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I don’t know how to handle this Psychology question and need guidance.

Respond to at least two different colleagues’ postings in one or more of the following ways:

Comment and elaborate on the practice and the patient population with regard to medical social worker roles your colleague shared.

Post additional ways to address challenges.

DB1

Becki

The emergency department (ED) is a specialized unit in the hospital setting.The ED is usually the first place that patients receive treatment in the hospital (Healy, 1981, p. 36; in Beder, 2006).Because many patients arrive via paramedics and ambulances, the ED is usually on the ground floor of the hospital and is physically close to imaging and the lab. The ED staff consists of specially trained emergency physicians, nurses, respiratory therapists, lab- and imaging- technicians, and social workers.The ED generally has dedicated admitting staff and unit clerks.Some EDs have attached or nearby or helicopter pads, and some rural hospitals have hospital-based helicopters.The ED that I am the most familiar with is in Kona Community Hospital in Kealakekua, HI.Kona Hospital’s ED is a level III trauma unit.This designation means that the hospital has dedicated and trained staff, including on-call surgical and orthopedic teams, an ICU, and that they can transfer patients to a higher level of care after they are stabilized (American Trauma Society, n. d.).

There is only one level I trauma center in Hawaii, on Oahu, about 200 miles (or 45 minutes by plane) from Kona.The hospital’s helicopter pad is not attached to the hospital, and there is no direct entry into the ambulance bay from the landing pad.To transport patients to or from the ED, the staff must call the local fire station to have an ambulance transport around the building.Because the hospital was built in the mid-1970s, the original architects did not plan on a helipad. When I began working there, in fact, whenever we had a county life-flight chopper land, the landing area was in the parking lot.We all had to run outside to move our cars when a chopper was inbound.When the administration planned the upgrade to the Level III status, they found the building itself was not structurally sound enough to put the landing pad on the roof.The staff joked that if the pilots tried to land on the roof, the patient would end up in surgery (on the third floor), then ICU (on the second floor), and then in the ED (in the basement/ground floor).

An ED serves many, if not all, members of a population.The ED is, as noted previously, the initial point of care for many of the patients in the hospital.The ED staff provides care to everyone who enters the doors. The Emergency Medical Treatment and Active Labor Act (EMTALA) requires all hospital EDs in Medicare-participating hospitals to provide emergency treatment and stabilization of all patients, whether they can pay for services (Centers for Medicare and Medicaid, 2012).Patients that seek care in the ED may be of any age and need care for all types of injuries, illnesses, substance use, or behavioral health issues.The patients may live in the surrounding community or from out of the area, state, or country.In Kona, the ED cared for people from around the world, with any number of medical issues.Some of the most memorable of my patients were involved in motor vehicle crashes, drowning or surf-accident injuries, and one death from a marlin. (The fisherman caught a marlin or billfish.These are deep water fish and can get very large.The person attached the fish to the side of the boat and returned to the harbor.Once there, he assumed that the fish was dead and went into the water to cut it loose and bring it to the dock to weigh and measure it.The fish was very much alive and used its 2-foot-long snout/bill to stab the fisherman through the heart, as it tried to escape.)

An ED social worker must be able to change activity and focus very quickly. The ED generally is a very fast-paced and changeable environment.Since patients come in randomly, with many different issues, the social worker must be very flexible and able to multitask effectively.They need to be aware that the unit has particular and needful tasks to help patients, sometimes even before they arrive.There is always a medicom on, linking the ED with paramedics and police/fire.The social worker, along with the other ED staff, needs to be alert to the tones that indicate that there is an incoming call.The social worker should also be aware of incoming calls, primarily if the calls are related to trauma, code blue, or other situation with an increased risk of death or distress.If the call is for a trauma patient or a code-blue, the social worker needs to stand by, behind the medical team, but still available to pick up any ID, cell phone, or any other patient identifying information. While the physician, nurses, and RT assess the patient and begin treatment, the social worker needs to find the patient’s ID and give it to the unit clerk to see if they are a prior patient.If there is no ID, the social worker may need to go through the patient’s clothing/wallet or purse/cell phone to try and determine who they are. The next step is to call the person’s emergency contact to ask them to come to the hospital emergency department if they are not already there.If the patient’s family or friends are there with them, the social worker stays with them, often going in and out of the ED as the patient is receiving treatment.The social worker acts as an information broker at this point – giving pertinent information to the physician and letting the family know what is happening with the patient.One thing that is also important, especially during a code, is to determine the family’s wish to be in the ED.Ultimately, the decision is up to the physician, however.Some physicians want the family to be present during a code, while others do not.In Kona, most of the physicians were agreeable to family or friends in the room if I kept them back and out of the way and answered their questions, allowing the ED staff and physician to focus on the patient.These are only a few of the roles and tasks I completed in the ED. Each patient and family were unique, and each had specific needs during their time in the ED.

