Social Care Workers Research Articles

Evaluation of a Quality Improvement Intervention to Improve Pediatric Palliative Care Consultation Processes.

A critical aspect of pediatric palliative care consultations is the assessment and documentation of patient and family needs. While these assessments usually include a focus on physical pain, there is less standardization of assessments of other physical symptoms and psychosocial, emotional, or spiritual needs. To improve the breadth of assessment of psychosocial and emotional needs, screen for symptoms other than pain among pediatric patients utilizing palliative care services, and to increase documentation of assessment data from 30%-40% to 80% through practice changes implemented in 2 Plan-Do-Study-Act (PDSA) cycles. This quality improvement project involved implementing provider education and adapting the palliative care consultation template in the electronic health record to improve breadth and consistency of assessment and documentation during consultations by the interdisciplinary pediatric palliative care team. Two PDSA cycles were performed. Chi squared tests and statistical control charts were used for data analysis. There was statistically significant improvement in the inclusion of documentation of a pediatric palliative care social work note from baseline (32%) to Cycle 2 (57%). Physical symptom screening declined slightly, but not significantly (p = .32) and socio-emotional discussions also declined but not significantly (p = .05). Screening for physical symptoms and discussions with patients and families about psychosocial/emotional needs during the initial palliative care consultations are extremely important in providing effective, holistic, patient-centered care. There is a need for development of pediatric-centric guidelines and quality measures to evaluate pediatric palliative care programs; further research is indicated to determine methods for evaluating compliance with these guidelines.

A Cross-Sectional Examination of the Mental Wellbeing, Coping and Quality of Working Life in Health and Social Care Workers in the UK at Two Time Points of the COVID-19 Pandemic.

As the COVID-19 pandemic continues to evolve around the world, it is important to examine its effect on societies and individuals, including health and social care (HSC) professionals. The aim of this study was to compare cross-sectional data collected from HSC staff in the UK at two time points during the COVID-19 pandemic: Phase 1 (May-July 2020) and Phase 2 (November 2020-January 2021). The HSC staff surveyed consisted of nurses, midwives, allied health professionals, social care workers and social workers from across the UK (England, Wales, Scotland, Northern Ireland). Multiple regressions were used to examine the effects of different coping strategies and demographic and work-related variables on participants' wellbeing and quality of working life to see how and if the predictors changed over time. An additional multiple regression was used to directly examine the effects of time (Phase 1 vs. Phase 2) on the outcome variables. Findings suggested that both wellbeing and quality of working life deteriorated from Phase 1 to Phase 2. The results have the potential to inform interventions for HSC staff during future waves of the COVID-19 pandemic, other infectious outbreaks or even other circumstances putting long-term pressures on HSC systems.

Risk, Vulnerability and Complexity: Transitional Safeguarding as a Reframing of Binary Perspectives

Transitional Safeguarding is emerging as a new concept in social work and social care, inviting us to reconsider the binary divides of existing adult and child safeguarding systems. These often fail to adequately meet the needs of young people, particularly those experiencing extra-familial risks and harm. Transitional Safeguarding acknowledges the ‘in-between’ position of young people in adolescence, relating both to their physical and psychosocial development but also to their rights to services, participation and wellbeing. As such, transitional safeguarding challenges conventional ideas about how we frame risk and vulnerability, requiring us to reconsider narrow conceptualisations of safeguarding systems and practice. From a psychosocial perspective, the splitting involved in creating binary, ‘either/or’ categories (such as who presents ‘a risk’ and who is ‘at risk’) may be a defensive response to overwhelming anxiety and complexity, a familiar characteristic of social work and social care practice. This conceptual paper is intended to help inform and underpin practice responses and is based on work from the first phase of a four year Economic and Social Research Council funded research project on how innovations in social care systems and practices can improve service experiences and outcomes for young people facing extra-familial risks and harm.

Clapping for carers in the Covid-19 crisis: Carers' reflections in a UK survey.

