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Nothing Beats Experience: Case Study of How Withstanding the Effects of a Prior Disaster Impacted Provider Preparedness and Response during the Pandemic

Nothing Beats Experience: Case Study of How Withstanding the Effects of a Prior Disaster Impacted... By the end of 2021, COVID-19 had infected over 50 million people in the United States, leading to more than 800,000 deaths, simultaneously altering how healthcare is delivered and the nature of the job for those who provide direct patient care. Many clinical social workers have experienced burnout or left the profession because of the stress and emotional overload (Holmes et al., 2021). Rates of turnover among social workers range from 30 percent to 65 percent (Chang, 2017); although that figure during the pandemic is unknown, it is likely larger because of the duration and intensity of the ongoing disaster. Turnover in the healthcare field is costly to agencies (Singh, 2021) and can have a rippling effect by disrupting care for clients and increasing provider caseloads. Research about social workers’ utilization of strategies to facilitate emotional well-being during the pandemic is recently emerging (Bender et al., 2021; Holmes et al., 2021; Kranke et al., 2021). Kranke et al. (2021) developed the term “emotional preparedness” (EP) and approaches to account for personal emotional concerns that may arise before, during, and after a disaster, in the context of a hurricane. Specific tactics include being psychologically present in the disaster and anticipating the event by making preparations to protect belongings. In addition, Bender et al. (2021) developed the term “emotional connectedness” (EC) to provide strategies about connecting with colleagues and addressing organizational concerns in providing care during the pandemic. Specific strategies include being vulnerable to express concerns and feelings to colleagues and being empathic to peers. Smaller qualitative studies (Bender et al., 2021; Kranke et al., under review) indicate that utilizing EP and EC strategies facilitated inpatient social worker well-being and sustained employment during the pandemic. Research on the efficacy of previous disaster experience is another consideration for healthcare workers’ ability to overcome obstacles from the pandemic. In the instance of a severe hurricane, findings reported that hospital leadership made a decision based on prior experience with a disaster that ultimately benefited the hospital itself, hospital patients, and the workforce during a subsequent disaster many years later (Ricci et al., 2015). The impact of the event was significantly mitigated by leadership’s decision to evacuate a hospital before Hurricane Sandy arrived on the East Coast. This case study illustrates how a U.S. Department of Veterans Affairs (VA) inpatient social worker’s prior experience with a large-scale disaster contributed to their well-being, sustained employment, and ability to provide organizational support for their colleagues. The VA is the largest employer of social workers in the United States; findings from studies of the VA system are likely generalizable to others because of commonalities with social workers in non-VA settings (Kranke et al., 2021). Findings from this study have implications for social work practice, as reflecting on lessons learned will help social workers be better prepared for the remainder of the pandemic and more informed for future disasters. Method The original qualitative study was approved by the Greater Los Angeles VA institutional review board, and collected data from (N = 12) inpatient social workers located in the Southwest and Midwest regions of the United States. Qualitative interviews were 45–60 minutes long, and contained questions about emotions, best practices, and barriers confronted by VA inpatient social workers who provided care to ill clients during the pandemic. The interviews were recorded, transcribed, converted into PDF files, and analyzed using Atlas.ti software (Version 15). The case study we present here about Alice (pseudonym) was selected because she was the only participant who indicated she had prior experience of conducting social work in a disaster. The case study is discussed using a narrative approach (Padgett, 2008) and applied as a previous case study framework that disseminated data about facilitators of empowerment among U.S. veterans (Kranke et al., 2017). The case study vignette consists of three temporal components: a beginning, a middle, and an end. The beginning illustrates particular actions and awareness acquired from others and events in the past. The middle examines how prior experiences informed Alice’s work in the present, applying those lessons to navigate difficult experiences during the context of the pandemic, especially those that were similar to and different from the context of a hurricane. At the end, the findings are organized by how Alice will incorporate the additional lessons from the past and present to make positive change among those impacted by the pandemic in her future work. The findings and particular quotations reported in the case study were selected by the lead author because of their relevance to disseminating how Alice’s prior experience during Hurricane Sandy led to her emotional well-being and ability to sustain employment during the COVID-19 pandemic. The secondary authors reviewed the quotes selected from the transcript and agreed that the organization