Perceptions of health care social workers in Ontario: challenges and facilitators to reflective practice

Background: Reflective practice in health care social work ensures that social workers provide effective and efficient services to clients as well as maintaining their mental and physical health. In this study, we aim to determine how health care social workers engage in and describe reflective practice and challenges related to their reflective practice in their work in the health care system.

Methods: We used the Reflective Dialogue Rating Scale (RDRS) developed by Marion Bogo et al. to structure qualitative face-to-face interviews with 23 health care social workers employed in a hospital in a large urban area in Ontario, Canada.

Results: Findings illustrated that all participants regularly engaged in reflective practice in order to carry out everyday social work activities, promote ethical practice, and to enhance the provision of services to their clients. The social worker participants consistently agreed that as a profession they faced challenges maintaining their knowledge of current research due to few opportunities for professional development, workload competing with educational opportunities, and a work climate that is not conducive to gaining professional development, thereby challenging reflective practice. Supportive working environments include: peer supervision, safe and private spaces to talk to colleagues, a supportive supervisor, and an overall positive organizational culture.

Discussion and conclusion: Reflective practice is a key component in health care social work. All 23 social workers stated that they used reflective techniques (such as peer supervision and debriefing) to deal with their own reactions and operated in a purposeful and intentional manner to form therapeutic relationships with clients. As such, participants stated that lifelong learning was paramount in providing quality care to clients.     

Attributions for physical activity in very old adults: predicting everyday physical activity and mortality risk

Objectives: Although physical activity is recognised as a health-promoting behaviour for older adults, notable barriers exist that may reduce physical activity in this age group. Limited research has explored causal beliefs (attributions) as a barrier to physical activity. Our study assessed associations between older adults’ attributions about physical activity and objective health outcomes. Methods: We examined the role of attributions as a predictor of everyday physical activity (EPA) and subsequent mortality risk over a 10-year period (2006–2016) in a sample of older adults (M_age?=?87, N?=?261). Results: OLS and Cox proportional hazard regression analyses revealed older adults who endorsed more internal and uncontrollable attributions for limited activity (physical incapacity) when feeling unwell had lower subsequent EPA (β?=??0.18), and higher 10-year mortality risk (HR?=?1.46). Other attributions with different dimensional properties (e.g. internal and controllable) were not associated with EPA or mortality. Discussion: Findings suggest that causal beliefs older adults have about their physical activity can influence their future behaviour and longevity. Psychological treatments designed to discourage maladaptive attributional thinking for older populations who face barriers to physical activity may be an important avenue for future research.     

Undoing the Effects of Seizing and Freezing: Decreasing Defensive Processing of Personally Relevant Messages

Health messages are directed at those who are at risk of incurring adverse consequences. However, previous experiments have found that people process personally relevant health messages in a biased, defensive manner. We examine the role of elaboration as a mechanism to encourage less biased processing of personally relevant health appeals. Results demonstrate that high-relevance consumers freeze on the threatening information, leading to lower change appraisal (perceived severity, self-efficacy, and response efficacy) and decreased message persuasion. For these individuals, renewed elaboration on the consequences of caffeine (Experiment 1) and olestra (Experiment 2) consumption reduces defensive processing. This elaboration "unfreezes" message processing, leading to greater change appraisal and increased persuasion. These experiments provide guidelines for practitioners to design more effective messages.     

Psychological experiences of renal transplant patients: A qualitative analysis

Introduction: Organ‐sourcing developments now permit increasing numbers of renal transplants. Recipients commonly experience negative affect pre‐ and/or post‐transplant yet research on patient experience is lacking. Aims: This study aims to develop theory based on the lived experience of recipients, and to guide psychological and support interventions by counsellors and professional carers for the benefit of patients. Methods: A sample of eight participants was interviewed about their transplant experiences. The interview data were analysed using grounded theory methodology. Uniquely the research was conducted by a renal transplant patient, which potentially adds interpretive insight. Results: The central finding is that the issues facing transplant patients before and after transplant may be summarised as living with paradox and conflict. Thus, recipients may need to juxtapose anger/sadness about losses with an adaptive attitude to making the most of a second chance at life, and negotiate a positive relationship with an ‘alien’ organ. Conclusions/implications: The study offers evidence‐based guidance to counsellors supporting recipients to adjust to a changing sense of self, and to form adaptive relationships with self, others and the new kidney. Finally the research recommends action on improving awareness of and access to counselling and other supports for renal transplantees, and the need for in‐depth experiential research in this expanding area.     

