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Social workers can use sense of coherence to predict burnout of end-of-life care-givers (research report from Japan)
- Authors:
- HIYOSHI-TANIGUCHI Kazuko, BECKER Carl B., KINOSHITA Ayae
- Journal article citation:
- British Journal of Social Work, 44(8), 2014, pp.2360-2374.
- Publisher:
- Oxford University Press
Social workers are deeply involved in supporting elder persons' home care-givers, who frequently border on burnout or nervous breakdown. Since social workers cannot fully assist every family caring for frail elders at home, it is valuable to pre-identify those care-givers in greatest need of social work support. Previous research suggests that care-givers' sleep interruption is a major factor in their sense of burden, but this alone proves inadequate to discriminate those in need of extra social work support. This study hypothesised that caregivers' Sense of Coherence (SOC) was the major factor in their sense of burden. With co-operation of social workers in rural and urban Japan, a survey was conducted of caregivers' SOC and sense of burden. The study of 177 family caregivers showed that a high SOC substantially mitigated their sense of burden, while caregivers with low senses of meaning felt more burdened. This suggests that social workers should administer a simple SOC test to home caregivers in order to predict those caregivers most needful of social work assistance during end-of-life home care. Moreover, if social workers could elevate home caregivers' SOC through social support or programmes of exercise or meditation, this might reduce home care-givers' sense of burden, ultimately reducing burnout, neglect and abuse of homebound elderly. (Edited publisher abstract)
Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease
- Author:
- KRAMER Betty J.
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 9(4), 2013, pp.308-330.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life. (Publisher abstract)
Advance care planning with residents in nursing homes in Singapore
- Authors:
- WEE Ng Tzer, WENG Suew Chee, HUAT Laurence Lim Eng
- Journal article citation:
- Asia Pacific Journal of Social Work and Development, 21(1), June 2011, pp.97-104.
- Publisher:
- Taylor and Francis
Project CARE is a pilot project which aims to promote advance care planning and to improve end-of-life care in 7 nursing homes managed by voluntary welfare organisations. Advance care planning refers to the process of discussion about future healthcare between an individual, their loved ones, and their care providers. The aim is to enable a person to make clear their wishes with regards to future treatment and care. This article provides preliminary observations from this project relating to the implementation of advance care planning and its challenges. Selected staff from the nursing homes received training to apply the Respecting Choices advance care planning framework. Since the implementation of Project CARE in September 2009, there have been approximately 400 advance care planning discussions held with residents and their family members. These discussions included exploring the preferred place of care at the end of life. The paper illustrates the range of challenges faced in these discussions. It also presents the roles of social workers in advance care planning, and concludes with factors that contribute to effective advance care planning facilitation.
Key role of social work in effective communication and conflict resolution process: medical orders for life-sustaining treatment (MOLST) program in New York and shared medical decision making at the end of life
- Authors:
- BOMBA Patricia A., MORRISSEY Mary Beth, LEVEN David C.
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 7(1), January 2011, pp.56-82.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
This paper reviews the development of the Medical Orders for Life-Sustaining Treatment programme. It particularly focuses on recent legislation in New York State in the context of advance care planning and decision making during end of life care, and suggests that social workers are central in working with patients, families and practitioners in the communication and conflict resolution process that is integral to health care decision making. The paper addresses the importance of ethics and end-of-life training and education for social workers. The paper also reviews data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making. In ending, recommendations are made for research on education and training of social workers involved in end-of-life and palliative care.
