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Gehring ND, Speed KA, Dong K, Pauly B, Salvalaggio G, Hyshka E. Social service providers' perspectives on caring for structurally vulnerable hospital patients who use drugs: a qualitative study. BMC Health Serv Res 2022; 22:1138. [PMID: 36076267 PMCID: PMC9461250 DOI: 10.1186/s12913-022-08498-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background People who use drugs and are structurally vulnerable (e.g., experiencing unstable and/or lack of housing) frequently access acute care. However, acute care systems and providers may not be able to effectively address social needs during hospitalization. Our objectives were to: 1) explore social service providers’ perspectives on addressing social needs for this patient population; and 2) identify what possible strategies social service providers suggest for improving patient care. Methods We completed 18 semi-structured interviews with social service providers (e.g., social workers, transition coordinators, peer support workers) at a large, urban acute care hospital in Western Canada between August 8, 2018 and January 24, 2019. Interviews explored staff experiences providing social services to structurally vulnerable patients who use drugs, as well as continuity between hospital and community social services. We conducted latent content analysis and organized our findings in relation to the socioecological model. Results Tensions emerged on how participants viewed patient-level barriers to addressing social needs. Some providers blamed poor outcomes on perceived patient deficits, while others emphasized structural factors that impede patients’ ability to secure social services. Within the hospital, some participants felt that acute care was not an appropriate location to address social needs, but most felt that hospitalization affords a unique opportunity to build relationships with structurally vulnerable patients. Participants described how a lack of housing and financial supports for people who use drugs in the community limited successful social service provision in acute care. They identified potential policy solutions, such as establishing housing supports that concurrently address medical, income, and substance use needs. Conclusions Broad policy changes are required to improve care for structurally vulnerable patients who use drugs, including: 1) ending acute care’s ambivalence towards social services; 2) addressing multi-level gaps in housing and financial support; 3) implementing hospital-based Housing First teams; and, 4) offering sub-acute care with integrated substance use management. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08498-x.
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Affiliation(s)
- Nicole D Gehring
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Kelsey A Speed
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Kathryn Dong
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Bernie Pauly
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada. .,Inner City Health and Wellness Program, Royal Alexandra Hospital, Edmonton, AB, Canada.
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Palinkas LA, Whiteside L, Nehra D, Engstrom A, Taylor M, Moloney K, Zatzick DF. Rapid ethnographic assessment of the COVID-19 pandemic April 2020 'surge' and its impact on service delivery in an Acute Care Medical Emergency Department and Trauma Center. BMJ Open 2020; 10:e041772. [PMID: 33082198 PMCID: PMC7577068 DOI: 10.1136/bmjopen-2020-041772] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Assess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related physical and mental health demands. DESIGN Rapid clinical ethnography of patient-provider encounters during an initial pandemic 'surge' conducted by a team of clinician-researchers using a structured protocol for qualitative data collection and analysis. SETTING Level 1 trauma centre at Harborview Hospital in Seattle Washington in April 2020. PARTICIPANTS Frontline clinical providers serving as participant observers during performance of their clinical duties recorded observations and summaries of conversations with other providers and patients. RESULTS We identified four different kinds of impacts: procedural, provider, patient and overall. Each impact highlighted two or more levels of a socioecological model of services delivery: (1) the epidemiology of COVID-19, (2) outer setting, (3) inner or organisational setting and (4) individual patient and provider. Despite significant changes in procedures that included COVID-19 screening of all admitted patients, social distancing and use of personal protective equipment, as well as changes in patient and provider behaviour, the overall impact of the pandemic on the emergency department and acute care service delivery was minimal. This is attributed to having a smaller surge than expected, a quick response by the healthcare system to anticipated demands for service delivery and protection of patients and providers, adequate supplies and high provider morale. CONCLUSIONS Although limited to one setting in one healthcare system in one community, the findings offer some important lessons for healthcare systems that have yet to be impacted as well as systems that have been more severely impacted. Each of the socioecological framework levels was found to impact service delivery to patients, and variations at each of these levels account for variations in that quality of care globally.
