Care Services Research Articles

Environmental disability – a languageless diffuse stigma

ABSTRACT The rising number of individuals affected by illnesses linked to everyday chemicals has become an urgent public health concern. The article aims to scrutinize the Institute of Public Health (FHI)’s language use and the potential consequences of its linguistic choices when discussing environmental disability (ED). The central research questions are: What characterizes the discourse through which FHI presents ED? And how might this influence social policy regarding ED as a disability? Utilizing Critical Discourse Analysis (CDA) as a methodological framework, the study analyses FHI’s discourse and its impact on public understanding and social policy related to ED. The findings reveal that FHI’s discourse potentially obscures the lived experiences of individuals with ED, hindering their inclusion in social work practices and policies. This lack of representation could leave those affected without the necessary support. The implications of these findings are significant for social workers and policymakers, underscoring the need for a more inclusive and representative discourse on ED.

Impact of a multidisciplinary team model on discharge efficiency and accuracy in internal medicine resident teams.

Efficient discharge planning is crucial for improving hospital capacity and patient care. Multidisciplinary rounds (MDRs) have been shown to enhance communication and coordination, yet their impact on resident teaching teams' discharge efficiency is less studied. To examine how embedding dedicated case managers (CMs) and social workers (SWs) into internal medicine (IM) resident teams impacts discharge efficiency. We conducted a retrospective cross-sectional study at The Queen's Medical Center comparing two resident multidisciplinary teaching (MDT) teams that included dedicated CMs and SWs with two resident standard care teams over an 8-month period (October 18 2023-June 25 2024). The outcomes assessed included length of stay (LOS), expected discharge date (EDD) accuracy, readmission rates and the rate of conditional discharge orders placed. A total of 1944 patients were included. The MDT teams showed significantly improved EDD accuracy (72.0% vs 66.7%, P = 0.0120) and more frequently placed conditional discharge orders (61.7% vs 43.8%, P < 0.0001) compared to standard care teams. No significant difference was observed in LOS or readmission rates. Embedding dedicated CMs and SWs within resident teams improved EDD accuracy and the rate of conditional discharge orders placed, suggesting an opportunity to integrate MDRs as a standard within IM residency training to enhance discharge planning efficiency.

Serious Illness Communication in a Randomized Trial of a Nurse and Social Worker Palliative Telecare Team.

Early serious illness communication (SIC) has numerous benefits for patients with cardiopulmonary illnesses, yet engaging patients in this complex, iterative communication process is challenging due to constraints on clinician time, limited clinician training in these conversations, and a lack of patient readiness. This study reports secondary SIC outcomes of a previously reported clinical trial. In a randomized clinical trial of a nurse and social worker palliative telecare team, one visit with the nurse and/or social worker focused on SIC using a protocolized guide. Participants were at high risk of hospitalization or death, had poor health status, and chronic obstructive pulmonary disease and/or heart failure or interstitial lung disease. Documented SIC, advance directive (AD) completion, and the four-item readiness to engage in advance care planning scale (ACP-4) were measured at baseline and 6 months. Differences in change between intervention and usual care were analyzed using linear models and linear mixed models. The 306 participants were on average 68.9 years, 90.2% male, 80.1% White, with multiple comorbidities (mean of 7.6). All outcomes were similar at baseline. ACP-4 increased more in the intervention group at 6 months compared to usual care (difference in change scores: 0.49; 95% CI 0.22-0.66, p < 0.001). Documented SIC at 6 months was higher in the intervention group compared to usual care (122/154, 79.2% vs. 7/152, 4.6%); adjusted difference in proportions 74.6% (95% CI 67.3-81.9, p < 0.001). The difference in proportion of participants with an AD at 6 months was not significant; adjusted difference in proportions, 0.01%, (95% CI -0.04-0.07, p = 0.64). After participation in a telephonic, protocolized SIC intervention, documented SIC increased, and readiness to engage in ACP increased. Future research should evaluate how documented SIC is used and the effect of SIC on downstream outcomes of healthcare decisions and patient well-being. ClinicalTrials.gov NCT02713347, https://clinicaltrials.gov/ct2/show/NCT02713347.

