Wednesday, October 27, 2010

MEDICAL SOCIAL WORK


Medical social work is a sub-discipline of social work, also known as Hospital social work. Medical social workers typically work in a hospital, skilled nursing facility or hospice, have a graduate degree in the field, and work with patients and their families in need of psychosocial help. Medical social workers assess the psychosocial functioning of patients and families and intervene as necessary.

Interventions may include the following:

· Connecting patients and families to necessary resources and supports in the community

· Providing psychotherapy

· Supportive counseling or grief counseling

· Helping a patient to expand and strengthen their network of social supports.

Medical social workers typically work on an interdisciplinary team with professionals of other disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy, etc.)

Medical Social Workers are graduates of schools of social work with a master's degree, and who use their knowledge and skills to provide social services for clients/patients (who may be individuals, families, groups, communities, organizations, or the society in general).

Definition

Medical Social Work is the application and adoption of the method and philosophy of social work in the field of health and medical care.

  • It is a branch of social work that deals with the social, physical and psychological aspects of a patient.

Nature

Medical Social Work is based on the assumption of the individual’s dignity

It deals with

  • The prevention of disease
  • After care of the patients
  • Rehabilitation

Mode of Operation:

  • By enabling the patient for solving his problems (building up his capacities)
  • By determining the social and psychological influence.
  • By developing the willpower and determination of the patient

· By enabling the patient to adjust with his problems.

· By developing a proper environment

History

Britain and Ireland

· Medical social workers in Britain and Ireland were previously known as Almoners, or Hospital Almoners.

· In Ireland, the origins of medical social workers go back to Dr. Ella Webb who in 1918 established a dispensary for sick children in the Adelaide Hospital in Dublin, and to Winifred Alcock who had trained as an Almoner and worked with Dr. Webb in her dispensary.

· In 1945 the Institute of Almoners in Britain was formed, which in 1964 was renamed as the Institute of Medical Social Workers.

· The Institute of Medical Social Workers was one of the founder organizations of the British Association of Social Workers which was formed in 1970.

· In Britain, Medical Social Workers were transferred from the NHS into local authority Social Services Departments in 1974, and generally became known as Hospital Social Workers.

United States

· The Massachusetts General Hospital was the first American hospital to have professional social workers on site in the early 1900s.

· The position was created by Richard Clarke Cabot to help patients to deal with areas of their life that made treatment difficult. This was important from an epidemiological point of view, as it made it easier to control and prevent outbreaks of syphilis and tuberculosis.

  • Year 1905: Boston medical institutions appointed Medical Social Worker for the first time.

India

  • Less importance was given to this important branch of health promotion
  • Tata institute of Social Sciences is only pioneering and struggling in this field
  • Less awareness and practice of this very useful extension of health care delivery in India
  • Most of the national health programmes are running at a snail pace due to non- use of this field of medicine.

The application of Medical Social Work is limited to few areas of health care in India:

  • Department of Sexually transmitted diseases
  • Department of pediatrics
  • Department of community medicine
  • Department of obstetrics

ROLE AND REQUIRED SKILLS:

The medical social worker has a critical role in the area of discharge planning. It is the medical social worker's responsibility to ensure that the services the patient requires are in place in order to facilitate a timely discharge and prevent delays in discharge that can cost the hospital thousands of dollars per day. For example, the medical doctor may inform the medical social worker that a patient will soon be cleared for discharge (a term that means that the patient no longer requires hospitalization) and will need home care services.

It is the medical social worker's job to then arrange for the home care service to be in place so that the patient can be discharged. If the medical social worker fails to arrange for the home care service, the patient may not leave the hospital resulting in a delay in discharge. In such situations the treating physician is ultimately held responsible for the delay. Nevertheless the medical social worker often bears the brunt of the blame for the delay in discharge and his or her failure to perform often attracts the attention of management.

Other skills required of the medical social worker are:

· An ability to work cooperatively with other health care staff as part of a multidisciplinary treatment team.

· Good analytical and assessment skills.

· An ability to communicate clearly with both patients and staff.

· An ability to quickly engage the patient in a therapeutic relationship.

The Medical Social Worker will inevitably have to be able to process almost a never-ending flow of paperwork, whilst retaining a willingness to advocate for the patient, especially in situations where the medical social worker has identified a problem that may compromise the discharge and put the patient at risk in the community.

For example, the medical doctor reports that a frail elderly patient is medically cleared for discharge and plans to discharge the patient home with home care services. However, after assessing the patient's psychosocial needs, the medical social worker determines that the patient does not have the requisite ability to direct a home care worker and recommends that the discharge be deferred pending further assessment of this problem. In such a case, it is the medical social worker's ethical duty to inform the medical doctor that the discharge may place the patient at risk and advocate for another, more appropriate discharge even if it means that the patient's discharge has to be postponed. It is precisely in such cases that the medical social worker proves his or her worth - by placing the needs of the patient above all other considerations.

CHALLENGES:

· As medical social workers often have large case-loads and have to meet tight deadlines to arrange for necessary services, medical social work is on the whole a very demanding job.

