The Intensive care social-worker: roles and protocols for the chronically, critically ill patient and family
The purpose of this study is to describe how the Intensive Care (I.C.U.) social worker responds to the delineated needs of the long-term, chronically, critically ill (C.C.I.) adult patient and their families in I.C.U., and to define and describe appropriate social work roles, functions and protocols required by that specific patient population. This thesis demonstrates that generic social work roles, functions and values are congruent with I.C.U. philosophy and combined with their own and other existing multi-disciplinary protocols can enhance the holistic care of the C.C.I. patient and family. This thesis emphasizes I.C.U. social work as a program priority. The study also describes the acute patient in I.C.U. (before 15 days) and the related crisis interventive work, thus documenting the need for social work interventions at the earliest point in the patients hospitalization. This thesis draws a portrait of the psychosocial, environmental, spiritual and physiological needs of the C.C.I. patient and family. C.C.I. patients have not been addressed in social work literature although it is documented that they make up a proportion of the social work interventions in intensive care. Forty-five percent (approximately) of all public general hospitals in Canada report social work involvement in I.C.U. A unified needs based treatment approach has been put forth with existing social work treatment and protocols in I.C.U. for this specific group. Increased utilization, cost and specialization in I.C.U. plus shifting population groups, illness/ disease patterns have brought a parallel extension of the social work role. Preventative treatment approaches must now concentrate on I.C.U. Syndrome/psychosis patient isolation, communication aids and team strategies to coordinate interventions. The acute care and lifesaving crises that daily occur require psycho-emotional support. This is compounded for the C.C.I. patient by the high incidence of utilization of breathing support equipment which limits communicative interaction between patient and staff. This has definite ramifications on the kinds of psychosocial interventions and therapies normally addressed by social workers. Social work training to date does not include a review of I.C.U. equipment and facilities which necessitates on-the-job orientation to technical terminology. This vital information enables the worker to knowledgeably assist the patient and family and access appropriate professionals in practice. Today, a new, aggressive treatment approach to the long-term C.C.I. patient has been established. This Critical Care Model with its final, common, systems-failure pathway demonstrates that the illlllediate psychosocial, physical and instrumental issues for the C.C.I. patient will arise from the complications, crises and dilemmas of their long term hospitalization rather than their initial illness typology. Synthesis of this information has resulted in sixteen social work protocols pertaining to systems from pre-admission to discharge planning and self-care. This thesis, through its utilization of relevant crossdisciplinary literature and practice data, recommends the inclusion of interdisciplinary education in social work training for intensive care or a combined field/practicum setting, plus initiation of research.
Bibliography: p. 168-183.
Osoff-Bultz, B. (1987). The Intensive care social-worker: roles and protocols for the chronically, critically ill patient and family (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/12107