Social Work in Health Care
ISSN: 0098-1389 (Print) 1541-034X (Online) Journal homepage: http://www.tandfonline.com/loi/wshc20
Self-care among healthcare social workers: An exploratory study J. Jay Miller, Joann Lianekhammy, Natalie Pope, Jacquelyn Lee & Erlene Grise-Owens To cite this article: J. Jay Miller, Joann Lianekhammy, Natalie Pope, Jacquelyn Lee & Erlene Grise-Owens (2017) Self-care among healthcare social workers: An exploratory study, Social Work in Health Care, 56:10, 865-883, DOI: 10.1080/00981389.2017.1371100 To link to this article: https://doi.org/10.1080/00981389.2017.1371100
Published online: 06 Sep 2017.
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SOCIAL WORK IN HEALTH CARE 2017, VOL. 56, NO. 10, 865–883 https://doi.org/10.1080/00981389.2017.1371100
Self-care among healthcare social workers: An exploratory study J. Jay Millera, Joann Lianekhammyb, Natalie Popea, Jacquelyn Leec, and Erlene Grise-Owensd a College of Social Work, University of Kentucky, Lexington, KY, USA; bFamily and Consumer Sciences Extension, University of Kentucky, Lexington, KY, USA; cDepartment of Social Work, University of North Carolina Wilmington, North Carolina, USA; dThe Wellness Group, ETC, Louisville, KY
ABSTRACT
ARTICLE HISTORY
Despite growing interest in self-care, few studies have explicitly examined the self-care practices of healthcare social workers. This exploratory study investigated self-care among practitioners (N = 138) in one southeastern state. Overall, data suggest that healthcare social workers only moderately engaged in self-care. Additionally, analyses revealed significant differences in self-care practices by financial stability, overall health, and licensure status, respectively. Interestingly, perceived health status and current financial situation were significant predictors for overall self-care practices. After a brief review of the literature, this narrative will explicate findings, elucidate discussion points, identify salient implications, and conclude with areas for future research.
Received 18 Jul 2017 Accepted 19 Aug 2017 KEYWORDS
Healthcare; social Work; selfcarel
Social workers constitute a significant portion of professionals providing services to clients and patients in healthcare settings (Held, Mallory, & Cummings, 2017; National Association of Social Workers, 2006; Reisch, 2012). According to the Bureau of Labor and Statistics (Bureau of Labor Statistics, 2017, approximately 155,590 healthcare social workers are employed in the United States. Contexts in which these professionals work include hospitals, hospice and palliative care, outpatient healthcare facilities (e.g., rehabilitation centers, etc.), nursing homes, and assisted living facilities, among others. Notably, the employment demand for social workers in healthcare is projected to increase 24% by 2020 (Bureau of Labor Statistics, 2017). The tasks of practicing social work in healthcare settings are becoming increasingly arduous and multifaceted (Lynch, Green, Teich, & Delany, 2016). Evolving practice and ethical guidelines, ever-changing political climates, resource reductions, and growing complications associated with healthcare treatment can make for increasing demands placed on practitioners employed in these sectors (Gellis, 2008; Reisch, 2012). The risk for occupational stress in this context necessitates a healthy, resilient workforce of practitioners who attend to their own health and CONTACT J. Jay Miller KY 40252, USA © 2017 Taylor & Francis
[email protected]
College of Social Work, University of Kentucky, Lexington,
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well-being proactively through self-care. Yet, research examining the self-care practices among social workers, in general, and those employed in healthcare settings, specifically, is scant. A literature review of relevant databases (e.g., Social Work Abstracts, EbscoHost, etc.) revealed no published studies that explicitly examined self-care practices among healthcare social workers. This exploratory study examined the personal and professional self-care practices of healthcare social workers (N = 138) in one southeastern American state. In addition to scaled data associated with self-care, researchers also collected demographic and general information related to employment context, history, and other professional data. After a brief review of the literature, this narrative will explicate findings, elucidate key discussion points, identify salient implications derived from the data, and conclude with pertinent areas for future research related to healthcare social work and self-care. Social work in healthcare Healthcare social work defined
Given the variety of tasks and divergent terminology associated with “healthcare social work,” the term can be difficult to define. Broadly, healthcare social work is a subspecialty of general social work practice; nearly every facet of the health system—oncology, pediatrics, general medicine, intensive care, rehabilitation, public health, and others—relies on social workers to play a unique role in service provision. Other terms associated with healthcare social work include medical social work (Grant & Toh, 2017), allied health workers (Barker, 2003), and health/medical social work case management, among others. In terms of function, healthcare social workers “provide individuals, families, and groups with the psychosocial support needed to cope with chronic, acute, or terminal illnesses” (BLS, 2016, para.1). Barker (2003) further explained that healthcare social work “sensitizes other healthcare providers about the socialpsychological aspects of illness” (p. 296). In health-related settings, social work practitioners perform a variety of tasks and services, including client/patient discharge planning, case management, brokering resources, advocating for client needs, assuring accessibility of services, facilitating therapeutic services and support groups, and so forth. Although healthcare social workers are employed in an array of practice settings (e.g., primary care offices, hospitals, nursing homes, and so forth), the Bureau of Labor Statistics (2016) reports hospitals employ the highest rate of healthcare social workers. Challenges facing healthcare social workers and problematic outcomes