Hospital-based specialist palliative care involvement before and during the COVID-19 pandemic: secondary analysis of a regional retrospective decedent cohort study in Ottawa, Canada

ObjectivesTo determine the occurrence and clinicodemographic associations of hospital-based specialist palliative care (SPC) referral before and during the COVID-19 pandemic, timing of completed SPC consultation and comparative prevalence of ‘no...

Integration of the national HIV curriculum in medicine, nursing, and pharmacy programs in the United States

BackgroundIncreasing the number of students who have learned to provide competent HIV care and prevention services is expected to reduce future HIV workforce shortages. To achieve this goal, the Midwest AIDS Training & Education Center (MATEC) at the University of Illinois Chicago embarked on a project to integrate the existing National HIV Curriculum (NHC) into the curricula of accredited graduate programs in medicine, nursing, and pharmacy to enhance the quality of HIV education at 23 health profession programs (HPPs) in the midwestern part of the United States between 2019 and 2022. This article describes the curriculum integration process and presents outcomes at the student level.MethodsHPPs completed faculty pre- and post-integration surveys for each course in which they integrated content from the NHC. The data from these surveys were used to describe the integration process. After studying material from the NHC, students completed a retrospective endpoint assessment designed to measure changes in knowledge of HIV prevention and care and intent to provide care to people with HIV and those at high risk of HIV in their future careers. All the surveys were created in Qualtrics and administered online. Paired t-tests were performed using SAS v. 9.4 to assess changes in knowledge and intent to work with people with HIV.ResultsThe NHC was integrated into 211 courses with an enrollment of 12,822 students. Integration strategies varied by profession discipline, with nursing programs preferring to use online self-study, medicine programs incorporating the NHC in lectures, and pharmacy programs creating learning groups on the NHC’s e-learning platform. Students across all three health disciplines reported statistically significant increases in knowledge of HIV prevention and care services and intent to provide care to people with and at high risk of HIV.ConclusionsThe NHC can be successfully integrated into the curricula of HPPs with positive outcomes for students. Given the current shortage of HIV clinicians, this intervention can have a positive impact on expanding the HIV workforce and provide a model for integrating national curricula at the preprofessional graduate level.

Social workers’ evaluation of ChatGPT for solving ethical dilemmas within the limits of confidentiality

ABSTRACT This study examined how social workers evaluate the use of ChatGPT in solving ethical dilemmas related to confidentiality in social work. The study employed qualitative document analysis based on a phenomenological approach, analysing assignments of 70 master’s degree students in social work. Participants compared their own solutions to ethical dilemmas with those proposed by ChatGPT. The analysis revealed three main issues: disparities in analysing complex professional dilemmas, differences in reference to ethical codes and laws, and disparities in emotional aspects and empathy. Study participants perceived their responses as more comprehensive, legally based, and empathetic compared to ChatGPT’s solutions, which were perceived as superficial and lacking emotional understanding. While ChatGPT offers potential as a supportive tool, it cannot replace social workers’ ethical judgement and empathy. Recommendations include developing AI training workshops and examining AI tools for ethical training while maintaining the profession’s human element.

Reimagining the pedagogy of professional judgment and decision making in social work: teaching evidence-based practice in parallel with field practicum

ABSTRACT Social work practice occurs in varied practice contexts. To promote successful service user outcomes, professional judgment and decision making are key. However, services are delivered in settings that may be complicated by a myriad of factors, all of which may negatively impact professional judgment and decision making. This complexity of service delivery makes it difficult for social work education to promote the knowledge and skills required for ‘real world’ practice. Evidence-based Practice (EBP) is one route to ethical and effective service, as it is a method of promoting decision making skills. However, EBP is not taught consistently in pedagogy, conceptualization, or application. A pedagogical model for teaching social work students professional judgment and decision-making skills through EBP is presented in this manuscript. EBP is the equal consideration of four key factors—case context, service user values and preferences, worker and organizational biases and experiences, research—which are assessed and integrated via critical thinking. This model presents teaching EBP within a seminar in parallel with field placements, where students are required to work through a case from their field placement. This model provides the time necessary for students to engage meaningfully in the process of learning and applying EBP.

