Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Initiatives have been developed to increase the recognition of social work in addressing end-of-life and palliative care needs (Christ & Blacker, 2005). However, little is known about the relationship between leadership domains and decision-making influence of social workers in end-of-life care. This study identified leadership domains needed by nursing home social workers involved in end-of-life care planning with residents, families and other healthcare professionals.

Methods: In-depth interviews ( McCracken, 1988) of approximately 25 minutes were conducted with a national purposive sample of 17 key informants recognized as experts in end-of-life care. Respondents representing social work, public health and medicine were asked about the required skills of social workers as effective leaders in end-of-life care in the nursing home, and recommendations for preparing social workers with those skills. Interviews were transcribed and analyzed using the constant comparative method (Glaser & Strauss, 1967). ATLAS.ti 5.0 (Scientific Software Development) was used for data coding and analysis. Key themes concerning the competencies needed by social workers to assume leadership roles were identified.

Results: The most common emergent theme was the value of a systems psychosocial perspective brought to the interdisciplinary team through social work leadership. Social work leadership was viewed as central to the implementation of this perspective. The most frequently identified competency needed by social work leaders was strong communication skills, especially in being able to articulate and promote social work values. Other key leadership domains included practice experience in nursing homes and end-of-life care, a clear understanding of the political/organizational environment, strong strategic skills, and conflict management skills.

Implications: This research demonstrated that the social work perspective of understanding the client system in the context of a rich psychosocial environment is highly regarded as a bridge across the multiple disciplines represented in end-of-life care; and that strong communications skills represented the predominant leadership competency required to advance social work leadership. Neither this practice perspective nor communication skills are new to social work education. Rather, this research suggests that renewed emphasis must be placed on these dimensions with their connection to developing leadership capacity for social workers in end-of-life care made explicit. Given the complexity of end-of-life care decision-making in nursing homes, social work leadership in advancing an inclusive environmental perspective can unify the multiple and sometimes competing disciplinary foci present on an interdisciplinary team. By identifying the component dimensions of social work leadership, the profession will be better able to educate social workers for leadership roles and guide end-of-life interdisciplinary care teams to their highest potential.

References: Christ, G. H., & Blacker, S. (2005). Series Introduction: The Profession of Social Work in End-of-Life and Palliative Care. Journal of Palliative Medicine, 8(2), 415-417.

Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded research. New York: Aldine De Gruyter.

McCracken, G. D. (1988). The long interview. Newbury Parks, CA: Sage Publications.