The nature of social work services in a large public medical center serving an impoverished multicultural population

Depressive symptoms among hospitalized patients in Israel

Depressive symptoms are common among hospitalized patients and can indicate more serious problems. This study examined the level of depressive symptoms among patients in one hospital in Jerusalem, the variables related to depression, and the extent to which social workers provided services to those patients. Over 60% of patients reported high levels of depressive symptoms. Levels were higher among Arabs, those with lower income, small social networks, stronger locus of control (powerful others), weaker internal locus of control, and low emotional support from staff. Social workers were in contact with 44% of patients who had high levels of depressive symptoms.

Improving social work in intensive care unit palliative care: results of a quality improvement intervention

OBJECTIVE

The intensive care unit (ICU) is a focal point for decision making in end-of-life care. Social workers are involved in providing this care for patients and families. Our goal was to examine the social worker component of an intervention to improve interdisciplinary palliative care in the ICU.

METHODS

The study took place at a 350-bed hospital with 65 ICU beds. We surveyed family members and social workers caring for patients who died in the ICU or within 30 hours of transfer from ICU. Clustered regression was used to assess the effect of the intervention on three outcomes: (1) families' satisfaction with social work, (2) social workers' reported palliative and supportive activities, and (3) social workers' satisfaction with meeting family needs.

RESULTS

Of 590 eligible patients, 275 families completed surveys (response rate, 47%). Thirty-five social workers received 353 questionnaires concerning 353 unique patients and completed 283 (response rate, 80%). Social workers reported significant increase in the total number of activities for family members after the intervention. Some of the activities included addressing spiritual or religious needs, discussing disagreement among the family, and assuring family the patient would be kept comfortable. Neither social workers' satisfaction with meeting families' needs nor family ratings of social workers were higher after the intervention. Increased social worker experience and smaller social worker caseload were both associated with increased family satisfaction with social work.

DISCUSSION

The increase in social worker-reported activities supports the value of the interdisciplinary intervention, but we did not demonstrate improvements in other outcomes. Increased social-worker experience and decreased social worker caseload were independently associated with better family ratings of social workers suggesting future directions for interventions to improve care by social workers. Future studies will need more powerful interventions or more sensitive outcome measures to document improvements in family-assessed outcomes.

Social workers in palliative care: assessing activities and barriers in the intensive care unit

Social workers are playing an increasingly important role in providing palliative care to dying patients and their families in the intensive care unit (ICU). The purpose of this study was to determine which activities social workers provided to families of patients who die in the ICU, what barriers to care social workers identified, and whether these activities and barriers were associated with the social workers' satisfaction with the care provided to family members. The study took place at a 350-bed hospital with 65 ICU beds. We examined hospital records and identified 253 consecutive eligible patients who had died in an ICU between August 2003 and March 2004. Of these, 157 (62%) received social work services from one or more social workers. One hundred and seventy-eight questionnaires were sent to 27 social workers; 20 social workers completed 150 questionnaires for 136 patients giving a response rate of 84% for questionnaires sent to social workers (150/178). A multiple regression model with clustering under social workers was used to analyze the data. Talking about the family's feelings and providing support for decisions made by the family were the most frequent activities provided by social workers; both were positively associated with the social workers' satisfaction with meeting families' needs. A heavy patient caseload was one of the most common barriers to care identified by social workers. In conclusion, we identified specific activities and barriers that, if targeted, might improve social workers' abilities to meet a family's needs and we also provided some preliminary evidence for the reliability and validity of questionnaires designed to assess these constructs.

Hospital social work: are we conducting the right type of research?

Given the current financial state of health care in the United States, intervention- or outcome-based research is essential for the survival of hospital social workers. The purpose of the current study was to systematically review the current literature on hospital social work to assess the effectiveness of hospital social work in implementing intervention- based research and to make recommendations for the future direction of research among hospital social workers. Over the 10-year period (1991-2001), a total of 44 peer-reviewed journal articles were identified for inclusion in the present study: 19 were qualitative articles and 25 were quantitative articles. Of these studies, only 5 studies were intervention based research. Possible strategies for increasing intervention research among hospital social workers were discussed.