School of Social Work, University of Washington, United States; Harborview Injury Prevention and Research Center, University of Washington, United States.
School of Social Work, University of Washington, United States.
Soc Sci Med. 2017 Apr;178:104-114. doi: 10.1016/j.socscimed.2017.02.014. Epub 2017 Feb 11.
The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED.
急诊科（ED）可以成为许多具有多方面需求的患者的重要干预点。社会工作者长期以来一直是跨学科 ED 团队的一部分。本研究旨在增进对社会工作者与患者互动的有限理解，并探讨影响这一环境中社会工作服务的因素。本文报告了对城市公立一级创伤中心创伤患者提供的社会工作服务的医疗记录笔记（N=1509）进行的定性内容分析，以及对 ED 社会工作者（N=10）进行的半结构化访谈的深入分析。确定了 8 个主要的社会工作角色：调查员、把关人、资源经纪人、护理协调员、问题解决者、危机管理者、倡导者、出院计划者。分析揭示了 ED 社会工作服务与多层次背景之间的复杂相互作用。我们使用社会生态框架，确定了微观或个人层面因素、中观或局部系统层面因素以及宏观环境和系统因素之间的相互作用，这些因素在 ED 互动和患者服务中发挥作用。宏观层面的背景影响是社会结构力量，包括健康方面的社会经济障碍、反映提供者和患者之间权力差异的社会等级制度，以及不信任或偏见。中观层面的力量包括资源有限、医疗系统协调不足、医疗模式内部的层级挑战以及快速出院的压力。微观层面的因素包括患者和社会工作者的特点、患者压力源的复杂性、共情疲劳、缺乏结案和同情心。所有这些力量都在患者与社会工作者的互动中发挥作用，并影响服务的提供。社会工作者有时能够成功地应对这些力量，但有时这些挑战是不可逾越的。开发了 ED 社会工作及其对患者与社会工作者互动影响的概念模型，以帮助指导创新研究和实践模式，改善复杂、快节奏的 ED 中的服务和结果。
