Expanding your toolkit: teaching social work practice in the healthcare setting

ABSTRACT

For social work education to remain current and responsive to the demands of the field, collaboration is required between those actively teaching, and those actively practicing. Examples, however, of co-construction of curriculums are minimal, with classroom subjects largely being taught as stand-alone components of the overall social work program, perhaps with occasional practitioners providing guest lectures about the practice context in which they work. Informed by transformational learning theory, relationship-based practice, and experiential education, practice-based learning requires social work students to engage with classroom content and skill development while at the same time building their job readiness through exposure to the modern workplace and current practitioners. To achieve this, a case example is given whereby academics and practitioners collaborated on developing advanced practice skills subject in the healthcare context, with a focus on developing empathy, authenticity and honoring the story as a core curriculum gap when teaching grief and loss skills. This case study demonstrates how experiential games, role plays and podcasts have been integrated into the teaching content and provides guidance as to the incorporation of experiential learning activities into formative and summative assessment tasks.

KEYWORDS:

• Social work
• transformational learning
• experiential learning
• podcast
• empathy
• curriculum

Background

The theoretical base of social work education draws heavily from transformational learning theory, particularly in the transforming of prior assumptions into future understandings and action (Mezirow, 2000). Transformational learning theory is informed by the body of work behind critical theory and its approach to social, rather than individual, transformation (Kreber, 2022), and post-structural explanations of the modern classroom, complete with an analysis of power in the subjective and performative teaching and learning environment (Youdell, 2006). Relationship-based practice has been able to further expand on how educators moderate the learning process in the social work classroom, including examining the teacher-student dyad as being a connector between the student’s personal life and the classroom learning (Spitz, 2020). It is through this relationship lens that social work education can be understood as a socially just practice (Keevers & Aboudha, 2012). While critically reflective questions can support students to deeply examine practice dilemmas and complex contexts (Watts, 2019), it is experiential learning that forces the student to grapple with their life experience via their bodily senses and situated learning activities (Cheung & Delavega, 2014; Kolb, 2015).

An identified area of social work practice that is neglected in social work education is end-of-life care (EOLC) and bereavement work (Cacciatore et al., 2015). Experiential learning in EOLC has been identified as more valuable than traditional didactic styles of teaching however, there remains to be limited examples of pedagogy (Pulsford et al., 2013). Wallace et al. (2019) suggest that EOLC education that explores student’s personal attitudes toward dying may be transformative in increasing comfort and satisfaction when working with the dying and the bereaved. In addition, empathy and the act of perceiving and understanding the emotional experience of someone else and responding compassionately (Misch & Pelouin, 2005), is often assumed to be something that people naturally have or are gifted with. Drawing on the early work of Carl Rogers in understanding empathy and its effect on ways of subjective knowing (Clark, 2010), in social work education empathy is understood as a core element of effective social work practice. In fact, the constant practice and rehearsal of empathy in experiential learning activities embeds its centrality (King, 2011). For social workers, working empathetically in end-of-life care means to seek an understanding of one’s unique experience of death (Grant, 2014), bear witness to their story, encourage personal expression and supporting them through their grief journey (Stanley & Hurst, 2011).

Along with empathy when caring for people at the end of life, authenticity is reported as the most important characteristic of a professional’s core attitude and is demonstrated by being present and accessible as a person, as opposed to behaving in a specific professional role (Simon et al., 2009). Authenticity broadly refers to expressing one’s true self whilst making measured and deliberate choices and fully owning and taking responsibility for those choices (Sutton, 2020). An authentic social worker therefore demonstrates attributes of loyalty and honesty and are believable, reliable, truthful, trustful and supportive (Runcan, 2020). For social work students learning about the healthcare setting, and particularly EOLC and bereavement skills, it is important that authenticity is understood as a relational connection and that students are critically challenged to question the healthcare system that employs them, and their presentation as authentic healthcare practitioners.

While experiential teaching activities can be more easily undertaken in the classroom, students are immersing themselves in learning at all times of day and night. The principles of allowing for a disruptive learning space, whilst developing empathy and authenticity skills, is able to be achieved through the integration of podcasts in the curriculum (Ferrer et al., 2019). Podcasts are a relatively new addition to the social work education toolkit. Since becoming mainstream podcasts have been included increasingly in social work curriculum around the world (Singer, 2019). Traditionally, podcasts have been used as a replacement for university lectures, and more recently as a supplement to social work classroom content. Descriptions of their integration and application, however, into the overall teaching and learning approach, both by the teaching staff and the students, is minimal, and therefore social work faculty searching for exemplars would be limited in what they could find.

Social work in healthcare: a case study

Social Work in Healthcare is a final year advanced practice subject in the Masters of Social Work (Qualifying) at the [name of university]. Prior to this subject, students have undertaken introductory practice skills subjects, as well as having completed one mandatory 500 hour field placement. Given the ever-changing nature of health social work practice, a curriculum co-design structure was implemented to ensure that the practice skills and content being taught in this subject were current and relevant to the context in which the graduating students would find themselves practising.

