Candyce S. Berger

A Laughing Matter? The Uses of Humor in Medical Interactions

As Coser (1962) demonstrated in her landmark hospital study, a humor is one of the great tools of reassurance on the hospital ward. After all, if something is ridiculous, how can it be threatening? In this study, the authors examine the role of humor in medical interactions, with an eye toward greater understanding of the means by which people manage the emotions of others. Through face to face interviews with 22 providers in a large hospital, this study garners empirical support for a previously developed definition of humor as interpersonal emotion management. In addition, the study uncovers the particular roles played by the contextual factors of humor, including actor, setting, and timing. These factors are critical in determining whether humor is appropriate and successful in achieving desired emotional change, or whether it will fail or even backfire, causing emotional and interactional harm. The study draws implications for the potential study of harmful coping and social support.

Vision and falls: A multidisciplinary review of the contributions of visual impairment to falls among older adults

Falls are a leading cause of mortality among older adults worldwide. With the increasing aging population, falls are rapidly becoming a public health concern. Numerous internal and external factors have been associated with an older adults increased risk of falling. Most notably visual impairments are gaining recognition for their critical role in fall events, particularly related to trips, slips and falls due to environmental hazards. This review presents the issue of vision and falls from a multidisciplinary health professional perspective. Discussions include the influence of visual impairment on mobility and activities of daily living, the effects of medications on vision, visual cognitive factors on falls risk and visual training interventions. Finally, implications for multidisciplinary health professional practice and suggestions for future research are offered.

An Evolving Paradigm of Supervision Within a Changing Health Care Environment

ABSTRACT As hospitals attempt to decrease their costs to survive in todays health care market, they are implementing resizing strategies that promise greater efficiency. A by-product has been the elimination of many management and supervisory positions. A self-administered questionnaire was sent to a stratified random sample of 750 hospitals (yielding a 46% return rate) to study the types of supervisory models being utilized and the factors associated with their differential use. While concern is expressed about the erosion of clinical supervision, the data suggests that the majority of social workers are receiving supervision from a social worker.

Dialysis staff influence patients in formulating their advance directives

Patients on chronic dialysis were surveyed to determine the degree to which completion of advance directives (ADs) was influenced by personal factors that patients bring to their dialysis situation (eg, demographic characteristics or personal preferences) and by environmental factors that are not under their control (eg, interaction with dialysis staff or hospital system). Of the 113 questionnaires distributed to the population of 40 hemodialysis and 73 peritoneal dialysis patients, 90 (80%) were completed. Although only 17% of the respondents had actually completed written ADs previously, respondents seemed to have a good general understanding of ADs, as evidenced by the 80% overall accuracy on a 19-question portion of the survey that tested knowledge regarding ADs. While a few personal factors, such as gender, dialysis, modality, perceived quality of life, and attitude toward death, were associated with completion of ADs, most other demographic variables, including age, marital status, religion, work status, number of years of education, disability status, locus of control, renal diagnosis, and number of years on dialysis, were not correlated. More prominently correlated with completion of ADs were environmental factors, such as having dialysis staff discuss ADs with patients, patients being asked to complete ADs at the time of hospitalization, and perception of staff as being comfortable discussing ADs with patients. The overall results of the survey suggest that discussing ADs as an ongoing activity may have been positively influenced by the Federal Patient Self-Determination Act of 1991.(ABSTRACT TRUNCATED AT 250 WORDS)

Managed Care and Its Implications for Social Work Curricula Reform: Clinical Practice and Field Instruction

ABSTRACT Managed care continues to be a major focus and debate within the health care field. Regardless of whether one is for or against managed care, it has become the predominant system for distributing finite health care resources. Many academicians and practitioners point to the uncertainty about the future of health care, and the role of social workers to practice within these new environments, schools of social work will need to integrate content related to managed care. Students should be exposed to a more balanced analysis of what is advantageous and problematic with managed care. This paper offers recommendations regarding ways in which the practice and field curriculum can be strengthened to more effectively prepare social workers for practice within a managed care environment.

The Impact of Organizational Change on Social Work Staffing in a Hospital Setting: A National, Longitudinal Study of Social Work in Hospitals

Abstract Market forces continue to shape the health care environment, producing radical changes within the hospital. These changes are affecting social work structure, staffing, and processes within the hospital setting, particularly in the area of social work staffing. This paper examines the changes impacting hospital settings over three fiscal years. A primary question is whether or not social work staffing is being negatively impacted by these hospital changes, and what factors predict the downsizing of social work staff.

Models and Methods in Hospital Social Work Supervision

This is the first qualitative study of the perceptions of hospital-based social work supervisees regarding their hospital supervision. Seventeen social workers were recruited using a national listserv and snowball sampling techniques. According to the perception of the clinical social workers participating in the study, hospital social work supervision is organizationally driven rather than worker-focused. Implications for social work education and research are discussed.

Managed Care and Its Implications for Social Work Curricula Reform: Policy and Research Initiatives

ABSTRACT A multitude of social, economic, and health factors are forcing the health care industry to examine the effectiveness and efficiency of health and mental health care delivery. Managed care has emerged in this environment of cost containment, as a viable distributive mechanism for the allocation of health care resources. Schools of social work must consider additions and/or revisions to their curriculum, in order to adequately prepare social workers to practice in a managed care environment. A major barrier is the negative attitude held by many practitioners and educators towards managed care. This paper discusses the evolution of managed care, and the challenges to social work education, including the necessity for developing a more balanced view of managed care. Suggested curricular revisions are provided for two major content areas: policy and research.