Complex Patients: Social Workers' Perceptions of Complexity in Health and Rehabilitation Services

Abstract

We report on a qualitative study exploring health social workers' understanding of complexity in relation to inpatients in subacute wards at three sites across a large health network in Melbourne, Australia. Findings indicate that social workers' understanding of complexity refers to five interrelated themes: multiple competing demands; uncertainty; patient and family characteristics; pending breakdown; systems challenges. Social workers with less practice experience report that complex clients present more challenges than do social workers with greater experience. Implications of these findings for advancing practitioners' capacities in working with complex patients are discussed, as are the limitations of the study.

Developing a complexity-informed approach to hospital end-of-life care for people with dementia and their families

“…Furthermore, the sheer number of variables present in complex systems contributing to outcomes and adjustment challenge clinicians to critically reflect around the strength of inputs on overall system behaviour. Indications of complexity necessitate constructing parameters and boundaries around social work involvement and expectations to alleviate clinician distress (McAlinden et al, 2013).…”

“…Alternatively, social workers have defined complexity based on social determinants of health and the length of time spent on interventions (Muskat et al, 2017). Within the hospital, McAlinden et al (2013) defined complexity as presenting through multiple clinical demands, unstable processes, patient and family characteristics, social vulnerability and the interface with stakeholders inside and external to the hospital.…”

Analyse Du Concept De « clientèle Multiproblématique » Dans Le RSSS

“…La définition de la clientèle complexe est en soit complexe comme le mentionnent Manning et Gagnon (2017), car ce terme devrait être utilisé dans une perspective plus large que la partie biologique seulement, mais en incluant l'environnement et la relation sociale. McAlinden, McDermott et Morris (2013) indiquent que la compréhension du client complexe par les travailleurs sociaux fait référence à cinq thèmes interdépendants : multiples demandes concurrentes; incertitude relativement aux services adéquats; caractéristiques du patient et de la famille; attente d'autres défaillances quelconques; défis de systèmes. D'autres auteurs mentionnent que les patients sont identifiés comme étant complexes lorsqu'ils ont une ou plusieurs des trois caractéristiques suivantes : comorbidités sévères ou multiples, dépendance et vie inadéquate (Ozkaynak et al, 2015).…”

<p>Describing a Clinical Group Coding Method for Identifying Competencies in an Allied Health Single Session</p>

“… 17 – 19 Maximizing the benefit of this single session also requires advanced competence that extends beyond diagnostics and biomedical treatments to the impact of social systems on health outcomes; multi-level advocacy for reduction of existing health disparities and equity in access to health and mental health services; and “working knowledge” of non-pharmacological treatments. 17 , 18 , 20 However, competencies for single session allied healthcare have not yet been empirically examined, and research on allied healthcare has primarily focused on team dynamics instead of direct practice with patients and their families. 2 , 15 …”