A number of challenges accompany the recent and projected expansion of healthcare social work (Lynch et al., 2016; Ulrich et al., 2007). A host of research
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studies have documented these challenges. For example, Levin and Hebert (1995) explored differential tasks associated with social work practitioners in hospitals. Findings revealed variation not only in tasks assigned to social workers, but also in the amount of supervision that social workers performing these tasks receive. Kim and Lee (2009) made similar assertions related to supervision. In a national study, Siefert, Jayaratne, and Chess (1991) asserted that role ambiguity and poor organizational structures can serve as specific challenges for healthcare social workers. Poor social and professional supports (e.g., Ben-Zur & Michael, 2007); perceived lack of importance, status, and power on multidisciplinary healthcare teams (e.g., Frost, Robinson, & Anning, 2005); high caseloads and regulatory paperwork (NASW, 2011); client/patient wait-lists for services (Gellis, 2008); and the dynamic landscape of healthcare reform (Reisch, 2012), among other issues, can lead to a myriad of problematic circumstances for healthcare practitioners. Indeed, as Pockett (2002) aptly suggested, healthcare settings can be “challenging and ambiguous environments for social work practice” (p. 1). In general, research suggests that social workers are at increased risk for a variety of professional problematic outcomes (Bride, 2007; Grise-Owens, Miller, & Eaves, 2016); for individuals practicing in healthcare settings, these problematic professional outcomes may be compounded. Research indicates high rates of burnout, compassion fatigue, and/or vicarious trauma among oncology social workers (Cohen & Gagin, 2005; Et Phil, Hocking, & Hampson, 2013), hospice social workers (Pelon, 2015), and trauma center social workers (Badger, Royse, & Craig, 2008). Indubitably, the challenges and associated outcomes facing healthcare social workers impact the quality of care provided to clients/patients. Burnout among nurses and medical residents is correlated with substandard patient care and decreased patient satisfaction, as reported by patients (Shanafelt, Bradley, Wipf, & Back, 2002; Vahey, Aiken, Sloane, Clarke, & Vargas, 2004). In a study that examined how fatigue and distress impacted self-perceived medical errors among medical residents, West, Tan, Habermann, Sloan, and Shanafelt (2009) found that higher levels of fatigue, burnout, depression, and reduced quality of life were all independently associated with medical errors. Fostering self-care: a response to these challenges
Increasingly, the importance of self-care is recognized within social service organizations, including healthcare settings (Cox & Steiner, 2013; Lee & Miller, 2013; Miller et al., 2016; Newell & Nelson-Gardell, 2014). This attention, at least in part, can be attributed to ethical edicts put forth by social work organizations and associations. For instance, the Delegate Assembly of the National Association of Social Workers (National Association of Social Workers, 2008) published a position statement on “Professional Self-Care and Social Work,” which declared, “Professional self-care is an essential underpinning to best practice in the
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profession of social work” (p. 268). Similarly, the International Federation of Social Workers (International Federation of Social Workers, 2004) Statement of Ethical Principles explicated that social workers have a “duty to take necessary steps to care for themselves professionally and personally in the workplace and society” (See Article 5. Professional Conduct, #6). Increasingly, self-care is being understood as a necessary part of adroit social service delivery (Cox & Steiner, 2013; Grise-Owens et al., 2016; Smullens, 2015). Although research on self-care practices among social workers is in the nascent stages (Lee & Miller, 2013), a small body of studies have documented the benefits of engaging in self-care practices. For example, Sanso et al. (2015) found that self-care and self-awareness were predictors of palliative care professionals’ competence in coping with death and dying. Asuero and colleagues (2014) created an intervention that incorporated mindfulness-based programs as a component of continuing education offered to healthcare professionals including physicians, nurses, social workers, and clinical psychologists. These researchers found the intervention to contribute to positive changes in attitudes related to being present, professionalism, and self-care. Cohen and Gagin (2005) described a program to enhance intervention skills among a sample of hospital social workers. This program was rooted in the premise that self-care can be effective in reducing burnout. Other authors have shared similar assertions regarding the importance of self-care in assuaging work-related distress encountered by social workers (Bloomquist, Wood, Friedmeyer-Trainor, & Kim, 2015; Lee & Miller, 2013; Skinner, 2015). The implications of this literature are clear. Healthcare social workers face myriad challenges. These challenges are often associated with problematic outcomes, which include burnout, secondary traumatic stress, and so forth. In turn, these outcomes impact the quality of care proffered to clients/ patients in healthcare settings. Fostering a culture of self-care among healthcare social workers can assuage problematic outcomes. Thus, a better understanding of healthcare social workers’ engagement in self-care and related factors is needed. Study purpose
The overarching purpose of the present study was to explore self-care practices among social work practitioners in healthcare settings. Three interconnected exploratory research queries guided the study: (1) How often do healthcare social workers engage in personal and professional self-care practices? (2) Are there differences in personal and professional self-care practices by demographic (e.g., relationship status, etc.) and professional characteristics (e.g., licensing status), respectively?