The ED, unlike most medical settings, requires that the social worker be able to work autonomously, part of the ED team, but focused on family or the psychosocial needs of the patient.This role is equally important, but parallel, to the medical team’s evaluation and treatment of the patient’s medical condition. The social worker must also be able to work in a loud and boisterous environment.Especially during a code blue or trauma activation, there is an increased level of noise as well as heightened physical energy in the area.The family and friends, and sometimes the patient themselves, may need the social worker to act as an interpreter of the situations/treatments or things happening in the ED. The social worker will need to be highly aware of medical terminology and be able to describe them in layman’s terms.As Beder (2012) indicated, the social worker may need to explain to the family what they will see when they enter the ED, or precisely what the medical team is doing to their loved one.This role is challenging when the staff is performing CPR or intubating the patient.In my experience, people tend to assume that CPR is like they have seen on TV or in the movies – a couple of thrusts and a few breaths, and the person is as good as new. That is rarely, if ever, the reality.CPR is brutal and may lead to broken ribs and increased recovery time if the person survives. About the only thing that is like on TV is that the person’s body does move when the team uses a defibrillator.

Another aspect that Beder (2006) did not touch on is the reality of seeing patients in extreme pain, who are crying out or screaming, often covered in blood or excrement, and who may have gunshot or other wounds, or open fractures, or who may have disfigurements.Some patients die in the ED.If a social worker is unprepared for this, it can be emotionally upsetting, especially as there is little or no time to manage their emotions.There are also challenges related to patients with active behavioral health symptoms or who are acutely intoxicated by substances.In the ED, there is always the risk that the patient or family may be highly upset or angry and become violent.Generally, security is in the ED as well, but there may still be a physical risk to the social worker or other staff.

To begin addressing the challenges above, the social worker must first determine their ability to work in a fast-paced, noisy, and confusing environment.As Beder indicates, a social worker who does not thrive in a chaotic work environment should not work in the ED.Also, the social worker should be prepared for an assault on their senses, seeing blood and injuries, smelling excrement and vomit, hearing moaning and screaming, and having to deal with their emotional reaction to these things – all while being a comforting, knowledgeable, and calm presence.Several of the social workers who came (and went) to Kona Hospital could not handle working in the ED.One of them completely lost their composure when the ED called a trauma activation because they were unable to tolerate the smell of the ED.

I would not recommend that a novice medical social worker works in the ED.It is all medical social work, from hospice through oncology to behavioral health, to OB, in one setting.The social worker in the ED must be able to act independently and simultaneously as a member of the team.They need a high level of skill and familiarity with medicine in general and emergency medicine in specific, coupled with strong evaluation skills.This last is essential because there is no time in the ED to complete an in-depth assessment.I conceptualize this as having a firm grounding in social work theory and assessment to be able to grok the situation quickly.This ability is critical, along with confidence in myself.There are times I needed to get the attention of (interrupt) highly trained, reactive, and focused professionals; and then to act upon my understanding in a chaotic and emotionally charged environment.

Despite the challenges inherent in working in an ED, I enjoyed my time there a great deal.I was unique in that I had little training or experience before I was quite literally thrown in the middle of a trauma code and had to figure my way through it.I learned a great deal about myself while working in the ED, especially that I can handle much more than I ever believed I could.

American Trauma Society. (n. d.). Trauma center levels explained: Designation vs verification. American Trauma Society. [webpage]. Retrieved 9/13/2020 from https://www.amtrauma.org/page/traumalevels#:~:text=Trauma%20Center%20designation%20is%20a%20process%20outlined%20anAd,are%20typically%20outlined%20through%20legislative%20or%20regulatory%20authority.

Beder, J. (2006). Social work in the emergency room. In Hospital social work: The interface of medicine and caring (pp. 135-142). Routledge.

Centers for Medicare and Medicaid. (March 2012). Emergency medical treatment & labor act (EMTALA). Centers for Medicare and Medicaid. [ webpage]. Retrieved 9/13/20 from https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA

DB2

Nicole

The health care setting I selected is hospice. This service is that of specialized care for patients and their families to assist in transitioning from the present to the end of life process according to the patients and family’s needs (Beder, 2006).

The patient population served at the setting is those who are terminally ill. This could be children and adults (Beder, 2006).

The hospice social worker can function in the home care setting where the assessment of needs of the patient and family is taken to further understand the required services needed. The hospice social worker coordinates the needs of the patient and family with available community resources and is the continued liaison for such services for the continuity of care within the home environment setting.

In the hospital setting, the hospice social worker is part of an interdisciplinary team that works with the patient in accepting the terminal illness and working with the families through the caring process of what is to take place. They help the patient to understand the steps and advocate on the patient’s behalf to ensure the proper level of care. Hospice social workers counsel not only the patient and families but staff in dealing with emotional support of a terminal illness.

Identify factors about the health care setting that might challenge the medical social worker. Explain why. Explain ways you might address the challenges.

Cultural issues with different ethnic groups may pose a challenge. Depending on the culture, they may have a ritual or way they may deal with death of a loved one that a social worker may not fully understand or have been exposed to (Beder, 2006). According to (NASW, 2016), health care social workers must be culturally competent and knowledgeable of the client they are serving to provide effective service required for its specified culture. This can be accomplished through continual learning of the many diverse ethnic groups [standard 4].

Containing emotion when a patient you have been working with transitions. Sometimes you see yourself in the patient, especially if they are around the same age. A fear may set in with that possibility of dying. One way to address this being able to separate the job from the personal life (Beder, 2006).

Beder, J. (2006). About medical social work. In Hospital social work: The interface of medicine and caring. Routledge. Retrieved from Walden Database [Vital Source e-reader].

National Association for Social Workers. (2016). NASW standards for social work practice in health care settings. Retrieved from https://socialworkers.org