CAPC Palliative Care Discussion Forum
Social Workers in Palliative Care Settings
While I do not have a direct answer to your question I hope that some of the following thoughts will be useful. I am assuming that you are on a hospital consult service and will answer from that perspective. One thing to consider is resources; are you a clinican dedicated to the palliative care team, what is your daily census, daily referrals, the focus of most referrals? Do you have time to assess all the patients ? Have you, your chaplain and other team members worked together long enough to have a sense of each others skill set so you can screen and triage for each other? My sense is that in many teams there is a fine awareness of each others skills and therefore referrals are easily made back and forth. Other teams are in the process of developing that awareness. Another thing that is interesting to ponder is that each discipline listens from their unique training; we may hear the same words but what we glean from those words is informed by our training which in part is what adds to the richness of interdisciplinary work. The question about frequency of visits often relates to resources as well as the varying needs of patients and families, the focus of the interventions and the anticipated outcomes. Some require daily visits consequent to the level of distress, needs of patient and family, focus of the work; others require less intense follow up based on clinical judgment.In some settings depending on the reason for referral and busyness of the consult service, a social worker or chaplain may be the first person to meet the patient or family. While a referral for symptom management would traige to MDs, NP in some settings a goal of care referral might begin with SW or chaplain making an initial contact. Referrals for pain and symptom management may also be enriched by the listening, perspectives and interventions of social work and chaplaincy as we often see that pain and symptoms are complicated by helplessness, suffering, family dynamics etc that goes beyond the physical. I hope that some of these ideas are helpful to you and your team as you create a process that works in your setting.
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Re:Tool for SW assessment and reassessment
--The JC wants to know that the palliative care social worker has specialty training and that expectations of the SW have been outlined in job descriptions and assessed in a competency based orientation.
--JC PCPC.4 states the interdisciplinary program team assesses and reassesses the patient's needs and that this is documented in the medical record. The team's processes and policies and procedures can define/outline what the frequency of visits needs to be and also what is expected in response time.
--The JC will look to see that the assessment includes information about cultural, spiritual, or religious beliefs and practices important to the patient that influence care, treatment and services.
--JC will will look to see that a psychosocial assessment is in the patient record including assessment of anxiety, stress, anticipatory grief and coping and other psychological symptoms and that the team uses standardized assessment scales when they are available.
--JC will look to see that the IDT completes and documents an assessment for grief and bereavement services for patients and family.
--The IDT routinely documents the patient's wishes about care across care settings and fulfills patient preferences when possible.
--The program conducts regular patient care conferences with members of the IDT to dicuss goals of care, disease prognosis and advance care planning and to offer support.
I know this resonse takes a different track from the initial questions but may be helpful as you are designing and evaluating how your IDT operates.
Sharol Herr, RN, BSN, MSEd, CHPN; Palliativei Clinical Manager; Mount Carmel Health Palliative Care Leadership Center; Cols., Ohio.