An Ecological Understanding of Caregiver Experiences in Palliative Care

Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner’s ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families.     

Caregiver Support Groups: Finding Common Ground

SUMMARY

Members of caregiver support groups for the elderly have much in common but also bring to the group different experiences and attitudes. This article explores how group workers knowledgeable about significant caregiver differences and their effects on the group can enrich the group experience for all members. The four caregiver issues examined are: (1) past history between the caregiver and care recipient, (2) ability of caregiver to privately pay for home care, (3) views on long-term care placement in a nursing home, and (4) stage of disease or level of care needed by care recipient. Essential beliefs regarding the value of differences described by Northen and Kurland provide a framework for the group worker.     

Practicing What We Preach: Creating Groups for Ourselves

ABSTRACT

This article focuses on the professional isolation faced by social group work practitioners and educators. It identifies the need for peer support and connection in an environment of limited opportunities for professional development. The paper describes and assesses long-term peer support groups initiated and developed by each of the authors, one for group work educators and the other for practitioners. It discusses the potential for expanding the development of such groups, which could benefit individual group workers as well as strengthen efforts to ensure the survival of group work.     

Korean American Dementia Family Caregivers’ Experience of a Psychoeducational Support Group: Investigation of Role of Culture

Seven Korean American dementia family caregivers participated in a psychoeducational group. A focus group was conducted to explore the effectiveness of the group work model. Analysis of the focus group presented four themes: (1) importance of education about dementia, (2) social support from other Korean caregivers, (3) role of language and Korean culture, and (4) heterogeneity of caregivers' needs. Implications for social work practice, policy, and research are provided.     

The Family Group Within the Nursing Home:

An ongoing monthly family group was implemented in an intermediate care facility in hopes of improving communication between staff and families of long term care residents. Other objectives of the group were to provide families with information about policies and procedures, education about the aging process, and to facilitate an informal support group network where families could share problems and concerns. The feedback and evaluation process indicated that sharing feelings of anger, quiet, frustration and other emotions helped the families deal with the responsibilities of institutionalizing a relative and helped to facilitate better communication between staff and family members.     

Group Work with Inner City Persons with AIDS

A model for serving inner city poor persons with AIDS through a medical facility is described. The mixed factors of ethnicity, gender, sexual orientation, race and modes of transmission are examined as influences on the group process. Objectives, pre-group planning, formation guidelines, and presenting problems of members are identified. Through case illustrations group issues are used to point out interventive strategies. Because of the shifting demographics of people with AIDS and their families, the group modality provides a vital educative and supportive vehicle to highly disadvantaged persons affected by the disease.     

A psychosocial approach to supporting injured dancers

Professional dancers experience injury as a crisis and threat to identity that often leads to numerous psychosocial concerns. This article describes a group model designed to help injured dancers recover. As a program of The Actors Fund, this 10-week Support Group for Injured Dancers reduces unwanted isolation caused by injury and provides dancers with strategies for stress reduction and healing. The purpose of this article is to aid practitioners in mitigating emotional distress among injured dancers by providing the history and rationale behind the group, an overview of the group’s structure and methods, and suggestions for further research and growth.     

Living Close to a Person With Cancer: A Review of the International Literature and Implications for Social Work Practice

To help family caregivers (FCs), social workers need to understand the complexity of FC’s experiences and challenges. For this systematic review, several relevant, multidisciplinary electronic databases were searched. Of 1,643 titles identified, 108 articles met the inclusion criteria and are included in this review. Various experiences, symptoms, and burden related to caregiving responsibilities are described and discussed. The understanding evolving from this study about the FC’s own health risk, caregiver burden, and experiences over time can enhance a social worker’s awareness of an FC’s challenging situation and the potential impact this has on the FC’s ability to provide care to the patient.     

The Maine Savvy Caregiver Project: Translating an Evidence-Based Dementia Family Caregiver Program Within the RE-AIM Framework

This article presents findings of a 3-year Savvy Caregiver Program translational study designed with the RE-AIM framework to create a statewide sustainable infrastructure and improve dementia family caregiver outcomes in one rural state. The RE-AIM dimensions—reach, effectiveness, adoption, implementation and maintenance—were evaluated using mixed methods. The program reached 770 caregivers and 87.7% (n = 676) participated in the study with 60.5% (n = 409) residing in rural locations. Participants demonstrated improved confidence, fewer depressive symptoms, and better managed their situation. Trainer resources, partnerships, and adequate planning were essential for program adoption and sustainability. Implications for replication are discussed.     

The Impact of Dementia:

Even though only one person in the marital relationship is likely to have the diagnosis, demenita really has two victims-the inflicted spouse and the caregiver. Research on both these 'victims' to date, has been largely restricted to furthering an understanding of the issues from a medical and stress/burden perspective. Only limited attention has been given to addressing the psychodynamic issues which evolve in reaction to the disease process. These issues however, have important implications on service needs and utilization and warrant exploration. Self psychology offers a promising framework for doing this. The purpose of this article is to examine the impact of dementia on the marital unit using this theoretical perspective.     

