The End of Life Care Strategy Challenges - Essay Example

When an individual's life is coming to an end, a multiple disciplinary team works together hand in hand to see to it that this individual's last moments are comfortable. The multiple disciplinary team consists of professionals from a wide variety of backgrounds, and the exact number of individuals on any given team is not known (National Audit Officer, 2008) Pain management specialists provide pain management services; the individual's last moments are pain free. Doctors manage the individual's care, seeing to it that health is properly maintained right up until the last moments of life. Hospice services are provided, so the patient's physical needs are met in the comfort of his home. Respite care is arranged and provided, should the family feel that this is necessary in order to provide their loved ones with the best care possible, as the respite care will allow them to replenish themselves. Religious leaders work with the dying patient to see to it that his spiritual needs are met. Then, there is the social worker. The social worker is responsible for seeing to it that the patient's emotional needs are met. This is an extremely important role for a number of reasons. One reason that the social worker has an important role in participating in the multiple disciplinary team is that there is a great deal of emotions that come with the ending of one's life. For one, the patient feels as though he is losing control. He feels that because he cannot stop himself from dying that things are out of his control, and he may try grasping at whatever he can to feel some sense of stability. He may also feel afraid, due to the fear of dying and of what may come afterwards. Along with these feelings, he will feel angry, sad, and hopeless. It is the social worker's responsibility to see to it that the patient has what he needs to cope with his circumstances, hence the reason that it is the social worker's role to help manage the stress of the client. The second reason that the social worker plays a large role is that he or she is responsible for coordinating care and support services for the patient (Sheldon, 2000; small, 2001). Without the proper care and support, the patient's last moments will be agonizing, and the patient's quality of life will substantially decrease, as he will not only be trying to cope with the myriad of difficulties that comes with dying, he will also have to contend with the stress of not having even the most basic needs met, which is not something that a dying person needs to be worrying about. If the proper care and support is provided, on the other hand, his final moments of life will be palatable. With all of his needs being met, whether emotional or physical, he will soon feel at peace. The social workers who truly care about their jobs know this, hence the reason for the immense dedication to the field. They do whatever possible to see to it that they do their job to the best of their ability, even though they may not have the support needed, even though the government does not back them as well as it should, even if they are loaded down with paperwork, which can sometimes cause them to have less time assessing the patient, even though they face a great deal of inconsistency and uncertainty, even if they must balance a number of roles and deal with extreme pressures. No matter what happens, the social workers who are truly interested in the well being of their clients endure because they know that it is in the best interest of their clients. Not to mention, there are a number of rewards for being in the field. As it concerns end of life strategy, there are a number of challenges as well as opportunities for social workers in local authority adult social care teams. The challenges that are presented to social workers are overwhelming. One challenge that social workers contend with on a regular basis is the lack of support from the government. For example, policies have been passed, as of late, that makes the environment more hostile for social workers, making more trouble for them than they already have. Concerning this, an article published in the British Journal of Social Work titled "Trusting in social work" states that the New labour Party government has put social workers in a difficult position, being that the policies enacted are in favor of greater government intervention (Butler, 2005). Furthermore, since the left New Labour Party has changed the country into a giant welfare state, social workers have heavier caseloads (Stepney, 2006). Social workers have been plunged into a world of uncertainty, more than has already been the case (Postle, 2002). More government intervention and hostile government policies means that the government will have more control over matters than is absolutely necessary, and the more control that the government has, the more their workers have to be responsible for. Not to mention, turning the country into a welfare state has given social workers much more to do than in previous times. This affects social workers immensely, as they are not able to spend as much time that is needed to assess the dying client's situation properly. This is due to the government control forcing them to adhere to bureaucracy, and such bureaucracy causes them to have to complete loads of paperwork, sometimes leaving them with just enough time to have very brief meetings with their clients, which, in the eyes of their clients, is not satisfactory at all. Furthermore, social workers are given a larger case load than what is manageable, and this, too, greatly affects the attention that dying clients receive, as they are not getting the time and attention that they deserve and that is necessary to see to it that all of their care is coordinated properly and all needs are met (Postle, 2002). IN order to assess how bad the situation actually is for dying clients, a study was conducted on a sample of social workers to see how much time is really spent fulfilling each task that is expected of them. The results were quite shocking. Findings show that social workers devote a shockingly five percent of their time in counseling and support services, seven percent monitoring the quality of the services received by the client, four percent of time is spent liaising with other professionals providing services, and thirty-two percent of their time is spent on administrative tasks. Excluding travel, sixty-four percent of their time is spent in direct and indirect activities as it relates to carers, and this does not include travel (Weinberg, Williamson, Challis, 2003). Numerous individuals receiving social services have complained about such matters, stating