An interesting comment was made in my practicum yesterday, which brought to mind the subject of confidentiality. As part of the support group I facilitate for the Addictions Foundation of Manitoba, I attend a weekly exercise class with a small group of seniors. Yesterday, one group member commented that she had been asked by someone else at the gym what kind of group we were, with one young woman doing exercises with a group of seniors. She had to do some quick thinking to avoid revealing that we were an addictions support group, which would have violated the confidentiality of the group members.
In my practicum, as well, as in all our social work education, the importance of confidentiality is always a major theme. Of course, this value is not specific to social work alone, but is a major consideration in the medical and legal professions, among others. Wynia (2007) suggests several reasons for the high priority we place on confidentiality; in the first place, it reflects our commitment to privacy, and in the second, it provides safe ground for clients to open up and frankly share information with care providers and professionals. Wynia also points out that like other ethical principles, confidentiality is not necessarily an absolute. I found this to be a very interesting argument, and wanted to consider how it could be integrated into our future role as social workers and some of the decisions we may have to make one day.
Actually, this topic really became interesting to me during a discussion with some friends about the duty to report child pornography when this recently became law. This led me to look up the relevant laws in Manitoba, which in this case are found in The Child and Family Services Act. The law makes it clear that anyone who suspects that a child is being abused has a duty to report that information to the relevant authorities. This law applies regardless of confidentiality from professional relationships, except that the lawyer-client relationship is exempt.
Although I definitely agree with this law in principle, it raises two significant problems for me. First, maybe I am interpreting this incorrectly, but if the law formalizes the opinion that child abuse is so terrible that reporting it is more important the doctor-patient or social worker-client confidentiality, then why is the lawyer-client relationship given a special status. The cynic in me wants to argue that perhaps this is because lawyers, but not doctors or social workers, write the laws.
Aside from this, the bigger question for me is about how the line is drawn when it comes to mandatory reporting - that is, violating confidentiality. To me, the basic principle behind this law is that children are such a vulnerable and defenseless group that the government considers their protection to be of the highest priority - so high that it outweighs many of the traditional confidentiality guarantees that people are owed by caregivers. In my practicum, I work with many elderly women who are incredibly vulnerable and in many ways are equally as helpless as children - or even more so. Their physical and emotional strength is sometimes almost non-existent, their cognition is in some cases regressing to a child-like level, and many have little or no financial resources. In short, they could scarcely be more vulnerable to abuse. Even worse, their increasing fragility means that unlike children who parents often find "seem to be made of rubber", senior women may suffer even greater consequences from physical abuse than do children who nature has designed to rebound from the inevitable bumps and blows of tripping on the playground or falling off of the tire swing.
Considering the above, then, if the law is resolved to overrule the principle of confidentiality (except for lawyers) with respect to children, why does it not do so for another intensely vulnerable group in society?
Of course, the pragmatic answer is that confidentiality cannot be lightly dismissed without incurring unintended consequences. As Wynia suggests, no ethical principle is absolute, and confidentiality serves a practical purpose as well as an ethical one. If seniors knew that any mention of elder abuse would mean a mandatory report on the part of their social workers, they are very likely to begin hiding information from their caregivers. Nevertheless, this argument can then be extended to children to point out that many children today are well aware of the dangerous power of the threat "if you hit me, I'll tell my teachers and they'll take us away from you!" The other side of that coin is that many children may fear to tell their teachers, doctors, social workers and so forth about abuse for fear that it may destroy their family. Whether or not this perception is correct is irrelevant, since only an element of doubt in confidentiality is needed to destroy the trust in the relationship.
Ultimately, there are no easy answers to this dilemma, but I really believe that as social workers who advocate and influence policy decisions, this is a very important question for each of us to carefully consider for ourselves.
References
Province of Manitoba. (2010). The Child and Family Services Act. Retrieved from http://web2.gov.mb.ca/laws/statutes/ccsm/c080e.php?ccsm=c80
Wynia, M. K. (2007). Breaching confidentiality to protect the public: evolving standards of medical confidentiality for military detainees. The American Journal of Bioethics, 7(8), 1-5.
Thursday, March 17, 2011
Saturday, March 12, 2011
It all adds up.
Remember when you were three years old and you were scared of the neighbour's dog, the old man around the corner, or the loud clown at your friend's birthday party? One way or another, it is probably safe to say that everyone has lived through some kind of trauma or other in their life. Now, consider an 80 year-old woman and the kind of trauma that she could have experienced in all her decades of life, with all the implications for treatment and practice that follows.
As an example, my husband's great-grandmother passed away some years ago at the age of 100. Some of the stories that she told my husband from her life really make me realize how easy our lives have become compared to that. For example, when she went into labour with her second child, her husband was extremely sick with a disease that would eventually become fatal. She had to walk over a mile through a blizzard in rural Ontario to a main road where she was able to hitchhike into town and to the hospital. Compared to this, the birth of our own child, with an epidural and a short ride to the comfortable hospital room in Health Sciences Center, almost seems like luxury.
She also told stories of living through both world wars - including seeing German bombers fly over their home in England - with brothers and a son serving in foreign theaters of war, having two husbands who died before her, and seeing their financial position ruined afterward by dishonest creditors.
For sure, these are events I could never relate to. Although I was born in a country that could be said to have been in a "permanent" war for many years, I have never even seen gunfire! In contrast, at my practicum, I have heard women share with us years of physical, sexual, emotional abuse by their partners and close family members. One of the practical issues that always strikes me when I think of these things is how hard it can be, as social workers, to build credibility with people who have lived through these hardships. Compared to their lives, we are little more than children - or even grandchildren - who have lived a pampered existence in a world incredibly different to their own. Even aside from the huge changes in the world since they were young, simply adding up so many more years of pain, stress, and sadness has left them with a higher "total" sum of trauma. Krause (2004) found exactly this kind of cumulative effect of lifetime trauma in a study on older adults.
Since my practicum deals mostly with seniors with substance misuse issues, the treatment for this trauma can sometimes lead to a double threat. Early trauma or stressful events can result in anxiety attacks, depression, and moderate to severe stress disorders later on. Those who seek help from their family doctor are often given a prescription medication to help minimize their suffering. Benzodiazepine such as valium, lorazepam or xanax are the most commonly used drugs to treat anxiety, or panic attacks, however, they are highly addictive and withdrawal effects could become very challenging to handle (Recovery Connection, 2011).
Many seniors struggle with medication dependencies and interactions with alcohol or on going life situations tend to intensify their health problems, family relationships and emotional well-being. Therefore, when we try to give them advice or convince them to make different choices, it is often difficult to understand what they have been through.
One thing in my practicum that I have found to be successful in helping to deal with this disconnect is to find some way - even if it is only a partial way - to find something in common with these seniors, and feelings that we can relate to. For example, even though I have not yet lost a husband or close family member, I have had older relatives pass away and can find a common ground to discuss feelings in this regard with our seniors. Another successful method that I have been able to use is to ask open-ended questions which encourage the client to talk and share their feelings and to listen to their responses with empathy and respect. Not only does this help me understand them better, but just having the chance to talk about these experiences with an interested listener can be therapeutic, as well.
I find that in general, establishing a rapport and mutual respect with these clients can help us get around the massive differences in our lives and get to a point where they are much more willing to listen to us as social workers because they see that we really care about them and have their best interests at heart. In the end, though, it is always extremely important to be aware that we do not let ourselves become condescending or pushy, since this can undo a lot of hard work in building the relationship.
Lastly, one thing that we have to bear in mind is that trauma can have some very unexpected and unpredictable consequences in terms of people's actions. Research has shown, for example, that people and animals who have been subjected to trauma which they are helpless to escape acquire learned helplessness and become incapable of responding in logical ways to even simple problems (Badhwar, 2009). As social workers, we may sometimes become astonished at the decisions that people make that seem to defy all rational explanation. I think it is very important for us to remember that in some cases, trauma can result in people behaving this way, and that trying to deal with the problem using conventional rational means is not likely to succeed.
Badhwar, N.K. (2009). The Milgram experiments, learned helplessness, and character traits. Journal of Ethics, 13, 257-289.