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(3) Is there a relationship between perceived health, age, hours worked per week, or time in the profession, and personal and professional self-care practices, respectively? By addressing these research questions, this study sought to contribute to addressing limitations in the current research literature associated with healthcare social workers. To date, few, if any, studies have explicitly examined self-care practices among this practitioner group. A review of pertinent databases revealed no published studies on the topic. Methods Protocol and sampling
No statewide listservs of healthcare social workers are available in the state in which the study took place. As such, sample recruitment relied on a snowball sampling approach, following institutional review board approval and the obtainment of a waiver of documentation of informed consent. A link to the web-based survey was administered to facilities known to employ healthcare social workers (hospitals, nursing homes, and so forth). In addition, participants were asked to forward the survey to other colleagues employed in social work healthcare settings. All participants self-identified as healthcare social work practitioners in one southeastern state. For the purpose of this study, researchers used the definition of healthcare social work provided by BLS (2016). This information was part of the survey. Primary data were collected during Winter 2017 and managed via Survey Monkey™. Practitioners who took part in the survey were offered a chance to enter a $500 incentive drawing for their participation. The survey employed Survey Monkey features that disable IP and email address tracking (See http:// help.surveymonkey.com/articles/en_US/kb/How-do-I-make-surveys-anon ymous). The incentive link was disconnected from primary survey via a separate link. Thus, participant responses were anonymous. Instrumentation
To collect primary data from participants in this study, researchers utilized the Self-Care Practices Scale (SCPS; Lee, Miller, & Bride, 2016). SCPS is a 38-item instrument designed to assess the frequency of personal and professional self-care, respectively. The measure uses a five-point Likert scale ranging from 0 (never) to 4 (very often) and produces three scores: a summative personal self-care score (0–64); a summative professional self-care score (0–88), and a total score comprising the sum of personal and professional self-care scores (0–152). For all scoring, the
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higher the score, the more frequently the respondent engages in self-care practices. Findings Descriptive statistics for key variables are presented in Tables 1 and 2. Respondents were primarily female (89.9%) and of white, non-Hispanic (88.3%) racial/ethnic background. Overall, respondents held a degree in social work (97.1%). In terms of self-care, on average, respondents engaged in moderate amounts of personal (M = 43.55, SD = 7.93), professional (M = 60.11, SD = 9.13), and total self-care practices (M = 103.67, SD = 16.66). Due to the exploratory nature of the study, one-way analyses of variances (ANOVAs) were conducted to investigate differences between key variables with appropriate sample sizes at each level on the dependent variables’ personal and professional self-care scores. No significant differences in personal or professional self-care scores were found between healthcare social workers employed in different settings (e.g., profit vs. nonprofit, public vs. private) or with varying levels of work focus (e.g., micro, mezzo, macro, or equally spread out). No differences in key descriptors source of income or relationship status were detected. Significant differences in mean personal and professional self-care scores were found for key variables health status, current financial status, and current license type. Table 3 contains a summary of results for the ANOVAs conducted. Current health status was self-reported as being “Poor,” “Fair,” “Good,” “Very Good,” or “Excellent.” A between-subjects effect was found comparing mean personal self-care score among respondents of different health status, F(3, 133) = 15.78, p < .001. A Tukey HSD test indicated that respondents in “Excellent” health (M = 49.77, SD = 6.63) had a significantly higher mean personal self-care score than those in “Good” (M = 39.18, SD 7.71) or “Fair” (M = 36.63, SD = 7.78) health. The mean personal self-care score for those reporting “Very Good” (M = 45.45, SD = 6.22) health was also significantly higher than the mean scores of those in “Good” or “Fair” health. When comparing mean professional self-care scores among respondents with different health status, a significant difference was also found, F(3,133) = 9.03, p < .001. Post hoc analysis revealed that the mean professional score for those in “Excellent” health (M = 67.89, SD = 8.43) was significantly higher than the mean scores of those in “Very Good” (M = 60.89, SD = 8.74), “Good” (M = 56.88, SD = 7.91), and “Fair” (M = 53.25, SD = 8.63) health. As a part of the survey, respondents were asked to select the response that best described their current financial situation: “I cannot make ends meet,” “I have just enough money to make ends meet,” “I have enough money, with a little left over,” or “I always have enough money left over.” Only a small number of responses noted that they were unable to “make ends meet” (n = 5); thus, these cases were filtered out from the analysis to better compare the other three
