The current research examines the nature and scope of client quality of life (QOL) outcomes as impacted upon by social workers in general hospitals. A new QOL instrument is conceptualised and qualitatively tested with social work clients in a hospital setting. The thesis has three broad aims, which are: 1) to explore and examine the nature and scope of client outcomes in an Australian public hospital; 2) to conceptualise a method to measure these outcomes that is in keeping with client-centred practice and the values of the social work profession and 3) to prepare and qualitatively pre-test an instrument to assess social work sensitive outcomes in a general hospital.
In recent years, there has been a burgeoning of interest in outcomes and outcomes measurement generally, as part of a broader outcomes movement. National and international literature, however, indicates that social work has lagged behind with regard to the conceptualisation and measurement of outcomes. Importantly, client perspectives are often marginalised in the contested discourse of the outcomes movement. The current research aims to centrally locate the stories of social work clients regarding the impact of social work interventions on their QOL.
To address the complexity of the social work role in general hospitals and the inexactitude in the literature regarding the nature and scope of social work outcomes, seven experienced practitioners, administrators and academics in the health field participated in a modified Delphi process. The aim of this process was to develop a degree of consensus regarding parameters of social work client outcomes in hospital settings. The International Classification of Functioning, Disability and Health (ICF), which is widely touted as a framework from which to develop outcome indicators for client functioning, was utilised to develop a questionnaire. Two round of the modified Delphi process were electronically administered. The quantitative data gathered were analysed through simple statistical analysis. Open-ended data were thematically analysed. The findings indicated that thirteen categories from the ICF classification were perceived by practitioners as relevant to social work practice in general hospitals.
In order to centrally locate subjective perspectives of client well-being in the study, fourteen former social work clients were recruited from the Royal Brisbane and Womens Hospital (RBWH), Queensland, Australia. Focussed interviews were conducted with individual participants. The content of the interviews addressed the impact of social work services on their QOL and data relating to the conceptualisation of QOL, including: time taken for effects to be perceived; relative importance of QOL outcomes; permeability of outcomes; intermediate and ultimate outcomes and the process-outcome linkage. The data were pooled across participants and analysed thematically. Data were managed with NVivo software.
A number of categories of client outcomes emerged from the participants accounts. These categories were: emotional well-being including mood, identification and expression of feelings; self-concept including ideas and feelings about self; developing a sense of control over feelings, thoughts and behaviours; quality of relationships with important others; having information about services, health and illness, personal development; acquiring strategies and skills to manage psychosocial well-being; acquiring the ability to manage stress and anxiety; achieving and maintaining basic financial security; achieving and maintaining personal independence within and outside the home; acquiring a safe and appropriate place to live, including nursing home and hostel placement; acquisition of goods and services to ensure personal well-being; the ability to participate in community life; maintenance of personal rights, which is inclusive of the right to self-determination, legal rights as a citizen and protection against discrimination and spirituality. Within each broad dimension, a range of sub-themes emerged.
Based on the data collated from the practitioners, administrators, academics and clients, the ICF, along with insights from the literature relating to QOL and client outcomes, a draft QOL instrument called the Quality of Life Social Work (QOL-SW) was designed to capture objective and subjective experiences of well-being across seven broad domains and fifteen facets.
The final component of the component of the study incorporated qualitative instrument pre-testing. Eight former social work clients were recruited in individual structured interviews utilising a think aloud process as they completed the instrument. The participants were also requested to respond to a number of questions about the format, relevance and interpretability of the instrument. Based on the findings of this component of the study, a number of revisions were made to the instrument. The thesis concludes with a draft instrument ready for quantitative testing.
The implications of this research centre on enhanced client-centred practice and research within general hospital settings. Importantly, enhanced practice requires greater clarity with regard to client outcomes. Such clarity will increase practitioners ability to develop effective intervention plans, leading to improved outcomes for clients. Furthermore, it is asserted that through increased clarity regarding client outcomes, social work practitioners are better able to facilitate clients participation in the development of individualised intervention plans. In the research domain, it is asserted that clarity regarding outcomes will allow efficacy researchers to develop more specific and targeted research questions. Furthermore, the draft instrument will potentially provide researchers with a tool to quantitatively measure the range of outcomes relevant to social work clients in the context of general hospitals. It is asserted that this will provide researchers with the capacity to answer the question, What works for whom and under what circumstances?