that the bureaucracy and the lack of necessary time and attention causes stress for the dying individual, making their last moments less palatable. Clausen, Kendall, Murray, Worth, Boyd, and Benton, who are experts in the field, as it pertains to social work and palliative care conducted a study just to see how deprived end-of-life patients are under the umbrella of bureaucracy. In the study, forty vulnerable adults were interviewed. The findings show that there are six areas in which social workers are falling short; providing support for the staff involved in the care of the dying patient, meeting the needs of carers, helping with family centered issues, providing help with spiritual and emotional struggles, dependency and loss, and providing assistance with tasks that are practical and of an everyday nature. Findings also demonstrate that due to the changes in the field of social work since the early 1990's, social workers have less of a therapeutic role and now must wear multiple hats; they must not only be therapeutic to clients but must also act as case manager, managing all of the patient's care needs. The study shows that these two roles are not compatible, as it is tough to fulfill both, and because of this, dying individuals are falling through the cracks, spending their last moments of life in a substandard fashion (Clausen, Kendall, Murray, Worth, Boyd, Benton, 2005). And while dying patients wish to die in the comfort of their own homes, they are not able to, a lot of the time, due to the lack of Social Care Services and NHS to supply their needs. Often times, these patients end up dying in hospitals, though, there is no real need for them to be there. And because of this, more money and resources are being wasted (National Audit Officer, 2008). Before the changes were made, social workers were able to spend more time being therapeutic with their clients. They were better able to provide emotional assistance to the client; sadly, though, social workers are not doing this as much, as this type of treatment disappeared when they were labeled as case managers (Postle, 2001). Patients also lament about the lack of treatment that they receive due to poor care management on the part of social workers. While some are very happy and grateful when they get a social worker on the case who really cares about the job, and who is willing to not allow bureaucracy, heavy caseloads, and paperwork to get in the way, and strives to see to it that the patient's care is properly coordinated, making sure that they are receiving the necessary support and care services that they need, some fall into the hands of social workers who see the job is nothing more than a job that is done at the end of the day. When clients fall into the hands of these social workers, the results can be disastrous. An article titled "There Are Wonderful Social Workers but it's a Lottery" states that such social workers do not see to it that the patient receive the dignity and respect that they deserve. Often times, they do not impart such treatment themselves because they are too busy trying to get onto the next client, doing what is minimally required. In these situations, patient autonomy is not respected, and often times, the wishes of the patient are either not known to all workers on the team: or, even if the patient does take the effort to make them known, they are not respected. Patients are angry about finding themselves in this situation, thus the need they speak out for better change, which includes respect to their decisions, and a more personal approach to managing their care (Manthorpe, Moriarty, Rapaport, Clough, Cornes, Bright, Iliffe, Oprsi, 2008). Patient autonomy is still a huge problem, and there is a long way until it is even partially improved upon (Limbery, 2002). Another challenge that social workers must contend with is that there is a significant gap in the education in training that they receive, as it is not enough to equip them for what lies ahead. Social workers receive minimal education, just enough to get by, and then they are expected to just figure it out the rest of the way, teaching themselves what they need to know. The lack of education and training creates an atmosphere of tension between social workers and their clients (Cagle, 2009; McDonald, Postle, Dawson, 2008). One area in which there is a severe lack of education and training as it pertains to social work is the need to integrate religion and spirituality in a client's palliative care plan. Many times, this is not done because there are a great deal of social workers that do not feel that religion and spirituality is appropriate in the realm of providing end-of-life care. One survey that was conducted between 2003 and 2004 show that there is a severe need for more education that focuses on the importance of integrating religion and spirituality in an end-of-life care plan. There is a greater need for social workers to competently be able to understand the crucial impact of faith and beliefs (Gilligan, 2006). When social workers are sympathetic to the religious and spiritual needs of the clients on their caseloads, the outcome is usually better. In order for this sympathy to occur, there needs to be changes made to the curriculum as it pertains to social work, as there is resistance to teaching religion and spirituality in the sector of education, and because of this resistance, studies as it pertains to religion and spirituality are either omitted or briefly covered (Holloway, 2007). Regarding the lack of training in religion and spirituality in social work educational programs, a study was conducted using a questionnaire that was issued to members of the British Association of Social Workers. Only twenty percent of the members responded to the questionnaire. Shockingly, more than three quarters of those who answered the questionnaire reported that little to no content in regards to religion and spirituality was covered in their training programs (Furman, Benson, Grimwood, Canda, 2004). This is hardly acceptable, and it is not fair to the clients. In order for social workers to correctly deal with the challenges that come with bereavement, it is imperative that they gain more knowledge, as it pertains to religion and spirituality, so they will be better able to understand their patients (Lloyd, 1997). Then there is the challenge of the social worker losing autonomy. Because of the new changes made to the job description, and due to the new government policies that have been enacted, social workers who really do want to help their clients are not able to do so as they'd like because their hands are tied. Even though they want to do everything in their power to