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Table 1. Demographic characteristics of social workers in health employment setting (n = 138). Gender Male Female Gender-Expansive Race/Ethnic Background White non-Hispanic Black non-Hispanic Other Current Relationship Status Married Partnered Widowed Divorced or Separated Never married Sexual Orientation Heterosexual or straight Gay, Lesbian, or Bisexual Other (Asexual) Highest Academic Degree Associate’s Bachelor’s Master’s Doctorate or Professional Degree Major/Area of Study Social Work Human Services or Counseling Other Employer Type Nonprofit Setting For-Profit Setting Public (e.g., Governmental) Private (including private practice) Level of Work Mostly micro-level work (e.g., clinical, individual therapy treatment, etc.) Mostly mezzo-level work (e.g., work with families, small groups, etc.) Mostly macro-level work (e.g., policy advocacy, community organizing, etc.) My work is spread out equally across more than one area Not specified Health Status Excellent Very Good Good Fair Poor Current financial situation I cannot make ends meet. I have just enough money to make ends meet. I have enough money, with a little left over. I always have money left over. Source(s) of total gross annual household income Single Income/One Source Single Income/More Than One Source Two Incomes Current License Type Undergraduate-Level Graduate-Level Clinical
N
%
12 124 2
8.7 89.9 1.4
121 12 4
88.3 8.8 2.8
91 8 3 17 19
65.9 5.8 2.2 12.3 13.8
125 12 1
90.6 8.6 0.7
1 15 117 5
0.7 10.9 84.8 3.6
131 2 5
94.9 1.4 3.6
79 59 78 60
57.2 42.8 56.5 43.5
67 23 10 37 1
48.6 16.7 7.2 26.8 0.7
20 64 45 8 0
14.6 46.7 32.8 5.8 0
5 36 68 29
3.6 26.1 49.3 21
40 8 83
29 5.8 60.1
15 76 35
11.9 60.3 27.8
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Table 2. Demographic characteristics of social workers in health employment setting (N = 138). Descriptives Age of Respondent (Years) Average hours of work per week Years Practicing Social Work Personal Scale Score (0–64) Professional Self-Care Score (0–88) Total Self-Care Score (0–152)
N 113 136 136 138 138 138
Mean 42.44 41.06 14.59 43.55 60.11 103.67
Std. Dev 10.70 7.56 9.89 7.93 9.13 15.66
Median 41.00 40.00 13.50 44.00 60.00 104.00
response types. In testing the assumptions of the one-way ANOVA, mean personal self-care scores for each category of current financial situation did not pass Levene’s test for homogeneity of variances. One current recommended approach to addressing violations to certain types of assumptions such as normality and variance equality is to use the Welch test, which is considered a reliable and valid statistical method to control Type I error and power issues (Cribbie, Fiksenbaum, Keselman, & Wilcox, 2012). A Welch F test was used to compare the mean personal self-care scores between the different financial status and was found to be statistically significant, Welch’s F(2, 63) = 7.242, p < .01. Games–Howell post hoc analysis revealed a significantly higher mean personal self-care score for those who indicated: “I always have money left over” (M = 47.45, SD = 6.85) versus “I have just enough money to make ends meet” (M = 40.08, SD = 8.74). The one-way ANOVA comparing mean professional self-scores for respondents with different financial status yielded a similar pattern of significant results, F(2, 130) = 9.689, p < .001. The Tukey HSD test indicated that the mean professional self-care score for those who selected “I always have money left over” (M = 65.80, SD = 7.52) was higher than the mean scores of those selecting “I have just enough money to make ends meet” (M = 57.24, SD = 8.42) and “I have enough money, with a little left over” (M = 59.53, SD = 8.07). Personal and professional mean scores were compared for healthcare social workers with varying types of current licensure: Undergraduate-level license, Graduate-level license, or Clinical license. While all levels of licensure type were normally distributed for personal self-care score, professional self-care scores for Undergraduate-level license had a slight, negative skew and did not pass the Shapiro–Wilk test of normality (p = .049). In this case, the Welch F test was utilized to compare differences in professional self-care scores by current license type. No effect of current license type was found on personal self-care scores (F(2, 123) = 2.372, p = .098). Significant differences in mean professional self-care scores were found for license type, Welch’s F(2, 35) = 5.697, p < .01. Follow-up Tukey HSD post hoc analysis showed that the mean professional self-care score for those holding a Clinical license (M = 64.55, SD = 9.15) was significantly higher than those with an Undergraduate-level license (M = 57.03, SD = 9.18) or Graduate-level license (M = 58.89, SD = 8.18).