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Affiliation(s)
- Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Lauren Whiteside
- Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison Engstrom
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark Taylor
- Division of Trauma, Burn and Critical Care Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Kathleen Moloney
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Negi NJ, Forrester P, Calderon M, Esser K, Parrish D. We are at Full Capacity": Social care workers persisting through work-related stress in a new immigrant settlement context in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e793-e801. [PMID: 31260160 PMCID: PMC10962019 DOI: 10.1111/hsc.12802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 03/29/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
Cities without a prior established history of Latina/o migration are experiencing the fastest rate of growth in new immigrants in the United States (Wainer, A tale of two cities (and a town): Immigrants in the Rust Belt, 2013; Lichter & Johnson, Immigrant gateways and Hispanic migration to new destinations. International Migration Review, 43, 496, 2009). These new immigrant settlement cities experience the challenge of adapting their social care context to become more responsive to the needs of immigrants. Yet as cities and social care organisations struggle to keep up with the "lag" time in the availability of culturally and linguistically responsive resources and services, social care providers often work in conditions of scarcity in a social care context that is often lacking in its ability to fully respond to the needs of immigrants. Literature indicates that such conditions of scarcity can lead to work related stress, burn-out, and can have a negative impact on the quality of services delivered by social care workers. Yet little is known regarding social care providers' motivations and responses to work stress; and how providers may positively respond and persist in their jobs despite such stressors. This study conducted in the new immigrant settlement city of Baltimore from 2014 to 2016, utilises semi-structured interviews to qualitatively explore the personal motivational beliefs, workplace and demographic factors associated with buffering stress and frustration among social care workers in a new immigrant settlement city (N = 29). Findings highlight important motivational and work-related factors that appear to minimise the impact of stress and frustration for social care providers and can be used in the development of burn-out interventions as well as improving quality of services for vulnerable populations such as, immigrants, especially in low-resource new immigrant settlement contexts.
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Affiliation(s)
- Nalini J Negi
- University of Maryland, School of Social Work, Baltimore, Maryland
| | | | - Marilyn Calderon
- University of Maryland, School of Social Work, Baltimore, Maryland
| | - Katherine Esser
- University of Maryland, School of Social Work, Baltimore, Maryland
| | - Danielle Parrish
- Baylor University, Diana R. Garland School of Social Work, Waco, Texas
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Moore M, Conrick KM, Reddy A, Allen A, Jaffe C. From Their Perspective: The Connection between Life Stressors and Health Care Service Use Patterns of Homeless Frequent Users of the Emergency Department. HEALTH & SOCIAL WORK 2019; 44:113-122. [PMID: 30855682 PMCID: PMC6642452 DOI: 10.1093/hsw/hlz010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/26/2018] [Accepted: 01/07/2019] [Indexed: 06/09/2023]
Abstract
The perspective of homeless adults on their health care service utilization is not well studied. This article describes a study that used in-depth, semistructured interviews with 18 individuals to highlight the viewpoints of homeless people who are frequent users of the emergency department (ED) about the influence of life events on service utilization. Participants reported high levels of pain and comorbid psychiatric, substance use, and medical conditions. They also reported an identifiable pattern of health care utilization, often centered on a crisis event, influenced by high perceived medical needs, inability to cope after crisis, predisposing vulnerability from social determinants of health, and health care system factors. A social work case management intervention often led to a period of stability and use of ED alternatives. Modifiable targets for intervention at the health care system and local levels include improving trust and convenience of ED alternatives, enhancing consistency of care at ED-alternative sites, and educating those at risk of frequent ED use about community alternatives.
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Affiliation(s)
- Megan Moore
- Megan Moore, PhD, MSW, is Sidney Miller endowed associate professor in direct practice, School of Social Work, and core faculty, Harborview Injury Prevention and Research Center, University of Washington, Seattle. Kelsey M. Conrick, MPH, is research coordinator, School of Social Work, University of Washington, Seattle. Ashok Reddy, MD, MSc, is assistant professor, University of Washington Division of General Medicine; physician investigator, Health Services Research and Development Service, Veteran’s Administration (VA); and primary care provider, VA Puget Sound Health Care System, Seattle. Ann Allen, LICSW, is social worker, School of Social Work, University of Washington, Seattle. Craig Jaffe, MD, is a psychiatrist, Harborview Medical Center, Psychiatry, and clinical assistant professor of psychiatry and behavioral sciences, University of Washington, Seattle. This work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000421 to MM) and the Northwest Center for Public Health Practice Training Program
| | - Kelsey M Conrick