Krause, N. (2004). Lifetime trauma, emotional support, and life satisfaction among older adults. The Gerontologist, 44(5), 615-623.
Recover Connection. (2011). Benzodiazepine. Retrieved from http://www.recoveryconnection.org/drug_index/benzodiazepine.php
As an example, my husband's great-grandmother passed away some years ago at the age of 100. Some of the stories that she told my husband from her life really make me realize how easy our lives have become compared to that. For example, when she went into labour with her second child, her husband was extremely sick with a disease that would eventually become fatal. She had to walk over a mile through a blizzard in rural Ontario to a main road where she was able to hitchhike into town and to the hospital. Compared to this, the birth of our own child, with an epidural and a short ride to the comfortable hospital room in Health Sciences Center, almost seems like luxury.
She also told stories of living through both world wars - including seeing German bombers fly over their home in England - with brothers and a son serving in foreign theaters of war, having two husbands who died before her, and seeing their financial position ruined afterward by dishonest creditors.
For sure, these are events I could never relate to. Although I was born in a country that could be said to have been in a "permanent" war for many years, I have never even seen gunfire! In contrast, at my practicum, I have heard women share with us years of physical, sexual, emotional abuse by their partners and close family members. One of the practical issues that always strikes me when I think of these things is how hard it can be, as social workers, to build credibility with people who have lived through these hardships. Compared to their lives, we are little more than children - or even grandchildren - who have lived a pampered existence in a world incredibly different to their own. Even aside from the huge changes in the world since they were young, simply adding up so many more years of pain, stress, and sadness has left them with a higher "total" sum of trauma. Krause (2004) found exactly this kind of cumulative effect of lifetime trauma in a study on older adults.
Since my practicum deals mostly with seniors with substance misuse issues, the treatment for this trauma can sometimes lead to a double threat. Early trauma or stressful events can result in anxiety attacks, depression, and moderate to severe stress disorders later on. Those who seek help from their family doctor are often given a prescription medication to help minimize their suffering. Benzodiazepine such as valium, lorazepam or xanax are the most commonly used drugs to treat anxiety, or panic attacks, however, they are highly addictive and withdrawal effects could become very challenging to handle (Recovery Connection, 2011).
Many seniors struggle with medication dependencies and interactions with alcohol or on going life situations tend to intensify their health problems, family relationships and emotional well-being. Therefore, when we try to give them advice or convince them to make different choices, it is often difficult to understand what they have been through.
One thing in my practicum that I have found to be successful in helping to deal with this disconnect is to find some way - even if it is only a partial way - to find something in common with these seniors, and feelings that we can relate to. For example, even though I have not yet lost a husband or close family member, I have had older relatives pass away and can find a common ground to discuss feelings in this regard with our seniors. Another successful method that I have been able to use is to ask open-ended questions which encourage the client to talk and share their feelings and to listen to their responses with empathy and respect. Not only does this help me understand them better, but just having the chance to talk about these experiences with an interested listener can be therapeutic, as well.
I find that in general, establishing a rapport and mutual respect with these clients can help us get around the massive differences in our lives and get to a point where they are much more willing to listen to us as social workers because they see that we really care about them and have their best interests at heart. In the end, though, it is always extremely important to be aware that we do not let ourselves become condescending or pushy, since this can undo a lot of hard work in building the relationship.
Lastly, one thing that we have to bear in mind is that trauma can have some very unexpected and unpredictable consequences in terms of people's actions. Research has shown, for example, that people and animals who have been subjected to trauma which they are helpless to escape acquire learned helplessness and become incapable of responding in logical ways to even simple problems (Badhwar, 2009). As social workers, we may sometimes become astonished at the decisions that people make that seem to defy all rational explanation. I think it is very important for us to remember that in some cases, trauma can result in people behaving this way, and that trying to deal with the problem using conventional rational means is not likely to succeed.
Badhwar, N.K. (2009). The Milgram experiments, learned helplessness, and character traits. Journal of Ethics, 13, 257-289.
Krause, N. (2004). Lifetime trauma, emotional support, and life satisfaction among older adults. The Gerontologist, 44(5), 615-623.
Recover Connection. (2011). Benzodiazepine. Retrieved from http://www.recoveryconnection.org/drug_index/benzodiazepine.php
Monday, March 7, 2011
I drink because I'm lonely and I am lonely becuase I drink
Yesterday, as I facilitated the seventh meeting of my support group which is the midpoint of this pilot project, it struck me that that there is a commonality between the reasons many of the women in our group have turned to these addictions. I have heard many stories these seven weeks from six women who struggle with some type of addiction such as gambling, drugs or medication use, and alcohol. I have noted that the women in our group tend to drink or misuse drugs to forget about their unhappiness and the loss of control they are experiencing as they get older.
For example, an 80 year-old member commented about the rich and varied life she enjoyed and major accomplishments she achieved in her life, and I cannot help but notice her sadness as she mentions how she now has to depend on someone to give her a ride whenever she wants to leave the house. Interestingly, I think that one of the reasons she drinks is actually to prove the point that she can do as she likes when it comes to drinking. I find that this bears some similarity to teenage "acting out" despite occurring 60 years since she was a teen. This seems like a very sad irony, especially because whereas the young person will eventually come to learn to express herself in more productive ways as she becomes empowered with age, this lady will only lose more and more of her independence as time goes on - more so if she begins to experience increasing health and/or financial problems. Unfortunately, women with addictions are at higher risks of presenting one or the other if not both.
The question arises for me; what is the appropriate way to treat this behaviour. The depth of loss that an elderly person suffers watching every aspect of their self-sufficiency fade away defies the imagination of a younger person. What we hope and what I learned from other age-specific groups in different provinces of Canada is that by helping seniors socialize and create or form new networks, they will be able to start seeing themselves as being vital and active individuals again at some level and to feel less as is the world has passed them by.
Another lady, an active gambler, has joined us and shared what she gets out of this addictive activity. She gambles to forget the problems she has in her family (specifically with her children) and the frustrations she has with her worsening health. None of the men in the group have commented about such frustrations with their family, which I think has an interesting tie-in to theory. We always hear that women tend to be more defined by their family and relationships than are men. Therefore, if a senior experiences any type of a relationship breakdown, for any reason, a female senior is more likely to be affected at a higher degree compared to a male senior. This has been an ongoing struggle within the program, which as mentioned is based largely on re-socialization. In many cases, we are finding that the distance that has developed between our members and their families is so huge that bridging it seems all but impossible. Even becoming motivated to try to reconnect seems to be beyond the willpower of many.
With many of the seniors on our program, we have found that a significant reason they turn to alcohol is loneliness and isolation. The data supports a similar conclusion; Fredriksen (1992) found that the majority of women admitted to their treatment program were lived in isolation from their friends and family. Also, Pettigrew and Roberts (2008) note that excessive alcohol consumption tends to be positively correlated with isolation in seniors. From my own experience, this seems to be a common theme in the narrative from members of both genders, however, I suspect that women are probably more affected by this problem. From a statistical point of view, it is well known that because women tend to live somewhat longer than men, there is a higher chance that the female spouse will outlive the male. As a result, the woman is more likely to experience living in isolation due to the death of her spouse. As with other cohorts, elderly women also tend to start drinking because of increasing isolation, as noted above. This is something I have definitely noticed in our group. In general, more of the women are alone than the men, since men will tend to end their lives with their spouse still alive, whereas women are more likely to end it alone. Helping our members break free from their isolation, as mentioned previously, is turning out to be more difficult than I would have previously imagined.
The support group was designed to help counteract drinking due to loneliness, however, again and again we are finding that it is not simply a matter of finding or creating opportunities for socialization; the challenge is convincing a group of people who have essentially lost all interest in social interaction that it is worth their time and effort to do so again. This is most dramatically demonstrated for us in the drastically reduced number of seniors who attend any of the group lunches or activities as compared to the number in the program. A major ethical question for us is what level of persuasion is appropriate in our position and at what point we need to respect the wishes of our clients despite how convinced we are that their wishes are working against their best interests.