15.778
1.059 4.519 2.372
F 0.805 0.889 2.141 0.106 7.242
0.000***
0.369 0.952 0.098 0.668
0.675 1.482 0.681
SE 1.495 1.361 1.366 0.678 0.675
Personal Self-Care p 0.195 0.205 0.947 0.956 0.001**
[42.164, 44.845]
[42.218, 44.886] [−2.842, 3.019] [42.410, 45.106]
CI 95% [−1.007, 4.904] [-.957, 4.424] [−2.610, 2.793] [42.164, 44.845] [42.218, 44.886]
9.027
0.949 1.631 5.697
F 1.048 0.005 0.808 0.786 6.005
0.000***
0.419 0.943 0.007**
0.781
0.777 1.290 0.796
SE 1.716 1.574 1.567 0.783 0.777
[77.674, 102.076]
[58.579, 61.651] [−3.497, 3.252] [58.669, 61.821]
CI 95% [−0.659, 6.126] [−2.275, 3.952] [−4.623, 1.573] [58.565, 61.660] [58.579, 61.651]
Professional Self-Care p 0.113 0.595 0.332 0.504 0.001**
*p < 0.05 **p < .01 ***p < 0.001 † In variables with two df reported as a result of utilizing the Welch test, df for personal self-care are listed first, followed by df for professional self-care.
Health Status
Source(s) of total gross annual household income Current member of professional organization(s)? Current License Type
Current Relationship Status Organization Type (For Profit/Nonprofit) Organization Status (Public/Private) Level of Work Current financial situation
df 1, 136 1, 136 1, 136 3, 133 3, 63† 3, 134 3, 138 1, 136 2, 123 2, 35† 3, 133
Table 3. Group comparison results for social workers in the health setting.
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Multivariate analysis
Data on the average amount of hours worked per week (average work time) were categorized into four classifications: part-time (10–32 hours), full-time (36–40 hours), full-time with some overtime (41–48 hours), or full-time with major overtime (50–65 hours). Initial comparisons of personal and professional self-care mean scores showed no significant differences between average work time. This finding seemed counterintuitive; as self-care is traditionally framed, working longer hours would likely leave less time for self-care. The relationships between average hours worked and other key variables were further explored. Interestingly, results of a two-way ANOVA analyzing personal and professional self-care scores among two levels of organization type (profit, nonprofit) and four levels of average work time (part-time, full-time, full-time with some overtime, or full-time with major overtime) yielded significant findings. No main effects were found for organization type or average work time, indicating little difference in personal self-care. However, an interaction effect between the two independent variables was statistically significant, F(3, 128) = 3.193, p < .05. Simple main effects were examined for personal self-care differences in average work time between organization type. There were no significant differences in the nonprofit setting, F(3, 74) = 1.304, p = .280, but there were significant differences in the for-profit setting, F(3, 54) = 3.744, p < .05. Results showed that healthcare social workers working full-time with major overtime for a for-profit organization had significantly lower personal self-care scores than those working full-time or full-time with some overtime who were also employed by a for-profit organization (see Table 4 for means and standard deviations). A last analysis was conducted with personal self-care scores as the dependent variable to examine whether there was a difference between nonprofit and for-profit settings for each level of average work time. Results showed that there was a significant difference in personal self-care scores for those working full-time with major overtime, depending on the organization type, F (1,19) = 14.120, p < .01. Those who reported working full-time with major overtime for a nonprofit organization had an average personal self-care score of 45.08 (SD = 6.58), while others working major overtime with a for-profit organization had a much lower average personal self-care score of 34.67 (SD = 5.85). A two-way ANOVA was subsequently conducted to determine if average work time and organization type also had an effect of professional self-care scores. No significant differences in main effects were found, but an interaction effect was present, F(3, 138) = 2.917, p < .05. Simple main effects were used to examine differences in average work time among organization type. Again, a difference in the for-profit setting was found, F(3, 54) = 3.144, p < .05, but not for the nonprofit setting, F(3, 74) = 2.060, p = .113. Follow-up analysis comparing differences among average work time in the for-profit setting revealed that those
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Table 4. Multiple regression predicting total self-care practices. Model† Age (Years) Relationship Status Not Married (Single, Separated, Divorced, Widowed) Married or Partnered Average hours of work per week, recoded Health status (1 = Excellent to 5 = Poor) Time in practice (years) Organization Type For-Profit Nonprofit Current Financial Situation I have just enough money to make ends meet I have enough money, with a little left over I always have money left over Current License Type Undergraduate Level Graduate Level Clinical
B 0.171
SE 0.172
p 0.323
−3.446 Reference −0.28 −8.594 0.265
2.862
0.232
0.187 1.756 0.189
0.137 0.000*** 0.165
−4.095 Reference
2.409
0.092
−7.432 −7.383 Reference
3.911 3.095
0.060 0.019*
−1.775 −2.511 Reference
4.576 2.698
0.699 0.354
† Statistically significant, p < .001, R2 = .43, adjusted R2 = .370. * p < .05 *** p < .001
reporting major overtime (M = 52.33, SD = 8.93) had significantly lower professional self-care scores than those only working full-time, with no overtime (M = 61.75, SD = 9.77). Differences in organization type were then examined among the four levels of average work time. A significant difference for those working full-time with major overtime was found, based on the organization type, F(1, 19) = 8.106, p < .05. Healthcare social workers working full-time with major overtime while employed at a for-profit organization reported significantly lower professional self-care practices (M = 32.33, SD = 8.93) than those working in the nonprofit setting (M = 61.70, SD = 6.19). A correlation coefficient was computed for personal and professional self-care scores to gain a better sense of the linear relationship between the two types of self-care domains. The result of the analysis showed that personal and professional self-care scores were positively related (r = .684, p < .001); as personal self-care scores increased, scores for professional self-care also increased. Those who engaged in personal self-care practices also reported engaging in professional self-care practices. To explore the effects key predictor variables may have on self-care practices overall, a multiple regression analysis was conducted on the total self-care score created by combining personal and professional self-care scores. As discussed, total possible self-care scores could range from zero to 152, with higher scores denoting greater engagement in self-care practices. Age, relationship status, average work time, health status, years practicing social work, organization type, current financial situation, and current license type were included as predictors of total self-care. This model was statistically significant, F(10, 96) = 7.238, p < .001,
