Social Workers' Perceptions Revised Social Research Proposal

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As the number of dementia patients with end-stage illness is increasing; a higher number of social workers will be required to treat them in the future. It is important to evaluate the behavioral patterns of social workers dealing with such patients. The main purpose of such research is to identify the possible causes for such behavior so that necessary measures can be taken to reverse the situation.

Role of Hospice Social Workers

As shown by the statistics presented by NHPCO, 2005, although more than 81% of end-stage dementia patients are adults over 65 years, only 8% are found to be treated in hospice settings. Since dementia lists under the top five illnesses causing death in elderly patients above 65 years, this equates to only a fraction of the thousands of patients who die annually of dementia receiving specialized end of life care provided by hospice programs (Simons et al. 2011).

When end-stage dementia patients are present in hospice settings, presence of social workers adds a psychological perspective to the organizational setting. These hospice social workers tend to perform a variety of functions such as counseling, brokerage of community resources, advocacy for end-of-life wishes and also educating the family of the patient about the dying process. All these roles emerge out of systems theory and promotion of patient's self-determination (Sanders & Swails, 2011). In addition to that, it is also a responsibility of the social worker to provide concrete and relevant information regarding patients' current state to their families. Furthermore, the nature of medical decisions that may be required in the process of treatment and also about the dying process, is the information that a social worker is expected to share with the family of the patient. (Shanley et al., 2011).

As far as the patients having end-stage dementia are concerned, the social workers' responsibility towards patients' caregivers and their other family members increases even more. However, this does not reduce the extent of responsibility of social workers to the patient. All the traditional roles played by the social worker while dealing with patients' family does not excuse them for not treating the patient rightly. This means that the role of social worker as a care taker towards the patient enhances when the patient is suffering from end-stage dementia (which further makes them unable to communicate and fail to show substantial responses to the treatment). This one-way communication and input of efforts makes the social workers feel discontent while interacting with the patient. However, the case might be opposite while dealing with the patients' families and caregivers. Such scenarios make the social workers face difficulty in identifying actual definition of their role with reference to end-stage dementia patients causing role ambiguity.

According to Sanders and Swails (2009), hospice social workers define their interaction with patients with dementia as "limited, ambiguous, and not rewarding" and commented that visits to patients with end-stage dementia were not a good use of time or expertise (given the perception of the social workers that meaningful therapeutic relationships could not occur). Hence, there is a visible strain on the relationship of social workers and patient which makes it rather challenging for hospice social workers to provide required care services to patients with dementia. Research has proved that the health of therapeutic alliance between the social worker and the patient depends on various factors where one is in a considerably healthy state than the other (Sanders and Swails, 2011). The research further leads to a conclusion that a cognitive impairment in patient can lead to a prevention of therapeutic alliance's formation i.e. therapeutic relationship may not develop between the patient and social worker. In case of end-stage dementia, this theoretical perspective is valid. As a result, an assumption can be made that there is some probability that an ineffective relationship between the end-stage dementia patients and the respective social care worker may exist from this inception. Since the relationship is ineffective from the start of the treatment; there is a possibility that the social worker may not be able to provide the required level of care.

Interaction between the Social Worker & Dementia Patients

Symbolic interactionism can act as a fundamental tool for understanding the significance of social worker's role while treating stage-end dementia patients. This phenomenon levies special emphasis on human interaction especially the one that takes place between the individual / group and those around him. When the symbolic interactionism is considered with reference to the relationship between the social worker and end-stage dementia patient, the patient is considered as the secondary person.
Looking at this model, there are three rationales involved: (1) People respond to each other on the basis of the meaning of relation which is created between them, (2) meanings are formed through interactions, and (3) these meanings are interpreted through a variety of factors that people use to make sense of situations (Sanders & Swails, 2011). Factors affecting the profile and behavior of any social worker includes past experiences with dementia patients, social values and other situational variables (which have a tendency of influencing the therapeutic relationship between the patient and the social worker).

All these factors collectively give rise to a need of conducting an empirical study which would define the relationship between end-stage dementia patient and the social work along with a thorough analysis of the possible reasons why the social workers face difficulty in complying with their fundamental principles such as equality while treating dementia patients. Along with that, the possible measures which would make the social workers more engaged with their patients of end-stage dementia, can also be find a solution to this problem.

Limitations in Earlier Studies

Various other studies have been conducted in this field of study (Sanders and Swails, 2011). However, there were certain limitations that these researches faced. For example, the other studies were projecting a behavioral analysis of social workers in the form of focused groups. Variables such as education, background, past experiences, made it difficult to apply these results onto general population due to differences in views. Agencies not dealing with dementia may have a different ideology all together as compared to those who treat end-stage dementia patients. There was also an existence of inherent biases since most of the research took place in the form of focused groups. Other inherent biases such as presence of supervisors and co-workers, fear of disclosure and engagement in the group-think, were also present. Since environmental factors had a tendency of affecting views of the subjects, therefore, there is a possibility that accurate views of social workers could not be obtained.

Considering these limitations in the earlier researches, it is important that a research model should be devised which would enable the outcomes to be applicable on the overall population. Additionally, the given research method should receive an accurate feedback from the subjects which are a part of the research so that a concrete and conclusive evidence can be obtained.

Research Problem Statement

According to the statistics provided by Alzheimer's Association, every 8th American is suffering from dementia in one way or another and this count is rising. Hence, a need arises for substantial number of social workers to be recruited in the hospice facilities dealing with end-stage dementia. Where equality acts as the fundamental principle for the social work practices; it demands the social workers to treat their patients irrespective of their health status. Furthermore, these social workers are required to develop a belief that every client has a tendency of benefiting from the therapeutic interventions. Since the number of end-stage dementia patients is increasing, the supply of experienced and trained social workers does not match the demand in this field.

Most of these health workers are observed to experience therapeutic nihilism which itself is a belief that no remedial measures will have a tendency of improving the health conditions of the patients (Sanders & Swails, 2009). This general belief greatly affects the interest and intent of social workers to get trained in treating patients with cognitive impairment and practice in this field. As a result, the induction of social workers in this particular domain has become really difficult. On the other hand, due to demotivation of these social workers, the quality of their work has also decreased considerably. The social care professionals in end-stage dementia care are seen as more prone to therapeutic nihilism.

The objective of this research is to evaluate why the social workers are reluctant of providing health care services to end-stage dementia clients. Another objective is to identify the reason for the declining number of practitioners in this field. Furthermore, in addition to this main area, the peripheral problems are an identification of the concerns of social workers and the barriers perceived by them which are prohibiting them from making contributions to patients' health care. This research has special significance since there is limited literature available on the treatment….....

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