- Megan Moore, PhD, MSW, is Sidney Miller endowed associate professor in direct practice, School of Social Work, and core faculty, Harborview Injury Prevention and Research Center, University of Washington, Seattle. Kelsey M. Conrick, MPH, is research coordinator, School of Social Work, University of Washington, Seattle. Ashok Reddy, MD, MSc, is assistant professor, University of Washington Division of General Medicine; physician investigator, Health Services Research and Development Service, Veteran’s Administration (VA); and primary care provider, VA Puget Sound Health Care System, Seattle. Ann Allen, LICSW, is social worker, School of Social Work, University of Washington, Seattle. Craig Jaffe, MD, is a psychiatrist, Harborview Medical Center, Psychiatry, and clinical assistant professor of psychiatry and behavioral sciences, University of Washington, Seattle. This work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000421 to MM) and the Northwest Center for Public Health Practice Training Program
| | - Ashok Reddy
- Megan Moore, PhD, MSW, is Sidney Miller endowed associate professor in direct practice, School of Social Work, and core faculty, Harborview Injury Prevention and Research Center, University of Washington, Seattle. Kelsey M. Conrick, MPH, is research coordinator, School of Social Work, University of Washington, Seattle. Ashok Reddy, MD, MSc, is assistant professor, University of Washington Division of General Medicine; physician investigator, Health Services Research and Development Service, Veteran’s Administration (VA); and primary care provider, VA Puget Sound Health Care System, Seattle. Ann Allen, LICSW, is social worker, School of Social Work, University of Washington, Seattle. Craig Jaffe, MD, is a psychiatrist, Harborview Medical Center, Psychiatry, and clinical assistant professor of psychiatry and behavioral sciences, University of Washington, Seattle. This work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000421 to MM) and the Northwest Center for Public Health Practice Training Program
| | - Ann Allen
- Megan Moore, PhD, MSW, is Sidney Miller endowed associate professor in direct practice, School of Social Work, and core faculty, Harborview Injury Prevention and Research Center, University of Washington, Seattle. Kelsey M. Conrick, MPH, is research coordinator, School of Social Work, University of Washington, Seattle. Ashok Reddy, MD, MSc, is assistant professor, University of Washington Division of General Medicine; physician investigator, Health Services Research and Development Service, Veteran’s Administration (VA); and primary care provider, VA Puget Sound Health Care System, Seattle. Ann Allen, LICSW, is social worker, School of Social Work, University of Washington, Seattle. Craig Jaffe, MD, is a psychiatrist, Harborview Medical Center, Psychiatry, and clinical assistant professor of psychiatry and behavioral sciences, University of Washington, Seattle. This work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000421 to MM) and the Northwest Center for Public Health Practice Training Program
| | - Craig Jaffe
- Megan Moore, PhD, MSW, is Sidney Miller endowed associate professor in direct practice, School of Social Work, and core faculty, Harborview Injury Prevention and Research Center, University of Washington, Seattle. Kelsey M. Conrick, MPH, is research coordinator, School of Social Work, University of Washington, Seattle. Ashok Reddy, MD, MSc, is assistant professor, University of Washington Division of General Medicine; physician investigator, Health Services Research and Development Service, Veteran’s Administration (VA); and primary care provider, VA Puget Sound Health Care System, Seattle. Ann Allen, LICSW, is social worker, School of Social Work, University of Washington, Seattle. Craig Jaffe, MD, is a psychiatrist, Harborview Medical Center, Psychiatry, and clinical assistant professor of psychiatry and behavioral sciences, University of Washington, Seattle. This work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000421 to MM) and the Northwest Center for Public Health Practice Training Program
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Palmer AD, Murphy-Oikonen J. Social work intervention for women experiencing early pregnancy loss in the emergency department. SOCIAL WORK IN HEALTH CARE 2019; 58:392-411. [PMID: 30776979 DOI: 10.1080/00981389.2019.1580237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
Often referred to as miscarriage, Early Pregnancy Loss (EPL) is the spontaneous death of a fetus experienced within the first 20 weeks of gestation and is the most common complication in pregnancy. Symptoms of an impending EPL are routinely managed in the Emergency Department (ED). EPL can have a substantial impact on women, potentially leading to psychological and emotional health issues and risks to future pregnancies. Despite the high prevalence of EPL, many women suffer in silence due to the common societal belief that EPL are insignificant. Many women experience EPL as an ambiguous loss and are at risk for disenfranchised grief. Compassionate, patient-centred care has been identified by women as an essential and often missing aspect of ED care and can have a profound impact on the overall well-being of women after EPL. Social workers play a critical role in the ED given that they prioritize the psychosocial well-being of patients in a system that is structured to primarily address trauma care. In an effort to reduce the psychological impact and complicated grief reactions of women experiencing EPL, specific recommendations for social work intervention to address the individual needs of women experiencing EPL in the ED are presented. These include acknowledging the loss, providing psychoeducation, honouring the loss, assessing resources, referral and additional information, and building capacity in the ED.
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Affiliation(s)
- Ashley D Palmer
- a School of Social Work , Lakehead University , Thunder Bay , ON , Canada
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