· Medical social workers often confront highly complex cases involving patients with multiple psycho-social issues, all of which require intervention and result in delays in discharge. For instance, in a major urban acute care medical center, it is not uncommon for the medical social worker to assess patients who experience one or many of the following social problems: homelessness, multiple chronic medical and psychiatric conditions, lack of stable employment, previous incarceration, and substance abuse problems. Any of these, separately and together, can impede timely discharge. Sometimes situations as mundane as the patient needing money for transport or clothing can lead to delays in discharge, especially if these needs are not identified early. This is why a complete and timely assessment of the patient's psychosocial needs is critical.

Working methods

  • Case study method,
  • Direct method of assistance
  • Indirect method of assistance


Case study method

  • By, case study method, MSW collects information with regard to the specific needs of the patient and works towards their fulfillment in accordance with the available means.

Direct methods of assistance

  • MSW is directly involved in the assistance.
  • Assistance is provided to the individual patient with the aim of developing his inherent capacity

Direct assistance

  • Social Group Work
  • MSW tries at strengthening the social relations of the patient and works towards the development of a healthy social environment


Indirect methods of assistance

  • Community organization
  • Social administration
  • Social insurance and social security
  • Social action
  • Social work research.

Indirect assistance

  • Community organization = organization of community resources with regard to health problem
  • Social administration= MSW guides the public opinion for enactment of new legislations or any amendment in prevailing legislations
  • Social security& insurance= enabling the patient to utilize the facilities under security and insurance
  • Social action= MSW participates in the movements of social action at the national (national health programme involvement) and international levels( world health days)
  • Social research= MSW inspires surveys and investigations regarding the socio-economic and psychological problems of the patient

Social work services in Medical Setting:

Social Worker provides services that support & maximize the psychosocial functioning & adjustment of patients & their families. These services are provided to ameliorate social & emotional stresses resulting from the interaction between the physical, social & psychological aspects of disease.

  1. Assessment forms, Administration of tests: Psychological, life satisfaction, Quality of Life, etc.
  2. Education: Support groups
  3. To obtain co-operation of patient & family in medical management
  4. Patient & family counseling to enhance recovery
  5. Providing help in decision making process for the treatment options.
  6. Co-ordination with multidisciplinary team members, (being a link between doctors, staff, patient & his family members)
  7. Planning intervention strategies / Life style changes
  8. Fund raising for patient’s treatment liaison with charities & NGOS.
  9. Rehabilitation
  10. Case evaluation
  11. Service outcome
  12. On going assessment
  13. Staff education
  14. Research activities

Social Work Responsibilities

  • The medical social workers job is to perform assessments with patients to assess for any physical, mental or emotional needs.
  • They assess the family support system and link the patient with services to help with care if needed.
  • The social worker can also provide assistance with financial concerns such as not being able to afford medications or pay household bills.
  • Some social workers provide counseling to patients who are suffering from depression or who are having difficulty coping.
  • Ultimately, a social worker links and makes referrals to agencies to assist the patient with all of these services.
  • One of the main benefits of a social worker is helping to be sure the patient knows what services are available. This can help increase patient safety and increase the possibility that the patient will not return to the hospital or ER for unnecessary medical treatment due to lack of medication or neglect.



Trends in Medical Social Work practice in Chennai:

  • Supportive Intervention
  • Individual Counseling
  • Group Work- Educational/Therapeutic
  • Work with Families and Careers
  • Bereavement counseling
  • Bereavement Programme/twice yearly
  • Crisis Intervention
  • Care planning/Discharge planning
  • Advocacy and mediation
  • Networking- liaising with statutory and voluntary services and agencies to keep patients/families/careers informed of their rights and linking them with appropriate support networks and groups.
  • HIV pre and post test counseling
  • Facilitating family meetings/case conferences

Scope of Medical Social Worker:

1. Social workers help people increase their capacities for problem solving and coping, and they help them obtain needed resources; facilitate interactions between individuals and between people and their environments.

2. The social worker practice includes rehabilitating those whose social functioning has been impaired. i.e. Cancer patients often may feel isolated and lonely because their family and friends may stay away and even stop telephoning because they can't deal with their cancer. The social worker can help reduce the feelings of isolation through support groups, and helping clients/patients to know other people who are facing the same things they are.

3. The activities of social workers are helping people become more self-sufficient; preventing dependency; strengthening family relationships; and restoring individuals, families, and groups to successful social functioning.

4. Social services include helping people obtain adequate financial resources for their needs, evaluating the capabilities of people to care for themselves, for children, or other dependents, counseling and psychotherapy, referral and channeling, mediation, advocating for social causes, informing organizations of their obligations to individuals, facilitating health care provisions, and linking clients/patients to resources.

5. Medical Social Workers provide social group work, in which small numbers of people who share similar interests or common problems convene regularly and engage in activities designed to achieve certain objectives. In contrast to group psychotherapy, the goals of group work are not necessarily the treatment of emotional problems. The objectives include exchanging information, facilitating support for clients/patients, helping them deal with their problems and education to improve the quality of life.

