Search

The BSW Experiential Learning (BEL) Program aims to infuse intergenerational content into the curriculum and recruit students to the field of social work by implementing face-to-face learning opportunities with older adults. This article discusses and compares the experiences of 4 diverse BEL projects that implemented gero-experiential learning activities into 1 or more of the BSW curriculum areas: introduction/social work practice, social welfare policy, human behavior in the social environment, social work research, and field practicum. “Three keys to success” are offered as ways in which gero-experiential activities may be successfully implemented by other programs.

This article describes the implementation and preliminary evaluation of a modified college experience for adults with intellectual and developmental disabilities (IDD) at a small liberal arts college. To increase social work students’ interest in working with this population and access of people with IDD to higher education, Bridges to Skidmore was founded in 2010 as a low-cost method for providing cooperative learning opportunities for students and individuals with IDD. Preliminary evaluation reveals that participation can change students’ attitudes toward those with IDD, which may increase their intention to work with this population in the future. The program has created an enriching experience for the college students, lecturing professors, and adults with IDD, and can be easily replicated on other campuses.

Objectives To provide a clinical update on practical strategies to enhance the quality of communication in the palliative and end-of-life medical care settings. Data Sources Published articles, textbooks, reports, and clinical experience. Conclusion The components of effective and compassionate care throughout the advanced illness trajectory require thoughtful and strategic communication with patients, families, and members of the health care team. Unfortunately, few health care professionals are formally trained in communication skills. Implications for Nursing Practice Nurses who possess self-awareness and are skilled in effective communication practices are integral to the provision of high-quality palliative care for patients and families coping with advanced malignancies.

Hospital readmission is an important indicator of health care quality and currently used in determining hospital reimbursement rates by Centers for Medicare & Medicaid Services. Given the important policy implications, a better understanding of factors that influence readmission rates is needed. Racial disparities in readmission have been extensively studied, but income and marital status (a postdischarge care support indicator) disparities have received limited attention. By employing three Poisson regression models controlling for different confounders on 8,718 patients in a veterans-integrated health care network, this study assessed racial, income, and martial disparities in relation to total number of readmissions. In contrast to other studies, no racial and income disparities were found, but unmarried patients experienced significantly more readmissions: 16%, after controlling for the confounders. These findings render unique insight into health care policies aimed to improve race and income disparities, while challenging policy makers to reduce readmissions for those who lack family support.

The purpose of this study is to validate the Swedish translation of the WHO (Ten) and WHO (Five) Well-Being Questionnaires among three samples of Swedes. Baseline data collected in 2008 from the Health Assets Project are the data source consisting of three cohorts of Swedes aged 19–64 years: (1) a randomized general population cohort (n = 4,027); (2) employees sick-listed reported by the employer (n = 3,310); and (3) self-certified sick-listed individuals (n = 498). The psychometric properties of the scales are assessed using factor analysis, Cronbach’s alpha, and examination of the relationship between scale scores and participants’ self-reported adverse health conditions. Factor analysis revealed a unidimensional factor structure for both scales, and Cronbach’s alphas are very good to excellent. The scales correlate in the expected direction with almost all of the adverse health conditions considered. The Swedish translation of the WHO (Ten) and WHO (Five) Well-Being Questionnaires is psychometrically sound, but the first item of both scales has weaker psychometric qualities in comparison with other scale items.

Many patients in the intensive care unit (ICU) have predictable medical and discharge outcomes, but some trajectories are marked with medical uncertainty. Stressed family-surrogates receive multiple medical updates from a variety of personnel. These circumstances can lead to confusion, which may result in conflicts and dissatisfaction with care. This study examined the effects of adding a family support coordinator to the surgical, neurological, and medical ICUs on family, physician, and nurse satisfaction with communication and care. A quasi-experimental design was conducted in 2 sequential phases (baseline and intervention). The data sources were 2 surveys: (1) Family Satisfaction Survey and (2) Nurse and Physician Perception and Satisfaction Survey. Family Satisfaction Survey data, a combined data set, were collected in the 3 ICUs. Nurse and Physician Perception and Satisfaction Survey data were collected from the attending physicians and critical care nurses in the medical and neurological ICUs. Results show that family ratings of satisfaction with ICU team communication and care generally increased as a result of the intervention. Overall, physician and nurse perceptions of communication and care did not change as a result of the intervention.