Social work advocacy in mental health clinical practice: a mixed methods study of professional practices and competencies

ABSTRACT Considered essential in social work practice, there is a lack of research on advocacy strategies employed by social workers to address systemic inequity and support client recovery. We present a sequential mixed methods study focused on identifying and understanding advocacy efforts and practices for enhancing client, family, and community wellbeing. Integrating descriptive and reflexive thematic analyses of a survey of frontline social workers (n = 43) and in-depth interviews (n = 12), we found 93% of social workers engaged in advocacy (91% individual/family-level, 51% cause-level), and codified experiential and tacit practice, along with identifying competencies required to engage in advocacy supporting client recovery.

More Than the Sum of Multiple Care: Ambivalence in Sandwich Care.

A growing population in economically developed societies are simultaneously providing childcare and older adult care, or sandwich care. The existing studies reveal that sandwich carers are more physically, mentally and financially challenged than those providing dyadic care. This article explores an understudied area of sandwich care and ambivalence. Ambivalence encompasses the difficulties, challenges, and range of feelings, including guilt, anger, isolation, sense of duty, fulfilment and many others that sandwich carers'experience. Building on the existing sociological approach to ambivalence,this paper proposes a theoretical framework for delineating the entangled structural and relational webs where sandwich carers' experiences and negotiations are situated. Our theoretical framework captures the temporal, socially structured and policy-contextual properties of ambivalence. We argue that ambivalence arises from historical and prospective family relationships (temporal) that intersect with the gendered expectations for parenting and family responsibility of adult social care (socially structured), which further intersects with care policy and available care services (policy contextual). The three qualities of ambivalence influence each other in multiple ways. Socially structured and temporal qualities of ambivalence can influence sandwich carers' access to and experience of using care services, but the social arrangement of care can also increase or mitigate ambivalence in sandwich care arising from them. While we illustrate this by drawing on considerable evidence from Japan, we argue that our study provides a useful theoretical framework attuned to understanding the experience of such carers in diverse social and cultural contexts.

Towards critical child protection: for a relationship-based and humane practice with children and families

ABSTRACT In the UK social work with abused children and their families has long been subject to changing conceptions, policies and practices. Post-war concerns about child cruelty, ‘battered child syndrome’ and non-accidental injury have been superseded by the current concern with child protection. Such changes are linked to the dominance of neo-liberalism and associated managerialism, resulting in a narrower, truncated role for social work as practitioners concentrate on speedily completing bureaucracy. Now the overall priority is to ration resources and assess/manage risk together with changing the behaviour and lifestyles of parents/carers under the threat of losing their child(ren) to adoption. In contrast, this article calls for a critical child protection, a relationship-based practice which acknowledges social justice issues and works towards a more just and equal society. Despite challenges arising from the neo-liberal world, such critical social work involves a humane practice of working alongside children and families with parents/carers supported and encouraged regarding the issues of concern.

Creation of the ECHO Idaho Podcast: Tutorial and Pilot Assessment.

