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This paper reports findings from a qualitative study on the triggers of hospital social workers' moral distress at a large southern U.S. health system. Moral distress occurs when ethical conflict cannot be resolved in a way that aligns with an individual's personal and professional values and ethics. Participants indicated that moral distress derives from both individual interactions and the culture and climate of health systems. For example, participants expressed how sources of moral distress derived from client-centered decisions, such as end-of-life care and patient autonomy; interpersonal dynamics, including team or supervisory conflict; structural issues, such as insurance barriers or internal hospital policies; and organizational values, such as perceptions of institutional support and validation. Implications of this research suggest that health systems need to foster positive ethical environments that nurture clinicians' health and mental health through programs that aim to increase moral resilience, promote empowerment, and foster wellness. [ABSTRACT FROM AUTHOR]

Hospice social workers face many challenges in attempts to replicate or supplement the holistic support and unique services hospice provides for individuals discharged alive. This discontinuity in care can impact the types of supports needed by individuals and caregivers, which may or may not be accessible within their community. Patients and families who have access to community-based palliative care programs following a discharge generally tend to navigate the process with fewer challenges. This qualitative study (N = 24) explored both the challenges of the live discharge process and the opportunities within social work practice in the US. Results from this study emphasize the need for a framework to better approach a live discharge to ensure appropriate supports are accessible for all patients and caregivers. Specifically, results highlight both the concrete and psychosocial challenges in live discharges as a result of tension between current eligibility requirements and individual feelings and needs. Social workers also provided suggestions to improve the live discharge process, including attention to communication and preparation. This paper outlines specific challenges of live discharge from hospice, a framework for understanding presented challenges, and implications for policy and practice. [ABSTRACT FROM AUTHOR]

The importance of cultural competence in social work practice is becoming increasingly more evident as the dividing lines between countries and cultures continue to fade away. Successful practice in today's global environment hinges on the ability to accept differences and to work towards a shared future. The necessity of cultural competence is painfully obvious when considering HIV prevention and care. From the start, HIV has been a global epidemic that has devastated many regions of world. The current paper examines the issue of HIV care and prevention from the perspective of Indonesia and the United States. Juxtaposition of these two countries reveals that they have approached HIV care and prevention differently because of their different histories. However, it is advanced that the two countries are likely to have a shared future given the highest infection rates are locating in similar populations, i.e., sex trade workers, intravenous drug users, street children-generally the poor, the oppressed, and their partners. Culturally competent social workers can play an important role in the fight against HIV by understanding and adapting to cultural differences and by merging best practices. [ABSTRACT FROM AUTHOR]

In all aspects of health and mental health care-the emergency room, the outpatient clinic, inpatient facilities, rehab centers, nursing homes, and hospices-social workers interact with patients from many different cultures. This paper will introduce an assessment tool for health care professionals to advance understanding of culturally diverse patients and their families. [ABSTRACT FROM AUTHOR]

With the advent of Medicaid Managed Care, health care professionals and administrators have sought ways to increase patient compliance and appropriate utilization of services under a capitated system. The major focus has been on medical managed care and utilization review to control cost. This paper focuses on the development and standardization of social indicators to identify the biopsychosocial problems that cause medical noncompliance and inappropriate utilization of medical services by the Medicaid patient. The development of what is called Life Indicators is discussed and serves as a basis for enhancing the medical case management model to control cost when providing services to patients with complex medical and social problems. [ABSTRACT FROM AUTHOR]

Long term care in the U.S. has been influenced greatly by the emergence and growth of alternatives to traditional nursing homes. Adult homes provide personal care and assistance to an increasing number of elderly and represent a growth sector of long term care services. However, adult homes have not been discussed widely in the healthcare literature. This paper summarizes findings from a study of adult homes and profiles their operating characteristics, services, and resident needs. Findings indicate differences between licensed and unlicensed homes for adults in terms of the needs of their residents, use of external resources and referral to other sources of care. Implications for coordination of care for the elderly are addressed. [ABSTRACT FROM AUTHOR]

Health and health care delivery continue as dominant domestic issues in the United States. Health also represents a highly sophisticated social work practice area, requiring specific expertise for intervention with complex biopsychosocial patient care issues. Current social work curriculum content must reflect contemporary practice issues and educational resources must be improved to meet the documented need for adequately prepared health care professionals. This paper proposes a curriculum template for practice education and offers additional recommendations to enhance the educational process through increased field and academic collaboration. [ABSTRACT FROM AUTHOR]

A focus group was conducted to determine the views of persons with AIDS about how to best conduct the process of establishing advance directives. (Advance directives are instructions regarding future medical care to be implemented should a patient be unable to communicate his/her treatment preferences.) Several hypotheses emerged from this focus group that were then formally tested with a questionnaire. The results of the questionnaire identified (a) predictors of attitudes toward advance directives and (b) predictors of the act of having established a directive. Based upon the findings from the focus group and the questionnaire, recommendations for social workers raising the issue of advance directives can be made. First, time for the client to adjust to seropositive notification should be allowed prior to raising the advance directive issue. Second, the advance directive issue should be raised in the context of empowerment rather than being embedded in other paper work. Third, people who are most likely to be disturbed by the process of establishing advance directives are those who have low health locus of control, low trait optimism, low reliance on active involvement as a coping mechanism, and low reliance on distraction as a coping mechanism. More time should be allotted for people with those characteristics. [ABSTRACT FROM AUTHOR]

There has been considerable progress in reducing barriers to care for African and Hispanics Americans. Yet current research indicates that overall African and Hispanic Americans are disproportionately encountering barriers to care. Unfortunately very little is known regarding the status of African and Hispanic Americans with disabilities. The purpose of this paper is to assess by using data from the 1987 National Medical Expenditure Survey (NMES), the degree of disability for African, Hispanic and Native Americans and the extent to which it is correlated with the use of services. The findings report that as in the case of other African and Hispanic Americans, African and Hispanic Americans with disabilities dis-proportionately encounter barriers to care. They are more likely than whites to lack insurance, a regular provider and less likely to see a doctor during the year. The implications of these findings for the care of persons with disabilities are discussed. [ABSTRACT FROM AUTHOR]