Duke Health
Durham, NC, United States


General Description of the Job Class:

Provide skilled specialist palliative care to patients with life threatening conditions and their families as a part of the Duke Regional Palliative Care team. Utilize psychosocial assessments, psycho-education, and intervention to help a patient and family adjust and cope with extended hospitalization, diagnosis, disease trajectory, symptom burden, and bereavement.
Actively participates in the mission to promote primary palliative care delivery through education, quality improvement, wellness initiatives, and program development.

Duties and Responsibilities of this Level:

 Psychosocial assessment including patient and family history, presenting concerns, and assessment of strengths, needs and vulnerabilities.
 Assesses patient/family/caregiver (PFC) physical, psychological, socioeconomic, spiritual and symptom management needs.
 Assesses PFC advance care planning needs and actively participate in goals of care conversations.
 Develops a social work treatment plan based on a biopsychosocial and spiritual assessment of PFC including variables such as environment, support systems, family dynamics, roles & relationships, finances, culture, perception of illness, cognitive and emotional integration of diagnosis, prognosis, history of loss, and expressed needs.
 Identifies and intervenes with barriers and risk factors that may impede symptom management, response to treatment and patient/family care.
 Referrals to appropriate community services and resources in collaboration with unit social workers and/or case managers.
 Anticipatory guidance for coping with emotional, psychological, physical and spiritual dimensions of the disease process.
 Collaboration with patient, family and team to identify options, goals and priorities for care - advanced care planning.
 Integrates supportive counseling, family interventions, crises intervention and cognitive behavioral techniques based on diagnostic assessment.
 Bereavement care planning and support.
 Facilitates communication between patient and/or family and team including active participation in family meetings.
 Conflict management
 Consults and coordinates with other psychosocial/spiritual care providers (social workers, chaplains, therapists, psychologists) as appropriate for patient and family.
 Documents findings, plan, and actions taken according to departmental guidelines and standards.
 Functions as an integral team member by receiving and offering feedback, building respect and trust.
 Participates and represents social work perspective in multidisciplinary team meetings (weekly IDT), team rounds, and Palliative Care Grand Rounds.
 Designs and provides education on palliative care to other health care professionals.
 Offers education and support on resiliency, compassion fatigue, and moral distress through debriefings and staff care.
 Attends and participates in staff, committee, department, and other administrative meetings.
 Participates in departmental and hospital continuous quality improvement efforts.
 Keeps current with social work and health care developments and seeks to enhance job related knowledge through involvement with local, state, and national palliative care initiatives (SWHPN).
 Participates in individual and group supervision.


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