The Influence of Cultural Beliefs on Medical Social Work Practice: A Qualitative Investigation

BACKGROUND AND PURPOSE: Across the nation, social work practitioners in health care settings are being challenged by an increase in job demands, fewer resources to meet their job requirements, and declines in staffing (Berger et al., 1996). Social workers in these settings need to be highly proficient at gauging their practice so that it responds appropriately to their clients' unique social service needs, as well as their cultural beliefs and practices. If cultural issues are not addressed appropriately, social workers can compromise the effectiveness of their interventions and the well-being of their clients. The social work profession's emphasis on culturally competent practice is especially salient in the current health care arena because the U.S. population is becoming more racially and ethnically diverse. The purpose of this study is to explore how medical social workers in urban hospitals attune their practice interventions to obtain optimal clinical outcomes and preserve the cultural beliefs and practices of their clients.

METHODS: A purposive sample of 47 medical social workers employed in hospitals and outpatient clinics was used to gather detailed accounts of everyday practice situations. This sample consisted of 58% European Americans, 17% Hispanics/Latinos, 6% Asians/Pacific Islanders, 6% African Americans, and 13% Mixed Racial/Ethnic Heritage. Participants' ages ranged from 26 to 62 years (M = 43.6, SD = 9.7). The majority of the social workers was female (87%), was employed full time (83%), and worked concurrently in two or more practice settings (60%). Participants' social work practice experience ranged from 1 to 25 years in health care settings (M = 10.7, SD = 6.6) and from 1 to 34 years in all practice settings (M = 13.8, SD = 8.8). Twenty-four, 90-minute, small-group interviews (i.e., 12 groups of social workers interviewed twice) were conducted at seven medical centers. Each interview was tape-recorded, transcribed, and corrected by two independent reviewers to ensure the transcript's accuracy. The interview narratives were analyzed using a constant comparative method and the data were coded using ATLAS.ti qualitative software.

RESULTS: Several salient themes emerged from the data that describe how medical social workers respond skillfully when dealing with their clients from diverse cultural backgrounds. These themes included: (a) honoring and accommodating various cultural norms with regard to end-of-life, death, and the treatment of bodily remains; (b) educating and empowering clients by providing resources and information that allow them to negotiate complex health care systems; and (c) preserving the client's sense of dignity and personhood by involving experts to inform hospital staff about a client's cultural practices and the influence of these practices on well-being.

CONCLUSIONS AND IMPLICATIONS: This study provides an examination of how medical social workers in urban hospitals frequently confront culturally sensitive issues in their day-to-day practice. Further, it documents some of the innovative ways social workers can preserve a client's dignity and cultural traditions in bureaucratized clinical settings. The findings offer valuable experiential accounts and practice exemplars that can be used as teaching tools for both clinical and macro social work practice.