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SWHPN Shares: Being a Hospice Social Worker in a Time of Crisis

A few months ago, a Child Life Specialist who I work closely with and I discussed talking about feelings. She assumed I'm good at this because I talk about feelings all day long—most days at work, and often with colleagues and friends who come to me to talk through difficult emotions. I laughed and said, "Yes, I spend all day talking to people about their emotions; that's easy. Talking about my emotions is something else altogether." If I were to gather a room full of social workers together, I'd be willing to bet the same would be true for many of us.

But now that a worldwide crisis has hit, we're forced to face at least some of our emotions on a daily basis in order to manage our own mental health and coping. For me, as someone with a mental illness (major depressive disorder), I have to be conscious not only of my treatment (medication and therapy adherence on a routine schedule) but also how I am tapping into my own coping mechanisms. As we ask in our field, how are they working for me? In addition to the struggles with depression I typically deal with, which can be amplified by isolation and hopelessness if I let them, I also struggle with a feeling that many people are confronting now, especially those with disorders: anxiety.

One tool we can use to help us manage anxiety is mindfulness, as it can help us to focus on the present moment and stop perseverating on the past and the future. There are a number of free tools out there right now that can be helpful with this: Mindful.org has a page of free resources, including articles and meditations. MindwellU has a 30-day mindfulness challenge that can encourage you to slow down a few times a day.

Another tool that can be helpful is to put the experience we are all having in a cognitive frame that makes sense for you. In the first episode of her podcast, Unlocking Us, Brene Brown speaks about something she labels "FFTs" for "_______ First Times", and she shares that the ability to normalize experiences that are foreign to us, like going through a pandemic, helps us realize that our responses, like anxiety and fear, are typical. This helps us put the experience into perspective and reality-check our expectations. In this way, Brown gives us a tool with which to respond to the FFTs we keep experiencing during this crisis, so that we can stop reacting to the experience and start living again.

Since we talk about going back to the social work basics in times of crisis, it doesn't hurt to mention the self-care basics when dealing with feelings of anxiety, stress, and worry:





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Goodbyes in the Time of COVID

As COVID-19 has changed visiting policies in hospitals and other facilities, it has also changed how people say goodbye to the ones they love, and how we as social workers support them in saying those goodbyes. Anticipatory grief is happening virtually and in isolation, and part of our work during this pandemic is connecting families with patients, supporting them as they say goodbye, and acknowledging the loss of saying that goodbye in person. As a palliative care social worker, I have encountered many instances in which family members could not be present to say goodbye to the patient. Some family members are COVID+ themselves, are immunocompromised, or live across the country or world. While one healthy visitor is allowed to visit a patient who is imminently dying, predicting someone’s final hours and minutes can be difficult to do, and sometimes family are concerned about coming to the hospital and putting themselves at risk.

Technology has allowed us to support families in their grief, and for those who do not have access to a video camera, telephone communication has proved vital. There are some roadblocks to connecting families with patients- clinicians working remotely, a limited number of staff who are allowed to enter a COVID+ patient’s room, a high number of palliative care consults, limited technology that staff and family members have access to, and ever present technological glitches. Despite these barriers, my palliative care colleagues have wielded creativity, compassion, and collaboration to facilitate goodbyes, and share messages of love in a time of overwhelming death and despair.

Over the past several weeks, my team has been able to coordinate Zoom video meetings so that families can see their COVID+ family members at the end of their lives. We have set up Zoom meetings, disseminated the login information, and our physicians and nurses have brought iPads to patients so families could see their hospitalized family members. In instances where the physician cannot enter a patient’s room (either to limit exposure or to conserve PPE), and the patient cannot hear their families on the iPad, we have invited those in attendance at these meetings to write messages in the chat box, or to say messages out loud with the promise that we would deliver these messages to the patient. Over Zoom, families have joined together in grieving the loss of their family members who have meant so much to them, sharing memories and gratitude, and saying their goodbyes.

After these meetings, I have transcribed their written and spoken messages so they could be placed by the patient’s bedside. The physician on my team suggested I compile them into transitional documents for families, which they could continue to reflect on as the patient transitioned. I have emailed the documents to families with space for additional messages for those who had been unable (either logistically or emotionally) to join the call, and placed one-page abbreviated versions by patients’ bedsides so physicians and nurses entering the rooms could read brief messages to patient from their families. This interdisciplinary intervention aimed to facilitate connections between patients and families, and we hoped it would provide opportunities for care providers to connect with their patients as well. Working within the boundaries we had, we hoped to provide support, and were grateful that families could connect with patients and with one another through video and written text.

Another intervention we have used with caregivers for patients who did not have access to a video camera or smart device, and were unable to visit at the end of life due to visitation restrictions, was to pass on messages verbally. In circumstances where bringing a phone to the patient is not possible, I have asked friends and family members what they wanted to say to patients. They have shared messages such as “You are not alone” and “I love you.” These messages are then imparted to the patients by physicians, nurses, and social workers. It is so important for friends and families to know that, though they are not with them physically, their messages will be delivered.