Characterizing areas of limited knowledge about anxiety disorders and their treatment may help inform treatment dissemination efforts and public health programming. In a sample of 626 adults recruited via Amazon's Mechanical Turk, this study evaluated 1) perceptions of symptoms of anxiety disorders and depression, 2) perceived usefulness of coping approaches (i.e., professional and non-professional help), and 3) awareness of available resources. Results indicated that participants generally recognized that symptoms warranted professional help, and recognition was associated with self-efficacy for seeking mental health care, but not with participants' own symptoms. Furthermore, participants perceived psychotherapy to be the most useful coping approach. Of concern is the perception that symptoms are the result of personal weakness (particularly among male participants and for social anxiety disorder), as well as limited knowledge about publicly available resources. In all, results suggest that there are areas for growth regarding mental health literacy for anxiety disorders.

This article describes the development of a 5-item scale that assesses family caregivers' self-efficacy in communicating with physicians about ill family members (Perceived Efficacy in Caregiver-Physician Interactions-PECPI) in the context of an evaluation study of an online training in health care communication skills for caregivers. A national sample of 197 self-identified family caregivers participated in an online webinar and completed a brief evaluation instrument before and immediately after the training. Results indicated that the webinar was effective in increasing perceived self-efficacy and self-reported knowledge about and level of preparation for medical visits. Principal component analysis indicates that the PECPI is unidimensional with a Cronbach's alpha of .91.

To study the internal consistency, factorial structure, and convergent validity of the Swedish translation of the General Self-Efficacy scale (S-GSE).The S-GSE and two items on mental and physical work capacity were completed by a randomized population cohort (n = 4,027) and two cohorts (n = 3,310 and n = 498) of incident cases of sick-leave (14 days).S-GSE means were higher among men than women in two of the cohorts and higher in the randomized population cohort than in the two sick-leave cohorts. Internal consistency was high with α = .90. Unidimensionality was indicated and factor loadings ranged between .64 and .80. Moderate correlations (.35-.38) between the S-GSE and mental work capacity were found in all cohorts. Yet, the correlation between S-GSE and physical work capacity was weaker in the sick-leave cohorts. The psychometric properties showed similar patterns across gender.Across three cohorts, additionally stratified by gender, the S-GSE comprised one single latent factor and showed high internal consistency. However, since S-GSE was more strongly related to self-assessments of mental work capacity than physical work capacity regardless of sick-leave status, the S-GSE may not be a strong predictor of beliefs about physical work capacity across all populations.

This article tracks the changing roles of certified nursing assistants (CNAs) as they transition from a traditional nursing home setting to a “deinstitutionalized” care setting called the Green House. The Green House concept, developed by William Thomas, MD and based on the Eden Alternative paradigm, emphasizes autonomy, dignity, privacy, and reciprocal relationships between residents and staff. This qualitative work focuses on how CNAs (called “shabazim” in the Green House) negotiated the transition from traditional nursing home to the Green House model. Interview, focus group, and participant observation data before and after the transition to the Green Houses reveal that in the traditional nursing home environment, informants report that resident-CNA interactions tend to be rushed, detached, and adversarial, whereas in the Green House care environment, interdependency and stronger ties are promoted. Shabazim report diminished guilt and enhanced sense of empowerment in their new role.