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R2 = .43, adjusted R2 = .370. Results revealed that only two variables significantly predicted total self-care: health status and current financial situation (p < .001 and p < .05, respectively). As one’s health decreases, it was estimated that total self-care score will decrease by 8.6 points, controlling for all other variables in the model. Experiencing a current financial situation of having enough money, with a little left over tended to lower total self-care scores by 7.4 points compared with those who always have money left over, controlling for all other variables. Although not significant, it is important to note that those with just enough money to make ends meet had a similar relationship with the observed total selfcare score compared with the reference group (p = .06). See Table 4 for the results of the regression analysis. Discussion The purpose of this exploratory study was to examine the self-care practices of self-identified healthcare social workers employed in one southeastern state. Despite the importance of self-care, in general, and among healthcare social workers, specifically, few, if any, studies explicitly examine the self-care practices of this employee group. Thus, this paper contributes to addressing limitations in the current literature by gleaning a better understanding of this group. This understanding can inform best practices in promoting self-care and future research. Overall, data suggest that healthcare social workers in this sample only engage in self-care at modest levels. Summative scores indicate that participants reported participating in self-care “sometimes.” Given the current contexts in which healthcare social workers engage, perhaps these finding are not surprising. As indicated in the literature review, the challenges facing social work practitioners are unique and complex. Indubitably, these challenges can make practicing self-care difficult (Bloomquist et al., 2015; Grise-Owens, Miller, Eaves, 2016). Likely, these difficulties are evident in these data. In terms of group differences related to self-care, analysis revealed that several exist. First, individuals with more financial stability appear to engage in personal and professional self-care at a significantly higher rate. This finding can point to the pragmatic effect of finances as a primary stressor; if not faced with this stressor, self-care would be viewed more positively. More subtly, this finding may be related to the traditional view of self-care as primarily activities involving costs, e.g., going to the spa, joining a gym, and so forth. And, these activities are done after work—as contrasted with integrated into time at work. Notably, several authors have suggested approaching self-care as a holistic lifestyle, rather than a set of discrete activities (Miller et al., 2016, etc.). Second, those who reported better health (e.g., “Excellent” health or “Very Good” health) participated in self-care practices at a higher rate than those who perceived their health to be worse (e.g., “Poor,” “Fair”). This finding may be
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related to several factors. For instance, as noted above, self-care has traditionally focused on participation in physical activities, such as going to the gym, running, yoga, and so forth. For a host of reasons, those who are physically healthier may be more able to engage in self-care practices. Or, individuals who are physically healthier may place a higher value on engaging in self-care. Third, individuals with a clinical license reported engaging in self-care practices at a higher rate than those with a graduate or undergraduate license. This finding makes sense, particularly in relation to professional self-care. In most instances, individuals with a clinical-level license have received additional training and education-based supervision associated with social work practice. Moreover, they would have likely engaged in structured supervision. These requirements are true for clinical licensees in the state in which this study occurred. Professional development and supervision are key components of professional self-care (Cox & Steiner, 2013; Orlinsky & Ronnestad, 2005). As such, professionals at that level of licensure would be naturally connected to these aspects of self-care. Additionally, clinicians may be more mindful about the need for self-care—due to supervision, reflection, and training required. Pragmatically, those with a clinical license may have more flexibility in their job and, thus, more time to engage in traditional self-care practices. Employment contexts also appear to have an impact on self-care. Data indicated that healthcare social workers working major overtime at for-profit organizations had significantly lower personal self-care scores than those working in for-profit organizations with no overtime. Results also indicated differences across nonprofit and for-profit job settings. Individuals working full-time with major overtime at a nonprofit organization engaged in significantly more personal self-care than those working full-time with major overtime at a for-profit organization. The finding in relation to time reinforces the earlier discussion about traditional definitions of self-care as primarily physical activities done after work hours. The findings regarding the difference between for-profit and nonprofit settings are compelling. People are often attracted to nonprofits because of the mission and the opportunity to pursue one’s personal values (Kanter & Sherman, 2017). Thus, employees in nonprofits may be sustained in their self-care by the value congruence (meaning); however, in the for-profit setting, employees may experience value dissonance, which creates more stress. This interaction between money and meaning needs to be examined more closely. Moreover, perhaps some nonprofit settings are more likely to have a workplace culture with norms and practices that support self-care. These dynamics point to the role of organizations in supporting self-care practices and the well-being in employees. Interestingly, perceived health status and current financial situation showed to be significant predictors for overall self-care for participants in this study. On the surface, these predictors could be interpreted as concrete facets. However, these findings merit more critical exploration. These findings are rooted in the