of quotes was most appropriate to delineating Alice’s pathway. Case Vignette Alice has worked as a senior social worker in inpatient medicine and surgery at the VA since April of 2020. She had prior experience providing care during Hurricane Sandy in a social worker role outside of the VA. This prior experience enhanced her understanding and feelings about disaster preparedness and her efficacy to bounce back: “I felt prepared in understanding that I’m not always gonna be doing what I would normally do. So, I would have to be somewhat flexible and open to doing different things.” Alice described how she performed essential duties during Hurricane Sandy, which would also be indicative of what she would have to do during the pandemic: For Hurricane Sandy, the hospital I worked at accepted patients from hospitals that closed due to flooding. And we also provided shelter services and case management to community, to residents in the community who were displaced for whatever reason. So, it wasn’t as imminent, but we were staying overnight; we weren’t working our regular hours. Alice’s prior experience informed her work during the pandemic while working at the VA, and addressed how the pandemic raised additional, different concerns: I guess for the pandemic we were just working our regular hours filling that capacity. It was business as usual. We just never knew how many COVID patients we would have the next day. That was really the main difference. And from a discharge planning perspective, with the COVID patients we never really knew what to expect in terms of what are this person’s needs going to be? And if they need to go to a nursing home, for example, are we even going to be able to get them there? Alice indicated challenges in working with other staff who did not have prior experience working during a disaster. Reliance on team and connectedness seemed to diminish during the current crisis. The main concern is being underprepared: Working with newer, less-experienced providers who are feeling very emotional, not only about what their patients are going through, but I also think because of their own limited experience working with patients in the situation. So, it was almost like work. The hidden work is easing the anxiety of these critical care first-year residents who just finished medical school and feel underprepared and, you know, their first few months working as doctors, they’re working with all these critically ill COVID patients. Alice spoke of red-flag reoccurrences in the field of social work that she has witnessed in her experience with providing care during disasters: I think one thing that I’m constantly talking to my non–social work colleagues about is the National Association of Social Workers’ Code of Ethics. A lot of the time other providers are suggesting that the social workers do things that aren’t necessarily appropriate within the code of ethics, and I’m constantly having to remind them of that. After witnessing the hardships that her colleagues experienced in critical care during the pandemic, Alice realized the importance of consulting with future social workers about the nature of the job to better prepare them for what might occur and to reduce the likelihood of turnover: I did talk to her [social work intern] about her future career as a social worker in a hospital. She said she might be interested in critical care, and I told her if going into a room wearing PPE [personal protective equipment] to see someone with COVID or someone on contact isolation is not something that makes you comfortable, you need to rethink whether or not a career in critical care will work for you. Ultimately, Alice declared that “conversations like that need to be started earlier.” Analysis Although our findings and conclusions are not generalizable, they provide further evidence that prior experience with and efficacy in handling a disaster of large proportion may have implications for instilling confidence and resilience among social workers to withstand the potential ill effects of subsequent disasters. We developed emerging themes because of the paucity of data on the examined phenomenon. The following are four specific actions taken by Alice that were a consequence of withstanding a disaster: Flexible outlook about daily professional responsibilities and tasks. This perspective helped Alice to manage and keep pace with the unpredictable nature of social work during the pandemic. Recognizing the lack of experience among peers and providing support in disaster situations. This action helped Alice to identify colleagues who were underprepared, ultimately allowing her to recognize where to fill in gaps in service. Identifying scope of practice boundaries. This process helped Alice to recognize limitations of her work as a social worker. Not doing so could have put her job at risk or increased the likelihood of professional liability. Providing career advice to new social workers about how the profession has changed because of the pandemic. Alice learned that giving input to social work interns can help prepare them for the stressors of the job during times of disaster, while also allowing the social work interns to make a fully informed decision whether social work is the field they want to enter. The analysis illustrates how the social worker learned from both positive and negative experiences. Although some tasks of the job were more open to scrutiny during times of distress (i.e., liability), collectively, they contributed to