COMMON DEFINITIONS:

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

As the patroness of health, Hygeia was charged with providing a healthy environment to prevent illness. In Greek, "hygieia" means health. Hygiene is the maintenance of healthful practices. In modern terminology, this is usually regarded as a particular reference to cleanliness.

Disease /dis·ease/ (dĭ-zēz´) any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown.

Illness is an abnormal process in which aspects of the social, physical, emotional, or intellectual condition and function of a person are diminished or impaired compared with that person's previous condition.

The World Health Organization defines Disability as follows: "Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. Impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives."

Medicine:

1. Any drug or remedy.

2. The diagnosis and treatment of disease and the maintenance of health.

3. The treatment of disease by no surgical means.

CHANGING CONCEPT OF HEALTH:

The word ‘health’ was derived from the old English word ‘hoelth’, which meant a state of being sound, and was generally used to infer a soundness of the body. Prior to the period of the somewhat enigmatic physician known as Hippocrates (c 460-377 BCE, or more appropriately, from around 5 BCE), health was perceived as a divine gift. Hippocrates was credited with the pioneering the move away from divine notions of health, and using observation as a basis for acquiring health knowledge. He was credited with encouraging a focus on environmental sanitation, personal hygiene and, in particular, balanced diets – “let food be thy medicine; and let thy medicine be food”. He theorized that what we currently regard as ‘health’ might be defined as the extent of a delicate balance of four fluids: blood, yellow bile, black bile, and phlegm. Ill health, he believed, resulted from an imbalance of these fluids.

Nevertheless, a divine view of health persists to this era. For example, Prophet Mohammed view of health, sickness and death – followed by a high proportion of practicing Muslims - may be inferred from the following verse in the Holy Koran; “The Lord of the worlds; it is He who heals me when I am sick, and He who would cause me to die and live again” (Koran 26: 80).

Health Belief Systems also influence perspectives on the meaning of health. For instance, Becker’s Health Belief Model might be used to explain differences in how the concept of health is perceived by individuals and groups - particularly in non-religious contexts - and how such perceptual differences influence response to ill health. But what is ‘Health’ in the 21st century?

Scores of definitions of ‘health’ are available. The most commonly quoted definition of health is that formalized by the World Health Organization (WHO) over half a century ago; “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.”

Several other generally accepted definitions of the noun ‘health’ exist. Bircher defines health as “a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility”, while Saracchi defines health as “a condition of well being, free of disease or infirmity, and a basic and universal human right”. Australian Aboriginal people generally define health thus “…Health does not just mean the physical well-being of the individual but refers to the social, emotional, spiritual and cultural well-being of the whole community. This is a whole of life view and includes the cyclical concept of life-death-life.

Critics argue that the WHO definition of health is utopian, inflexible, and unrealistic, and that including the word “complete” in the definition makes it highly unlikely that anyone would be healthy for a reasonable period of time. It also appears that ‘a state of complete physical mental and social well-being’ corresponds more to happiness than to health.

Bircher’s definition takes into account changing health needs, especially in relation to age, culture, and personal responsibility. Health Belief Systems, which are a essentially function of age, culture, and personal responsibility, strongly influence subjective experience of health and ill-health.

Sarrachi’s definition provides an intermediate concept, linking the WHO’s ideal to contemporary issues of human rights, equity, and justice. Aboriginal Australians incorporate community health and spiritual well being as core aspects of the definition of health.

These and other definitions introduce valuable concepts that may be used to enrich and revise the current WHO definition of health. A useful starting point for such revision and enrichment might be for the WHO to clarify its philosophy for ‘Health’ in the 21st century.

CONCEPT OF PATIENT AS A PERSON:

(Patient is any person who receives medical attention, care, or treatment. The person is most often ill or injured and in need of treatment by a physician or other health care professional, although one who is visiting a physician for a routine check-up may also be viewed as a patient.

The word patient originally meant 'one who suffers'. This English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering.)

The word patient connotes sickness. The word patient perpetuates the assumption that a person is non-functioning and dependent. If the people around you treat you like a patient, it is pretty normal to start viewing yourself as a patient. If you view yourself as a patient, then the expectation that you should meet your needs is severely diminished. How can a person who has been stigmatized as being “sick” and non-functioning and dependent feel worthwhile or have a positive self-image? Hence it is necessary to equip a patient centered relationship. Patient-centered communication skills include active listening and providing empathy and support.

Objectives

· To explore the personal and psychosocial effects of illness in the life of a patient, productive and nonproductive means of coping with those effects, and the role of the physician in this process.

· To explore the impact of dying and death upon the students/physicians, patients and their families, and the difficult decisions concerning the treatment of the dying patient.

Goals

  1. Recognize the patient's emotional reaction, his illness, his family and his physician.
  2. Understand physician's responsibility toward his ill patient.
  3. Recognize the influences of age, culture, ethnicity, education on patient response to and manner of coping with illness.
  4. Recognize the impact of death and dying on the physician and patient/family.

The Patient's Emotional Reaction to Illness

  • Loss
  • Identity
  • Suffering

The Physician's Responsibility

  • Determine the cause of the illness
  • Treat the symptoms
  • Understand and support the human being who is experiencing those symptoms

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