The patient's vulnerability, dependence and exposed situation in the discharge process: experiences of district nurses, geriatric nurses and social workers

Abstract A live discharge from hospice can occur when a patient stabilized under hospice care and no longer meets the life expectancy hospice eligibility criteria. In 2018, 220,000 hospice patients across the United States were discharged alive from hospice care, with 1 in 6 discharges due to stabilization, with a life expectancy exceeding hospice’s six-month criteria. Hospice practitioners prepare patients and their caregivers upon enrollment for the possibility of a live discharge should their condition stabilize, however, there is no explicit discharge process available within hospice to guide practitioners in transitioning patients (and caregivers) out of hospice care. This transition process largely falls within the domain of hospice social workers, yet there is no research documenting the challenges and facilitators to conducting a live discharge from hospice. This study aimed to understand social workers' perspectives on the live discharge process. To better understand challenges and facilitators to the live discharge process, we conducted focus group interviews with hospice social workers at four hospice agencies across the U.S. We asked participants to discuss specific tasks associated with the live discharge process for a patient and their caregiver including identifying concrete services needed post-discharge; assessing the psychosocial and grief risk of patient and caregiver; and developing a post-discharge follow-up plan. Using constant comparison analysis we identified several themes including the need for clear professional roles during a live discharge, interprofessional education, and the need for dedicated time for live discharge follow-up. Policy implications and opportunities also will be discussed.

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Spotlight on the Clinician in the Life Participation Approach to Aphasia: Balancing Relationship-Centered Care and Professionalism

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00025 ◽

2020 ◽

Vol 5 (2) ◽

pp. 414-424

Author(s):

Rochelle Cohen-Schneider ◽

Melodie T. Chan ◽

Denise M. McCall ◽

Allison M. Tedesco ◽

Ann P. Abramson

Keyword(s):

Social Workers ◽

Therapeutic Relationship ◽

Interprofessional Collaboration ◽

Opportunity To Learn ◽

Subjective Experiences ◽

Speech Language Pathologists ◽

Self Disclosure ◽

Centered Care ◽

High Standards ◽

Therapeutic Encounter

Background Speech-language pathologists make clinical decisions informed by evidence-based theory and “beliefs, values and emotional experiences” ( Hinckley, 2005 , p. 265). These subjective processes, while not extensively studied, underlie the workings of the therapeutic relationship and contribute to treatment outcomes. While speech-language pathologists do not routinely pay attention to subjective experiences of the therapeutic encounter, social workers do. Thus, the field of social work makes an invaluable contribution to the knowledge and skills of speech-language pathologists. Purpose This clinical focus article focuses on the clinician's contribution to the therapeutic relationship by surfacing elements of the underlying subjective processes. Method Vignettes were gathered from clinicians in two community aphasia programs informed by the principles of the Life Participation Approach to Aphasia. Results and Discussion By reflecting on and sharing aspects of clinical encounters, clinicians reveal subjective processing occurring beneath the surface. The vignettes shed light on the following clinical behaviors: listening to the client's “whole self,” having considerations around self-disclosure, dealing with biases, recognizing and surfacing clients' identities, and fostering hope. Speech-language pathologists are given little instruction on the importance of the therapeutic relationship, how to conceptualize this relationship, and how to balance this relationship with professionalism. Interprofessional collaboration with social workers provides a rich opportunity to learn ways to form and utilize the benefits of a strong therapeutic relationship while maintaining high standards of ethical behavior. Conclusion This clinical focus article provides speech-language pathologists with the “nuts and bolts” for considering elements of the therapeutic relationship. This is an area that is gaining traction in the field of speech-language pathology and warrants further investigation.

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