This paper reports and discusses the weekly Clapping for Carers – described as ‘front‐line heroes’ that took place across the United Kingdom during the first national lockdown of the coronavirus pandemic. Data are drawn from a UK‐wide online survey of health and social care workers, completed in May to July 2020. The survey received 3,425 responses of which 2,541 were analysed; free‐text comments were categorised. One question asked specifically: ‘Do you think the “Clap for Carers” was a helpful response from the public?’, and 815 comments were provided. Responses were extracted from these 815 free‐text comments and categorised as follows: unequivocally Yes, predominantly Yes, mixed feelings, predominantly No and unequivocally No. Most comments revealed mixed feelings about the helpfulness of Clapping with only a minority being entirely supportive. The free‐text comments offer some explanations for these views with many feeling that Clapping distracted from the severity of the pandemic and the inadequate resources. The free‐text comments reveal workforce concerns that the support demonstrated for the frontline workforce in Clapping might be transitory and that it may not translate into workforce improvements and political commitment to further funding of health and social care. Some saw the value of Clapping as illustrative of community cohesion. There was little mention of Clapping for heroes, and where it was the notion of heroism was rejected. The demonstration of public support in Clapping for Carers may have directly benefitted the public, but only indirectly the workforce. Future recruitment data may help discern if public support has translated into a desire to join the workforce.

HIV-related stigma in the UK then and now: to what extent are we on track to eliminate stigma? A qualitative investigation

BackgroundThe introduction of effective antiretroviral treatment in the late 1990s led to the perception that HIV was a chronic but manageable condition. Nevertheless, stigma remains one of the major hurdles for people living with HIV (PLWH) to accessing healthcare and biomedical preventions. Thus, Fast Track Cities has set a target of zero HIV discrimination by 2030 as part of its strategy to end HIV transmission.MethodsFifty-three participants from the United Kingdom, including PLWH (n = 21, 40%), health and social care workers (n = 24, 45%), and charity workers and activists (n = 13, 25%), were recruited. Semi-structured interviews investigated stigma and discrimination, focusing on both before and after the widespread use of effective antiretroviral treatment in the late 1990s. Data were analysed using a thematic approach.ResultsBefore effective antiretroviral treatment narratives were shaped by two main themes: 1) the media’s role in influencing public opinion and contributing to misunderstandings of HIV transmission; and 2) personal experiences of HIV-related stigma, which for PLWH included incidents of physical violence and aggression, as well as fears of their HIV status being publicised. Contemporary narratives on stigma experiences were organised around four themes: 1) discrimination in healthcare settings; 2) stigma amongst men who have sex with men (MSM); 3) stigma towards African and Afro-Caribbean PLWH; and 4) the limits of change in public HIV-related knowledge and attitudes. Contemporary narratives indicated a reduction in enacted stigma, but continued anticipation of discrimination and self-reported shame, particularly in MSM and African and Afro-Caribbean PLWH.ConclusionThe nature of stigma against those with HIV has evolved. The intersection of PLWH and minority groups (e.g. MSM and African and Afro-Caribbean persons) may enhance anticipatory and internalised stigma, with some suggestion that this may contribute to reduced engagement in HIV care and prevention services. Our findings indicate the need for further research in this area, as well as proactive interventions with community groups to enhance knowledge of HIV.

Blue Prescription Programmes in Health and Social Care Settings and Their Implications for Current and Post COVID-19 Pandemic Mental Healthcare: A Systematic Review of Evidence Using Realist Synthesis

Background: The importance of mental health is increasingly recognised, but mental health services are under strain to meet demand, and this is compounded by the impact of COVID-19. Evidence suggests how blue spaces improve health and wellbeing. Acknowledging the growing interest in nature-based social prescribing, we investigated how blue prescriptions are implemented in health and social care settings, developed determinant frameworks, and extrapolated these to current and post COVID-19 blue space management measures to support mental health.Methods: We conducted a systematic review by searching six databases for original research, published between January 2000 and February 2020, in English, on blue prescriptions by health or social care workers with the outcome of improved health or wellbeing. We excluded studies where participants were recruited by non-health professionals. We also added articles cited in relevant literature. We employed thematic analysis and realist synthesis to describe beneficiaries, mechanisms, outcomes, and contexts where blue prescriptions work. Our study was registered with PROSPERO, CRD42020170660.Findings: We identified 5447 records, of which after screening, 15 studies with adequate to strong quality based on QualSyst tool were included. Health, social care workers, or health-trained professionals referred or prescribed blue space activities to individuals with physical, mental, and social health conditions. Patient- (enrolment, engagement, adherence) and programme-related (communication protocol and long-term programme sustainability) implementation principles described successful blue prescription programmes. Patient-related determinants were clear referral information reinforcing patient belief; free blue space activities and logistics; social support; natural environment and biodiversity; skills and values of service providers. Effective communication channels, multi-stakeholder collaboration, financing, and trained link workers sustained implementation of blue prescription programmes.Interpretation: Findings underscore critical determinant frameworks generating outcomes of successful blue prescription programmes in health, social care, and educational facilities that could be adopted during and post-pandemic.Funding: Scottish Government Hydro Nation Scholars ProgrammeDeclaration of Interests: We declare no competing interests.

