Louise Harms

Parental experiences of their infant's hospitalization for cardiac surgery

BACKGROUNDnParents are increasingly recognized as important partners in childrens health care. Despite their involvement in care, parental experiences of their childs hospitalization have received little research attention. In this study we explored parents perceptions of what they found difficult, what they would like to be different and what they found to be helpful during their infants hospitalization and surgery for the treatment of congenital heart disease.nnnMETHODSnStructured interviews were conducted with 154 parents (91 mothers, 63 fathers) whose infant underwent cardiac surgery (at <3 months of age) 1 month post discharge from hospital. Thematic and frequency analyses were performed.nnnRESULTSnParents reported a range of difficulties from dealing with their babys unfolding illness, surgery and recovery to the structural and systemic issues associated with the broader context of their experiences. In an effort to be near their baby, parents struggled to obtain the necessities for daily living at the hospital and negotiate transitions between their hospital and home lives throughout the admission. Domains parents identified for change included the availability of facilities and resources and the quantity and quality of information and emotional support. Parents reported relationships with hospital staff as the most common source of support during this challenging time.nnnCONCLUSIONSnOpportunities to improve parents experiences when their infant is in hospital exist at an organizational level as well as at the clinical level. The significance of parents relationship with hospital staff indicates the potential for each professional to impact on families experiences on a daily basis. The range of challenges indicates the scope and need for allied health services.

Social Work: Frameworks, models and practice

TO SUGGEST that social work theory and empirical research necessarily informs and strengthens practice underestimates the difficulties in bringing together conceptual and practical endeavours. Building linkages between theory, research and practice has been a long-standing challenge in social work. Busy practitioners have little opportunity to keep abreast of new research, and the higher-order nature of some theories and perspectives means that they lack straightforward translation into practice. As a consequence models of practice have emerged from theoretical ideas. These function as bridges between broader theoretical ideas and intervention strategies within daily practice. For example, empowerment perspectives (see chapter 7) do not provide a tractable practice pathway, yet the Family Group Conference is a good example of a practice model that can trace its roots to the empowerment tradition (Connolly 1999). This is an example of a practice model emerging from theoretical concepts and ideas. When theory, knowledge and practice come together in this way the result becomes part of a rich and continually evolving intellectual tradition within social work. Connolly and Healy (2009: 32) note the integrative potential of accessible frameworks for practitioners in their day-to-day work: ‘Based on research findings, “good practice” principles and natural justice for clients, practice frameworks provide clarity with respect to understanding the critical aspects of the social work task, and the means through which knowledge can influence intervention pathways.’

Social Work: Social work knowledge, theory and practice

Social workers practise across a wide range of settings, with all kinds of different people who have diverse cultural experiences. Some work primarily with individuals, whereas others work with families or groups of people in therapeutic or community contexts. Some social workers focus on community advocacy, community action and social change. In such diverse practice contexts, the notion of theoretically informed practice can seem complicated. Yet social workers do draw upon a range of theoretical perspectives in their work, using theory to help understand and make sense of what is, in reality, a complex human world. Many theories used by social workers can also be found influencing the practices of allied professionals: counsellors, psychologists and others working within the human services. Theories explored in this book are not the sole purview of the social work profession, nor can they be claimed as necessarily emerging from within a social work paradigm. Professional interpretations of knowledge and theory overlap and interweave (Trevithick 2012). We would nevertheless argue that theory applied in social work has a disciplinary character that distinguishes it from the application of the same theories across allied disciplines. This is because knowledge and theory in practice are critically influenced by disciplinary attachments and the underpinning values and nature of the profession itself. Social works interpretive lens In the following chapters, we explore a range of practice theories that have been influential in social work. First, however, we will tease out the disciplinary nature of social works interpretive lens to see how it influences the application of knowledge and theory, what we understand theory to be, and how contemporary debates have influenced the application of theory over time. We propose that the social work interpretive lens is enriched by four additional lenses that together influence the ways in which we apply theory in practice: the relational lens; the social justice lens; the reflective lens; and the lens of change. The relational lens According to Howe (2009), relationship-based practice has been an integral part of social work since its inception, and some writers have argued that it represents a critical component of effective social work (Teater 2010).