Collaboration has always been inherent in palliative care, though I have never been as grateful for it as I am now. As families and patients remain in quarantine, healthcare workers are bringing people together virtually in a number of creative ways, and palliative care social workers are uniquely positioned to provide anticipatory grief support to the families and friends of patients with COVID-19. As we navigate the psychosocial impact of COVID-19 on grieving families, we can continue to explore new ways of facilitating communication and share our newfound interventions with each other.


Kasey Sinha, Palliative Care Social Work Fellow at Mount Sinai Beth Israel in New York, NY. SWHPN is accepting guest submissions on COVID-19 practice and interventions at [email protected].

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Statement on Hospice and Palliative Care Social Work Practice In Times of Health Care Crisis

The words "essential" and "non-essential" may become two of the most repeated words of 2020. We hear them in press conferences, read them in work e-mails, and see them on chyrons posted across the bottoms of our TV screens. For many of us in the Hospice and Palliative Care Social Work (HAPC-SW) field, these words have also been applied to our jobs in ways that, as many of us have discussed at our nightly support calls, have provoked conflicting feelings of both guilt and relief (when labeled non-essential) or fear and pride (when labeled essential).

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Update on Social Work Open Discussions

Over the past month, our weeknight Social Work Open Discussions have been attended by social workers and psychosocial professionals from over thirty states and four countries! Thanks to all who participate and make these meetings the dynamic discussions they are during this critical time.

We are updating our schedule over the coming weeks to consolidate these meetings, as well as provide some discussion around specific topics. As always, these remain informal gatherings and safe places for clinicians and colleagues to share feelings and fears in an effort to find renewal, support, and social connection.

Beginning Tuesday, May 5th, please join us on Tuesdays and Thursdays at 7:00 pm EST. You can register to participate here. Come as little or as often you need.

See the updated schedule:

  • Thursday, April 30th: Topic: Grief and Trauma with special guest April Naturale. Looking to the future, there will likely be some level of grief and trauma for our colleagues and a large portion of the world that exists for a long time. What are we going to do about that as a field and as individuals?
  • Tuesday, May 5th: Open Discussion
  • Thursday, May 7th: Topic: New Normal. What does the "new normal" for hospice and palliative social work look like, and what can we do to ensure that our field is equipped to support patients, families, and colleagues? What are you hoping for, what are you worried about?
  • Tuesday, May 12th: Open Discussion
  • Thursday, May 14th: Topic: Transitions. How has your role changed since COVID-19? If you're working from home or have changed locations, what support do you need? How are you adapting? What things will remain post-COVID? 

You can find our most updated list of events and Social Work Open Discussion topics on the SWHPN Events Calendar.





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When You're Working Remotely as a Hospice or Palliative Care Social Worker

 

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SWHPN Announces New Leadership

Though our field is facing unprecedented challenges, we are pleased to announce several exciting leadership changes taking place the Social Work Hospice and Palliative Care Network (SWHPN) to lead our members through these uncertain times.

SWHPN appointed Jessica Strong as permanent Executive Director, after serving in the role of interim Executive Director for the past year. This appointment followed an organizational search and board voting process. In addition to leading the outstanding team of professionals who have implemented SWHPN’s annual General Assemblies over the past five years, Jessica led SWHPN’s most recent strategic planning process that initiated the formalization of SWHPN’s current organizational structure. The goals set in that process have helped to provide extraordinary growth of SWHPN this year and have set the course for a bright future. One of her first initiatives was successfully securing a two-year grant from the Cambia Health Foundation to provide educational webinars to support the professional development needs of hospice and palliative care social workers. We are grateful to the Cambia Health Foundation for their continued support which will support these new initiatives.

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SWHPN releases Core Curriculum for Palliative and Hospice Social Work

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What does Social Justice mean to you?

Make your voice heard by participating in a SWHPN-endorsed study on the role of social justice in hospice and palliative care. Your participation is important because social justice is a defining professional value and social justice issues are directly relevant to our field, as well as to our patients and families. The study will help identify common social injustices that social workers encounter in hospice and palliative care settings and possible strategies to address them.

The study consists of a single online survey. Your participation in the survey is completely voluntary. Should you agree to participate, you will be asked to complete a brief (10-15 minute) survey on what social justice means to you. The survey consists of two sections – the first with open-ended questions on your experience with social justice in the field, the second with a few demographics questions. Upon completion of the survey, no further actions will be requested as completing the survey constitutes full participation in the study. Participation is anonymous and will allow us to gain a better understanding of how you incorporate social justice into your practice.

This study is led by Dr. John Cagle and his team at the University of Maryland School of Social Work. Study procedures have been reviewed and approved by the University of Maryland, Baltimore IRB (#HP-00088264). If you have questions about the study, please contact Dr. Cagle (Principal Investigator) or Rachel Brandon, whose contact info is below.