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traditional definitions of self-care as physical activities done after work. These findings elicit some critique of the traditional conceptualization of self-care. Some advocate that self-care is how people take care of themselves before, during, and after work—i.e., not work-life balance, but life balance (GriseOwens et al., 2016; Kanter & Sherman, 2017). Similarly, self-care takes many forms that do not necessarily require good physical health, nor necessarily financial resources—such as mindfulness practices. More exploration and more development are needed to pursue a useful and informed reconceptualization of self-care.
Limitations
This research was exploratory, seeking to understand the self-care practices of healthcare social workers. As with any research endeavor, there are limitations to this study. All participants self-identified as healthcare social workers practicing in one southeastern state. The data reflect the opinions of participants who provided responses, and may not reflect the experiences of other healthcare social workers in other geographic areas (e.g., other states). Though appropriate for an exploratory study, a larger sample size may have yielded additional/different findings. Future studies should look to address these limitations. Implications The field of healthcare social work has grown significantly over the past several years; the employment prospects for the foreseeable future are strong. Concomitantly, the tasks associated with carrying out the practical employment functions of healthcare social workers will likely become increasingly complex. Thus, healthcare social worker employers should engage in wide-ranging approaches to fostering the development of robust personal and professional self-care practices. To this end, the following discussion briefly outlines pertinent implications derived from the afore-presented results. In an interlocking manner, self-care needs to be embedded in professional practice through promoting the professional value of self-care; reconceptualizing self-care as holistic and systemic; and building best practices and a knowledge base pertaining to self-care.
Promoting the professional value of self-care
In general, data from the current study suggest that healthcare social workers could certainly improve their self-care practices. This finding has implications at several levels. Broadly, the profession should more proactively promote the value of self-care. Though research suggests that social workers increasingly see the
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value of self-care, data from the current study suggest this value has not yet been actualized. For healthcare social workers, this value may manifest in varied ways. Professional member organizations such as the Society for Social Work Leadership in Healthcare and others may adopt standards and/or policy statements explicitly related to the concept of self-care. This practice is consistent with other groups, such as National Association of Social Workers (NASW) and International Federation of Social Workers (IFSW), who have adopted similar approaches. Professional associations and other entities who offer continuing education courses should include workshops on self-care. Likewise, licensing and credentialing boards may promote these trainings as requirements for licensure. Similarly, professional programs should integrate self-care into curricula. Because self-care is a core competency, effective professional preparation should include attention to valuing and developing the skills for self-care (Grise-Owens, Miller, Escobar-Ratliff, George, 2017; National Association of Social Workers, 2008). The Council of Social Work Education (CSWE) accredits social work programs and delineates certain professional competencies that students must demonstrate (CSWE, 2015). CSWE should explicitly include self-care in the competencies expected of those who graduate from social work programs. Reconceptualizing self-care as holistic and systemic
These value shifts provide the necessary grounding for self-care to be actualized. To achieve the aim of value and action congruence, the construct of self-care needs to be reconceptualized. This reconceptualization should be predicated on the notion that self-care is not an ancillary activity that occurs away from work. Self-care is not an “extra”; it is an “essential.” Furthermore, self-care must be understood as a lifestyle and an important way of how work is done. As such, self-care should be integrated into the workplace. This integration could include self-care as a component of employee professional development plans. Supervision and team meetings could include attention to self-care as an integral aspect of effective work. A reconceptualization should also acknowledge the integral, systemic role of healthcare organizations in fostering the development of healthy self-care practices among healthcare social workers (Cox & Steiner, 2013; Kanter & Sherman, 2017). This systemic reconceptualization may include comprehensive wellness initiatives, which include a range of aspects of self-care—not just physical health. Participatory processes are integral for developing these types of initiatives. If offered at all, typical organizational wellness plans are put in place by upper administration and include activities, such as gym memberships. These initiatives must extend to address a more comprehensive, holistic approach to self-care and wellness.