Finally, a unique issue when it comes to women and alcohol is the increased level of social stigma for women who drink (Fredriksen, 1992). A certain portion amount of this stigma may come from practical grounds, based on the fact that women have the unique ability to give birth to children and are in much greater danger of harming unborn children by drinking. Another part of this stigma, however, may be based only on old stereotypes that in general women are considered to be responsible for the care of others, and that they fail in this regard when they abuse alcohol or drugs. Women are supposed to be giving and sacrificing and therefore drinking is something that we see as being more unacceptably selfish for us than for men. From a practical standpoint, besides continuing to advocate against double-standards, there is much less that we actively do for our clients in this respect.
The lessons for practice that I take away from this discussion are similar to those mentioned above; that in order to treat a person suffering from an addiction, it is necessary to first understand what factors drive them towards the addictive behaviour. In the case of many elderly women, loneliness and isolation are two such factors, and by helping reduce these factors through socialization, we may be able to help dis-incentivize seniors to continue drinking, using drugs, etc.
References
Fedriksen, K.I. (1992). North of market: Older women's alcohol outreach program. The Gerontologist, 32(2), 270-272.
Pettigrew, S., & Roberts, M. (2008). Addressing loneliness in later life. Aging & Mental Health, 12(3), 302-309
For example, an 80 year-old member commented about the rich and varied life she enjoyed and major accomplishments she achieved in her life, and I cannot help but notice her sadness as she mentions how she now has to depend on someone to give her a ride whenever she wants to leave the house. Interestingly, I think that one of the reasons she drinks is actually to prove the point that she can do as she likes when it comes to drinking. I find that this bears some similarity to teenage "acting out" despite occurring 60 years since she was a teen. This seems like a very sad irony, especially because whereas the young person will eventually come to learn to express herself in more productive ways as she becomes empowered with age, this lady will only lose more and more of her independence as time goes on - more so if she begins to experience increasing health and/or financial problems. Unfortunately, women with addictions are at higher risks of presenting one or the other if not both.
The question arises for me; what is the appropriate way to treat this behaviour. The depth of loss that an elderly person suffers watching every aspect of their self-sufficiency fade away defies the imagination of a younger person. What we hope and what I learned from other age-specific groups in different provinces of Canada is that by helping seniors socialize and create or form new networks, they will be able to start seeing themselves as being vital and active individuals again at some level and to feel less as is the world has passed them by.
Another lady, an active gambler, has joined us and shared what she gets out of this addictive activity. She gambles to forget the problems she has in her family (specifically with her children) and the frustrations she has with her worsening health. None of the men in the group have commented about such frustrations with their family, which I think has an interesting tie-in to theory. We always hear that women tend to be more defined by their family and relationships than are men. Therefore, if a senior experiences any type of a relationship breakdown, for any reason, a female senior is more likely to be affected at a higher degree compared to a male senior. This has been an ongoing struggle within the program, which as mentioned is based largely on re-socialization. In many cases, we are finding that the distance that has developed between our members and their families is so huge that bridging it seems all but impossible. Even becoming motivated to try to reconnect seems to be beyond the willpower of many.
With many of the seniors on our program, we have found that a significant reason they turn to alcohol is loneliness and isolation. The data supports a similar conclusion; Fredriksen (1992) found that the majority of women admitted to their treatment program were lived in isolation from their friends and family. Also, Pettigrew and Roberts (2008) note that excessive alcohol consumption tends to be positively correlated with isolation in seniors. From my own experience, this seems to be a common theme in the narrative from members of both genders, however, I suspect that women are probably more affected by this problem. From a statistical point of view, it is well known that because women tend to live somewhat longer than men, there is a higher chance that the female spouse will outlive the male. As a result, the woman is more likely to experience living in isolation due to the death of her spouse. As with other cohorts, elderly women also tend to start drinking because of increasing isolation, as noted above. This is something I have definitely noticed in our group. In general, more of the women are alone than the men, since men will tend to end their lives with their spouse still alive, whereas women are more likely to end it alone. Helping our members break free from their isolation, as mentioned previously, is turning out to be more difficult than I would have previously imagined.
The support group was designed to help counteract drinking due to loneliness, however, again and again we are finding that it is not simply a matter of finding or creating opportunities for socialization; the challenge is convincing a group of people who have essentially lost all interest in social interaction that it is worth their time and effort to do so again. This is most dramatically demonstrated for us in the drastically reduced number of seniors who attend any of the group lunches or activities as compared to the number in the program. A major ethical question for us is what level of persuasion is appropriate in our position and at what point we need to respect the wishes of our clients despite how convinced we are that their wishes are working against their best interests.
Finally, a unique issue when it comes to women and alcohol is the increased level of social stigma for women who drink (Fredriksen, 1992). A certain portion amount of this stigma may come from practical grounds, based on the fact that women have the unique ability to give birth to children and are in much greater danger of harming unborn children by drinking. Another part of this stigma, however, may be based only on old stereotypes that in general women are considered to be responsible for the care of others, and that they fail in this regard when they abuse alcohol or drugs. Women are supposed to be giving and sacrificing and therefore drinking is something that we see as being more unacceptably selfish for us than for men. From a practical standpoint, besides continuing to advocate against double-standards, there is much less that we actively do for our clients in this respect.
The lessons for practice that I take away from this discussion are similar to those mentioned above; that in order to treat a person suffering from an addiction, it is necessary to first understand what factors drive them towards the addictive behaviour. In the case of many elderly women, loneliness and isolation are two such factors, and by helping reduce these factors through socialization, we may be able to help dis-incentivize seniors to continue drinking, using drugs, etc.
References
Fedriksen, K.I. (1992). North of market: Older women's alcohol outreach program. The Gerontologist, 32(2), 270-272.
Pettigrew, S., & Roberts, M. (2008). Addressing loneliness in later life. Aging & Mental Health, 12(3), 302-309
Tuesday, March 1, 2011
If You Want a Successful Collaboration in an Interdisciplinary Team
While I do my practicum, I frequently recognize a resident’s chart is very important for staff members who are working with residents with cognitive impairment. The chart is divided into many sections, such as medical consultations, interpersonal progressive notes, care conferences, new admissions, and all referred documents from the previous place. After I read Bronstein’s (2003) article; a model for interdisciplinary collaboration, I felt that the function of an interdisciplinary team was the same as the chart. Since the chart is written by other professionals, such as physicians, nurses, pharmacists, an occupational therapist, a dietician, recreation facilitators, and a social worker, it provides not only a number of information, but also provides a chance to gain knowledge and experiences from the other professionals’ different perspectives. In other words, the chart is the collection of a record.
However, unlike other professionals’ records, I found that a record seen in a psychosocial aspect is scarce. It was difficult to look at residents’ personal histories, family relationships, or backgrounds that may cause residents’ behaviours or problems. Therefore, when I read Bronstien’s (2003) article, I agreed that an interdisciplinary team was important. As a social work student who attends many staff meetings and care conferences, I think the interdisciplinary team relevantly works together while the chart has some limitations to communicate among other professionals. The diverse opinions and experiences from different professionals are valuable. Then, I wonder what factors can help to establish better collaboration among different professionals. I think flexibility and personal characteristics are big contributors.
The extensive body of literature has suggested the importance of collaborative relationships among different professionals in health care settings. Bronstein (2003) is one of the people who reviewed a number of academic literature, which emphasizes the importance of interdisciplinary teams, and components of successful interdisciplinary collaboration. Bronstein (2003) stresses that it is important to have “interdependence, newly created professional activities, flexibility, collective ownership of goals and reflection on process” (n. p.). to make better interdisciplinary collaboration between social workers and other professionals. Among these factors, I feel that flexibility may be the most critical component to lead successful collaborations.
Mattessich and Monsey (1992) emphasize team members need to think that “they have more to gain than lose by collaboration and an ongoing flow of communication among colleagues” (as cited in Bronstein, 2003). I feel that this thought not only leads an effective communication among interdisciplinary team members, but it also leads “less hierarchical relationships” (Bronstein, 2003) in roles of members. In my practice setting, such flexibility appears when a dietician is absent in a care conference. For example, after a social worker briefly reports a nutrition assessment on behalf of the dietician, and suggests a family member to call back to the dietician, or helps a family member to make an appointment with the dietician in another time.