Social Work: Mountain-moving theories

IN THE LAST OF OUR METAPHORICAL DISTINCTIONS we turn to the group of theories and perspectives within social work that seek to eliminate disadvantage and empower people to realize their hopes and aspirations. Over time these theories have been described in many ways: activist, progressive, structuralist, political, radical, anti-oppressive and emancipatory, to name just a few. They share an important common aim: to connect the personal with the political and, in doing so, to shift focus from individual blame to collective solutions across social, economic and political domains (Trevithick 2005). In this sense they apply ‘mountain-moving’ effort to create a more equal society. Mountain-moving theories stretch this effort, conceptually and practically, across individual, family, community and societal concerns. Understanding the nature of injustice and social inequality is of critical importance, and changing structures, systems and processes to increase their responsiveness is a key practical activity in reducing disadvantage. As we look at the development of these theoretical ideas over time, nevertheless, we will see the complexity of incorporating a social action reform agenda within contemporary practice environments.

Social Work: Onion-peeling theories

IN OUR PREVIOUS CHAPTER we explored systems theories and how they have provided an overarching focus for social work practice. In many ways, onion-peeling theories have some of the same characteristics as systems theories. Within psychodynamic and person-centred approaches, for example, the primary systems of focus are our inner selves and our inner-world organisation, and family or relational systems. The system of the self (both conscious and unconscious) emerges through systems of relationship with others. Unlike the broader ecological approaches, however, they focus on very specific relational systems. They share some of the language of systems theories in relation to boundaries, roles and dynamics, but their use is informed by different theoretical understandings. We have used the metaphor of onion peeling to describe the characteristics of insight-focused theories because they seek to peel back layers of experience to reach understanding. Like an onion, human experience reflects a layering: layer upon layer, building up around us and influencing our lives, sometimes in complex and repetitive ways. These layers, accumulated throughout our lives, have the potential to protect us positively and help us to make our way in the world. At other times they can present barriers to the realization of important needs and wants. Onion-peeling theories focus on peeling back these layers so that we can see how they influence who we are today. By increasing our awareness of these influences and understanding their origins, it becomes possible to engage in conscious change and develop greater emotional maturity. Awareness and insight lead to change and optimal functioning.

Social Work: Faulty-engine theories

IN OUR LAST CHAPTER our onion-peeling theories focused primarily on insight as the key mechanism for change. It was frustration with this insight focus that created the impetus for the development of more action-focused theories, in particular behaviourism and cognitive-behavioural responses. These relatively new theories, which we have grouped together using the ‘faulty-engine’ metaphor, brought with them ideas and techniques that would shift practice attention to the present and more concrete evidence of change. In many ways our ‘faulty engine’ metaphorical distinction is a bit unfair when describing behavioural and cognitive behavioural theories, although they have received critical appraisal for their perceived mechanistic, almost uncaring characteristics (Trevithick 2005); something to which we return later in the chapter. They do tend to be more structured and directive than other theories, and they do focus on actively changing thoughts and behaviour in the here and now. But there is no reason whatsoever why they cant be as engaging, respectful and empowering as any other theory when interpreted through a social work lens. We will start by looking at behavioural approaches. BEHAVIOURAL APPROACHES As we have noted, approaches based on the modification of behaviour largely emerged in response to a general sense of frustration with psychoanalytic approaches that delved into the past, focused on insight and a hope that greater awareness would actually change things for the better. During the 1970s psychodynamic approaches increasingly came under fire from a strengthening radical social work movement, which saw the micro focus on individual pathology as deeply discriminatory and failing to address issues of social justice and empowerment (Howe 2009). From another camp entirely, social workers with an inclination for science were questioning the effectiveness of psychoanalytic approaches that seemed to go on forever in what they perceived as some kind of confused morass. Social work was an applied science:n Like all good applied sciences, social work should be rational. Its techniques, when applied, should bring about the desired change. If social work is about helping people to cope better and change their behaviour, it seemed logical to suggest that social workers should have a good look at behaviour modification and its techniques for inspiration. And this is what happened. (Howe, 2009: 49)

Social Work: Story-Telling Theories

HUMAN BEINGS have always gathered stories. Long before we could keep them in any recorded form, stories have been gathered as oral traditions and passed down through families for many generations. They become powerful narratives that influence human well-being and identity. In the same way as these life narratives create meaning for us, story-telling theories in social work focus on the stories we live by, as individuals, families and communities. This group of theoretical approaches proposes that stories of strength and resilience can influence how we think, feel and act. By listening to our own internalized stories and others that are shared with us, we can begin to understand both their meaning and the influence they have on the ways in which people live their lives. Story-telling theories are critically interested in this and in the ways stories can be reauthored to enable more positive and rewarding life outcomes. Story-telling as a therapeutic process has been most fully articulated in narrative therapy. We explore throughout this chapter how narrative work enables people to cope more effectively with adversity and difficulty. Stories also transform communities and societies, and we will look at how giving voice and transforming marginalized, silenced and oppressed stories can do so. But before we explore narrative ways of working we will first look at a broader influence that has supported narratives of strength and resilience: the strengths perspective in social work practice.