SWEC 4 || Module 3 ||

MODULE 3 Weeks 7–9  •  Role of the Social Worker in Health Care

 Ptra. Kathryn B Santiago, RSW MSW MMin
Instructor

MODULE OUTCOME Highlight a holistic and integrated approach to social work practice in the field of health.

 

Intended Learning Outcomes

1. Explain the concept of the patient as a person and as a whole, and outline a social assessment of the patient’s family.

2. Analyze illness behavior, treatment behavior, and the impact of illness and of long-term hospitalization on patient and family.

3. Describe palliative care, pain as a bio-psycho-social experience, patient rights, and medical ethics relevant to social work.

4. Specify the role of the medical social worker in organ transplantation, spinal cord injury, epilepsy, medico-legal cases, and rural/urban community health, within a multidisciplinary team.

Pre-Assessment

1. A 19-year-old is admitted after a motorcycle crash and may never walk again. List five non-medical problems this person and family will face in the first month.

2. Who should decide if a terminally ill parent is told the diagnosis: the doctor, the eldest child, or the patient? Why?

Lesson 3.1  •  The Patient as a Person

“Patient as a person” means the one in the bed is not a room number, a diagnosis, or a payer classification. The person has a name, history, work, loves, fears, faith, and a future that illness has interrupted. “Patient as a whole” means assessment covers body, mind, relationships, environment, culture, and meaning. Social work assessment therefore includes the presenting health problem and also housing, income, caregiving capacity, family decision patterns, beliefs about the illness, and available supports.

Social assessment of the patient’s family

Families in the Philippines are often the real care unit. Assess composition (who lives in the household, who decides, who pays, who stays overnight in the ward), genogram and ecomap, previous experience with hospitals, competing burdens (other children, overseas work, harvest season), and risk of caregiver burnout. Ask about secrets: a family may hide a diagnosis from the patient, or hide a pregnancy, HIV status, or VAWC injury from the team. Assessment is ongoing, not a one-page form completed at admission.

Understanding the problem of the patient

The “problem” is rarely only the disease. It may be: I cannot miss work; I am afraid of surgery; my spouse will leave; we have no one to watch the children; I caused this by sin (a belief that needs pastoral sensitivity, not argument alone); I do not trust this hospital. Problem definition must be collaborative. The worker’s theory should not overwrite the patient’s words.

Lesson 3.2  •  Illness Behavior, Treatment Behavior, and Impact

Illness behavior is how people notice, interpret, and act on symptoms. Some minimize (“hanggang ubo lang ito”). Some somatize distress. Some shop from clinic to herbolaryo. Treatment behavior is what people do with the plan: adhere, modify, abandon, or negotiate. Non-adherence is usually a puzzle to solve, not a moral failure. Causes include cost, side effects, poor explanation, depression, competing family needs, and distrust.

Impact of illness on patient and family includes loss of role (provider, student, parent), body image change, sexual and marital strain, children’s anxiety, spiritual crisis, and financial shock. Anticipatory guidance—telling families what strain is common—is already an intervention.

Long-term hospitalization

Long stays intensify dependency, boredom, hospital-acquired infection risk, and family exhaustion. Children miss school. Jobs are lost. Relationships with staff can become too intense or openly conflictual. The medical social worker schedules family rotations, connects to lodging or meal help when available, keeps the discharge horizon visible, and watches for learned helplessness. For the patient, identity work matters: I am still a father, a believer, a person with preferences.

Lesson 3.3  •  Palliative Care, Pain, Rights, and Ethics

Palliative care improves quality of life of patients and families facing life-threatening illness. It is not limited to the last 48 hours of life and is not the same as giving up. Pain is physical and also emotional, social, and spiritual (total pain). Social work contributions include family conferences about goals of care, support for truth-telling that is paced and compassionate, grief work, legacy activities, and coordination with pain and chaplaincy services.

Patients’ rights in Philippine health care include adequate information, informed consent, privacy and confidentiality, refusal of treatment within legal limits, and humane treatment. The Magna Carta of Patient’s Rights and Obligations has been proposed in various forms; hospitals also have their own bills of rights. Professional ethics for social workers include service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. Medical ethics adds autonomy, beneficence, non-maleficence, and justice. Tension is common: a family asks the team to withhold a cancer diagnosis; a minor is pregnant; a medico-legal case requires a report that the patient fears. Supervision and the Social Work Code of Ethics are required tools, not optional reading.

Lesson 3.4  •  Teamwork and Specialized Functions

Multidisciplinary teamwork means physicians, nurses, social workers, physical and occupational therapists, dietitians, pharmacists, psychologists, and chaplains share one care plan. The social worker’s unique contribution is the psychosocial assessment, family system work, resource network, and advocacy. Speak in team language: clear, brief, linked to the medical goal (“If we discharge tomorrow without a ground-floor room and a caregiver, this patient will return in three days”).

Organ transplantation

Roles include evaluating social support and adherence capacity, helping families understand waiting and uncertainty, addressing guilt in living donors and families of deceased donors, and after-care planning. Coercion of a poor relative to donate is an ethical red flag.

Spinal cord injuries

Counseling addresses grief for lost mobility, sexuality, work, and independence. Rehabilitation planning includes home modification, caregiver training, assistive devices, school or job redesign, and peer support. Depression and suicide risk must be screened. Community reintegration is the long goal.

Epilepsy

Stigma remains strong. Families may hide the condition or use unsafe traditional restraints. Education on first aid during seizures, school advocacy, medication adherence, and employment discrimination are social work tasks.

Medico-legal cases

These include injuries from accidents, violence, abuse, sexual assault, and cases that may go to court. The social worker documents observations, follows hospital and DSWD/WCPD protocols, protects the patient from further harm, arranges safe discharge, and does not play detective or lawyer. Confidentiality has legal limits when a child is abused or a person is in imminent danger.

Rural and urban community health

In rural settings the worker deals with distance, seasonal income, barangay health workers as partners, and scarce specialists. In urban settings the worker deals with overcrowding, informal settler conditions, hospital shopping, and complex NGO landscapes. In both, health needs are promoted through education, organization of support groups, and linkage of facility care to the community.

 

FAITH INTEGRATION The Good Samaritan paid attention to a wounded stranger and stayed through cost and inconvenience. Multidisciplinary care is a modern form of neighboring. Palliative presence—remaining when cure is no longer the goal—echoes accompaniment, not abandonment. Christian character in this module is measured by how we speak about patients who cannot pay and patients who will not recover.

Learning Activities

Activity A  •  Family assessment drill

Using a fictional case provided by the instructor (or the spinal-cord vignette above), complete a one-page assessment: genogram sketch, presenting problem, family strengths, risks, and three interventions.

Activity B  •  Ethics huddle

In groups of five, debate: Should the team follow the family’s request to hide a terminal diagnosis from an adult patient? Prepare a 4-minute position that cites at least one ethical principle and one social work value.

Activity C  •  Role play

Role-play a 7-minute first interview with a parent of a child in a medico-legal case. Observers score safety, consent, empathy, and clarity of next steps.

Assessment Tasks

1. Case analysis paper (800–1,000 words) on one specialized area: transplant, SCI, epilepsy, or medico-legal.

2. Ethics huddle performance and one-page individual position.

3. Reflection: “The patient I must not reduce to a diagnosis.”

Module 3 References

• Parrott, L. (2008). Values and ethics in social work practice.

• Sheafor, B. W., Morales, A. T., & Scott, M. E. (2010). Social work: A profession with many faces.

• Farley, W. (2012). Introduction to social work.

• Code of Ethics of Social Workers in the Philippines; RA 11036; hospital patient-rights policies.