Toward Empowerment: ReVisioning Family Support Groups

ABSTRACT

Family support groups (FSG) have been recognized as an important and viable means for responding to the needs of family caregivers. How these groups work, however, is not well understood. The purpose of this qualitative exploratory study was to explore the impact of attending a family support group on the caregiving experience from the perspective of the family member. Personal, semi-structured interviews took place with eleven family members who had participated in at least one FSG. Data was analyzed for themes, using a constant comparative categorizing strategy. This analysis suggests that attending a FSG impacts the caregiving experience in four important ways: helping the family member to construct a self-identity as a ‘caregiver’; promoting a sense of personal competence; fostering the use of formal support groups; and creating a community context within which to experience the caregiving role. Cumulatively, these have the potential to contribute to a sense of empowerment for the family member by helping him or her to reposition the caregiving experience as more than a personal issue and promoting the emergence of a more collective voice.     

The Melanoma Patient Exchange: Insights from a Supportive Group Intervention for Melanoma Patients and their Caregivers

Melanoma is one of the fastest growing cancers worldwide, and the psychosocial impact of its diagnosis and treatment can be substantial. The authors implemented a support group for melanoma patients and caregivers to address a gap in support services. The authors describe insights from the first year of the program, including group format and dynamics, participant feedback, and satisfaction. Feedback was collected using the Group Session Rating Scale and two open-ended questions. Sixty-six members participated and responses demonstrated high satisfaction with the group (Mean = 38.7/40.0). Similar organizations may utilize these strategies to provide a support group option for their population of interest.     

A Comparison of the Effectiveness of Various Approaches to Visiting Isolated Community Elderly

Two studies were conducted evaluating the effectiveness of friendly visitor programs in increasing clients' life satisfaction. Study 1 found no difference between face-to-face visiting, phone visiting, and a no treatment control on client life satisfaction. Study 2 found a marginally significant difference in favor of a personal history approach over a companionship approach to visiting in increasing client life satisfaction. Clients' living situation (alone or with others) had no effect on changes in life satisfaction in Study 1. However, in Study 2 clients who lived with someone increased their life satisfaction more than clients who lived alone.     

Using a Student-Led Support Group to Reduce Stress and Burnout Among BSW Students

This study evaluates the efficacy of using a student-led support group to decrease levels of stress and reduce burnout among BSW students. The exploratory mixed-methods study used a 10-item Perceived Stress Scale measuring levels of stress, a single item measuring burnout, and narrative journal entries submitted by students. This was part of a larger study that also explored the efficacy of using a student-led group to increase students' knowledge of group work. Although limited in its scope, this research suggests that student-led group work increases the knowledge process and reduces level of burnout among social work students.     

Challenges in Rural Social Work Practice: When Support Groups Contain Your Neighbors,Church Members,and the PTA

Rural social work occurs in unique practice environments with challenges and rare opportunities. Strong social ties, commonly found in rural communities and often missing in urban areas, can serve as sources of resilience for group members facing adverse life circumstances. Therapeutic formal and informal support groups, bolstered by this support and led by social workers in rural communities, can face numerous challenges due to locale, lack of transportation, and potential worker burnout. This article highlights ethical considerations rooted in a theme of rural group work while providing helpful hints based on the IASWG Standards for Social Work Practice with Groups.     

The Faculty Meeting: Practicing Social Justice-Oriented Group Work

Social group work scholars and practitioners have begun to locate and recognize important sites for thinking about and practicing social group work as increasing evidence demonstrates its diminishing importance. This article identifies faculty meetings as a significant site for integrating social group work more fully into departments and schools of social work and helping to achieve the profession's social justice mission. Challenging the meaning of the faculty meeting and thinking of it as a faculty group is a necessary prerequisite to realize this goal. A set of principles is presented and next steps explored to reclaim and reinsert the value of social group work for the profession today.     

THE USE OF PROGRAM

This paper focuses on whar has been thought of in social group work as "program"-program skills, program content, program media, or use of program- and what is now known as nonverbals, exercises, simulations or games, or expressive therapy. Certain dilemmas of rhe past, e.g., process vs. product (content), talking vs. doing, social work vs. recreation, are reviewed as obstacles to the integration of doing-oriented activities within the major rheorerical approaches to group work in social work. Such obstacles haw been less encumbering to other professions which have presently assumed the dominant theorerical leadership in this area. Some recent developments in knowledge, technology, and social-culrural forces are described which have contributed to a present milieu that places increased value of diverse modes of expressiveness. The paper concludes with seven future-oriented proposals that theory, practice, and research in this area demand.     

Couple Meaning-Making and Dementia: Challenges to the Deficit Model

By combining a relationship- and strengths-based approach, the article suggests that, with the onset of progressive cognitive impairment, verbal, nonverbal, and embodied exchanges can function as meaning-making processes for life-partner co-carers. These exchanges can sustain a sense of relatedness, which has been shown to increase wellbeing. The article identifies gaps in knowledge and practice limitations that result from the deficit approach to dementia research and care that currently dominates the field. Suggestions for future research and the development of interventions are included. In addition, the article challenges theoretical assumptions about meaning-making, arguing for a reexamination of dementia-affected couplehood processes.     

Child protection, family support and social work: a critical appraisal of the Department of Health research studies in child protection

This paper provides a critical appraisal of the Department of Health Research Studies in Child Protection and their recommendations for policy and practice. It argues that there are a number of conceptual and methodological problems and a failure to thoroughly articulate and represent the tensions and complexities of child protection work, particularly at the point of allegation and initial referral. In the process it fails to fully appreciate the significance of risk in the current social and political climate, the way front-line professionals, particularly social workers, are held to account and the nature of the responsibilities they carry. As a consequence, the paper suggests that attempts to shift the balance of policy and practice from narrowly defined child protection to family support for children in need may be far more difficult than the research suggests.