This article highlights the findings of a qualitative study among social workers in primary care settings in Namibia that was concluded by Freeman in July 2017. The study explored social workers’ perceptions of their role in the provision of palliative care to patients with life-limiting illnesses in six hospitals across Namibia.
A qualitative grounded theory approach was used in which in-depth interviews were conducted with twenty (20) social workers. Key findings of the study showed, among other things, that several social workers were uncertain what palliative care is, and what it entails, thereby underscoring the need for palliative care education and training in the primary health setting.
Respondents cited the multi-dimensional roles played by social workers’ in the provision of palliative care services in primary health, including that of:
- broker /mediator,
- patient liaison,
- discharge planner and
- manager of in-country referrals, among others.
Other findings were that the roles played by social workers are not well understood by other healthcare professionals, and this often results in the social workers receiving inadequate support. There is also a lack of in-service training and continuous education in palliative care.
Policy guidelines and further research are needed to identify ways to improve the field of palliative care social work. This can be achieved through effective training of social workers, providing continuous education, and establishing a Centre of Excellence on palliative care provision.
The study also looked at the perceptions of the proportion of social work focusing on palliative care and their interactions with the multi-disciplinary health care teams, and went further to compare these perceptions against the actual experiences of the social workers in the provision of palliative care services.
The conditions that hinder and promote the social workers’ ability to deliver palliative care services were also highlighted in the study, and some recommendations to address them and to ensure social workers’ role in palliative care is optimized were given. These are summarized below.
Conditions that hinder Social Workers’ ability to deliver PC services
i. Roles of the social workers in the provision of palliative care not understood by other healthcare professionals
ii. Lack of palliative care training; in-service training; continuous education and research on palliative care in the Namibian context
iii. Communication barriers, e.g. explaining medical jargon used by doctors with patients
iv. Delayed referrals from doctors and nurses to the social workers
v. Shortage of specialized palliative care social workers and workloads of the hospital based social workers
vi. Well-being of the social workers
vii.Lack of supervision; debriefing and support from management
viii. Lack of appreciation for the role of the social worker in providing palliative care
ix. Shortage of bed space in the hospitals
Recommendations on how to optimize and promote social workers’ ability to deliver PC services
i. Mainstream of referrals of palliative care patients from doctors and nurses to social workers
ii. Palliative care social work education; in-service training; continuous education;
iii. Research and a national palliative care policy
iv. Collaborating with the multi-disciplinary team / Networking with other stakeholders
v. Designated palliative care social worker
vi. Strengthening the skills of palliative care social workers
vii. Palliative care internship and clinical placements sites
viii. Awareness and education on palliative care
ix. Supervision and debriefing opportunities
The study argues that the social work profession is well positioned to draw upon its values, culture and experiences (particularly from their clients) to get involved in creating a constructivist grounded theory of social workers’ roles and identities in the provision of palliative care.
The study concludes with specific recommendations to improve the field of palliative care social work and education, which can be achieved through a palliative care policy, continuing palliative care education and practice opportunities in the establishment of a centre of excellence for palliative care provision.