In order to design the curriculum, the lead academic for the subject and a group of health social work educators met to share ideas. The health social work educators worked across three separate Local Health Districts in New South Wales representing a large geographical area where the social work graduates would eventually be seeking employment. The social work educators identified several key content areas that they felt were not adequately addressed in social work education, including skills in grief, loss, and bereavement support. When discussing teaching methods, the social work educators felt that it was important that the students were exposed to working social workers, not just academics, in their classroom so that they were receiving up-to-date guidance and advice on emerging and changing practice domains. Through developing the subject, the group of academics and social work educators recorded a number of experiential learning resources to be used in the classroom and in assessment. In each of the grief and bereavement resources, there were three core areas for skills development: developing a sense of empathy for the dying process and the imminent loss, developing a professional sense of self that is grounded in authenticity, and honoring the story of those we sit beside.

Teaching resource 1: hospital scavenger hunt

The aim of this activity is for students to immerse themselves in the experience of navigating a hospital environment

In the first few weeks of the subject, students are asked to complete a hospital scavenger hunt. In the hospital scavenger hunt students engage in a series of photos taken at a local hospital. The photos include scenes from the hospital lobby, lifts, corridors, wards, toilets, and cafeterias. Students are asked to brainstorm the various reasons why people come to a hospital. They are to make a list of the reasons and as a group identify the potential emotional state of the people who are coming to access the hospital. After studying the photos, the students are asked to make a list of the barriers that a vulnerable person would face for each photo. They are asked, how would these experience impact the potential emotional state of people coming to access the hospital?

Assessment idea: This activity can be included in a formative reflective assessment whereby students comment on the process the group have undertaken and then critically examine social work’s role in equalizing public spaces and places.

Teaching resource 2: recorded role play

The aim of this activity is for students to isolate the social work practice skills that are utilized in a grief and bereavement social work intervention

Further into the subject, students watch a role play recorded by two senior health social workers. In this role play one plays the clinician, while the other plays a patient who has been given a terminal diagnosis of a brain tumor. Following the recording, students are asked to list the client’s main issues during the interview and to identify the social work skills they saw displayed in the role play (including key phrases or wording that the social worker used to demonstrate those skills). In addition to this, students are asked to give examples of authenticity and empathy (both verbal and nonverbal) that occurred between the clinician and patient throughout the role play. Finally, the students are asked to conduct their own role-play that demonstrates these same skills, with the caveat of including a group contract before they begin with a focus on self and collective care for each other.

Assessment idea: This two-part role-play activity can be recorded to facilitate the student’s analysis of their skills identification and development, complete with micro-skills checklists. Students can provide each other with feedback following the role plays, which can be utilized in a formative piece of written assessment.

Teaching resource 3: the social work stories podcast, episode 67: a good death in hospital and the social work role (https://socialworkstories.com/episodes/ep-67-a-good-death-in-hospital-and-the-social-work-role)

The aim of this activity is to critically reflect on a sense of self in the death and dying clinical space through an example of professional authenticity and the practice of honoring the dying and bereaved persons’ stories.

Towards the end of the subject students are asked to listen to an episode of the Social Work Stories Podcast where a social worker discusses what a good death in a hospital could look like. This discussion steps the listener through the micro-skills used, the theoretical frameworks informing the practice, and demonstrates reflective practice in the death and dying clinical space. Students are then asked to engage with the following critical questions before bringing their responses back to the larger class setting:

• How did the social worker display their authenticity in the storytelling?

• Consider issues of power and control- who held the power in this story?

• Thinking about our social work values of social justice, respect, and professional integrity, can you give examples of how these values were demonstrated?

• Are you able to identify the points at which the social worker ‘held space’? What does ‘holding space’ present as when working with grieving people?

• What social work interventions did the social worker use to honor the patient and his family?

• What did the social worker do to empower the patient and the family in this story?

• What cultural considerations were important to the patient and their family and how did the social worker or team meet their needs?

Assessment idea: Following this engagement with critical questions students can be asked to identify their own critical questions that they would like to pose to the social worker in the episode who tells the story. In addition, students can be asked to use the podcasting format to record their own stories about grief and loss, emphasizing the universality of end-of-life issues and bereavement. This would form the basis of a summative assessment, encapsulating the whole of the social work in healthcare curriculum.

Engaging with the teaching resources

In delivering a comprehensive curriculum on working in the social work healthcare context, it was important to draw on a range of creative teaching resources that could both expose the student body to the lived experience of being unwell and potentially dying in a public health system, and to develop advanced social work practice skills that would lead to job readiness for the healthcare sector. By using a combination of games, role plays, and podcasts this subject has been able to scaffold areas of learning, ensuring that social work students are able to engage with the content despite their learning preferences. The aim is that through the variety of experiential learning activities utilized, students can develop advanced skills in end-of-life and bereavement care. To build on this potential skill development, evaluation of experiential and immersive teaching and learning activities in the social work healthcare field would only be beneficial.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Mim Fox

Mim Fox is Associate Professor Social Work at the University of Wollongong. Mim researches social work practice, health social work and social work education, with a focus on podcasting. Mim is also the co-host of The Social Work Stories Podcast and co-founder of Social Work Media (www.socialwork.media).

Joanna McIlveen

Joanna McIlveen is the South Eastern Sydney Local Health District Grief and Bereavement Coordinator providing clinical and strategic support to clinicians and services with a primary focus on community engagement, capacity building and coordination of services. Jo is also a PhD candidate at the University of Wollongong investigating hospital and community partnerships in caring towards end of life.

James Sabbagh

James Sabbagh is a medical social worker with an interest in end-stage care, working clinically in aged care and rehabilitation at The Sutherland Hospital in Sydney, Australia.