I believe that this flexibility comes from the value of acceptance of other professionals’ opinions because it is possible when a staff member have trust and interdependent relationships with colleagues. I also agree with Bronstein (2003), who notes such flexibility can come when interdisciplinary team members spend time together formally or informally, when they have oral and written communication among professional colleagues, and when they have respects for colleagues’ opinions and input. Abramson and Rosenthal (1995) state that such flexibility also may come from a belief “reliance on others for certain tasks, and resources allows collaborators to spend their time doing what each knows and does best” (as cited in Bronstein, 2003).
According to the literature, social workers may have a lot of conflicts with other professionals because of their role that advocates clients. Larson (2008) states that the medical model that upholds power to medical professionals is hierarchically structured in health care settings. Under this system, social workers who advocate residents’ needs may meet conflicts because the residents are in passive positions, compared to the medical professionals, who diagnose residents’ health conditions and prescribe treatments. However, Billups (1987) argues that “neither the extreme of perfect unison nor that of unbridled conflict” (as cited in Bronstein, 2003). This means that social workers need to be flexible and understand a situation that they cannot always agree with other professionals. Billups (1987) emphasizes that the social workers can overcome extreme conflicts when they have flexible thinking. I believe that Billups is right because this statement asks a question: how can you be flexible.
To gain a successful collaboration in an interdisciplinary team, I think flexibility is important. However, I wonder how this flexibility can effectively work between other professionals and social workers in the medical model setting, and what can lead them to work better as team members. Bronstein (2003) interprets the review of the literature that self-evaluation and giving feedback may deconstruct conflicts, and may lead to effective communications in interdisciplinary teams.
Bronstein (2003) also states that a professional role, structural characteristics, personal characteristics, and a history of collaboration that influences on interdisciplinary collaboration.
The most interesting parts amongst these factors are about role theory, and personal characteristics. I realize these factors are important for social workers to understand their roles or values when they socialize with other professionals. Their interaction with other professionals should be based on their social work values. I also realize that when social workers have a competent professional role and flexibility, they can reduce their conflicts among other professionals. In addition, I believe that personal characteristics are a strong contributor to collaborative relationships because if social workers work with other professionals in positive thoughts and attitudes, the other professionals will be respectful to them.
References
Bronstein, R., L. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297-306.
Larson, G. (2008). Anti-oppressive practice in mental health. Journal of Progressive Human Services, 19(1), 39-54.
However, unlike other professionals’ records, I found that a record seen in a psychosocial aspect is scarce. It was difficult to look at residents’ personal histories, family relationships, or backgrounds that may cause residents’ behaviours or problems. Therefore, when I read Bronstien’s (2003) article, I agreed that an interdisciplinary team was important. As a social work student who attends many staff meetings and care conferences, I think the interdisciplinary team relevantly works together while the chart has some limitations to communicate among other professionals. The diverse opinions and experiences from different professionals are valuable. Then, I wonder what factors can help to establish better collaboration among different professionals. I think flexibility and personal characteristics are big contributors.
The extensive body of literature has suggested the importance of collaborative relationships among different professionals in health care settings. Bronstein (2003) is one of the people who reviewed a number of academic literature, which emphasizes the importance of interdisciplinary teams, and components of successful interdisciplinary collaboration. Bronstein (2003) stresses that it is important to have “interdependence, newly created professional activities, flexibility, collective ownership of goals and reflection on process” (n. p.). to make better interdisciplinary collaboration between social workers and other professionals. Among these factors, I feel that flexibility may be the most critical component to lead successful collaborations.
Mattessich and Monsey (1992) emphasize team members need to think that “they have more to gain than lose by collaboration and an ongoing flow of communication among colleagues” (as cited in Bronstein, 2003). I feel that this thought not only leads an effective communication among interdisciplinary team members, but it also leads “less hierarchical relationships” (Bronstein, 2003) in roles of members. In my practice setting, such flexibility appears when a dietician is absent in a care conference. For example, after a social worker briefly reports a nutrition assessment on behalf of the dietician, and suggests a family member to call back to the dietician, or helps a family member to make an appointment with the dietician in another time.
I believe that this flexibility comes from the value of acceptance of other professionals’ opinions because it is possible when a staff member have trust and interdependent relationships with colleagues. I also agree with Bronstein (2003), who notes such flexibility can come when interdisciplinary team members spend time together formally or informally, when they have oral and written communication among professional colleagues, and when they have respects for colleagues’ opinions and input. Abramson and Rosenthal (1995) state that such flexibility also may come from a belief “reliance on others for certain tasks, and resources allows collaborators to spend their time doing what each knows and does best” (as cited in Bronstein, 2003).
According to the literature, social workers may have a lot of conflicts with other professionals because of their role that advocates clients. Larson (2008) states that the medical model that upholds power to medical professionals is hierarchically structured in health care settings. Under this system, social workers who advocate residents’ needs may meet conflicts because the residents are in passive positions, compared to the medical professionals, who diagnose residents’ health conditions and prescribe treatments. However, Billups (1987) argues that “neither the extreme of perfect unison nor that of unbridled conflict” (as cited in Bronstein, 2003). This means that social workers need to be flexible and understand a situation that they cannot always agree with other professionals. Billups (1987) emphasizes that the social workers can overcome extreme conflicts when they have flexible thinking. I believe that Billups is right because this statement asks a question: how can you be flexible.
To gain a successful collaboration in an interdisciplinary team, I think flexibility is important. However, I wonder how this flexibility can effectively work between other professionals and social workers in the medical model setting, and what can lead them to work better as team members. Bronstein (2003) interprets the review of the literature that self-evaluation and giving feedback may deconstruct conflicts, and may lead to effective communications in interdisciplinary teams.
Bronstein (2003) also states that a professional role, structural characteristics, personal characteristics, and a history of collaboration that influences on interdisciplinary collaboration.
The most interesting parts amongst these factors are about role theory, and personal characteristics. I realize these factors are important for social workers to understand their roles or values when they socialize with other professionals. Their interaction with other professionals should be based on their social work values. I also realize that when social workers have a competent professional role and flexibility, they can reduce their conflicts among other professionals. In addition, I believe that personal characteristics are a strong contributor to collaborative relationships because if social workers work with other professionals in positive thoughts and attitudes, the other professionals will be respectful to them.
References
Bronstein, R., L. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297-306.
Larson, G. (2008). Anti-oppressive practice in mental health. Journal of Progressive Human Services, 19(1), 39-54.
Sunday, February 20, 2011
Verbal or Emotional Abuse against Older Adults
Aging population is increasing in Canada because of low fertility and high life expectancy. Particularly, females live longer than males. In Manitoba, the life expectancy of females in 2006 is 81.7 years, while the males’ is 76.8 years in 2006 (Ready, 2010). Podnieks (2008) states that this demographic change carries “the important of understanding the experiences, situations and challenges faced by various cultural or other subgroups within communities…Elder abuse and neglect is one such concern” (p. 127).
Most older adults are satisfied with their lives, and get emotional or financial support and comfort from their families. Nevertheless, many academic researchers have been concerned about abuse against older adults. One national survey, which was quoted by The Age and Opportunity in Winnipeg, tells that “at least four percent of older Canadians living within our communities have experienced some form of abuse” (n.p.). Further, one research study in Quebec found that the majority of abusers were males and the majority of victims were females (Novak & Campbell, 2010). It is shocking to know a result of this study that most abuse come from families, such as spouses or adult children. Despite a number of debates in academia, and resources of social services, such as support groups, and counseling for older adults, why does such abuse still exist among older adults? To help better understand elder abuse, I will firstly explore how researchers classify categories of abuse. I will discuss a specific category of abuse: verbal and emotional abuse by providing two examples from my practicum. However, I should ask readers to consider if my two examples are really abuse against older adults.
Although there is no specific definition of elder abuse, many scholars define abuse or neglect as any harmful action or inaction towards older adults who are vulnerable. Podinieks, Pillemer, Nicholson, Shillington, and Frizzel (Podnieks et al., 1990) classify four categories of abuse: Material (financial) abuse, chronic verbal aggression, physical abuse, and neglect (as cited in Novak & Campbell, 2010). According to Novak and Campbell (2010), one random sample study in the United States reveals that most of abuse cases in the study include emotional, financial, passive, and verbal abuse, rather than physical violence or neglect. These authors note that the majority of abuse is verbal, emotional, or financial abuse rather than physical violence or neglect.