help their clients, they must fight through heaping amounts of bureaucracy, trying to find any way possible that they can get around stringent policies that have been enacted against the favor of the social worker as well as the client. New legislation has not only put strains on the relationship between social worker and client, the social worker is not able to have the power to make decision as was once the case (Lymbery, 1998). Aside from the numerous challenges that social workers must face, there are many wonderful opportunities that also lay ahead. For one, social workers have the opportunity to make a massive difference in the life of a dying person, especially if he is dying alone without any family or friends at his side. To show that there is such a wonderful opportunity for social workers, a study was conducted on a sample of dying patients. The results were absolutely striking. Patients stated that they did not merely see their social workers just as social workers; they saw them as friends, someone who cared about their predicament and wanted to do everything they could to help. These individuals appreciated the empathy and the warmth that was imparted to them (Beresford, Croft, Adshead, 2008). Despite the enormous bureaucratic impositions placed upon them, social workers have still managed to find a way to see to it that the client's emotional needs were respected, and the client social worker relationship remained well in tact (Morrison, 2007). Another opportunity for social workers is that they can help to make change in the educational materials. Good social workers know the importance of a proper education, and they understand that knowledge is power. The social workers realize that there is presently a major problem in the educational programs that are provided to social workers (Quinn, 1998). Such social workers have the opportunity to make their voices heard, improving the future for clients and social workers after them (Yardley, Walshe, 2009). While steps are being taken in the right direction to make change for the better, a lot has to be done before this change is even made possible. For one, social workers need to be given more support than they are at present. Government policies must be made that will help to restore the system rather than tear it down. Social workers also need to work in a more unified fashion with everyone else on the multiple disciplinary team that is responsible for providing care and support services for end of life patients (Beresford, Croft, 2004). And because social work plays a major role in our society, as it pertains to the entire wellbeing of the dying patient, both social and healthcare policies need to be explored (Reith, Payne, 2004). There is plenty of opportunity for social workers to fight to make change for the better, as well as make a difference in the lives in whom they provide services for. References Beresford, Croft (2004) Service Users and Practitioners Reunited: the key component for social work reform. British Journal of social work, 34, 53-68 Beresford, Croft and Adshead (2008) 'We don't see her as a Social Worker': A Service User Study of the Importance of the Social Worker's Relationship and Humanity. British Journal of Social Work, 38, 1388-1407 Butler, Drakeford (2005) Trusting in social work. British Journal of Social Work, 35, 639-653 Cagle, Kovacs (2009) Education: A complex and empowering social intervention at the end of life. Health and Social Work, 34, 1, 17-26 Clausen, Kendall, Murray, Worth, Boyd, Benton (2005) Would Palliative Care Patients benefit from Social Workers retaining the traditional 'Casework' role rather than working as care managers A Prospective Serial Qualitative Interview Study. British Journal of Social Work, 25, 277-285 End of Life Care (2008) National Audit Officer Furman, Benson, Grimwood, Canda (2004) Religion and Spirituality in Social Work Education and Direct Practice at the Millennium: A survey of UK social Workers Gilligan, Furness (2006) The Role of Religion and Spirituality in Social Work Practice: Views and Experiences of Social Workers and Students, British Journal of Social Work, 36, 617-637 Holloway, M (2007) Spiritual Need and the Core Business of Social Work. British Journal of Social Work, 37, 265-280 Lymbery (1998) Care Management and Professional Autonomy: The impact of community care legislation on social work with older people. British Journal of Social Work, 28, 863-878 Lymbery (2001) Social work at the crossroads. British Journal of social work, 31, 369-384 Lloyd, M. (1997) Dying and Bereavement, Spirituality and Social Work in a Market Economy of Welfare. British Journal of Social Work, 27, 175-190 Morrison, T (2007) Emotional Intelligence, Emotion and Social Work: Context, Characteristics, Complications and Contributions. British Journal of Social Work, 37, 245-263 Manthorpe, Moriarty, Rapaport, Clough, Cornes, Bright, Iliffe, OPRSI (2008) There are wonderful social workers but it's a lottery. Older People's views about social workers. British Journal of Social Work, 38, 1132-1150 McDonald, Postle, Dawson (2008) Barriers to retaining ad using professional knowledge in local authority social work practice with adults in the UK. British Journal of Social Work, 38, 1370-1387 Postle, K. (2001) The social work side is disappearing: It started with us being called care managers. Practice 13, 1:13-26 Postle (2002) Working between the idea and the reality: Ambiguities and tensions in care managers' work. British Journal of social work, 32, 335-351 Reith, Payne (2009) Social work in end of the life and palliative care. The Policy Press Small, N. (2001) Critical Commentary: Social Work and Palliative Care, British Journal of Social Work, 31, 961-971 Sheldon, FM (2000) Dimensions of the role of the social worker in palliative care. Palliative Medicine, 14, 491-498 Stepney (2006) Mission Impossible Critical Practice in Social Work. British Journal of Social Work, 36, 1289-1307 Quinn, A. (1998) 'Learning from palliative care: concepts to underpin the transfer of knowledge from specialist palliative care to mainstream social work settings ' Social Work Education Vol. 17, no 1 Wee, Hillier, Coles, Mountford, Sheldon, Turner (2001) Palliative Care: a suitable setting for undergraduate interprofessional education. Palliative Medicine, 15, 487-492 Weinberg, Williamson, Challis, Hughes (2003) What do Care Managers do - a study of working practice in older peoples' services. British Journal of Social Work, 33, 901-919 Yardley, Walshe, Parr (2009) Improving training in spiritual care: a qualitative study exploring patient perceptions of professional educational requirements. Palliative Medicine, 23, 601-607 Read More