better withstanding the effects of another disaster. Next Steps Future qualitative research in narrative forms should investigate the subjective experiences—trajectory of lessons learned throughout the temporal components of the pandemic—among social workers who sustained employment and maintained their own well-being. The guiding question for such a narrative approach could be, “How will your experience providing care during this pandemic impact the perspective and work you do in the future?” Data collection from outpatient, inpatient, and social workers in cross-training (those who provide both inpatient and outpatient services) is vital to provider health, as the environments and ecological systems for the respective positions are unique. Even before the pandemic, it has been suggested that social work organizations such as the Society for Social Work and Research or the Council on Social Work Education do not adequately address social work’s role during disasters (Bauwens & Naturale, 2017). This pandemic is the first disaster experience for many social workers, and the field may benefit by adopting guidelines or recommendations during disasters and by creating opportunities at conferences that exclusively allows social workers to disseminate best practices and shared experiences related to disasters. It is vital that social workers who provide care during the pandemic reflect on their experiences and the situations they already have and will likely encounter in the future during the remainder of the pandemic, or other future disasters. Creating disaster-specific tracts/sections and forums for research and practice sharing at conferences would present a golden opportunity for education of new and current social workers. References Bauwens J. , Naturale A. ( 2017 ). The role of social work in the aftermath of disasters and traumatic events [Editorial]. Clinical Social Work Journal , 45 , 99 – 101 . Google Scholar Crossref Search ADS WorldCat Bender A. E. , Berg K. A., Miller E. K., Evans K. E., Holmes M. R. ( 2021 ). “Making sure we are all okay”: Healthcare workers’ strategies for emotional connectedness during the COVID-19 pandemic . Clinical Social Work Journal , 49 , 445 – 455 . Google Scholar Crossref Search ADS WorldCat Chang J. ( 2017 , June 10). State child protection agency halts hiring, citing drop in turnovers. Austin American-Statesman. https://www.statesman.com/story/news/2017/06/10/state-child-protection-agency-halts-hiring-citing-drop-in-turnovers/10053192007/ Holmes M. R. , Rentrope C. R., Korsch-Williams A., King J. A. ( 2021 ). Impact of COVID-19 pandemic on posttraumatic stress, grief, burnout, and secondary trauma of social workers in the United States . Clinical Social Work Journal , 49 , 495 – 504 . Google Scholar Crossref Search ADS PubMed WorldCat Kranke D. , Gable A. R., Weiss E. L., Dobalian A. ( 2017 ). “I’m in a good place now”: A case study of empowerment of a combat veteran engaged in peer-led disaster relief . Social Work in Mental Health , 15 , 663 – 676 . Google Scholar Crossref Search ADS WorldCat Kranke D. , Mudoh Y., Gioia D., Alenkin N., Dobalian A. (under review). Social work providers’ strategies to facilitate emotional wellbeing during the COVID-19 pandemic. Kranke D. , Mudoh Y., Weiss E. L., Hovsepian S., Gin J., Dobalian A., Der-Martirosian C. ( 2021 ). ‘ Emotional preparedness’: A nuanced approach to disaster readiness among social workers . Social Work Education . Advanced online publication. https://doi.org/10.1080/02615479.2021.1900099 Google Scholar OpenURL Placeholder Text WorldCat Padgett D. K. ( 2008 ). Strategies for rigor. In Padgett D. K. (Ed.), Qualitative methods in social work research (2nd ed., pp. 179 – 188 ). SAGE . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC Ricci K. A. , Griffin A. R., Heslin K. C., Kranke D., Dobalian A. ( 2015 ). Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making . Prehospital and Disaster Medicine , 30 , 233 – 238 . Google Scholar Crossref Search ADS PubMed WorldCat Singh J. ( 2021 , September 20). Justifying a budget for physician wellness. Physician’s Weekly. https://www.physiciansweekly.com/justifying-a-budget-for-physician-wellness © 2022 National Association of Social Workers This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2022 National Association of Social Workers http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Health & Social Work Oxford University Press

Nothing Beats Experience: Case Study of How Withstanding the Effects of a Prior Disaster Impacted Provider Preparedness and Response during the Pandemic

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References (7)

Publisher
Oxford University Press
Copyright
© 2022 National Association of Social Workers
ISSN
0360-7283
eISSN
1545-6854
DOI
10.1093/hsw/hlac015
Publisher site
See Article on Publisher Site

Abstract