One of the ways I have witnessed possible form of verbal abuse in my practicum is through the use of names, such as honey, dear, sweetheart, mom, or mommy. A policy in my field placement prohibits calling residents using these terms. I thought calling with these terms was abuse for older adults because of the lack of respect. However, I think about it again that calling residents using these terms may not abuse older adults. Even though most all staff is trained to call residents’ first names, some staff still uses these terms, while others put Mr. or Mrs. before residents’ names, especially in morning meetings. Interestingly, I find that some staff who comes from other countries and are from different cultures usually use these terms.
As a Korean-Canadian, I understand that they may feel more comfortable when they use these terms. For the staff, calling residents “honey”, may be a friendly expression to show their compassion and care. In my home country, almost all people never directly call older adults’ first names. Instead, they use another term, such as grandma or grandpa. Specifically, if you, as a young girl, visit a personal care home, and meet a group of older women, you may greet to them during the breakfast like this: “Hello, Gandma. How is a grandma’s breakfast?” In this dialogue, you will see the term ‘grandma’ and ‘grandma’s’ instead of the term ‘your’. As this, Koreans never call older adults using ‘you’ as well as first names. Even if you have never met these older women before, you should call them grandma instead of calling their first names. This expression is one of the respectful manners towards older adults in Korea.
Of course, some people may ask me that I am living in Canada as a Canadian citizen. They, therefore, may tell me that I should follow a Canadian way. However, let’s think about this situation. If I meet a Korean older adult who speaks little English in the facility, should I call him using his first name? I am sure that I cannot call his first name. I may avoid calling him. If I call him using an alternative term “grandpa”, I will against a policy in my field placement. Do I abuse him if I call him as grandpa?
Straka (2010) states that infantalization, which means to treat older adults like a child, is one of the forms of elder abuse. I understand the infantalization is verbal and emotional abuse. However, let’s think about a situation. A resident asks staff “what I am going to do?” Staff answers “Snack is coming around. You can take snack, honey”. I have observed this staff member uses the resident’s first name all the time. If she says like this sometimes, does she abuse the resident? Is she infantilizing to an older adult? Although I understand these terms’ real meanings, I doubt myself this is a real abuse case for older adults because her expression is used as a sign of friendship.
Names are very important for everybody especially in personal care home because names generally not only present residents’ appearances or characteristics, but names also help staff or other residents remind who is who. Calling people using their first names is common in Canada even if they are old. It may be very convenient for staff to find someone by calling their names. However, I am sure that this policy is not very familiar with immigrants who did not learn this manner and had different cultures, especially who came from Asian countries.
The other example I am confused whether it is abuse or not is relating to a language barrier. One day, I found an Asian resident, who could not speak English, was cleaning up in the dining rooms and a lounge. Since she could not talk with others in English, she looked boring and lonely. To me, she looked like a bird in a bird cage. I thought that she might feel she was in an invisible prison. I understood her situation how a language barrier made it hard for her to get involved in activities or programs. This language barrier leads her to be isolated from other residents, and leaves her alone in her room. She is silent most of the time. Even though she lives in the facility, she is not accepted by others. She may get emotionally hurt very much when she is frustrated with herself because she cannot speak English. If she is not given an opportunity to speak her first language for many years, isn’t she marginalized from dominate groups which consists of Caucasians? I assume that she needs to speak her first language. If she speaks her first language freely, her life in this facility will be better. Even if she is always provided appropriate care like other residents, her real needs are not met yet.
Novak and Campbell (2010) pointed out that any forms of mistreatment are abuse against older adult. Especially, these authors emphasized to older women, who were cognitively impaired or physically frail were at the high risk of abuse. I do not know whether my examples are really abusive cases or not. Nonetheless, I think that the study of emotional abuse based on different cultural and ethnic backgrounds will be valuable in the future. I recognize that how language barrier leads someone to be isolated, and marginalized. Neglect or mistreatment of a resident’s needs is also abuse.
References
Age and Opportunity. (n. d.). Community services: Elder abuse
Novak, M., & Campbell. L. (Eds.). (2010). Aging and society: A Canadian perspective. United States: Nelson Education.
Podnieks, E. (2008). Elder abuse: The Canadian experience. Journal of Elder Abuse & Neglect, 20(2), 126-150
Ready, A. E., (2010, September 21). Demographics and theories of aging. Presented at KIN/ NURS 2610 lecture at the University of Manitoba, Winnipeg, MB.
Straka, S. (2010, September 27). Online transactions [Infantilization of older adults by professionals]. Message posted to http://swrk4200.blogspot.com/2010/09/infantilization-of-older-adults-by.html
By Eunkyeong
Most older adults are satisfied with their lives, and get emotional or financial support and comfort from their families. Nevertheless, many academic researchers have been concerned about abuse against older adults. One national survey, which was quoted by The Age and Opportunity in Winnipeg, tells that “at least four percent of older Canadians living within our communities have experienced some form of abuse” (n.p.). Further, one research study in Quebec found that the majority of abusers were males and the majority of victims were females (Novak & Campbell, 2010). It is shocking to know a result of this study that most abuse come from families, such as spouses or adult children. Despite a number of debates in academia, and resources of social services, such as support groups, and counseling for older adults, why does such abuse still exist among older adults? To help better understand elder abuse, I will firstly explore how researchers classify categories of abuse. I will discuss a specific category of abuse: verbal and emotional abuse by providing two examples from my practicum. However, I should ask readers to consider if my two examples are really abuse against older adults.
Although there is no specific definition of elder abuse, many scholars define abuse or neglect as any harmful action or inaction towards older adults who are vulnerable. Podinieks, Pillemer, Nicholson, Shillington, and Frizzel (Podnieks et al., 1990) classify four categories of abuse: Material (financial) abuse, chronic verbal aggression, physical abuse, and neglect (as cited in Novak & Campbell, 2010). According to Novak and Campbell (2010), one random sample study in the United States reveals that most of abuse cases in the study include emotional, financial, passive, and verbal abuse, rather than physical violence or neglect. These authors note that the majority of abuse is verbal, emotional, or financial abuse rather than physical violence or neglect.
One of the ways I have witnessed possible form of verbal abuse in my practicum is through the use of names, such as honey, dear, sweetheart, mom, or mommy. A policy in my field placement prohibits calling residents using these terms. I thought calling with these terms was abuse for older adults because of the lack of respect. However, I think about it again that calling residents using these terms may not abuse older adults. Even though most all staff is trained to call residents’ first names, some staff still uses these terms, while others put Mr. or Mrs. before residents’ names, especially in morning meetings. Interestingly, I find that some staff who comes from other countries and are from different cultures usually use these terms.
As a Korean-Canadian, I understand that they may feel more comfortable when they use these terms. For the staff, calling residents “honey”, may be a friendly expression to show their compassion and care. In my home country, almost all people never directly call older adults’ first names. Instead, they use another term, such as grandma or grandpa. Specifically, if you, as a young girl, visit a personal care home, and meet a group of older women, you may greet to them during the breakfast like this: “Hello, Gandma. How is a grandma’s breakfast?” In this dialogue, you will see the term ‘grandma’ and ‘grandma’s’ instead of the term ‘your’. As this, Koreans never call older adults using ‘you’ as well as first names. Even if you have never met these older women before, you should call them grandma instead of calling their first names. This expression is one of the respectful manners towards older adults in Korea.
Of course, some people may ask me that I am living in Canada as a Canadian citizen. They, therefore, may tell me that I should follow a Canadian way. However, let’s think about this situation. If I meet a Korean older adult who speaks little English in the facility, should I call him using his first name? I am sure that I cannot call his first name. I may avoid calling him. If I call him using an alternative term “grandpa”, I will against a policy in my field placement. Do I abuse him if I call him as grandpa?
