Men at risk: considering masculinity during hospital-based social work intervention.

The needs of hospitalized male patients are often unrecognized and unmet. Men occupy greater than half of all inpatient hospital beds and incur a broad array of illnesses and injuries at higher rates than women--yet often receive health care that pays surprisingly little attention to the concept of patient masculinity, or to masculinity's influence on the male patient's perspectives, behaviors, goals, interests, needs, and challenges. Little emphasis is placed on considering hospitalized male patients as men , understanding their need for patient-centered care within this context, and intervening in ways that regularly allow strengths to be adequately recognized and utilized. In this article, we explore how hospital social workers can reconsider masculinity as a vibrant and formative component of male patients' lives and actively view its characteristics as comprising more than just potential challenges to medical treatment--but also as untapped sources of resilience and strength.

An evidence-based case for the value of social workers in efficient hospital discharge.

A study was undertaken to make an evidence-based case for the value of social workers in efficient discharge of patients from acute care hospitals and to assist hospital managers in making informed staffing decisions. Hospital administrative databases from March 1 to November 30, 2008, were used for the analysis of inpatient discharges on days when social workers were on vacation compared with days fully staffed with social workers. Two performance measures, daily discharge rate and average length of stay, were evaluated. During the study period, 1825 patients were discharged from the General Internal Medicine inpatient service. Team discharge rates were significantly lower on social work vacation Fridays versus regular Fridays. In contrast, the average length of stay for patients discharged on social work vacation Fridays was significantly shorter than that for patients discharged on regular Fridays. It was concluded that daily discharge rate better quantified the role of social work in patient discharge. More generally, these results provide preliminary support for the need for adequate social work staffing in timely and efficient patient discharge.

Practice-based research:changing the professional culture and language of social work.

Practice-based evaluation integrates research skills and techniques into the clinical process in order to correlate clinical interventions with treatment outcomes. Although most clinicians recognize the importance of some form of practice evaluation, barriers including lack of time, resources, expertise, and organizational support may deter such evaluation efforts. However, there are numerous advantages for clinicians and agencies to develop a culture that values and integrates practice evaluation into its daily work-life; these include opportunities for teamwork, collaboration, mentoring, and innovation. This paper defines practice evaluation research, identifies strategies for its implementation, and describes a framework for creating a "research friendly" culture. It further describes the implementation of such an innovative program in both a hospital and a mental health agency setting.

Delayed discharge from mental health hospitals: results of an English postal survey.

This paper reports findings from a postal survey conducted by the UK's NHS Confederation to explore the rate and cause of delayed hospital discharges in mental health inpatient services. With delayed discharges the subject of considerable UK government activity in general hospital settings, there has been debate about extending recent financial penalties to mental health, fining social services departments for delayed discharges (a system known as reimbursement). Against this background, the NHS Confederation sent a postal survey to all 83 English mental health trusts and Primary Care Trusts with responsibility for providing mental health services. This asked respondents about delayed discharges from mental health inpatient beds in terms of number of delays, duration of delay, specialty and cause. Responses were then analysed quantitatively (in terms of number and extent of delays) and qualitatively (attitudes to reimbursement and other policies that might help resolve the issue). Overall, the survey reveals high levels of delayed discharges (with from 4% to 16% of beds affected and some 25 to 2,366 bed days lost depending on specialty). The causes of delayed discharge are varied, with a range of factors interacting. Although opinion was divided on the benefits of extending reimbursement, closer analysis revealed greater agreement than may at first be apparent. In particular, those favouring extension tended not to be 'pro-reimbursement' per se, but rather desperate to tackle delayed discharges and prepared to consider any policy that might help. This is an important addition to the current literature and debate, as it suggests that those seemingly in favour of reimbursement may actually be more motivated by a desire to try anything that might reduce delays rather than by commitment to this particular policy.

"Everybody puts a lot into it!" Single session contacts in hospital social work.

For the most part, social casework literature is based on the assumption that social workers have on-going contacts with clients over a period of time. However, the experience of social workers in a number of fields of practice suggests that it is common for social workers to see clients only once. This paper reports on a qualitative study of hospital social workers' experiences of single session contacts with clients. Analysis of the data from focus groups with hospital social workers indicated that they do not always give single session work the significance it deserves, although a high level of skill is seen to be required to do such brief work well. A number of distinctive characteristics of single session work were identified including setting clear goals and parameters, establishing rapport quickly and adhering to the social work principle of self determination at the same time as working quite directively. The implications of these findings for future research are discussed.

Client satisfaction and empowerment through social work intervention.

This study examines the utility of satisfaction questionnaires in gauging the effectiveness of social work services in a paediatric hospital setting. Participants completed an empowerment scale before seeing a social worker. Approximately four weeks later, participants completed the empowerment scale again, at which time they also completed a satisfaction questionnaire. The difference between the pre- and post-test empowerment scores was compared with the satisfaction scores, and the influence of some demographic and intervention variables was examined. The results indicated that there was no significant relationship between participants' reported level of satisfaction with the social work service provided and the change in participants' empowerment scores before and after intervention. Most demographic and intervention variables tested did not yield any significant associations with satisfaction or change in empowerment. However, it was found that those who received both counselling and practical assistance (rather than only one or the other) and those with a higher level of education were more likely to report an increase in their level of empowerment after receiving social work intervention. This study lends further support to the contention that satisfaction questionnaires alone may not provide reliable information with regard to the utility and effectiveness of paediatric hospital social work intervention.