By the end of 2021, COVID-19 had infected over 50 million people in the United States, leading to more than 800,000 deaths, simultaneously altering how healthcare is delivered and the nature of the job for those who provide direct patient care. Many clinical social workers have experienced burnout or left the profession because of the stress and emotional overload (Holmes et al., 2021). Rates of turnover among social workers range from 30 percent to 65 percent (Chang, 2017); although that figure during the pandemic is unknown, it is likely larger because of the duration and intensity of the ongoing disaster. Turnover in the healthcare field is costly to agencies (Singh, 2021) and can have a rippling effect by disrupting care for clients and increasing provider caseloads. Research about social workers’ utilization of strategies to facilitate emotional well-being during the pandemic is recently emerging (Bender et al., 2021; Holmes et al., 2021; Kranke et al., 2021). Kranke et al. (2021) developed the term “emotional preparedness” (EP) and approaches to account for personal emotional concerns that may arise before, during, and after a disaster, in the context of a hurricane. Specific tactics include being psychologically present in the disaster and anticipating the event by making preparations to protect belongings. In addition, Bender et al. (2021) developed the term “emotional connectedness” (EC) to provide strategies about connecting with colleagues and addressing organizational concerns in providing care during the pandemic. Specific strategies include being vulnerable to express concerns and feelings to colleagues and being empathic to peers. Smaller qualitative studies (Bender et al., 2021; Kranke et al., under review) indicate that utilizing EP and EC strategies facilitated inpatient social worker well-being and sustained employment during the pandemic. Research on the efficacy of previous disaster experience is another consideration for healthcare workers’ ability to overcome obstacles from the pandemic. In the instance of a severe hurricane, findings reported that hospital leadership made a decision based on prior experience with a disaster that ultimately benefited the hospital itself, hospital patients, and the workforce during a subsequent disaster many years later (Ricci et al., 2015). The impact of the event was significantly mitigated by leadership’s decision to evacuate a hospital before Hurricane Sandy arrived on the East Coast. This case study illustrates how a U.S. Department of Veterans Affairs (VA) inpatient social worker’s prior experience with a large-scale disaster contributed to their well-being, sustained employment, and ability to provide organizational support for their colleagues. The VA is the largest employer of social workers in the United States; findings from studies of the VA system are likely generalizable to others because of commonalities with social workers in non-VA settings (Kranke et al., 2021). Findings from this study have implications for social work practice, as reflecting on lessons learned will help social workers be better prepared for the remainder of the pandemic and more informed for future disasters. Method The original qualitative study was approved by the Greater Los Angeles VA institutional review board, and collected data from (N = 12) inpatient social workers located in the Southwest and Midwest regions of the United States. Qualitative interviews were 45–60 minutes long, and contained questions about emotions, best practices, and barriers confronted by VA inpatient social workers who provided care to ill clients during the pandemic. The interviews were recorded, transcribed, converted into PDF files, and analyzed using Atlas.ti software (Version 15). The case study we present here about Alice (pseudonym) was selected because she was the only participant who indicated she had prior experience of conducting social work in a disaster. The case study is discussed using a narrative approach (Padgett, 2008) and applied as a previous case study framework that disseminated data about facilitators of empowerment among U.S. veterans (Kranke et al., 2017). The case study vignette consists of three temporal components: a beginning, a middle, and an end. The beginning illustrates particular actions and awareness acquired from others and events in the past. The middle examines how prior experiences informed Alice’s work in the present, applying those lessons to navigate difficult experiences during the context of the pandemic, especially those that were similar to and different from the context of a hurricane. At the end, the findings are organized by how Alice will incorporate the additional lessons from the past and present to make positive change among those impacted by the pandemic in her future work. The findings and particular quotations reported in the case study were selected by the lead author because of their relevance to disseminating how Alice’s prior experience during Hurricane Sandy led to her emotional well-being and ability to sustain employment during the COVID-19 pandemic. The secondary authors reviewed the quotes selected from the transcript and agreed that the organization of quotes was most appropriate to delineating Alice’s pathway. Case Vignette Alice has worked as a senior social worker in inpatient medicine and surgery at the VA since April of 2020. She had prior experience providing care during Hurricane Sandy in a social worker role outside of the VA. This prior experience enhanced her understanding and feelings about disaster preparedness and her efficacy to bounce back: “I felt prepared in understanding that I’m not always gonna be doing what I would normally do. So, I would have to be somewhat flexible and open to doing different things.” Alice described how she performed essential duties during Hurricane Sandy, which would also be indicative of what she would have to do during the pandemic: For Hurricane Sandy, the hospital I worked at accepted patients from hospitals that closed due to flooding. And we also provided shelter services and case management to community, to residents in the community who