Healthcare professionals’ perspectives on unique communication and care needs for Chinese American cancer patients.

e24122 Background: Effective clinician-patient discussions of cancer diagnoses and prognoses are essential to enhance health outcomes in diverse oncology populations. To provide guidance on communication preferences and needs among Chinese Americans, one of the fastest growing yet understudied ethnic groups in the United States, we explored considerations and observations from healthcare providers experienced in caring for this oncologic population. Methods: In this inductive, emergent qualitative study, we completed 20 semi-structured virtual interviews with providers from assorted healthcare disciplines with experience caring for Chinese American cancer patients in Boston’s Chinatown. Responses were systematically collected and analyzed using open and focused coding, constant comparative methods, and thematic analysis. Results: Twenty healthcare professionals with experience working with the Chinese American patients were interviewed including medical oncologists, radiation oncologists, primary care physicians, nurses, nurse practitioners, social workers, case managers, patient navigators and dietitians. Fifteen were female, 5 were male, and 11 participants self-identified as Asian. Six key themes were identified: (1) Discussing cancer diagnoses and prognoses is taboo and often avoided by Chinese Americans in family, community, and healthcare settings. (2) A cancer diagnosis may be considered a death sentence by Chinese Americans, regardless of cancer location or stage. This could be related to the meaning implied by direct translation of the word “cancer.” (3) In settings where cancer diagnoses and prognoses are discussed, Chinese American patients often prefer indirect communication approaches including use of expressions such as “tumor,” “mass,” or “illness” to avoid the use of the word “cancer.” (4) The family centered role in medical decision making for Chinese American cancer patients and the preference of some family units to protect the patient from their diagnoses present unique challenges in the context of standard care. (5) Obtaining a detailed psychosocial history is important to guide communication approaches, as patient characteristics like age, generation since immigration, and education play a foundational role in communication preferences. (6) Karma and nutritional beliefs should be considered and addressed in oncologic care, as they play a critical role in health and disease management for Chinese American cancer patients. Conclusions: Further exploration of these insights and confirmation of their accuracy by discussing directly with Chinese American patients is imperative. If these findings are corroborated through further investigation, this knowledge can be used develop educational tools and implement clinical practice changes to enhance care outcomes and communication with Chinese American cancer patients.

Power and Care in Statutory Social Work with Vulnerable Families

ABSTRACT Families subject to child protection services are often in a marginalised position with less resources to live up to normative expectations of parenthood. Statutory social workers and parents often hold conflicting views regarding the child’s needs and the family situation, and their relationship is asymmetric leaving the parents with less power to define the situation. This is legitimised in the child’s need for protection and care. However, parents and families can also be vulnerable. Therefore, a core ethical concern is how to act carefully in consideration of different positions and perceptions. In this article, we argue that within such a context of state power and service delivery ethical reflection is crucial, but in a way that makes visible the connection between power and care. Consequently, we offer an analysis of the connection between power and care in statutory social work that captures core ethical, relational and professional dilemmas. This analysis combines notions from care ethics with sociological perspectives on power, conflict, trust, recognition and social suffering, and is illustrated by the case Cecilia and her children. Based on this, we suggest possibilities for care ethics in statutory social work and further research on care and power.

Psychological, social, and situational factors associated with COVID-19 vaccination intentions: A study of UK key workers and non-key workers.