A cross-sectional study of 76 family caregivers of older veterans with congestive heart failure utilized the McMaster model of family functioning to examine the impact of family functioning variables (problem solving, communication, roles, affective responsiveness, and affective involvement) on caregiver burden dimensions (relationship burden, objective burden, stress burden, and uplifts). Regression analyses indicated that the five dimensions of family functioning were significantly related (p

In 1995, Kenneth B. Schwartz founded the Kenneth B. Schwartz Center Foundation whose mission is to promote compassion in health care. One of the Center's most popular initiatives is the Schwartz Center Rounds, a multidisciplinary forum where medical professionals come together to discuss and process the difficult emotional issues that can arise in patient care. This article briefly describes implementation of Schwartz Center Rounds at a VA hospital, summarizes findings from a study that examines Rounds' outcomes, discusses their utility in providing support for palliative care professionals, and provides lessons learned for others who may want to consider Rounds' implementation.

The Council on Social Work Education's Commission on Accreditation approved a policy in 2004 that allows well-established social work programs the option to complete an alternative to the traditional self-study process. This alternative consists of the completion of a reaffirmation compliance audit and special project that is significant to social work or the program's specific goals and objectives. This article describes how one small BSW program successfully implemented the alternative process by completing a modified self-study, a new site visit protocol, and a threephased project including a needs assessment, a seminar on conducting agency evaluations, and a collaboration with a local mentoring agency. Outcomes for community stakeholders, faculty, and students were positive; although requiring extensive resources, the alternative process was worthwhile. Based on their experience, the authors share suggestions for programs considering this option.

Objectives To provide practical strategies to enhance the quality of communication in the palliative and end-of-life medical care settings. Data sources Published articles, textbooks, and reports. Conclusion The components of effective and compassionate care at the end of life require successful communication with patients, families, and members of the health care team. Unfortunately, few health care professionals are formally trained in communication skills. Implications for nursing practice Nurses who possess self-awareness and are skilled in effective communication practices are integral to the provision of high-quality palliative care for patients and families coping with advanced malignancies.

Difficult ethical problems are often faced by patients, families, and social workers who assist in decision-making around issues regarding end-of-life care. In qualitative interviews with 12 hospital social workers in one large urban cancer center, common ethical issues identified through thematic analysis were preservation of patients' autonomy/self-determination, beneficence of health care providers, and medical futility of end-of-life treatments. Continued communication with all parties involved was key in resolving ethical problems. Discussion, along with referrals of more complex cases to ethics committees and ethics consultation teams, also occurred. Participants further indicated the potential helpfulness of developing practice guidelines for social workers dealing with decision making about end-of-life care.

This qualitative study examines the judgment standard preferences of older adults related to surrogate decision-making for medical treatment. Thirty community dwelling adults over the age of 60 were presented with scenarios that depicted three decision-making standards, two of which are the predominant legal standards (substituted judgment and best interests), and a proposed third standard that allows the surrogate to consider the interests of the family in the decision-making process (best judgment). Half of the sample preferred substituted judgment, five preferred best interests, and ten chose best judgment. Selected cases are presented that demonstrate the themes associated with each judgment Standard preference.

In order to add to the growing literature on intergenerational rates of family violence, data were collected from a community-based child abuse agency. The study's purpose was to compare the co-occurrence of child abuse/neglect (CAN) and domestic violence (DV), and the prevalence of CAN and parent's childhood history of abuse. Data were collected from 537 families through intake and subsequent interviews in an attempt to determine the relationship among CAN and DV, and CAN and parent's childhood history of abuse. A chi-square analysis indicated significant relationships among these variables. Of the participants in this sample, 48.9% had experienced both CAN and DV. These results also indicated that 66.3% of participants had a childhood history of CAN and were currently experiencing issues of CAN with their own children. Logistic regression was utilized to examine whether families involved with Child Protective Services (CPS) were at higher risk for DV and/or parental childhood history of CAN. The results indicate that CPS-involved families were approximately three times as likely to have a parent reporting a childhood history of CAN but were not at significantly higher odds for DV. Implications for service delivery are discussed.