Involvement of Japanese care managers and social workers in advance care planning
- Authors:
- HIRAKAWA Yoshihisa, et al
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 14(4), 2018, pp.315-321.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
Successful advance care planning relies heavily on effective communication between the elderly and their families, care managers, and social workers. However, care managers and social workers are often not adequately prepared to conduct such discussion. The aim of the present study was to identify the specific challenges facing Japanese care managers and social workers when involvement in advance care planning. Two focus group discussions were held between August and November 2017, involving eleven care managers and three social workers employed at two long-term care facilities actively pursuing advance care planning initiatives. Four main themes were identified, through content analysis, as barriers and facilitators: client readiness, communication, variation-rich client individuality, and difficult-to-explain end-of-life options. This study revealed the importance of building rapport with the residents and their families in order to assess their readiness to discuss care options and preferences. Obstacles included lack of medical knowledge of care managers and social workers. Study findings suggested that a multi-disciplinary team, facilitated by care managers and social workers, was fundamental to achieving the goals of advance care planning. (Publisher abstract)
Advance care planning in South Korea: Social work perspective
- Authors:
- KWON Sung Ae, KOLOMER Stacey
- Journal article citation:
- Social Work in Health Care, 55(7), 2016, pp.545-558.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
As ethical issues arise concerning the continuation of futile medical treatment for dying patients in Korean society, advance directive planning initiatives have been put into place to guide practice. This article describes the awareness and attitudes of social workers in Korea regarding advance care planning and related factors. A total of 246 gerontological/geriatric social workers completed a mailed or in-person survey regarding awareness and attitudes toward advance care planning. Seventy-three percent (n = 180) of the participants reported no knowledge of advance directives. Social workers who emphasised self-determination as a professional value, professed a preference for hospice care, and who were comfortable discussing death were more likely to have a positive attitudes toward advance care planning. This study reinforces the need for the infusion of advance care planning and end-of-life training in social work education in Korea. (Publisher abstract)
Listening: a psychosocial intervention in an end-of-life case of trauma and emotion in the “space” of a residential care facility
- Author:
- ROBERTSON Matra
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 4(3), 2008, pp.214-228.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
The author examines the context of social work practice in end-of-life care by describing and discussing her interview experience with an elderly patient who was reported as depressed, hopeless and suicidal after being placed in residential care. The patient had ischemic heart disease and congestive cardiac failure. The role of listening to the patient is stressed. The author comments that for individuals at the end of life who experience hopelessness, post-traumatic stress disorder and suicidal thoughts, psychosocial factors of their health care and even the arrangement of their living spaces in the hospice or residential care facility environment may contribute to their anxiety. In order to challenge those institutional interventions in end-of-life care that may pathologise those experiencing hopelessness the author suggests that social workers in palliative care reconsider and advocate for the place of listening. She emphasises the need for social workers in palliative health care to recognise the delicate nature of the relationship between hope, place and trauma to enhance care for both the dying person, and their families.
Challenges to providing end-of-life care to low-income elders with advanced chronic disease: lessons learned from a model program
- Authors:
- KRAMER Betty J., AUER Casey
- Journal article citation:
- Gerontologist, 45(5), October 2005, pp.651-660.
- Publisher:
- Oxford University Press
This American study explored the challenges in providing end-of-life care to low-income elders with multiple comorbid chronic conditions in a fully "integrated" managed care program, and it highlighted essential recommendations. A case-study design was used that involved an extensive analysis of qualitative data from five focus groups with interdisciplinary team members, two in-depth interviews with administrators, and open-ended survey responses from social workers detailing death experiences of 120 elders. Seven major themes characterized primary end-of-life care challenges: (a) the nature of advanced chronic disease; (b) the incapacity of support systems; (c) barriers to honoring care preferences; (d) challenges with characteristics and needs of participants; (e) needs of complex family systems; (f) barriers with transitions; and (g) barriers with culture and language.
Medicare constrains social workers' and nurses' home care for clients with Alzheimer's disease
- Author:
- CABIN William D.
- Journal article citation:
- Social Work: A journal of the National Association of Social Workers (NASW), 60(1), 2015, pp.75-83.
- Publisher:
- Oxford University Press
The Medicare home health prospective payment system (PPS) has existed for 13 years, yielding significant profits to providers. However, studies indicate many unresolved questions about whether PPS improves patient quality of care, is cost-effective, and reduces patient levels of unmet need. In addition, PPS has undermined the provision of social work home health services. The article presents the views of 29 home health care nurses regarding the impact of PPS on their care decisions for people with Alzheimer's disease and their caregivers. The nurses identify Alzheimer's disease symptom management and psychosocial needs as phantoms, omnipresent below the surface but not attended to by home care clinicians. The interviews support the greater involvement of social workers to more adequately address the psychosocial needs of Medicare home health patients. The article contends that the current failure to simultaneously address the cost, needs, and quality-of-life issues of people with Alzheimer's disease who are cared for at home is analogous to the end-of-life care situation before passage of the Medicare Hospice Benefit. A collaborative demonstration project - social work and nursing - is proposed to determine how PPS might better address quality of life and costs of home-based people with Alzheimer's disease and their caregivers. (Publisher abstract)
Unit costs of health and social care 2015
- Authors:
- CURTIS Lesley, BURNS Amanda
- Publisher:
- Personal Social Services Research Unit
- Publication year:
- 2015
- Pagination:
- 274
- Place of publication:
- Canterbury
This report provides unit costs estimates for a range of health and social care services and staff. It comprises five sections. Section 1 estimates the costs of services for older people, people with mental health problems, people who misuse drugs or alcohol, people with learning disabilities, adults with physical disabilities, children and their families, hospital and related services and care package. Sections 2, 3 and 4 provides cost estimates for community-based health and social care staff and hospital-based staff. These include: allied health professionals, nurses, general practitioners, social workers, home care staff, scientific and professional staff and specialist doctors. Section V details the sources of information used. The report also includes four discussion and research papers, examining some of the implications of the 2014 Care Act, the development of a new survey tool to gather self-reported data about respondents’ care needs, use of formal care, and their use and provision of informal care, the costs of vision rehabilitation services in England, and resource-use questionnaires used in trial-based economic evaluations. (Edited publisher abstract)