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Discharge Planning in Hospitals: How can we improve?

By: Megan Ferguson BSW, RSW


social work 1

Discharge planning is a vital component of a patient’s hospital stay, it is the moment where the healthcare team connects patients and their close family members with integral resources so that they can receive follow up healthcare services in the community. However, as I am developing my career as a hospital social worker, I notice that in many hospitals social workers are tasked with both coordinating discharge planning and providing emotional support to patients and families (Mizrahi & Berger, 2001). However, within these two tasks, social workers perform multiple sub-tasks including 1) Assessing a family’s social situation, 2) Consulting with interdisciplinary team members about patient care planning, 3) Identifying the psychological, emotional, social or spiritual barriers that interfere with treatment or discharge planning, 4) Engaging in advocacy on behalf of patients and families, 5) Providing crisis and emotional counselling and/or intervention, 6) Counselling around end-of-life, grief and bereavement issues, 7) Counselling around suspected abuse, 8) Addressing substance misuse issues, as well as 10) Engaging in writing, teaching and research activities (Gregorian, 2005, p.4). Patients that are typically seen by social work are patients who lack social supports, need assistance with income, need assistance with locating accessible and stable housing and individuals who may struggle with addiction or mental health challenges. Social workers are also the core discharge planners and lead the team to transition patients back into the community with the resources and support that they require.

Although I quite enjoy my work as a hospital social worker, my experience as a frontline social worker has allowed me to understand the obstacles and limitations that social workers in health care have to face in order to advocate for their patients while following multiple policies, standards, and guidelines. Tensions exist between “advocacy and collaboration” as well as, “commitment to patients and the organization” (Mizrahi & Berger, 2001). I find it challenging at times to maintain provincial, and regional guidelines of social work, while also following the Canadian Association of Social Workers’ (CASW) Code of Ethics (2005) and Guidelines for Ethical Practice (2005). The health care system also requires social workers to abide with hospital patient flow and length of stay standards, which can also further complicate patient care when many social issues are prevalent. Within these challenges Dr. Anna Reid, Former President of Canadian Medical Association, stated that “An estimated one in every five dollars spent on health is directly attributable to the social determinants of health,” in her final address (Eggertson, 2013, p. E657). However, these social determinants of health bring forward multiple barriers. Some of the most prevalent barriers may include income, housing, and food insecurity, which is further maintained by oppression and discrimination against minority groups such as women and First Nations individuals (Raphael, Curry-Stevens, & Bryant, 2008). These barriers force social workers to advocate on behalf of patients and families in order to work towards change and make social and policy adjustments to empower patients to better their health and well-being.

Social workers have a very large role and this role may differ depending on the client, and the unit that a social worker is working on. Collaboration is also so important when working in healthcare, unlike other social services agencies where social workers may make up the majority of professionals working in that area (Gregorian, 2005). Instead, hospital social workers play a more consultative role where they aim to collaborate with many disciplines each day (Gregorian, 2005). However, more emphasis must be placed on the importance of collaboration and interdisciplinary teamwork in order to initiate better patient outcomes and eliminate the power struggle between healthcare disciplines.

As social workers, we often work in collaboration with community social services agencies such as income and housing government organization as well as nonprofit organizations that assist with mental health and addiction. However, not enough of these organizations exist and we must continue to support these agencies in order to have resources that community members can draw on in times of crisis.

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Megan Ferguson is a Master’s student in the School of Social Work at the University of Calgary. Megan holds a BSW as well with a Specialization in Aging. She also sits on the Board of Directors for A & O: Support Services for Older Adults. Megan currently works as a Social Worker for the Acquired Brain Rehabilitation Program and Stroke Rehabilitation Program at a hospital in Winnipeg.

References

CASW. (2005). Social work Code of Ethics. Ottawa: CASW.
CASW. (2005). Guidelines for Ethical Practice. Ottawa: CASW.
Eggertson, L. (2013). Health equity critical to transforming system, says outgoing CMA president. Canadian Medical Association Journal, 185(14), E657-E658, DOI: 10. 1503/cmaj.109-4588.
Gregorian, C. (2005). A career in hospital social work: Do you have what it takes?. Social Work in Healthcare, 40(3), 1-14. DOI: 10.1300/J010v40n03_01
Mizrahi, T. & Berger, C.S. (2001). Effect of a changing health care environment on social work leaders: obstacles and opportunities in hospital social work. Social Work, 46(2), 170-182
Raphael, D., Curry-Stevens, A. & Bryant, T. (2008). Barriers to addressing the social determinants of health: insights from the Canadian experience. Health Policy, 88(2-3). DOI: 0.1016/j.healthpol.2008.03.015

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