Social Work - Theses
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ItemSliding doors: how we can effectively manage the transition from palliative hospice care to residential care( 2011)The increasing survival of patients with advanced-stage cancer, coupled with the increased presence of end-stage chronic illness in an ageing population, is leading to an increase in demand for patients requiring palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few of these are able to offer any long-stay admission for those whose symptoms have been stabilised. Transfer from an inpatient palliative care facility may then be necessary, when a patient is considered to be no longer requiring specialist palliative care services. A core component of the role of palliative-care social workers involves working with patients and their families/carers1 when the care pathway shifts and the option of residential care (in this context, nursing homes) needs to be considered. As a social work clinician, I have observed that, when this process has been considered or contemplated, the patient and their families often display anxiety, anger and distress. This practice research study has explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary healthcare team treating the patient. This study has analysed this phenomenon in two ways. In the first part of the study, a data-mining process was utilised. A sample of 30 consecutive patients who were assessed as being eligible for high-level care (or nursing-home level care) was included. Medical files/histories were reviewed using an audit tool that was developed based on the literature review. The salient or pertinent characteristics of the population group were documented. In the second part of the study, an investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to residential care and highlight the opportunities to improve clinical practice in this area. This investigation analysed the literature and clinical practice, and interviewed the key stakeholders involved in this process. A tripartite approach was adopted by conducting face-to-face interviews with patients, their carers and members of the interdisciplinary healthcare team. As social work clinicians have a substantive role in this area of transition, telephone interviews were also conducted with 10 social workers working in similar inpatient palliative-care facilities in the area of Victoria to gauge their experiences. A thematic analysis discerned a number of common themes highlighting the impact and difficulties of this transition on the key stakeholders. The results suggested recommendations to improve or best manage this process and service delivery. The research study has highlighted the difficulties that patients/families encounter in the transition from palliative care in a hospice to nursing home care and emphasises the importance of protecting the integrity of the patient and family by holding open and continuous dialogue, particularly through family meetings, and working in collaboration with the patient, the family and the team. Understanding the experience of this transition is crucial to the knowledge required to provide psychosocial care to this population. This practice-based research study incorporates the ‘voices’ of terminally ill patients, families and members of the healthcare team on matters directly affecting them. Their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a residential-care facility has been documented with the hope of enabling their input to have some real impetus on clinical practice and service delivery. The importance of this work is that it highlights issues that can arise in the terminal phase of illness and illustrates the benefits of practice based, qualitative research.
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ItemTo be a family: changes experienced within south Sudanese families in Australia( 2011)This research focuses on changes to family as experienced by men and women from south Sudanese backgrounds who have resettled in Melbourne. The study investigated factors that have influenced change, documenting experiences that are unique as well those common amongst participants. Concurrently the study investigated experiences of accessing community and government services for assistance with family related difficulties and sought the opinions of participants on how services could be improved to better meet the needs of families from south Sudan living in Melbourne. The findings reveal how gender, age and personal agency each contributes to how family is experienced by individuals. Although some experiences were shared by participants within gender and age groups, others were not, demonstrating the importance in non-essentialising all people from the same ethnic or cultural background in research and community service development with refugee groups. The findings illustrate three factors influencing change; interactions with Australian social environments, transnational ties to kin and concurrent south Sudanese culture in Africa and interactions within the local south Sudanese ‘community’ in Melbourne. These influences impacted on how participants understood and participated within their families in Australia, placing them in unique and often conflictual situations, which are mostly unrecognised by Australian service providers. The community-based collaborative research approach undertaken for the study models the practice approaches suggested in the findings; namely, the importance of working both with refugee ‘communities’ and within their existing structures, which may sit outside traditional service sectors and research settings. If researchers, policy makers and service practitioners adopt collaborative approaches to practice, they are more likely to establish positive working relationships with people from refugee backgrounds, ultimately leading to service provision that is more appropriate and therefore more helpful.
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ItemSocial work in secure forensic mental health inpatient services: towards cultural competence( 2011)International migration has moved to the forefront of the global agenda and has become a challenge for governments around the world. According to the Department of Immigration and Citizenship [DIAC] (2007), Australia has become “one of the most culturally diverse societies of the 21st century” with more than six million migrants having arrived since 1945 (p.1). This is despite Australia’s history of racist immigration and indigenous policy, and continued social disadvantage and discrimination experienced by many indigenous and CALD (Culturally & Linguistically Diverse) Australians. Secure forensic mental health inpatient services, like many services, are not meeting the needs of the indigenous and CALD population. This paper will use a critical literature review, from a critical theory and social constructionist perspective, to answer three fundamental questions: What are the problems for indigenous and CALD patients in secure forensic mental health inpatient services? What factors contribute to, and sustain, these problems? What can social workers do about these problems? While cross-cultural forensic mental health research is scarce and often methodologically flawed, key themes emerge. Secure forensic mental health inpatient services are influenced by a complex, socially constructed tangle of institutions, policies and practices. The ‘caring’ mental health system and the ‘custodial’ criminal justice system often have conflicting goals and expectations. Furthermore, public and media perceptions of danger frame the policy context. This leaves patients commonly experiencing discrimination, disempowerment and social exclusion. However, patients from indigenous and CALD populations are further marginalised and have reduced ‘social quality’ (social inclusion, socio-economic security, social cohesion and empowerment) (Huxley & Thornicroft, 2003). The literature attributes this to factors including: discriminatory and reactive government policies, an ethnocentric mental health system that relies on culturally invalid classification systems, and culturally incompetent clinicians and organisations. Social workers have been implicit in these systemic failures through their lack of contribution to the literature and their lack of influence in forensic mental health. This is despite the compatibility of the social work person-in-environment perspective, and its focus on social justice and social quality, with good cross-cultural practice. Frequent references to ‘unexplored’ socio-cultural and environmental factors in the literature, and a mental health policy shift in Victoria towards social inclusion and community development, provide a timely opportunity for social work to assert itself. In this paper, my purpose is to demonstrate how social workers can affect structural change on a professional ecosystem that impedes culturally competent practice. Through this conceptual framework, I have developed Culturally Competent Guidelines for Social Workers in Secure Forensic Mental Health Inpatient Services. These guidelines aim to provide social workers with tools that might empower them to become more culturally competent clinicians, and in the process, enable them to strive for social justice by improving social quality and cultural competence at all levels.