ObjectivesVaccine hesitancy is a growing concern and threat to public health. This research will begin to examine the relative influence of relevant psychological, social, and situational factors on intent to engage with a hypothetical COVID‐19 vaccine among key workers and non‐key workers.DesignCross‐sectional.MethodsThe study utilized a sample of UK adults who completed the 1‐month follow‐up of The COVID‐19 Psychological Wellbeing Study during April/May 2020 and indicated having not been previously diagnosed with COVID‐19 (key workers n = 584; not key workers n = 1,021). These groups were compared in relation to their intentions to vaccinate, perceived risk of infection, and symptom severity. Binary logistic regression was used to examine predictors of vaccine hesitancy.ResultsOverall, 74.2% of the sample (76.2% key workers, 73.1% non‐key workers) indicated they would accept a COVID‐19 vaccine in future. Key workers (in particular health and social care workers) had a higher perceived risk of becoming infected in the coming months. For key workers, being female and perceiving oneself as having relatively low infection risk in the next 6 months was associated with increased likelihood of vaccine hesitancy. For non‐key workers, however, being aged 25–54, having a low or average income and not knowing someone diagnosed with COVID‐19 were associated with hesitancy.ConclusionsThe proportion of individuals willing to accept a vaccine is encouraging but there is much room for improvement. Given the unique predictors of vaccine hesitancy in each group, public health campaigns may benefit from targeted messaging.

Simulation-Based Continuing Education in Health Care Social Work: A Case Study of Clinical Training Innovation.

Health care social workers practice in a fast-paced, demanding work environment, and do not always have the opportunity to reflect meaningfully on their work or to practice new skills. This article describes an innovative program, the Partnership for Excellence in Social Work Practice in Health Care (“the Partnership”), which provides a professional development opportunity for health care social workers and contributes to the larger mission of providing comprehensive and coordinated care to high-risk populations. The Partnership aims to help social workers respond to the current challenges of health care practice through simulation learning as an educational reflective practice technique. Through this program, social workers at all levels of experience have the opportunity to practice real-world scenarios in a safe and structured space, receive feedback, and reflect on their skills. The Partnership utilizes professional actors who portray patients, doctors, and care partners (formal or informal caregivers) in case examples that explore key issues in the field. This enables learners to be exposed to a representative set of patient experiences, expediting the development of their skills, enhancing their competence, and facilitating the habit of ongoing reflection in practice and in the development of one’s professional identity. Implications of the program for clinical social work practice and directions for future study are discussed.

Liminal space and the negotiation of care work in extra-care housing.

This is a qualitative case study of care work in a liminal space, specifically the case of an extra-care housing residence, which is an innovative housing alternative for elderly people in need of care in Sweden. The study is an exploration of social care workers' perceptions about their workplaces and their understandings of themselves, which are shaped by their embeddedness in architectural space. The extra-care housing residence appeared as a liminal space in which two dominant spaces - home care services and residential care - underpinned the staff's perceptions of an unclear workplace and their identity work.

Hospital admissions due to COVID-19 in Scotland after one dose of vaccine

The BNT162b2 mRNA vaccine from Pfizer–BioNTech1 and the ChAdOx1 nCoV-19 vaccine from Oxford–AstraZeneca2 were the first two products deployed in the UK's COVID-19 vaccination programme. In accordance with the strategy set by the nation's Joint Committee on Vaccination and Immunisation (JCVI), vaccines were initially prioritised for care home residents and staff, individuals older than 80 years, and front-line health-care and social care workers. In December, 2020, in response to surging transmission of SARS-CoV-2, JCVI advised delaying the second dose of these vaccines to achieve broader population coverage with the first dose.

Identifying what matters most for the health of older adults in Alberta: results from a James Lind Alliance Research Priority Setting Partnership.