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Particularly, these initiatives should be informed by participatory processes that engage a range of employees in determining the aspects of the wellness initiative (Kanter & Sherman, 2017). Organizations should integrate participatory mechanisms to ensure buy-in and sustainability. For instance, these wellness initiatives should have a planning/steering committee comprising a range of employee representation (i.e., direct care, supervisors, and administrators). This committee would provide oversight to the conceptualization, planning, implementation, evaluation, and sustaining phases of the initiative. Likewise, organizations could implement a self-care champions component, whereby representative employees in units throughout the organization serve as “champions” of self-care. These participatory approaches promote broad-based engagement, which empower employees to engage in self-care practices and promote organizational effectiveness. Building best practices and a knowledge base
Contrary to a common myth, self-care does not just happen; it requires “intentionality, structure, and accountability” (Grise-Owens et al., 2016, p. 19). As with any skill development, self-care must be learned, practiced, and honed throughout a career. Resources are needed for supporting the development of the skill of self-care. From information about stress and other factors contributing to burnout to pragmatic skill development, best practices for effective and sustainable self-care are needed. Individually, practitioners should learn how to develop a comprehensive and sustainable self-care plan. Grise-Owens et al. (2016) offered a template for such a plan, which includes developing SMART goals and identifying accountability measures. Practitioners should consistently increase their understanding of and engagement with self-care practices (Cox & Steiner, 2013; Lee & Miller, 2013; National Association of Social Workers, 2008; Skovholt & Trotter-Mathison, 2011; Smullens, 2015). As with any area of practice, a knowledge base grounded in research is needed. Research implications abound. Assuredly, more research is needed related to self-care, as well as research on organizational wellness. Studies might continue to examine the predictive models associated with self-care. Notably, the findings related to finances, health, and organizational contexts need to be examined more closely and critically. Moreover, studies should include other variables, such as self-compassion, self-empathy, and so forth, which may be related to self-care. Similarly, studies should describe and evaluate effective organizational wellness initiatives. More information and models are needed to support organizations in implementing practices and approaches that support staff well-being. Studies should articulate effective trainings and other offerings that promote self-care. Schools of social work should contribute models for
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curricula that infuse self-care as an integral part of professional competency development. This study examined the practices of healthcare social workers in one state. Though appropriate for an exploratory study of this type, perhaps national and international studies are warranted. The current study can serve as the foundation of these, and other future, research endeavors. Conclusion Because self-care, or lack thereof, can impact the services proffered to clients/ patients, healthcare social workers are ethically compelled to give attention to their own well-being. Likewise, healthcare settings are compelled to support this aim. This exploratory study contributes to a better understanding of the self-care practices of healthcare social workers. The study indicates that ongoing and invested attention is needed to promote the value of self-care; reconceptualize self-care as holistic and systemic; and build best practices and a knowledge base. With the increasing demand in the healthcare sector, an effective and sustainable workforce is critically needed. Attention to self-care is not optional; it is imperative. References Asuero, A. M., Queralto, J. M., Pujol-Ribera, E., Berenguera, A., Rodriguez-Blano, T., & Epstein, R. M. (2014). Effectiveness of a mindfulness education program in primary health care professionals: A pragmatic controlled trial. Journal of Continuing Education in the Health Professions, 34(1), 4–12. doi:10.1002/chp.21211 Badger, K., Royse, D., & Craig, C. (2008). Hospital social workers and indirect trauma exposure: An exploratory study of contributing factors. Health & Social Work, 33(1), 63– 71. doi:10.1093/hsw/33.1.63 Barker, R. (2003). The social work dictionary. (5th ed.). Washington, DC: NASW Press. Ben-Zur, H., & Michael, K. (2007). Burnout, social support, and coping at work among social workers, psychologists, and nurses. Social Work in Health Care, 45(4), 63–82. doi:10.1300/ J010v45n04_04 Bloomquist, K. R., Wood, L., Friedmeyer-Trainor, K., & Kim, H. (2015). Self-care and professional quality of life: Predictive factors among MSW practitioners. Advances in Social Work, 16(2), 292–311. doi:10.18060/18760 Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52, 63–70. doi:10.1093/sw/52.1.63 Bureau of Labor Statistics. (2016). Occupational employment and wages: Healthcare social workers. Retrieved from https://www.bls.gov/oes/current/oes211022.htm. Cohen, M., & Gagin, R. (2005). Can skill-development training alleviate burnout in hospital social workers? Social Work in Health Care, 40(4), 83–97. doi:10.1300/J010v40n04_05 Council on Social Work Education. (2015). 2015 educational policy and accreditation standards. Retrieved from http://www.cswe.org/Accreditation/EPASRevision.aspx Cox, K., & Steiner, S. (2013). Self-care in social work: A guide for practitioners, supervisors, and administrators. Washington, DC: NASW Press.
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