Straka (2010) states that infantalization, which means to treat older adults like a child, is one of the forms of elder abuse. I understand the infantalization is verbal and emotional abuse. However, let’s think about a situation. A resident asks staff “what I am going to do?” Staff answers “Snack is coming around. You can take snack, honey”. I have observed this staff member uses the resident’s first name all the time. If she says like this sometimes, does she abuse the resident? Is she infantilizing to an older adult? Although I understand these terms’ real meanings, I doubt myself this is a real abuse case for older adults because her expression is used as a sign of friendship.
Names are very important for everybody especially in personal care home because names generally not only present residents’ appearances or characteristics, but names also help staff or other residents remind who is who. Calling people using their first names is common in Canada even if they are old. It may be very convenient for staff to find someone by calling their names. However, I am sure that this policy is not very familiar with immigrants who did not learn this manner and had different cultures, especially who came from Asian countries.
The other example I am confused whether it is abuse or not is relating to a language barrier. One day, I found an Asian resident, who could not speak English, was cleaning up in the dining rooms and a lounge. Since she could not talk with others in English, she looked boring and lonely. To me, she looked like a bird in a bird cage. I thought that she might feel she was in an invisible prison. I understood her situation how a language barrier made it hard for her to get involved in activities or programs. This language barrier leads her to be isolated from other residents, and leaves her alone in her room. She is silent most of the time. Even though she lives in the facility, she is not accepted by others. She may get emotionally hurt very much when she is frustrated with herself because she cannot speak English. If she is not given an opportunity to speak her first language for many years, isn’t she marginalized from dominate groups which consists of Caucasians? I assume that she needs to speak her first language. If she speaks her first language freely, her life in this facility will be better. Even if she is always provided appropriate care like other residents, her real needs are not met yet.
Novak and Campbell (2010) pointed out that any forms of mistreatment are abuse against older adult. Especially, these authors emphasized to older women, who were cognitively impaired or physically frail were at the high risk of abuse. I do not know whether my examples are really abusive cases or not. Nonetheless, I think that the study of emotional abuse based on different cultural and ethnic backgrounds will be valuable in the future. I recognize that how language barrier leads someone to be isolated, and marginalized. Neglect or mistreatment of a resident’s needs is also abuse.
References
Age and Opportunity. (n. d.). Community services: Elder abuse
Novak, M., & Campbell. L. (Eds.). (2010). Aging and society: A Canadian perspective. United States: Nelson Education.
Podnieks, E. (2008). Elder abuse: The Canadian experience. Journal of Elder Abuse & Neglect, 20(2), 126-150
Ready, A. E., (2010, September 21). Demographics and theories of aging. Presented at KIN/ NURS 2610 lecture at the University of Manitoba, Winnipeg, MB.
Straka, S. (2010, September 27). Online transactions [Infantilization of older adults by professionals]. Message posted to http://swrk4200.blogspot.com/2010/09/infantilization-of-older-adults-by.html
By Eunkyeong
Wednesday, January 12, 2011
Caring for the Elderly. The New Generation.
A short while ago, my husband, who is learning Spanish, was reading the book "Como Agua Para Chocolate", written by mexican author Laura Esquivel. This is the story of a young woman who lives all her life without ever really finding love because her mother insists that she stay home to take care of her into her old age. My husband found it very surprising that until very recently - and sometimes even today - it was quite a common assumption in some Latin American countries that the youngest daughter will stay at home to look after her aging parents and basically forget any idea of living her own life. This got me thinking a lot about the idea of caring for our older relatives in the modern world and what my own assumptions are for this period in life that must someday arrive.
One thing that I am very conscious of is that my life is much different than the way my ancestors lived. By the time my parents and those of my husband need care, we will already be educated professionals with careers and very busy schedules. Growing up, my parents never mentioned once, we would be expected to take care of them, and as my grandparents aged and died at home, as children, we could already see a relatively small amount of care provided by family members. That being said, I know my parents would actually be bothered if I would ever consider to give up my career to look after them, as the girl in the story does.
In the past, there were fewer options to send elderly parents away to professional care homes, so between this and the fact that careers have now become so much more important, there is much less chance that we would end up taking care of my parents. But perhaps because I grew up in a more traditional, family-oriented culture, I sometimes think that in later life I may begin to question these priorities. For one thing, even in non-traditional cultures, there is a presumption that women are supposed to provide the majority of the informal caregiving.
Sawatzky and Fowler-Kerry (2006) noted that 75% of the informal caregivers in this country are women, and that the burdens imposed by providing this care essentially made it impossible for many of them to have jobs or even meaningful lives besides providing that care. Again, for myself at this point in life, it would be very unlikely that I would choose to quit my school to provide care for my parents. By this, I don't mean I would not have mixed feelings, but I believe I would probably end up being much more open to the idea of putting either of my parents into care relatively quickly instead of providing informal, intensive care on a long-term basis. I believe that in this case, having been born in the modern world and having gone through university may mean that I am less likely to accept the assumption that I should be willing to drop everything and take care of my parents than if I had been raised even a generation ago when attitudes were even more patriarchical than they are now.
Of course, where all of the above was written about my parents, it would obviously be quite a different story if my husband were to require care when we are much older and retired. In that case, because we would be past the busiest part of our life, I would probably be much more able and willing to provide care for him to a greater degree. Even then, again I would probably be much less likely than my ancestors to hold out as long because I was not brought up with quite the same traditional assumptions about a wife being slavishly devoted to their husbands.
Despite the fact that I feel this way now, however, it is also true that at this point my parents are neither fragile nor dependent. When the moment comes, I am certain that the decision to send them into professional care would probably be incredibly hard. Caron, Ducharme, and Griffith (2006) discussed the process of making this decision amongst people who were providing care for relatives with dementia. I found it interesting that many of these families basically provided care up until the point when they could physically no longer do so safely. I wonder, is this actually best for everyone involved, or is the hardship endured by the caregivers worse than sending the patient to a home earlier on?
At the same time, however, I am conscious of the fact that the modern attitude that I have would definitely seem cold to a traditionalist and even though I think that as a human I have a right to enjoy a fulfilling life, I also know that this could sound harsh and self-centered to many people. I also believe in the importance of discussing different options with our seniors while they are still competant. This could help make it easier both for the family as well as for the client when the times comes to move into care.
Maybe the level of exposure we have to the elderly while growing up is an important factor. As I reflect on my upbringing, I remember having very little contact with most of my older relatives. Visits were very short and quite rare, which I suspect might contribute to me subconsciously tending to see seniors as not a major part of life. In comparison, my cousins who grew up in the same house as my grandparents, tend to have a better appreciation of the elderly and have an easier time relating to them, and therefore, although they are from the same generation would be most likely to provide longer care than I would.
References
Caron, C., Ducharme, F., & Griffith, J. (2006). Deciding on institutionalization for a relative with dementia: The most difficult decision for caregivers. Canadian Journal on Aging, 25(2), 193 – 205.
Sawatzky, J., & Fowler-Kerry, S. (2003). Impact of caregiving: listening to the voice of informal caregivers. Journal of Psychiatric and Mental Health Nursing, 10, 277 – 286.
One thing that I am very conscious of is that my life is much different than the way my ancestors lived. By the time my parents and those of my husband need care, we will already be educated professionals with careers and very busy schedules. Growing up, my parents never mentioned once, we would be expected to take care of them, and as my grandparents aged and died at home, as children, we could already see a relatively small amount of care provided by family members. That being said, I know my parents would actually be bothered if I would ever consider to give up my career to look after them, as the girl in the story does.
In the past, there were fewer options to send elderly parents away to professional care homes, so between this and the fact that careers have now become so much more important, there is much less chance that we would end up taking care of my parents. But perhaps because I grew up in a more traditional, family-oriented culture, I sometimes think that in later life I may begin to question these priorities. For one thing, even in non-traditional cultures, there is a presumption that women are supposed to provide the majority of the informal caregiving.
Sawatzky and Fowler-Kerry (2006) noted that 75% of the informal caregivers in this country are women, and that the burdens imposed by providing this care essentially made it impossible for many of them to have jobs or even meaningful lives besides providing that care. Again, for myself at this point in life, it would be very unlikely that I would choose to quit my school to provide care for my parents. By this, I don't mean I would not have mixed feelings, but I believe I would probably end up being much more open to the idea of putting either of my parents into care relatively quickly instead of providing informal, intensive care on a long-term basis. I believe that in this case, having been born in the modern world and having gone through university may mean that I am less likely to accept the assumption that I should be willing to drop everything and take care of my parents than if I had been raised even a generation ago when attitudes were even more patriarchical than they are now.