Background:As the number of older adults continues to increase, addressing their health becomes increasingly important for both the population and the health care system. The aim of this priority setting partnership was to use direct engagement with older adults, caregivers and health care providers to identify and prioritize the most important topics on the health of older adults that should be addressed by future research.Methods:We followed the James Lind Alliance method. We conducted an initial online and paper survey from Jan. 22 to May 2, 2018, with older adults in Alberta aged 65 years and older to identify what respondents saw as being most important for the health of older adults. We formed responses into summary questions and checked them against existing evidence. We administered a second survey (July 3 to Aug. 2, 2018) to shortlist summary questions and held an in-person workshop (Aug. 30, 2018) to rank the list through discussion and shared decision-making.Results:We recruited 670 participants (32.7% older adults, 19.7% caregivers, 46.9% health and social care workers) in the initial survey to tell us what topics on the health of older adults mattered most to them. Over 3000 responses generated 101 summary questions, of which only 4 were completely answered by existing evidence. The second prioritization survey was completed by 232 participants (28.4% older adults, 24.6% care partners, 47.0% health and social care workers) to produce a shortlist of 22 high priority questions. Twenty-two attendees participated in the summary workshop to create a prioritized list of 10 questions for future research that address aspects of the health system, provision of care and living well in older adulthood.Interpretation:Older adults, caregivers and clinicians collectively produced a prioritized list of questions that matter most to older adults’ health in Alberta. Provincial researchers and research funders should consider these unmet knowledge needs of end-users in future endeavours.

The protective effect of SARS-CoV-2 antibodies in Scottish healthcare workers.

BackgroundHealthcare workers (HCWs) are believed to be at increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. It is not known to what extent the natural production of antibodies to SARS-CoV-2 is protective against re-infection.MethodsA prospective observational study of HCWs in Scotland (UK) from May to September 2020 was performed. The Siemens SARS-CoV-2 total antibody assay was used to establish seroprevalence in this cohort. Controls, matched for age and sex to the general local population, were studied for comparison. New infections (up to 2 December 2020) post antibody testing were recorded to determine whether the presence of SARS-CoV-2 antibodies protects against re-infection.ResultsA total of 2063 health and social care workers were recruited for this study. At enrolment, 300 HCWs had a positive antibody test (14.5%). 11 out of 231 control sera tested positive (4.8%). HCWs therefore had an increased likelihood of a positive test (OR 3.4, 95% CI 1.85–6.16; p<0.0001). Dentists were most likely to test positive. 97.3% of patients who had previously tested positive for SARS-CoV-2 by reverse transcriptase (RT)-PCR had positive antibodies. 18.7% had an asymptomatic infection. There were 38 new infections with SARS-CoV-2 in HCWs who were previously antibody negative, and one symptomatic RT-PCR-positive re-infection. The presence of antibodies was therefore associated with an 85% reduced risk of re-infection with SARS-CoV-2 (hazard ratio 0.15, 95% CI 0.06–0.35; p=0.026).ConclusionHCWs were three times more likely to test positive for SARS-CoV-2 than the general population. Almost all infected individuals developed an antibody response, which was 85% effective in protecting against re-infection with SARS-CoV-2.

Innovation in a Time of Crisis: A Systematic Review of Three-Dimensional Printing in the COVID-19 Pandemic.

The coronavirus (COVID-19) global pandemic resulted in the breakdown of traditional supply chains responsible for providing essential equipment to hospitals and personal protective equipment (PPE) for health and social care workers. The three-dimensional (3D) printing community has responded to emerging need by recognizing shortages across health care systems and providing innovative solutions in real time, circumventing short-term global supply issues. A systematic review was undertaken to investigate the role of 3D printing in the COVID-19 pandemic in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE, EMBASE, and World Health Organization (WHO) COVID-19 databases. Newspaper and internet article sources were identified using the NEXIS media database. All studies and articles on the application of 3D printed solutions during the peak of the COVID-19 pandemic were included. The literature search identified 26 related articles, and 13 studies met inclusion criteria and were suitable for full-text review. One thousand two hundred and one unique digital media articles were identified; after removal of duplicates and screening of headlines for the inclusion and exclusion criteria, 460 articles were suitable for full-text review. The cross-collaboration between the 3D printing community and health care systems has aided in the provision of innovative solutions to combat the COVID-19 crisis. The applications for 3D printing ranged from oxygenation equipment to noninvasive and invasive ventilatory parts and innovative solutions for infection control and quarantine hubs. This review has identified that 3D printing technology has made the biggest contribution to the production of PPE in particular face shields, mirroring the areas of greatest shortage and need. Additive manufacturing has played a pivotal role in aligning disciplines in engineering, science, and medicine for the greater good. We have witnessed the rapid reconfiguration of traditional supply chains to circumvent global shortages, while making advancements in effort to limit the impact of this and future pandemics.