Toward a Model Informed Consent Process for BRCA1 Testing: A Qualitative Assessment of Women's Attitudes

As an initial part of a project to develop a model informed consent process for BRCA1 testing, we conducted a series of focus groups. At the groups, women initially expressed great interest in testing, but their interest diminished after learning more. If offered testing, women would most want to learn about test accuracy, practical details of testing, and management options if the result was positive. Perceived benefits of testing included gaining information leading to risk reduction, relief of uncertainty, more responsible parenting, and assisting in research. Perceived risks included the discomfort and cost of the testing process itself, and anxiety after a positive result. The risk of possible insurance discrimination was rarely mentioned spontaneously. Many women would want their providers to make recommendations, rather than be nondirective about testing. We observed that women vary greatly in their informational and counseling needs, and suggest that the informed consent process should be individualized, taking into account a woman's perception and her preferences for how testing decisions should be made.     

Factor structure of the McCarthy scales for school-age children with low GCIs

This study aimed to cross-validate the factor analysis of the McCarthy Scales and to determine the construct validity of these scales for children who score one standard deviation below the normative mean on general cognitive ability. The sample was comprised of 77 children aged 6 to $\text{8}\text{1}\text{2}$ with a mean General Cognitive Index (GCI) of 61.6. Principal factor analysis produced four meaningful factors which corresponded closely to four of the scales on McCarthy's battery. The present findings discourage the interpretation of the Quantitative Scale for school-age children with GCIs below 84. Other implications of the results for the interpretation of McCarthy profiles for low-scoring school-aged children are discussed.     

The Ethics of Citizen Selection of Refugees for Admission and Resettlement

The global space is in need of creative solutions to the challenges posed by those seeking, and deserving of, asylum. In some democratic states, experiments in permitting citizens to have a greater role in selecting refugees for admission are underway; in this article, I consider the conditions that must apply to any citizen-selection scheme, in order for such a scheme to be morally acceptable. I begin with an account of the way in which citizen-selection schemes – usually called ‘sponsorship programs’ – operate presently. I then offer a justification for engaging citizens in refugee resettlement in general, as well as in selecting specific refugees for admission in particular, and then identify several conditions that must attend any permissible citizen-selection scheme. I defend this account from two objections: (1) that states should be the primary, and indeed only, agent that selects refugees for admission and (2) that citizens will inevitably use problematic criteria in selecting refugees for admission, so they should be denied the right to do so. I conclude with some proposals for how a citizen-selection scheme can be crafted to respond to this latter worry, including an outline of an exception clause that permits citizens to make the case that some refugees ought to be resettled, even if not specially selected by the UNHCR for resettlement priority, including especially family members and friends.     

Belief-level markers of physical activity among young adult couples: Comparisons across couples without children and new parents

The health benefits of regular moderate–vigorous intensity physical activity (MVPA) are well established, yet young adults, particularly parents, often show declines in MVPA and may represent a critical population for intervention. Theory-based correlates used to guide future interventions are scant in this population. The purpose of this study was to examine theory of planned behaviour (TPB) belief-level constructs as correlates of directly assessed MVPA across cohorts of couples without children and with their first child over the initial 12?months. Participants were 238 adults (102 not expecting a child, 136 expecting first child) who completed baseline demographics, belief measures of the TPB and seven-day accelerometry, followed by assessments at 6 and 12 months. Results showed select medium-sized belief-PA correlations with sex and cohort interactions. Overall, women had larger affect-based behavioural belief associations with MVPA than men (e.g. PA relieves stress), and among new parents, mothers showed larger associations with control over MVPA than fathers. Mothers also had larger associations between control beliefs and MVPA compared to women without children (e.g. domestic duties, bad weather). Extremely high means and low variability on the behavioural beliefs show limited room for possible changes in intervention while control beliefs had low means suggesting room for change. Interventions targeting control among new mothers may be paramount for increasing MVPA, yet the TPB yielded less insight into the targets for promoting MVPA among young men.