Project ECHO (Extension for Community Health Outcomes) is an innovative program that uses videoconferencing technology to connect health care providers with experts. The model has been successful in reaching health care providers in rural and underserved areas and positively impacting clinical practice. ECHO Idaho, a replication partner, has developed programming that has increased knowledge and confidence of health care professionals throughout the state of Idaho, United States. Although the ECHO model has a demonstrated ability to recruit, educate, and train health care providers, barriers to attending Project ECHO continuing education (CE) programs remain. The asynchronous nature of podcasts could be used as an innovative medium to help address barriers to CE access that health care professionals face. The ECHO Idaho "Something for the Pain" podcast was developed to increase CE accessibility to rural and frontier providers, while upscaling their knowledge of and competence to treat and assess substance use disorders, pain, and behavioral health conditions. This paper describes the creation and preliminary assessment of the ECHO Idaho "Something for the Pain" podcast. Podcast episodes consisted of interviews with individuals as well as didactic lectures. Audio from these recordings were edited for content and length and then professionally reviewed by subject matter experts (eg, featured episode speakers). Target audiences consisted of health care providers and community members interested in behavioral health and substance use disorders. Metrics on podcast listeners were assessed using SoundCloud's RSS feed, continuing education survey completion, and iECHO. The ECHO Idaho "Something for the Pain" podcast's inaugural season comprised 14 episodes with 626 minutes of CE material. The podcast series received a total of 2441 listens from individuals in 14 different cities across Idaho, and 63 health care providers listened and claimed CE credits. The largest professional group was social workers (n=22; 35%). We provide preliminary evidence that podcasts can be used to provide health care providers with opportunities to access CE material. Health care providers listened to and claimed CE credits from the ECHO Idaho "Something for the Pain" podcast. Project ECHO programs should consider creating podcasts as an additional platform for disseminating ECHO material.

The digital divide in people with severe mental illness: lessons learned and challenges lying ahead.

In the post-COVID-19 pandemic era, a 'digital-first' agenda is being adopted in health/social care services, while digital exclusion has not been fully addressed. People with severe mental illness face profound inequalities at many levels (i.e. social, financial and health). Digital exclusion may further exacerbate some of these inequalities.

Study of Nurses' Malpractice Tendencies and Burnout Levels.

Malpractice, which occurs when a reasonable standard of service cannot be provided, is a critical situation in nursing care and interventions. Nurses' tendency toward medical errors and burnout levels are important due to their impact on patient safety and the quality of care. This study was conducted to investigate nurses' malpractice tendencies and burnout levels and the relationship between the two. The data of this descriptive, cross-sectional, and correlational study were collected from 292 nurses working in a training and research hospital in Istanbul province between January and February 2021. A Descriptive Information Form, the Malpractice Trend Scale in Nursing (MTSN), and the Maslach Burnout Inventory (MBI) were used to collect data. In data analysis, internal consistency coefficient, descriptive, non-parametric comparisons, and correlation analyses were performed. The mean age of the nurses participating in the research was 31.13 ± 7.87 years; 79.8% were women, 50.7% were single, and 68.5% had an undergraduate degree. When nurses' opinions about malpractice were examined, it was determined that 88.7% had not committed malpractice before and 53.4% had witnessed someone who committed malpractice. Nurses' overall MTSN score was 233.48 ± 15.32. Their Maslach Burnout Inventory score was 18.20 ± 8.83 on the emotional exhaustion subscale, 8.07 ± 3.86 on the depersonalization subscale, and 21.31 ± 4.00 on the personal accomplishment subscale. The reliability coefficients of the scales and subscales ranged between 0.61 and 0.95. There was a significant difference between the MTSN scale and MBI subscales according to nurses' positions and satisfaction with the environment (p < 0.05). A negative correlation was found between the mean scores on the total MTSN and the MBI emotional exhaustion (r = -0.314) and depersonalization (r = -0.293) subscales, and a positive and statistically significant relationship (p < 0.001) existed between the MTSN total scale and the personal accomplishment (r = 0.359) subscale. The level of burnout is associated with a tendency to malpractice. Taking measures to prevent nurses from experiencing burnout may be important for reducing medical errors. These measures will be reflected in better care service and quality.

