The intensive care unit has become a focal point for decision making in end-of-life care. High technology medicine can often extend life beyond the point of providing benefit to the patient. In these circumstances we have a modern social problem of prolonged death. Palliative care programs have been expanding in U.S. hospitals with the goal of promoting patient comfort and patient and family involvement in treatment planning and decision making. Social workers are frequently part of palliative care consult teams and are involved with families to assist them with decision making, end-of-life care, bereavement counseling, and discharge planning. However, many of these social workers report lacking specialized training for their work.
This study evaluated a palliative care training program for social workers who work in intensive care units. The social workers received training in the principles of palliative care in the ICU, communication with patients and families, pain and symptom management, withdrawal of life-support, bereavement support, and cross-cultural awareness. The program was based on Bandura's theory of self-efficacy. Data were collected from social workers and other clinicians and family members of patients who died while in the ICU. The study used a pre-post intervention design and the analysis included t-tests, linear regression and multilevel modeling.
An overall positive effect for the intervention was found. Social workers increased their satisfaction with meeting family needs and reported more total social worker activities after being trained in the principles of palliative care. Four individual social workers who saw more than 20 families had more consistently high scores on the outcome variables. A multilevel model showed that when the number of families seen by a social worker was controlled for as a predictor, social workers reported engaging in an increased number of activities with families. The findings are encouraging that palliative care training can be delivered in an ICU environment with good effects. Social workers are encouraged to expand their work in palliative care and recommendations for practice and research are made.
|School:||Portland State University|
|School Location:||United States -- Oregon|
|Source:||DAI-A 68/07, Dissertation Abstracts International|
|Subjects:||Health education, Social work, Adult education, Continuing education|
|Keywords:||Palliative care, Self-efficacy, Social workers|
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