The role of a medical social worker in patient care:Mediation and Advocacy

  A nurse attending to a patient

A nurse attending to a patient

Medical social workers play a great role in patient care. While the doctor and nurse focus on the medical aspect of patient care, the medical social worker focuses on the psychosocial aspect of patient care.

Like other social workers, the role of a medical social worker includes, but is not limited to that of a counselor, mediator, advocate, broker, therapist, teacher/educator and facilitator. This article focuses on the mediation and advocacy roles of a social worker in the medical setting.

Because of the varying needs of a patient, there is the need to have a multidisciplinary healthcare team working together to deliver comprehensive patient care. This team comprises of the doctor, nurse, psychologist, social worker, dietician and physiotherapist. Each of these professionals provides specific services to the patient, focusing on the issues in which they specialise.

The doctor/nurse-client relationship is one characterised by power imbalance. The doctor or nurse is usually in a position of power while the patient or client is a dependent and has less power. This power imbalance leaves patients in a vulnerable position without much defense. They are usually left at the mercy of the treatment process. In Ghana, it is a common thing to find nurses abusing patients verbally and emotionally. Patients have little say in the way they are treated, even if they are being abused.

It is the duty of the medical social worker to “fight” for the rights of the patient, especially in situations where the patient appears to be ignorant and vulnerable. Patients are encouraged to seek the intervention of a medical social worker when they have problems with a doctor, nurse or any member of the healthcare team. Doctors and nurses are also encouraged to seek the intervention of a medical social worker when they encounter problems with a patient.

Being part of the broader society, the medical setting is not without problems, especially in the area of patient care. One common problem area lies in the doctor/nurse-client relationship. This problem is conflict; conflict between the doctor and patient or between the nurse and patient. Conflict usually arises as a result of misunderstanding between a doctor and his patient or a nurse and her patient. This is where the mediation and advocacy role of a medical social worker comes in.

Conflict in the doctor/nurse-client relationship if not handled well could lead to undesirable and disastrous consequences.

The consequences of unresolved conflicts in the doctor/nurse-client relationship results in a loss either to the doctor or nurse as a professional or the patient as a client. Whether the doctor loses or the patient loses, it’s a loss to the nation.

As a medical social worker, I have come to the realisation that some patients see the healthcare provider or professional as an abuser. If the patient sees the healthcare process as unfriendly or “harmful”, they will label the healthcare provider or professional as an abuser. For instance, in a situation where an in-patient is given so many injections over a period of time by a particular nurse which may be painful to him, he may see that nurse as an abuser causing him harm and therefore label that nurse as an enemy.

Such a patient could refuse to continue receiving treatment and could even request to be discharged from the hospital when he has not fully recovered.

I once witnessed a scene at the Nsawam Government Hospital where a middle aged male patient was complaining angrily to the nurses that he wanted to go home. He complained of the numerous injections he was being given and threatened to leave the hospital.

The nurses did their best to calm him down but he wasn’t ready to listen to what they had to say. As he went on ranting and raving and drawing the attention of both patients and visitors, I thought he had a mental problem but when I listened carefully to what he was saying, I realised he was sound in mind and was making a good argument.

He fumed and said, “I have a festival to attend. What’s the point in you people keeping me here? Since I came here, you people have been giving me so many injections! Why? Why? Why? I’m going home!” I realised that he had a problem with the many painful injections he had been given while on admission.

I also realised that he did not understand why he was in the hospital. It seems to me he had been brought in by his daughter because I heard the nurses telling him to calm down and that his daughter would come and take him home when it was time for him to be discharged. He saw the hospital as a useless place of abuse.

The worst part of it was that he was not ready to listen to any explanation by the nurses. I said to myself, “A social worker needs to be called in to have a session with the patient.” I knew he needed some counseling to help him understand why he was on admission and why he was receiving the treatment he was being given. He also needed to be counseled on the implications of a forced discharge. It doesn’t mean that the nurses could not have counseled him. They could but he wasn’t ready to hear any of them.

The solution in a situation like this is to get a neutral person to intervene. It’s important to call the social worker. Perhaps the social worker’s intervention would make a difference since all the nurses were being seen as abusers and they were not being listened to.

Patients are urged not to use violent means to have their demands or needs met in the hospital. As a patient in the hospital, if you feel the nurses and doctors are not treating you right, you can call for the social worker to intervene.

Make a genuine complain to the social worker. The social worker’s intervention could make a difference in your life as an in-patient or even an out-patient. If you feel it’s a case of discrimination or racism, call at the social worker’s office.

Sometimes the nurse or doctor may not fully understand the needs of a patient and so may ignore some of those needs but the social worker, because of his specialised training, understands the patient’s psychosocial needs in a way the doctor and nurse may not find needful. Sometimes the seemingly insignificant needs of a patient are so important that when given attention to, will make a great difference in the wellbeing and enhancement or restoration of the patient’s capacity for psychosocial functioning and recovery.

Let’s look at this scenario:

Kwame is 25 years old. He has had some severe burns and has been placed on admission at the hospital. He is going to be there for some weeks. He is alone in a side ward and feels lonely and afraid. He wants to be moved to a ward where he can have company but Nurse Parham, the nurse in-charge says he can’t be moved to a new ward because there is no bed available as all the beds are occupied.

Kwame feels Nurse Parham is being insensitive to his loneliness and keeps complaining. Nurse Parham thinks Kwame is making an unreasonable demand. Kwame calls for the social worker, Mr. Brantley.

Mr. Brantley comes in, does his assessment and realises that Kwame has a genuine need that needs to be met. Mr. Brantley realises that Kwame is a person who is unable to sleep all alone in a room. He has grown up all his life sharing a room with other members of his family.

He has always had company sharing a room with others during his high school days in the boarding house. He also shared a room with a colleague back in college.

This information is unknown to Nurse Parham but the social worker with his tactfulness and critical assessment skills has been able to obtain this information from Kwame. Mr. Brantley proceeds with intervention. He has a discussion with Nurse Parham and explains some things to her about Kwame’s problem.

He asks her some questions: Is his condition going to affect other patients if they are brought together in the same ward? Is it possible to move another patient to the side ward where Kwame is? Is there a patient who wants a quiet place like the side ward where they can be alone and have some privacy? Nurse Parham begins to see some possibilities in Mr. Brantley’s proposals.

They interact with some patients and find a patient who is willing to join Kwame in the side ward and keep him company.

Kwame’s loneliness problem is solved and he feels happy and relieved. This aids him to recover quickly and he enjoys his four week stay at the hospital.

This case is a typical example of a nurse-client conflict that was resolved through the intervention of a medical social worker through the use of mediation and advocacy

By George Ofusu Oti

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