Reconciling Safety and Safeguarding in Health and Social Care: Implications for Just Culture

Reconciling Safety and Safeguarding in Health and Social Care: Implications for Just Culture

The impact of Covid-19 on inter-organizational coordination in Swedish eldercare: a mixed methods study

BackgroundIn Sweden, healthcare provision for the frail elderly entails coordination between municipalities and regions. Despite formal agreements, deficiencies persist in achieving practical coordination, leading to adverse effects on patients and increased costs. The Covid-19 pandemic further strained the health- and social care system, exposing shortcomings in eldercare coordination. This paper explores the impact of crises on inter-organizational coordination between long-term organizational collaborators, operationalized through medical care coordination in Swedish nursing homes during the Covid-19 pandemic.MethodsThe study examines coordination between regionally employed physicians and municipal nursing home nurses through a mixed methods approach. A survey was sent to regional physicians and municipal nurses working in eldercare, as well as managers at both nursing homes and healthcare centers. A total of 170 responded to the survey, and 20 participants took part in a subsequent follow-up interview.ResultsFindings indicate that medical care coordination was perceived to have functioned relatively well during the pandemic and even to have improved afterward. Key factors contributing to this outcome include the adoption of innovative solutions, such as digital technologies, to address both staff shortages and increased demand brought on by the crisis. Trust and shared cultural values among staff fostered collaboration, while personal engagement became crucial when compatibility was lacking. The respondents also highlighted improved communication channels and enhanced coordination as a means to combat uncertainties during the crisis.ConclusionsThe perception of well-functioning crisis coordination among the respondents contrasts with more critical views in general society. This discrepancy might be attributed to different expectations during crises; healthcare professionals adhere to specified standards, values, and beliefs within their specialized cultures. Healthcare professionals might therefore have a more nuanced perception of what they believe constitutes good medical care coordination. The contributions of this study include integrating the crisis management literature with inter-organizational coordination in healthcare. The approach provides new insights to clarify the impact of crises on medical care coordination and identify important factors regarding inter-organizational coordination during crises.

Teaching Note—SBIRT: Opportunities to Expand Addiction-Related Clinical Processes, Technical Skills, and Relational Competencies in Social Work

ABSTRACT Social work plays a critical role in preparing professionals for substance use screening, intervention, and treatment. Educators must offer competency-based, clinical learning experiences grounded in social work values and ethics to build student competence and confidence. This Teaching Note introduces the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, highlighting its evidence base, application in clinical social work curricula, and alignment with Council for Social Work Education competencies. SBIRT equips students with practical, adaptable skills in assessment, clinical practice, and care coordination. Moreover, SBIRT’s theoretical framework translates social work values and ethics into action through a patient-centered approach. Given the prevalence of substance use, this content is relevant for students in community-based behavioral health, schools, and healthcare settings.

The Touch of Artificial Intelligence in Social Work: Analysis of Social Investigation Reports in Child Welfare with ChatGPT

ABSTRACT Purpose This research aimed to examine the responses given by ChatGPT to seven social investigation reports prepared in the field of children regarding deficiencies, risk factors and protective factors, social work intervention plan and institution suggestions in Türkiye. Materials and methods Anonymized reports were accessed via web pages on Google and content analysis was conducted using qualitative research methods. The data obtained were analyzed by using the MAXQDA22 program with thematic analysis method and three main themes were created. Results In the first theme, social investigation reports are comprehensively evaluated by ChatGPT, deficiencies in both form and content are identified and improvement suggestions are presented. Risk factors and protective factors as the second theme are divided into sub-themes as individual characteristics and experience, family, social environment, health, education, housing, economic and social situation. In the last theme, it is observed that the objectives are established before the social work intervention plan and the institutions providing services are suggested by taking into account different practice areas. Conclusion Future studies could investigate the effects of the use of AI in social work practice on social work experts.

Healthcare and productivity cost of osteoporosis: a Danish register-based quasi-experimental study.