To provide preliminary evidence of the types and amount of involvement by healthcare industry representatives (HCIRs) in surgery, as well as the ethical concerns of those representatives.A link to an anonymous, web-based survey was posted on several medical device boards of the website http://www. cafepharma.com. Additionally, members of two different medical device groups on LinkedIn were asked to participate. Respondents were self-identified HCIRs in the fields of orthopedics, cardiology, endoscopic devices, lasers, general surgery, ophthalmic surgery, oral surgery, anesthesia products, and urologic surgery.A total of 43 HCIRs replied to the survey over a period of one year: 35 men and eight women. Respondents reported attending an average of 184 surgeries in the prior year and had an average of 17 years as an HCIR and six years with their current employer. Of the respondents, 21 percent (nine of 43) had direct physical contact with a surgical team or patient during a surgery, and 88 percent (38 of 43) provided verbal instruction to a surgical team during a surgery. Additionally, 37 percent (16 of 43) had participated in a surgery in which they felt that their involvement was excessive, and 40 percent (17 of 43) had attended a surgery in which they questioned the competence of the surgeon.HCIRs play a significant role in surgery. Involvement that exceeds their defined role, however, can raise serious ethical and legal questions for surgeons and surgical teams. Surgical teams may at times be substituting the knowledge of the HCIR for their own competence with a medical device or instrument. In some cases, contact with the surgical team or patient may violate the guidelines not only of hospitals and medical device companies, but the law as well. Further study is required to determine if the patients involved have any knowledge or understanding of the role that an HCIR played in their surgery.

Nine minority and eleven White low-income community-dwelling senior adults participated in semi-structured qualitative interviews regarding end-of-life decision-making related to the completion of advance directives (e.g., living wills and health care proxies). The seniors were asked to discuss the role of their own evaluations and beliefs and their perceptions of the influence of significant others in their decisions to complete advance directives. Religious affiliation and a measure of religiosity were also examined. The participants overwhelmingly evaluated the completion of advance directives as positive, but many of the seniors reported that discussing end-of-life issues with their children was difficult. In addition, depth of religious belief figured prominently in medical treatment planning for some of the participants, particularly the minority seniors

Hospital readmission rate has been broadly accepted as a quality measure and cost driver. However, success in reducing readmissions has been elusive. In the US, almost 20 % of Medicare inpatients are rehospitalized within 30 days, which amounts to a cost of $17 billion. Given the skyrocketing healthcare cost, policymakers, researchers and payers are focusing more than ever on readmission reduction. Both hospital comparison of readmissions as a quality measure and identification of high-risk patients for post-discharge interventions require accurate predictive modeling. However, most predictive models for readmissions perform poorly. In this study, we endeavored to explore the full potentials of predictive models for readmissions and to assess the predictive power of different independent variables. Our model reached the highest predicting ability (c-statistic =0.80) among all published studies that used administrative data. Our analyses reveal that demographics, socioeconomic variables, prior utilization and Diagnosis-related Group (DRG) all have limited predictive power; more sophisticated patient stratification algorithm or risk adjuster is desired for more accurate readmission predictions.

In this study we explored frail elders’ experiences with and perceptions of the phenomenon of health so as to develop a deeper understanding of living with diseases and disorders in old age. Frail elders participated in qualitative interviews that explored the meaning of the phenomenon of health for them. Eleven men and 11 women, who had diverse ratings of self-perceived health ranging from poor to excellent, were selected by means of a purposeful strategic sampling of frail elders taken from a broader sample that participated in a larger quantitative study on health. In total, 22 individual interviews were analyzed using Giorgi’s descriptive phenomenology. We found that frail elders described health as being in harmony and balance in everyday life, and this occurred when participants were able to adjust to the demands of their daily lives in the context of their resources and capabilities.