Of course, where all of the above was written about my parents, it would obviously be quite a different story if my husband were to require care when we are much older and retired. In that case, because we would be past the busiest part of our life, I would probably be much more able and willing to provide care for him to a greater degree. Even then, again I would probably be much less likely than my ancestors to hold out as long because I was not brought up with quite the same traditional assumptions about a wife being slavishly devoted to their husbands.
Despite the fact that I feel this way now, however, it is also true that at this point my parents are neither fragile nor dependent. When the moment comes, I am certain that the decision to send them into professional care would probably be incredibly hard. Caron, Ducharme, and Griffith (2006) discussed the process of making this decision amongst people who were providing care for relatives with dementia. I found it interesting that many of these families basically provided care up until the point when they could physically no longer do so safely. I wonder, is this actually best for everyone involved, or is the hardship endured by the caregivers worse than sending the patient to a home earlier on?
At the same time, however, I am conscious of the fact that the modern attitude that I have would definitely seem cold to a traditionalist and even though I think that as a human I have a right to enjoy a fulfilling life, I also know that this could sound harsh and self-centered to many people. I also believe in the importance of discussing different options with our seniors while they are still competant. This could help make it easier both for the family as well as for the client when the times comes to move into care.
Maybe the level of exposure we have to the elderly while growing up is an important factor. As I reflect on my upbringing, I remember having very little contact with most of my older relatives. Visits were very short and quite rare, which I suspect might contribute to me subconsciously tending to see seniors as not a major part of life. In comparison, my cousins who grew up in the same house as my grandparents, tend to have a better appreciation of the elderly and have an easier time relating to them, and therefore, although they are from the same generation would be most likely to provide longer care than I would.
References
Caron, C., Ducharme, F., & Griffith, J. (2006). Deciding on institutionalization for a relative with dementia: The most difficult decision for caregivers. Canadian Journal on Aging, 25(2), 193 – 205.
Sawatzky, J., & Fowler-Kerry, S. (2003). Impact of caregiving: listening to the voice of informal caregivers. Journal of Psychiatric and Mental Health Nursing, 10, 277 – 286.
Monday, December 6, 2010
Beyond Grief and Loss
Everyone who is born in the world dies some day. It is difficult to describe what death is like, and how painful it may be. It is also difficult to know if people of different ages feel the same way about death as I do. Presumably, people will experience death differently because they have different cultures and learn about it from different perspectives. These thoughts that people may differently experience death became stronger after I observed several residents who were in the end-of-life stage. Since I took my field placement I have often seen residents’ empty beds after they died. Most of them who died due to old age or chronic illness looked just like the other residents one week ago. Indeed, one of the female residents with dementia who looked very healthy suddenly died one week later due to a stroke. My instructor told me that the stroke bursted in her brain. I was in shock, but I could not even cry. I could not say anything about her because I felt that someone hit the back of my head. A few minutes later, when I remember what she told me several days ago, I cried. I learned that older adults could die very fast regardless of gender, race, and ability/disability. I was also shocked the dying process was so fast.
I began to recognize and acknowledge how this loss made it hard to control myself, and thought about how I will never forget her. On the other hand, I had to learn to cope with this loss. I had to exit from the moment of grief and move on to other work. I found out that this kind of sudden death was the most difficult death for me because I did not say good bye to her. Probably, this was really difficult for her family too. I only saw her for several months, but her family had relationships with her for many years. When I saw her for the last time, she complained to me that nobody wanted to talk with her, and did not listen to her. She thought that others secretly talked about her, and she wanted to know what they were talking about. When I listened to her, she was happy and told me “thank you so much”. When I reflected on what she said to me, I felt comforted. I recognized she left me, and that she was no longer in the world. I think my own grief was resolved because I feel that I had a positive experience with her. However, a puzzle still remains in my mind. If a family had negative experiences with family members, how could a social worker help the family to resolve their grief?
Along with this first question, several other questions arose in my mind. In personal care home settings, if social workers know who is close to dying, how can the social workers help him or her to maximize quality of life? If a family does not have a chance to say good bye, how can social workers help this family? If a person wants alcohol or other substances that the person really had enjoyed in life, should the person be allowed to drink alcohol before death? After a person who had bad relationships with his or her family dies, the family may not want to come to collect all belongings. How can social workers handle this situation? Are there palliative care centres in Winnipeg, Manitoba? As many families experience bereavement, grief, and loss, social workers who work in personal care homes may also experience deep sadness. As a human being and a professional, how can social workers deal with this situation? It is worthwhile to understand what social workers do for families who are in bereavement.
According to Kail, Cavanaugh, and Ateah (Kail et al, 2006), “bereavement is the state or condition caused by loss through death. Grief is the sorrow, hurt, anger, guilt, confusion, and other feelings that arise after suffering a loss. Mourning concerns the ways in which we express our grief” (p. 624). To help families who lost loved ones, social workers need to understand the grief process, and how people experience grief. Worden (1991) notes, “grief is an active process in which a person must do several things” (As cited Kail et al, 2006, p. 625). What Worden emphasizes is that people must recognize the reality that their loved ones died. People must appropriately adjust to a new situation, and must find effective ways to say good bye by freeing from themselves the bonds of the dying person. Maybe, this active coping process for family means that after the loss, they arrange to come to the resident’s place, which was the resident’s physical world, to pick up belongings left behind, and interact with family and friends by sharing their experiences (Kail et al, 2006. p. 625).
Attig (1996), and Stroebe et al. (1996) assert that the grieving process is very different because individual experience differently. Therefore, social workers should remember that there may not be the best grief process. Also, during bereavement, each family has own needs to deal with issues regarding the loss, social workers should not underestimate the grief time. There is a critical point that social workers must think about an ethical decision-making at the end of life (as cited in Kail et al. p. 625). As Foster and McLellan (2002) point out, even if there is “a tendency still exists toward a paternalistic approach in ethical decision-making with an emphasis on the biological” (p. 38), social workers should consider the psychosocial perspectives and practices as well as considering bioethical perspectives. As NASW press (1994) notes, “Clinical social workers [should] focus on internal and interpersonal dynamics related to the experience of moral pain in such decisions; their interventions include clarifying advance directives, advocating for a patient’s right to choose, supportive counseling, acting as liaison to the team, and encouraging family involvement and the exploration of end of life options and resources” (As cited in Foster & McLellan, 2002, p. 40).
When social workers conduct psychosocial assessments, crisis intervention, and implication for social work practices, social workers in clinical settings should assist families as a “counselor, context interpreter, advocate, and team member” (Bern-Klug, Gessert, & Forbes, 2001, p.45). The palliative care centres below are in Winnipeg. It is helpful to know these resources may give some hopes to improve quality of life at the end of life stage.
Services provided by Personal Care Homes:
▪Bethania Mennonite Personal Care Home (204)-667-0795
They offer a program that is very similar to palliative care. They call it comfort care within their facilities. It consists of a trained end of care team that has been educated through Palliative Care and Hospice Care Manitoba.
▪Deer Lodge Personal Care Home (204)-837-1301
They offer a program called No One Dies Alone (NODA), which stands for no one dies alone. This program was created for residents that may not have family members to help them through end of life care. It is provided by on-call volunteers. These volunteers have been trained through the center and accompany residents during this time.
▪Park Manor Personal Care Home (204)-222-3251
They offer a service through a course called “A friend in hand”, which was introduced by the Palliative Care and Hospice Manitoba organization. The course focuses on teaching staff, volunteers, and people of the public the importance of palliative care. After completion of the course the person taking the course can request to be put on an on-call palliative care list. This list indicates their availability and their hobbies.
▪River East Personal Care Home (204)-688-7460
They offer a palliative care course through Hospice and Palliative Care Manitoba. Staff, residents, and volunteers can take this course to become better educated about this new service.
Services provided by Hospitals:
▪Deer Lodge Hospital (204)-837-1301
▪Grace Hospital (204)-837-0111
They have 12 beds reserved for palliative care.