As the prevalence of osteoporosis rises, driven by an ageing population, quantifying its financial impact and guiding resource allocation becomes crucial. The aim of this paper is to establish the healthcare (medical and social care) costs and productivity costs attributable to osteoporosis and osteoporosis-related fractures in Denmark. The osteoporosis and osteoporosis fracture groups were identified from Danish healthcare registers using ICD-10 codes. The intervention group included individuals born in 1930-1950 with an osteoporosis diagnosis or an osteoporotic fracture with incidence between 2000 and 2021. A control group without osteoporosis and osteoporosis fractures was matched 1: 1 on a number of clinical and demographic variables from the general Danish population. Difference-in-difference approach was applied through generalised estimating equations with individual-level fixed effects to establish attributable costs. Osteoporosis and osteoporosis-related fractures can be attributed with more than €3097 annually in healthcare costs for individuals aged 50 to 91, with expenses increasing sharply with age. Cumulative attributable healthcare (medical and social care) cost of osteoporosis between the ages of 50 and 91 was estimated at reach €127,000 per person. For the identified population of over 667,000 people with osteoporosis, the total annual healthcare burden attributable to the disease would amount to over €2 billion. The osteoporosis group also incurred an annual productivity loss of €3883, until the age of 66. Osteoporosis carries a pronounced economic burden for the health system and the individual. Resource allocative decisions should consider whether implementing strategies improving prevention, earlier detection, and better management of osteoporosis could be efficient given the high identified costs.

Behind the Mask of Black Women Social Workers: Workplace Integration, Code-Switching, and the Silent Struggles

ABSTRACT Black women social workers (BWSWs) face institutional barriers that affect their perception of themselves as professionals. The scientific literature is unclear about how BWSWs navigate their work environments while grappling with self-doubt, feelings of fraudulence, invisibility, and questioning their accomplishments. To fill the gap in knowledge, 17 BWSWs were interviewed across the United States. Using hermeneutic phenomenology, a qualitative content analysis was conducted to examine work experiences. Findings suggest that BWSWs experienced workplace environments where they needed to code switch. Code-switching was caused by unsolicited microaggressions, leading to imposter syndrome, invisibility, and distress. Workplace integration represents one solution to improve BWSWs’ experiences. Future research should expand on understanding the need for workplace integration for BWSWs into organizational cultures.

Checklist of Paediatric Advance Care Planning: A Delphi Study.

To develop a comprehensive decision-making checklist for paediatric advance care planning tailored to the needs of terminally ill children and their families. A Delphi Study. Underpinned by Delphi methodology, a four-phase procedure was adopted: (1) drafting items by the working group, (2) refining items based on an experts' survey, (3) further refining based on the same experts, and (4) final adaptations and approval. This study was initiated by the Paediatric Palliative Care Subspecialty Group of the Paediatrics Society of the Chinese Medical Association. The process involved 60 healthcare providers (physicians, nurses, and social workers) from 14 paediatric palliative care teams. The developed checklist included 5 topics, 24 subtopics, and 45 items. Five topics were (1) medical and nursing decision-making, (2) social support planning, (3) psychological support planning, (4) spiritual support planning, and (5) posthumous affairs planning. This checklist addresses symptom management for terminally ill children, integrating support for their psychological, social, and spiritual well-being, and addresses the care needs of their family members. The study provided a paediatric advance care planning checklist derived from the expert consensus that includes key elements and items. This checklist provides healthcare providers with a structured framework to set paediatric advance care planning and ensure that all aspects of children's well-being and their families' needs are considered. This study also lays an evidence-based foundation for the design of related documents. This study developed a comprehensive paediatric advance care planning checklist with 5 topics, 24 subtopics, and 45 items. This study provides a comprehensive decision-making checklist for healthcare providers and families, ensuring that critical decisions are addressed timely. This article is presented in accordance with the CREDES guidelines. Limited patient and public involvement was incorporated, focusing on reviewing the initial checklist draft.