour in the residential environment. The findings have implications for the development of staff training and the support of residential care workers managing challenging behaviour.     

Risk Management Paradigms in Health and Social Services for Professional Decision Making on the Long-Term Care of Older People

Risk management systems and structures are developing rapidlywithin UK health and personal social services. However, therisk management strategies of organizations need to take intoaccount the conceptual frameworks used by professionals. Thisgrounded theory study used data from nineteen focus groups andnine semi-structured interviews (ninety-nine staff in total)to explore perspectives on risk and decision-making regardingthe long-term care of older people. Focus group participantsand interviewees comprised social workers, care managers, consultantgeriatricians, general medical practitioners, community nurses,occupational therapists, home care managers and hospital dischargesupport staff. Social work and health care professionals conceptualizedrisk and its management according to six paradigms that appearedto be in a state of reciprocal tension: (i) Identifying andMeeting Needs; (ii) Minimizing Situational Hazards; (iii) Protectingthis Individual and Others; (iv) Balancing Benefits and Harms;(v) Accounting for Resources and Priorities; and (vi) Warinessof Lurking Conflicts. The effective translation into practiceof risk management strategies needs to address the complex andoften contradictory issues facing health and social servicesprofessionals.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

A family-centred practice supervision project conducted for a child welfare agency

ABSTRACT

This paper reports on a supervision project that aimed to enhance a child welfare agency staff’s professional competence in family-centred practice through a strength-based approach. A qualitative study was designed to explore the effectiveness and the change agents of the supervision. Purposive sampling was used. Two agency supervisors and two social workers participated the study voluntarily. The findings indicated that after the period of supervision, the staff had changed in three respects: their conceptualisation of the meaning of family work in the care context; their understanding of the importance of relationship-based interventions with families; and their development of alternative ways of practice. The agents of change from the supervision were the consultants’ modelling effect and the co-worker experience of the consultants and the social workers. This supervision approach can discern the synergistic effect of supervision on an agency’s routine supervision and balance the cultural beliefs in qing, yuan and ‘face’ embedded in the supervisory process.     

Health and distress in social workers: Results of a national survey

Abstract

This study investigated the physical and emotional health status of professional social workers as well as their levels of distress. The results of this national survey of 668 randomly selected NASW‐member social workers indicated that while most were healthy and satisfied with work and relationships, 17% experienced distress, defined as substance abuse, emotional problems, and/or physical illness. The distressed social workers were more likely to experience difficulties in many areas of their lives, including dissatisfaction with work and low self‐esteem. Some of the social workers reported seeking help for personal/ emotional problems, but very few sought help for alcohol/other drug problems.     

Helping the helpers: Post‐traumatic distress and need for help among Israeli social workers in foster care agencies following armed conflict

This study examined the associations between exposure to armed conflict, perceived support, work experience, needing help, and post‐traumatic distress among Israeli social workers in foster care agencies based on Conservation of Resources theory. The study used a mixed‐methods design. Six months after the end of an armed conflict, 82 social workers responded to a web‐based questionnaire with closed‐ and open‐ended questions. Results showed that exposure to the armed conflict was moderately associated with post‐traumatic stress symptoms and functional impairment. Only the workers' perceived need for personal help (but not help for professional matters) was positively associated with their psychological distress. The qualitative analysis suggests that social workers showed strengths and wanted help mainly to improve their professional skills. Yet they also elaborated on the complexities involved in conducting their professional work, especially home visits, because such visits put their own lives in danger and meant deserting their own families. Practice implications are as follows: Foster care agencies should make greater efforts to provide knowledge and skills, support, supervision, and a “safe haven” for their workers, in the context of armed conflict.     

Navigations between regulations and gut instinct: the unveiling of collective memory in decision‐making processes where teenagers are placed in residential care

The decision to take a young person away from his or her family into out‐of‐home care and treatment is the most drastic intervention within the statutory powers bestowed upon social services. The results of reports on the quality of residential treatment reveal that state supervision has not proven to be a good substitute for parental care. In this paper we analyse the decision‐making process when young persons are placed in residential care. Focus groups and individual interviews with different stakeholders were conducted. The results show that the placements are a collective process involving negotiations between the different parties with a coordinating social worker in the middle, with the aim to bring something to build hope on in often desperate situations, regardless of the specific treatment method used. To inform the process, the social workers draw on a ‘collective memory’ shared among colleagues in the department. Important signs of quality of a residential unit were the relational and collaborative competence from the staff. The inclination to use soft, diffuse information in decision‐making shows a striking lack of evidence upon which social workers can build well‐informed and knowledge‐based decisions.     

Critical Incident Debriefing and Social Work

ABSTRACT

A debriefing is a structured group process that responds to the cognitive, emotional, physical and social reactions resulting from disasters and other traumatic events. This article describes debriefings and reviews research critically examining their effectiveness. The author proposes ways that social workers can contribute to theoretical frameworks, expand debriefing models, contribute to skill development and advance debriefing research and scholarship.     

Developing Practice Tools for Social Workers in End-of-Life Care

Abstract

This article describes the National Association of Social Workers' (NASW) strategies for providing social workers with important practice and policy information about palliative and end-of-life care. With funding from a Soros Foundation's Project on Death in America grant, NASW developed practice standards, a Web-based continuing education course, and drafted a new policy statement to guide social workers in end-of-life care practice. The article provides an in-depth view of the development and scope of these resources for professional social workers.     

“A game of two halves?” Understanding the process and outcomes of English care home closures: Qualitative and quantitative perspectives

With care services increasingly delivered via a market there is always a risk that care homes could fail financially or struggle in terms of quality, ultimately having to close. When this happens, the received wisdom is that subsequent relocation can be detrimental to the health and well‐being of older residents (possibly even culminating in increased mortality). However, there is very little formal evidence in the United Kingdom (UK) or beyond to guide policymakers and local leaders when undertaking such sensitive work. Against this background, this article reports findings from an independent evaluation of what is believed to be the largest care home closure program in the UK (and possibly beyond). This consisted of qualitative interviews with older people, families, care staff, and social work assessors during the closure process in one case study care home and one linked day center, as well as self‐reported health and quality of life data for older people from 13 homes/linked day centers at initial assessment, 28 days after moving and at 12‐month follow up. The study is significant in presenting public data about such a contested topic from such a large‐scale closure process, in its focus on both process and outcomes, in its mixed‐methods approach, and in its engagement with older people, families, and care staff alongside the use of more formal outcome measures. Despite significant distress part‐way through the process, the article suggests that outcomes either stayed the same or improved for most of our sample up to a year after moving to new services. Care homes closures may thus be a “tale of two halves”, with inevitable distress during the closure but, if done well, with scope for improved outcomes for some people in the longer term. These findings are crucial for current policy and practice given that the risk of major closures seems to be growing and given that there is virtually no prior research on which to base local or national closure processes. While some of this research is specific to England, the underlying issue of care home closures and lessons learned around good practice will also apply to other countries.