To participate in this short – but important – study, please click the button here:

 
TAKE THE SURVEY

John G. Cagle, MSW, PhD
Associate Professor
University of Maryland, Baltimore
School of Social Work
525 West Redwood Street, 3W13
Baltimore, MD 21201
410-706-6106
[email protected]

Rachel Brandon
Research Team Member
University of Maryland, Baltimore
School of Social Work
525 West Redwood Street, 3W13
Baltimore, MD 21201
[email protected]

Montefiore Medical Center Announces Palliative Care Social Work Fellowship

The Palliative Care Social Work Fellowship is a one-year, full-time position from July 1, 2020 through June 30, 2021. The goal of the Fellowship is to develop specialty trained palliative care social workers who will contribute to the care of seriously ill older adults in underserved communities in New York City and become future leaders in this field.

As part of a large academic medical center, the Montefiore Palliative Care Service offers a rich environment for learning. Medical students, residents and fellows from other specialties rotate with the Palliative Care Service, as well as advanced practice nursing, social work and chaplain students.

The Fellowship includes rotations at various sites within Montefiore, including the Palliative Care Inpatient Unit, the Moses, Einstein and Wakefield Hospitals, and the outpatient Oncology and Palliative Care Clinics. If the Fellow identifies another particular area of interest, there may be an opportunity for an elective rotation. The Hospice and Palliative Medicine Program Faculty will provide ongoing supervision and mentoring in clinical and other components of the Fellowship program. Social work specific training and mentoring is provided by experienced specialist social workers at all sites.

The Fellowship provides extensive educational opportunities, including weekly didactics, interdisciplinary team meetings, journal club, research/quality improvement meetings, complex case discussions, psychosocial oncology rounds, roundtable discussions and grand rounds. The Fellow will have the opportunity to attend local palliative care conferences, as well as continuing education classes at Fordham University Graduate School of Social Service.

The Fellow will participate in a research/quality improvement project with mentoring from Dr. Cathy Berkman from Fordham University Graduate School of Social Service. The Fellow will also conduct training on generalist-level palliative care within the Montefiore Health System and to local community organizations.

The position includes a stipend and benefits. The Palliative Care Social Work Fellowship is generously funded by the Fan Fox and Leslie R. Samuels Foundation.

ELIGIBILITY

Applicants to the Montefiore Palliative Care Social Work Fellowship must:

  • have an MSW degree from a CSWE-accredited program;
  • hold a NYS social work license, or limited permit, by the start of the Fellowship;
  • demonstrate a strong commitment to a career in palliative care social work and to serving the population of older adults in New York City after completion of the Fellowship; and
  • be a U.S. citizen or permanent resident.

For further information on the Fellowship or to apply, please go to the website listed below: https://www.einstein.yu.edu/departments/family-social-medicine/education/fellowships/palliative-care-social-work-fellowship-program/

Applications are due by March 15, 2020.

Social workers: we need your input for the HPC Workforce Study!

SWHPN is inviting its members, colleagues, and friends to participate in a research study questionnaire asking about your work experience, future plans, and professional stressors: the HPC Workforce Study. A social work-specific section is included for your input. If you work with seriously ill patients, you should consider participating in this study. This workforce survey is for all members of the interdisciplinary team.

SWHPN is proud to be participating, along with several other national organizations including AAHPM, HPNA, PAHPM and SCA/HCCN, in this important study. The results may be published as part of a Palliative Care specialty workforce series in Health Affairs.

By completing this survey, you are consenting to participate. No identifying information will be collected or reported. Other than contributing to our field's knowledge in this area, there are no other benefits to participation. The survey will take less than 15 minutes to complete, and is available here: http://www.hpcworkforcesurvey.com/

New National Guidelines Seek to Improve Access to Palliative Care for People Living with Serious Illness

New national palliative care clinical practice guidelines seek to ensure the millions of people living with serious illness, such as heart failure, lung disease and cancer, have access to vital care that can help meet their needs. The guidelines promote improved access to palliative care, which is focused on giving patients and their caregivers relief from the symptoms and stress of serious illness, is based on need, not prognosis, and can be provided along with disease-focused treatment.

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Survey: Experiences of LGBT Patients and Families in Hospice and Palliative Care

The lesbian, gay, bisexual, and transgender (LGBT) community has a long history of experiencing discrimination and stigma in many arenas, including health care and social services. Gary L. Stein, JD, MSW (SWHPN Vice Chair, Professor at Wurzweiler School of Social Work at Yeshiva University) and Cathy Berkman, PhD, MSW (SWHPN Board, Associate Professor at the Graduate School of Social Service at Fordham University) are conducting a study to learn about the experiences of LGBT persons and their family and friends with palliative care and hospice programs. The goal of this study is to the ways in which their care is discriminatory, disrespectful, or inappropriate based on their sexual minority status. Study findings will be used to develop and disseminate policy and practice remedies.

Your participation is voluntary. If you do participate, you have the option of remaining anonymous. If you choose to share your identity, your responses will be confidential. Study findings will be reported in the aggregate and it will not be possible to identify individual respondents or their institutions. We expect that the national sample will include several hundred hospice and palliative care respondents from social work, medicine, nursing, chaplaincy, administrators and elder law attorneys.

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