The aim of this study was to explore and identify influences on frail older adults’ experience of health. A sample of older adults, 11 men and 11 women aged 67e92, with diverse ratings of self-perceived health ranging from poor to excellent were selected through a purposeful strategic sampling of frail older adults taken from a broader sample from a quantitative study on health. In total, 22 individual qualitative interviews were analyzed using qualitative content analysis in which themes were developed from raw data through a systematic reading, categorization of selected text, theme development and interpretation. To feel assured and capable was the main theme, which consisted of five subthemes: managing the unpredictable body, reinforcing a positive outlook, remaining in familiar surroundings, managing everyday life, and having a sense of belonging and connection to the whole. The importance of supporting frail older adults in subjective resilience in their context is emphasized.

This article summarizes the development of the caregiver-provider relationship assessment (CPRA) designed to measure family caregivers' perceptions of relationship quality with health care providers. Using an online sample of family caregivers (n = 156), the patient reactions assessment (PRA) was adapted for use with family caregivers and subjected to principal component and reliability analyses. Analyses indicate that the CPRA factor structure is analogous to the original PRA scale, and Cronbach's α for the three CPRA subscales range from .85 to .91. The tool can be used by clinicians and researchers in efforts to help family caregivers become more effective communicators in health care contexts.

The study examined the effect of adding a full-time family support coordinator to the surgical intensive care unit team on family satisfaction, length-of-stay, and cost in the surgical intensive care unit.A quasi-experimental design was conducted in two phases: baseline (8 mos) and intervention (10 mos) phases. Data on family satisfaction, length-of-stay, and costs from both phases were collected.The intervention added a new role, the family support coordinator, to the surgical intensive care unit team. The family support coordinator functioned as a liaison between the patient's family and the health care team.The results revealed that generally the intervention was associated with increases in family satisfaction with communication for all surgical intensive care unit team members, with physicians, social workers, and respiratory care therapists showing increases in significance. The largest increase was for physician communication (p = .0034). Families also rated their perceptions of the quality of care provided to their family members by various members of the surgical intensive care unit team. Mean ratings increased for all areas of care, with respiratory and nursing care showing the largest increases. Families' perceptions of the care and treatment they received during the stay of their family member showed increases in all areas of satisfaction between baseline and intervention, particularly those areas most related to the intervention.The implementation of the family support coordinator intervention increased family satisfaction across a range of parameters. Although there were decreases in length-of-stay and costs, they were not statistically significant. Further research is needed to determine whether intervention refinement could produce lower length-of-stay and costs.

The stress associated with a career in emergency medical services (EMS) can impact the work-family fit and function of the family system for EMS personnel. Little research has been conducted on how the demands associated with a career in EMS influences family life. Objective. To describe salient EMS work factors that can impact the family system.Twelve family members (11 spouses and one parent) of EMS workers were interviewed using a semistructured qualitative interview guide that explored issues related to their family members' work that could impact the quality of family life. Using a phenomenological approach, transcribed interview data were examined for themes that illuminated factors that influence work-family fit.Data analysis revealed that shift work impacts numerous aspects of family life, including marital and parental roles, leisure and social opportunities, and home schedules and rhythms. Furthermore, families coped with challenges associated with their loved one's EMS work through negotiating role responsibilities, developing their own interests, giving their family member "space," and providing support by listening and helping the EMS worker process his or her reactions to difficult work. In addition, family members reported concern over their EMS worker's physical safety.Implications from the data are discussed vis-a-vis the work-family fit and family systems models. Education, communication, support systems, and individual interests are key ways to promote a healthy work-family fit.

The Communicating Effectively with Health Care Professionals (CE) workshop curriculum is designed for family caregivers to encourage caregiver empowerment, effective health care communication, and advocacy in medical care contexts with the goal of promoting positive health outcomes for care recipients. This mixed-method study employed a cross-sectional quantitative mail survey (N= 51) and semi-structured qualitative telephone interviews (N= 14) to examine the effectiveness of the curriculum in promoting self-reported changes in caregiver attitudes and communication behavior. Respondents reported increased as-sertiveness in medical encounters, feelings of empowerment, and preparation and organization of medical information for their care recipients as a result of workshop participation.

