The Effects of External Factors on Social Work Practitioners’ Ethical Decision-Making with Hospital Discharges

: An Interpretative Phenomenological Enquiry

Abstract

This thesis is an interpretative phenomenological enquiry into social work practitioners’ lived experience of their ethical decision-making and what the outside factors are that influence it. It contributes to the body of knowledge in that it records the lived-experiences of social work practitioners’ ethical decision-making involved with hospital discharge cases in the Scottish context at the time of continuing pressures on social work practice from managerialism and the integration of health and social care.

Participants in the study were qualified social work practitioners in Scotland, either in employment or recently retired, who had experience with hospital discharge cases. Data for the research was collected via a diary study and semi-structured interviews and analysed by using Interpretative Phenomenological Analysis (IPA).

The results of this study demonstrate that the participants had a clear understanding of what their role is with hospital discharges and that it is based on commonly agreed social work values. Most participants had experienced their role in ethical decision-making being contested from outside. The main factors that the participants’ identified as influencing their ethical decision-making were the policy objective to avoid delayed discharges from hospital, limited time available to complete work, lack of suitable resources and fraught relationships with hospital consultants and senior social work managers.

The phenomenon was mainly experienced intersubjectively, in relationships with others, which also transcended to be experienced in embodiment as well as spatially and in temporality. The respondents felt that the role of a social worker was integral to how they see themselves as a person, thus any attack on the role was felt as an attack on the self. The health environment was felt as being somewhat hostile territory whereas the presence of peers provided a supportive environment. Practitioners struggled to provide adequate social work input in the limited time available for their involvement with a client.

Social work values are fundamental to delivering a coherent standard of professional service. Such is their importance that there needs to be a systematic and structured approach to their application through initial social work education and ongoing practice.

More generally there needs to be a broader understanding of social work practice which goes beyond the profession itself. This calls for approaches within the integration process of health and social care to inform and educate non-social work practitioners of the core aims of the profession as this cannot be left as a task for individual practitioners. With integrated health and social care more attention should be placed on the multidisciplinary working of health and social care professionals as early as possible in the training stages.

Date of Award	2019
Original language	English
Supervisor	Tim Kelly (Supervisor) & John Young (Supervisor)