Duke University, Durham, North Carolina, USA.
Department of Pediatrics and Duke University School of Medicine, Durham, North Carolina, USA.
J Palliat Med. 2022 Aug;25(8):1236-1242. doi: 10.1089/jpm.2021.0574. Epub 2022 Mar 14.
Communication challenges in the neonatal intensive care unit include fragmented communication, challenges managing expectations amidst uncertainty, and navigating complex medical information. Social workers are well suited to mitigate these challenges. In this study, we aimed to characterize the extent and nature of social worker participation in family conferences for critically ill infants. We used a longitudinal observational mixed-methods design, enrolling infants with a neurological condition, their parent(s), and their clinicians. All audio-recorded conferences were transcribed and de-identified. Emergent themes and subthemes were identified using conventional content analysis. We enrolled 40 infants and 61 parents. Sixty-eight conferences were held and audio recorded for 24 infants. Social workers were present for 51 of these conferences ( = 51/68, 75%) across 18 cases ( = 18/24, 75%). We identified four themes, conceptualized as distinct roles played by social workers in family conferences: (1) Translator: social workers served as a communicative bridge between parents and the medical team; (2) Coordinator: social workers simplified logistics and connected parents to community resources, including home health agencies and financial assistance; (3) Expectation manager: social workers provided anticipatory guidance and helped parents conceptualize the remainder of the hospital stay, discharge, and life at home; and (4) Advocate: social workers validated parental values and concerns and provided immediate emotional support. Social workers participated in three-quarters of family conferences for critically ill infants. When they participated, they facilitated communication, coordinated care, managed expectations, and advocated for families. These findings underscore the important, varied, and concurrent roles social workers play in the care of critically ill infants. Future communication and family support interventions should leverage these distinct roles.
新生儿重症监护病房中的沟通挑战包括沟通不完整、在不确定中管理期望的挑战以及处理复杂的医疗信息。社会工作者非常适合缓解这些挑战。在这项研究中，我们旨在描述社会工作者参与危重新生儿家庭会议的程度和性质。我们使用纵向观察性混合方法设计，招募患有神经疾病的婴儿、他们的父母及其临床医生。所有录音会议都进行了转录和去识别。使用常规内容分析确定了出现的主题和子主题。我们招募了 40 名婴儿和 61 名父母。举行了 68 次会议，并为 24 名婴儿录制了音频。在 18 个案例（24 名婴儿中的 18 名，75%）中，有 51 次会议（68 次会议中的 51 次，75%）有社会工作者参加。我们确定了四个主题，将社会工作者在家庭会议中的角色概念化为：（1）翻译：社会工作者在父母和医疗团队之间充当沟通桥梁；（2）协调员：社会工作者简化后勤工作，并将父母与社区资源（包括家庭健康机构和财务援助）联系起来；（3）期望管理者：社会工作者提供预期指导，帮助父母构思住院剩余时间、出院和在家生活；（4）倡导者：社会工作者验证父母的价值观和关注点，并提供即时的情感支持。社会工作者参加了四分之三的危重新生儿家庭会议。当他们参加会议时，他们促进了沟通、协调护理、管理期望并为家庭提供支持。这些发现强调了社会工作者在危重新生儿护理中扮演的重要、多样和并发角色。未来的沟通和家庭支持干预措施应利用这些不同的角色。