The experience of urban aboriginals with health care services in Canada: implications for social work practice.

This exploratory study investigates the experience of Canadian Urban Aboriginal persons as consumers of health care services. Results highlight significant gaps in the training, skills, and knowledge of health care providers to optimally serve their Aboriginal patients. Also, several programs which are potentially most problematic for Aboriginal patients are identified. The discussion outlines important roles for hospital social workers in improving the care provided to urban Aboriginal patients.

Towards the development of a paediatric discharge planning screening tool.

This study reports the second phase in the development of a paediatric discharge risk screening tool. It describes evaluation of the reliability and validity of this tool, which is designed to identify children in need of post-discharge care beyond that of routine nursing and physician teaching and follow-up. The first group identified was children who possessed a non-routine or unpredictable pathway of post-hospital treatment. The second group encompassed those with multifaceted, complex post-hospital care needs, requiring extensive internal hospital department coordination and involvement of community-based care providers in the discharge planning process. It was found that discharge risk factors reflecting objective and easily observable illness and treatment criteria were the most reliable predictors of need for social work discharge planning. It is recommended that a discharge risk tool be completed in partnership with unit nursing staff, and that it be subjected to further review in other organizational settings.

Differences and similarities between social work and nurse discharge planners.

Historically the tasks involved in discharge planning have been a part of the practice of social work as well as the field of nursing. Based on this history and need for collaboration, a study conducted in 1998 measured the responses of 178 nurses and social workers who practiced discharge planning in 58 different hospitals in Alabama. According to the information gathered in this sample, it was clear that social workers as well as nurses continued to be important service providers in the area of discharge planning. Demographic data, work setting, caseload, and task difference were compared and significant differences were reported. This article makes recommendations for social work's participation in advocacy, policy, and outcome research in discharge planning.

[Methodology for the comprehensive evaluation of the quality of performance of activities of medical and social experts]. / Metodologiia kompleksnoi otsinky iakosti diaial'nosti ustanov mediko-sotsial'noi ekspertyzy.

The paper scientifically substantiates methodology, approaches, criteria, and control indices for assessment of activities of establishments of medical-and-social performance. Most indices for efficiency and certain indices for week points in the work of establishments of the service depend on interaction thereof with curative- and prophylactic institutions; the best results with the problem of prevention of disability and rehabilitation of invalids are supposed to be achieved through collaborative efforts. Other criteria and intermediate indices having an effect on the quality of activities reflect the resource- and trained personnel supplies of establishments of the service, amount of work, organizational measures designed to raise the quality of medical-and-social expert performance.

A pilot survey of social work services in pediatric primary care programs in urban teaching hospitals.

OBJECTIVE: To determine the current status of social work presence in pediatric primary care clinics in urban teaching hospitals. DESIGN: Survey instrument mailed to the medical directors of outpatient pediatrics in the major pediatric teaching hospital of approved residency programs in the 100 largest metropolitan areas in the United States. RESULTS: Sixty responses (60%) were received. Eighty percent of practices reported having on-site social work services, with a median of 14,805 annual clinic visits per social work full-time equivalent. Ninety-five percent of respondents considered on-site social work services in pediatric primary care to be important, whereas half of respondents considered social work services "less than adequate" at their site, and most of these felt this inadequacy had led to additional hospital visits or other adverse outcomes. There were no significant associations of reported adequacy of social work services with any characteristics of hospital, practice, or population. CONCLUSION: Pediatric primary care clinicians at teaching hospitals consider on-site social work services to be important, but most report these services are less than adequate in their practices, and for many, adequacy has declined.

Evaluate the contribution of social services.

Performance measures are generally easiest to determine for social work activities that have clearly defined goals. According to Patrice Spath, RHIT, by using a patient and family satisfaction survey, the case management team can collect data about patient and family perceptions of staff performance, set goals, and make constant improvements in quality.

Ethical dilemmas in general hospitals: differential perceptions of direct practitioners and directors of social services.

Two distinct groups of social workers in general hospitals, fourteen directors of social work services and eighteen direct practitioners, were interviewed concerning their perception, ranking and resolution patterns of ethical dilemmas. The reverse order of importance and somewhat different content of ethical dilemmas identified by the two groups reflect their differential position in the hierarchy of hospitals and the difference in their experience in dealing with ethical dilemmas vis-à-vis clients. The directors tended to depend more on internal loci of authority, and were far more concerned with how to interpret and apply the relevant laws than the direct practitioners. Their decision making patterns seemed to be more virtues focused in contrast to the utilitarian and rights based focus of the direct practitioners. The findings emphasize the need for social workers' knowledge of ethical theories, rules and principles, and ethical self-knowledge. They also point out the need for written protocols of debates and/or detailed descriptions of applications of ethical decision making models to case situations in practice. The latter may provide guidelines for social workers in similar situations in the future, and at the same time be used as material for teaching and supervision.