▪Riverview Hospital (204)-478-6203
They have 30 beds reserved for palliative care patients.
▪Seven Oaks (204)-632-7133
They are just beginning to develop the NODA program in their facility.
▪St. Boniface (204)-233-8563
They have 15 beds reserved for palliative care patients. This facility has access to labs and research tools to better assist the patients.
Services provided by Community:
▪Hospice and Palliative Care Manitoba (204)-889-8525
This is a non-profitable organization that is not affiliated with Winnipeg Regional Health Authorities. Their focus is to provide a provision of care to people facing life limiting illness. They provide community hospice, volunteer program, volunteer visitors, volunteer education, telephone support, bereavement support, fundraising, and sponsorship.
▪Harmony Home Hospice (204)-982-2953 It is a residential community based service. It is based upon physician referral. It provides a wide range of service like respite care, medication, psychological assessment, and family bereavement.
References
Kail, R., Cavanaugh, J. C., & Ateah, C.A. (2006). Human development: A life-span view. Canada: Thomson Nelson
Foster, L. W., & McLellan, L. J. (2002, December). Translating psychosocial insight into ethical discussions: Supportive of families in end-of-life decision-making. Social Work in Health Care, 35(3), 37-51. Retrieved December 5, 2010, from EBSCOhost, AgeLine database (91374).
Bern-Klug, M., Gessert, C., & Forbes, S. (2001, February). The need to revise assumptions about the end of life: Implications for social work practice. Health & Social Work, 26 (1), 38-47. Retrieved December 5, 2010, from EBSCOhost, Academic Search Premier database (4119501).
I began to recognize and acknowledge how this loss made it hard to control myself, and thought about how I will never forget her. On the other hand, I had to learn to cope with this loss. I had to exit from the moment of grief and move on to other work. I found out that this kind of sudden death was the most difficult death for me because I did not say good bye to her. Probably, this was really difficult for her family too. I only saw her for several months, but her family had relationships with her for many years. When I saw her for the last time, she complained to me that nobody wanted to talk with her, and did not listen to her. She thought that others secretly talked about her, and she wanted to know what they were talking about. When I listened to her, she was happy and told me “thank you so much”. When I reflected on what she said to me, I felt comforted. I recognized she left me, and that she was no longer in the world. I think my own grief was resolved because I feel that I had a positive experience with her. However, a puzzle still remains in my mind. If a family had negative experiences with family members, how could a social worker help the family to resolve their grief?
Along with this first question, several other questions arose in my mind. In personal care home settings, if social workers know who is close to dying, how can the social workers help him or her to maximize quality of life? If a family does not have a chance to say good bye, how can social workers help this family? If a person wants alcohol or other substances that the person really had enjoyed in life, should the person be allowed to drink alcohol before death? After a person who had bad relationships with his or her family dies, the family may not want to come to collect all belongings. How can social workers handle this situation? Are there palliative care centres in Winnipeg, Manitoba? As many families experience bereavement, grief, and loss, social workers who work in personal care homes may also experience deep sadness. As a human being and a professional, how can social workers deal with this situation? It is worthwhile to understand what social workers do for families who are in bereavement.
According to Kail, Cavanaugh, and Ateah (Kail et al, 2006), “bereavement is the state or condition caused by loss through death. Grief is the sorrow, hurt, anger, guilt, confusion, and other feelings that arise after suffering a loss. Mourning concerns the ways in which we express our grief” (p. 624). To help families who lost loved ones, social workers need to understand the grief process, and how people experience grief. Worden (1991) notes, “grief is an active process in which a person must do several things” (As cited Kail et al, 2006, p. 625). What Worden emphasizes is that people must recognize the reality that their loved ones died. People must appropriately adjust to a new situation, and must find effective ways to say good bye by freeing from themselves the bonds of the dying person. Maybe, this active coping process for family means that after the loss, they arrange to come to the resident’s place, which was the resident’s physical world, to pick up belongings left behind, and interact with family and friends by sharing their experiences (Kail et al, 2006. p. 625).
Attig (1996), and Stroebe et al. (1996) assert that the grieving process is very different because individual experience differently. Therefore, social workers should remember that there may not be the best grief process. Also, during bereavement, each family has own needs to deal with issues regarding the loss, social workers should not underestimate the grief time. There is a critical point that social workers must think about an ethical decision-making at the end of life (as cited in Kail et al. p. 625). As Foster and McLellan (2002) point out, even if there is “a tendency still exists toward a paternalistic approach in ethical decision-making with an emphasis on the biological” (p. 38), social workers should consider the psychosocial perspectives and practices as well as considering bioethical perspectives. As NASW press (1994) notes, “Clinical social workers [should] focus on internal and interpersonal dynamics related to the experience of moral pain in such decisions; their interventions include clarifying advance directives, advocating for a patient’s right to choose, supportive counseling, acting as liaison to the team, and encouraging family involvement and the exploration of end of life options and resources” (As cited in Foster & McLellan, 2002, p. 40).
When social workers conduct psychosocial assessments, crisis intervention, and implication for social work practices, social workers in clinical settings should assist families as a “counselor, context interpreter, advocate, and team member” (Bern-Klug, Gessert, & Forbes, 2001, p.45). The palliative care centres below are in Winnipeg. It is helpful to know these resources may give some hopes to improve quality of life at the end of life stage.
Services provided by Personal Care Homes:
▪Bethania Mennonite Personal Care Home (204)-667-0795
They offer a program that is very similar to palliative care. They call it comfort care within their facilities. It consists of a trained end of care team that has been educated through Palliative Care and Hospice Care Manitoba.
▪Deer Lodge Personal Care Home (204)-837-1301
They offer a program called No One Dies Alone (NODA), which stands for no one dies alone. This program was created for residents that may not have family members to help them through end of life care. It is provided by on-call volunteers. These volunteers have been trained through the center and accompany residents during this time.
▪Park Manor Personal Care Home (204)-222-3251
They offer a service through a course called “A friend in hand”, which was introduced by the Palliative Care and Hospice Manitoba organization. The course focuses on teaching staff, volunteers, and people of the public the importance of palliative care. After completion of the course the person taking the course can request to be put on an on-call palliative care list. This list indicates their availability and their hobbies.
▪River East Personal Care Home (204)-688-7460
They offer a palliative care course through Hospice and Palliative Care Manitoba. Staff, residents, and volunteers can take this course to become better educated about this new service.
Services provided by Hospitals:
▪Deer Lodge Hospital (204)-837-1301
▪Grace Hospital (204)-837-0111
They have 12 beds reserved for palliative care.
▪Riverview Hospital (204)-478-6203
They have 30 beds reserved for palliative care patients.
▪Seven Oaks (204)-632-7133
They are just beginning to develop the NODA program in their facility.
▪St. Boniface (204)-233-8563
They have 15 beds reserved for palliative care patients. This facility has access to labs and research tools to better assist the patients.
Services provided by Community:
▪Hospice and Palliative Care Manitoba (204)-889-8525
This is a non-profitable organization that is not affiliated with Winnipeg Regional Health Authorities. Their focus is to provide a provision of care to people facing life limiting illness. They provide community hospice, volunteer program, volunteer visitors, volunteer education, telephone support, bereavement support, fundraising, and sponsorship.
▪Harmony Home Hospice (204)-982-2953 It is a residential community based service. It is based upon physician referral. It provides a wide range of service like respite care, medication, psychological assessment, and family bereavement.
References
Kail, R., Cavanaugh, J. C., & Ateah, C.A. (2006). Human development: A life-span view. Canada: Thomson Nelson
Foster, L. W., & McLellan, L. J. (2002, December). Translating psychosocial insight into ethical discussions: Supportive of families in end-of-life decision-making. Social Work in Health Care, 35(3), 37-51. Retrieved December 5, 2010, from EBSCOhost, AgeLine database (91374).
Bern-Klug, M., Gessert, C., & Forbes, S. (2001, February). The need to revise assumptions about the end of life: Implications for social work practice. Health & Social Work, 26 (1), 38-47. Retrieved December 5, 2010, from EBSCOhost, Academic Search Premier database (4119501).
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