Social workers as members of burn care teams: A qualitative thematic analysis

BackgroundSocial workers on interprofessional teams contribute to treating the psychosocial sequelae of burn trauma patients in cooperation with many other burn-treatment team members. However, the roles and skills exercised by social workers can vary between burn units as well as the skills social work students are taught in their academic programs. MethodsA purposive sample of 13 burn unit social workers were interviewed online using semi-structured questions. This qualitative thematic analysis of data was conducted to identify how social workers perceive their roles, responsibilities, and knowledge as they relate to their work with patients and their families in a burn unit. ResultsSkills, challenges and barriers to rehabilitation, and resources were identified during thematic analysis within and across participant data as factors social workers found to be important for their work in burn units. ConclusionBy expanding the body of knowledge about factors that impact social work care for burn patients, Social work academic programs may better understand how to prepare medical social work students for best practices in the care of burn-injured patients, survivors, and families at inpatient and community levels.

Supply chain regulation in Scottish social care: Facilitators and barriers

Drawing on a study of a Scottish government initiative to ensure the provision of a living wage to social care workers, the article sheds new light on the value of regulating domestic supply chains to enhance labour standards in supplier organisations, and the factors that facilitate and hinder such regulation. The study confirms that supply chains driven by monopsonistic purchasers tend to drive down employment conditions, while indicating that the studied initiative met with a good deal of success due to a combination of the government generated ‘soft’ regulation and support from care providers that reflected both value and pragmatic considerations. It also highlights the contradictory tensions that can arise between policy aspirations and business objectives and suggests that to be effective, initiatives to enhance labour standards in supply chains need to address adverse market dynamics.

International Collaboration in the Time of COVID-19: The World Hospice and Palliative Care Social Work Network

In the context of widespread loss, isolation, and grief due to COVID-19, palliative social workers came together in the fall of 2020 to form an international group named the World Hospice and Palliative Care Social Work Network (WHPCSW). This emerging global network is committed to amplifying the innovative work, nuanced skills, research, and education and training provided by palliative social workers across different settings around the world. This article highlights some of the novel interventions developed by social workers in response to the pandemic and describes this coalescing WHPCSW network along with information about its mission and membership.

The Long Shadow: Collateral Impact and Finding Resilience Amidst a Global Pandemic Pediatric Palliative Care Social Work During COVID-19

This manuscript illuminates the nuanced ways in which the COVID-19 pandemic has impacted the pediatric palliative care social work role and clinical care in caring for children with life-limiting illnesses and their families throughout the country. The authors discuss memorable moments, logistical impacts, telehealth usage, decision-making experiences, end of life care, bereavement practices, specialized interventions, and self-care. The paper concludes with lessons learned and practical recommendations for the future.

Rapid prioritisation of topics for rapid evaluation: the case of innovations in adult social care and social work

BackgroundPrioritisation processes are widely used in healthcare research and increasingly in social care research. Previous research has recommended using consensus development methods for inclusive research agenda setting. This research has highlighted the need for transparent and systematic methods for priority setting. Yet there has been little research on how to conduct prioritisation processes using rapid methods. This is a particular concern when prioritisation needs to happen rapidly. This paper aims to describe and discuss a process of rapidly identifying and prioritising a shortlist of innovations for rapid evaluation applied in the field of adult social care and social work.MethodWe adapted the James Lind Alliance approach to priority setting for rapid use. We followed four stages: (1) Identified a long list of innovations, (2) Developed shortlisting criteria, (3) Grouped and sifted innovations, and (4) Prioritised innovations in a multi-stakeholder workshop (n = 23). Project initiation through to completion of the final report took four months.ResultsTwenty innovations were included in the final shortlist (out of 158 suggested innovations). The top five innovations for evaluation were identified and findings highlighted key themes which influenced prioritisation. The top five priorities (listed here in alphabetical order) were: Care coordination for dementia in the community, family group conferencing, Greenwich prisons social care, local area coordination and MySense.Ai. Feedback from workshop participants (n = 15) highlighted tensions from using a rapid process (e.g. challenges of reaching consensus in one workshop).ConclusionThe method outlined in this manuscript can be used to rapidly prioritise innovations for evaluation in a feasible and robust way. We outline some implications and compromises of rapid prioritisation processes for future users of this approach to consider.