The Physician Orders for LifeSustaining Treatment (POLST) form provides choices about end-of-life care and gives these choices the power of physician orders. The POLST form assures end-of-life choices can be implemented in all settings, from the home through the health-care continuum. The use of the POLST form was evaluated in a pilot study in nursing homes in two eastern Washington counties. Chart reviews and template analysis of interviews revealed the POLST form accurately conveyed end-of-life wishes in 19 of 21 cases. An informed consent process was evidenced in 16 of 21 cases, and the POLST form was congruent with residents' existing advance directives for health care. The findings support the continued use, development, and evaluation of this promising tool for improving end-of-life care.

The emerging field of palliative care in the United States must respond to the health care needs of persons living and dying from advanced illness. The literature suggests that professional nursing education in palliative care is limited, inconsistent, and sometimes neglected. In response to these identified needs, the Michigan (MI) Advanced Practice Nurse (APN) Palliative Care Project was designed to integrate palliative education into existing graduate nursing curricula and to provide continuing education for postgraduate nurses.

Background Medication overuse headache (MOH) is a chronic headache disorder, caused by overuse of acute medication. To date, it remains unclear why some people overuse these medications. The aim of this qualitative study was to explore how individuals with MOH use medications and other strategies to manage headaches in their daily lives, and their thoughts about their own use of acute medication. Our intention was to develop a theoretical model about the development of MOH, from the perspective of those with MOH. Methods Data collection and analysis were conducted according to grounded theory methodology. The participants were recruited via newspaper advertisements. Fourteen persons with MOH were interviewed in individual qualitative interviews. Results The basic process leading to medication overuse was holding on to the indispensable medication. The acute medication was indispensable to the participants because they perceived it as the only thing that could prevent headaches from ruining their lives. The participants perceived headaches as something that threatened to ruin their lives. As a result, they went to great lengths trying to find ways to manage it. They tried numerous strategies. However, the only strategy actually perceived as effective was the use of acute medication and they eventually became resigned to the idea that it was the only effective aid. The acute medication thus became indispensable. Their general intention was to use as little medication as possible but they found themselves compelled to medicate frequently to cope with their headaches. They did not like to think about their medication use and sometimes avoided keeping track of the amount used. Conclusions This qualitative study adds understanding to the process via which MOH develops from the perspective of those having MOH. Such knowledge may help bridge the gap between the perspectives of patients and health-care professionals. © 2013 Jonsson et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose Globally, the prevalence of mental illness is on the rise, although few people with psychiatric disorders actually seek mental health care. One under-researched factor that may impact help-seeking behavior from health care professionals is self-efficacy. This research presents the development and validation of the Self-Efficacy to Seek Mental Health Care (SE-SMHC) scale, a nine item-self report measure. It was hypothesized that self-efficacy for seeking mental health care would be positively associated with higher rates of self-reported help-seeking behavior and higher rates of advising others in distress to access mental health treatment. Methods A randomized population sample of 977 South Africans completed the SE-SMHC as part of a larger study on barriers to health care for mental illness. SE-SMHC data were subjected to principal component analysis, and data from the larger study were utilized to test the hypotheses. Results Two latent factors emerged from the oblique rotation and accounted for 70% of the variance: SE-KNOW (confidence in one’s ability to know how to successfully interface with mental health care systems) and SE-COPE (confidence in one’s ability to cope with the consequences of seeking care). Cronbach alphas for both subscales were 0.87 and for the total scale score was 0.93. Both hypotheses were confirmed suggesting evidence of the scale’s validity. Conclusions This data suggests that the SE-SMHC demonstrates good psychometric characteristics and may be a useful research tool and screening instrument for targeted interventions.