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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]

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]

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]

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]

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]

With the advent of second-wave feminism during the 1970s,a significant body of literature emerged describing sexist practices in women's health care. Geder-bias and gender disparities found in women `s health care became concerns that garnered considerable attention in the United States because of the increased health risks posed for women. This article describes key historical challenges and accomplishments made in U.S. women `s health care policy during the quarter century spanning 1970-1995 that influence contemporary health care social work practice and social work education. [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]

Social workers in large bureaucratic settings face the pressure to define their service in relation to other professional disciplines and to maintain a quality service despite conflicting mandates and economic restraints. Few strategies exist for providing training and education to senior social workers in order to help them develop leadership roles in multidisciplinary environments. This paper examines the characteristics and qualities necessary to provide social work leadership in a complex hospital environment. The ideas emerged from an international leadership exchange program with The Mount Sinai Medical Center in New York City. Aspects of this experience are used to illustrate leadership roles. [ABSTRACT FROM AUTHOR]

The article discusses the challenges faced by the field of social work research in the U.S. with regard to health care. According to the author, for the last ten years, social work research has attempted to meet the demands of a dynamic health care system. The author posits that the emphasis of social work practice in health care is on the mutual interaction of the patient and the patient's context. Moreover, social work research in healthcare must utilize a conceptual framework for understanding behavior that encompasses a view of people in a network constantly in motion.

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the “graying of America” promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education. [ABSTRACT FROM AUTHOR]

Agencies that deliver health care services to H1V-positive substance abusers living in rural areas of the United States face particular treatment challenges and barriers to care. Rural consumers of HIV/AIDS health care-related services identified long travel distances to medical facilities, lack of transportation, lack of availability of HlV-specific medical personnel, a shortage of mental health and substance abuse services, community stigma, and financial problems as leading barriers to access to care. This article discusses barriers to care for rural HIV-positive substance abusers, and challenges for rural health care providers. In addition, it presents a case study of Health Services Center. a model program that has devised innovative practices in the delivery of health care services to HIV-positive substance abusers in rural northeastern Alabama. [ABSTRACT FROM AUTHOR]

This study addresses the fit between social work education and practice in health care. A random sample of NASW members identifying with health care (N = 179) responded to a mail survey about the utility of core knowledge and roles that we had identified by reviewing seven commonly used health care social work texts. Quantitative data revealed knowledge and roles most frequently used in health care settings as well as differences in roles used dependent upon department name; and different professionals supervising social workers. Qualitative data from four open-ended questions provided suggestions for what knowledge and skills should be taught in social work programs, the best forums/methods for teaching this content, and topics for continuing education. Findings are discussed in relation to six key areas of the peer-reviewed literature: vulnerable populations/diversity, ethical dilemmas, interdisciplinary collaboration, mental health, managed care/accountability, and advocacy. Implications for social work practice, education, and research are discussed. [ABSTRACT FROM AUTHOR]

Using qualitative data, this study examines hardiness and social support among twenty-two African American and Hispanic subjects, at least 18 years of age, who received treatment for a jaw fracture and participated in an hour-long focus group to discuss the treatment they received at King/Drew Medical Center, an inner-city hospital in Los Angeles, California. Treatment was either a non-surgical wiring of the teeth closed for six to eight weeks or surgical placement of a metal bone plate in the lower law with a short period of jaw fixation following surgery. A mandibular fracture is one of the most common orofacial traumas for minority individuals, and the majority of these fractures among patients at urban trauma centers are a result of interpersonal violence. Thus the link between psychosocial stress and oral health is evident, yet exposure to daily stress does not automatically place one at risk for distress. Some people under daily stress have hardiness, conceptualized as an internal personal resource consisting of control, commitment, and challenge. This study examines hardiness and social support relevant to an underserved, minority population. Hardiness and social support were identified and noted in order of frequency according to participant characteristics of treatment type, gender, and ethnicity. Main themes related to hardiness and social support are highlighted with verbatim quotes providing additional context to the theme presented. [ABSTRACT FROM AUTHOR]

Behavioral medicine has become increasingly important in medical education over the past two decades, but adoption of its principles and methods has been slow. Behavioral medicine stresses the effects of human behavior on health and illness using a biopsychosocial approach. It also focuses on the use of the doctor-patient relationship, which, if developed using appropriate communication skills, can result in greater patient satisfaction and increased compliance. The authors surveyed all 124 American medical schools to assess both national trends and specific efforts in the teaching of behavioral medicine principles and methods. A review of the types of behavioral medicine programs offered reveals that eight percent of U.S. medical schools had integrated programs of behavioral medicine. Several successful and effective programs were identified, as were a number of specific curricular components. There are several options available to medical schools to integrate behavioral medicine into medical education. The authors conclude that medical education must include behavioral medicine in order to improve the health of the public and to meet the demands of a changing health care system. [ABSTRACT FROM AUTHOR]

Conducts an assessment of wayfinding issues in health care with the transport disabled during pending reform of the health care system of the United States. Certificate of Need (CON), American with Disabilities Act (ADA) and Urban Mass Transportation Act (UMTA) as wayfinding services for the transport disabled.

If patients are not readily available, family members or others sometimes are used as substitute informants when evaluating consumer satisfaction. Little is known, however, about the extent to which responses of patients and proxies are interchangeable. In this study, patients (N = 225) or significant others (N = 115) provided an overall rating of discharge plans, as well as information on psychosocial, health, and post-hospital service related factors, at 3-4 weeks post-discharge. While no difference was found between mean plan ratings for the two groups, substantial differences were found in factors predicting satisfaction for patients and for proxies. Results indicate that care should be taken in using proxy ratings in the place of patient ratings, particularly when developing strategies for enhancing consumer satisfaction. Findings are discussed as they relate to continuity of care initiatives and programs for enhancement of desirable health utilization behaviors, in the context of managed care. [ABSTRACT FROM AUTHOR]

Individuals of diverse ethnic backgrounds often have beliefs about health, disease and treatment which vary significantly from American scientific medical practice. Cultural and subcultural health beliefs also vary among blacks, Hispanics and Asians. Individual differences within cultural groups may be influenced by length of time in the United States, age and social economic status. Social work activities which can improve health care services to ethnic minorities are identified. [ABSTRACT FROM AUTHOR]