were displaced for whatever reason. So, it wasn’t as imminent, but we were staying overnight; we weren’t working our regular hours. Alice’s prior experience informed her work during the pandemic while working at the VA, and addressed how the pandemic raised additional, different concerns: I guess for the pandemic we were just working our regular hours filling that capacity. It was business as usual. We just never knew how many COVID patients we would have the next day. That was really the main difference. And from a discharge planning perspective, with the COVID patients we never really knew what to expect in terms of what are this person’s needs going to be? And if they need to go to a nursing home, for example, are we even going to be able to get them there? Alice indicated challenges in working with other staff who did not have prior experience working during a disaster. Reliance on team and connectedness seemed to diminish during the current crisis. The main concern is being underprepared: Working with newer, less-experienced providers who are feeling very emotional, not only about what their patients are going through, but I also think because of their own limited experience working with patients in the situation. So, it was almost like work. The hidden work is easing the anxiety of these critical care first-year residents who just finished medical school and feel underprepared and, you know, their first few months working as doctors, they’re working with all these critically ill COVID patients. Alice spoke of red-flag reoccurrences in the field of social work that she has witnessed in her experience with providing care during disasters: I think one thing that I’m constantly talking to my non–social work colleagues about is the National Association of Social Workers’ Code of Ethics. A lot of the time other providers are suggesting that the social workers do things that aren’t necessarily appropriate within the code of ethics, and I’m constantly having to remind them of that. After witnessing the hardships that her colleagues experienced in critical care during the pandemic, Alice realized the importance of consulting with future social workers about the nature of the job to better prepare them for what might occur and to reduce the likelihood of turnover: I did talk to her [social work intern] about her future career as a social worker in a hospital. She said she might be interested in critical care, and I told her if going into a room wearing PPE [personal protective equipment] to see someone with COVID or someone on contact isolation is not something that makes you comfortable, you need to rethink whether or not a career in critical care will work for you. Ultimately, Alice declared that “conversations like that need to be started earlier.” Analysis Although our findings and conclusions are not generalizable, they provide further evidence that prior experience with and efficacy in handling a disaster of large proportion may have implications for instilling confidence and resilience among social workers to withstand the potential ill effects of subsequent disasters. We developed emerging themes because of the paucity of data on the examined phenomenon. The following are four specific actions taken by Alice that were a consequence of withstanding a disaster: Flexible outlook about daily professional responsibilities and tasks. This perspective helped Alice to manage and keep pace with the unpredictable nature of social work during the pandemic. Recognizing the lack of experience among peers and providing support in disaster situations. This action helped Alice to identify colleagues who were underprepared, ultimately allowing her to recognize where to fill in gaps in service. Identifying scope of practice boundaries. This process helped Alice to recognize limitations of her work as a social worker. Not doing so could have put her job at risk or increased the likelihood of professional liability. Providing career advice to new social workers about how the profession has changed because of the pandemic. Alice learned that giving input to social work interns can help prepare them for the stressors of the job during times of disaster, while also allowing the social work interns to make a fully informed decision whether social work is the field they want to enter. The analysis illustrates how the social worker learned from both positive and negative experiences. Although some tasks of the job were more open to scrutiny during times of distress (i.e., liability), collectively, they contributed to better withstanding the effects of another disaster. Next Steps Future qualitative research in narrative forms should investigate the subjective experiences—trajectory of lessons learned throughout the temporal components of the pandemic—among social workers who sustained employment and maintained their own well-being. The guiding question for such a narrative approach could be, “How will your experience providing care during this pandemic impact the perspective and work you do in the future?” Data collection from outpatient, inpatient, and social workers in cross-training (those who provide both inpatient and outpatient services) is vital to provider health, as the environments and ecological systems for the respective positions are unique. Even before the pandemic, it has been suggested that social work organizations such as the Society for Social Work and Research or the Council on Social Work Education do not adequately address social work’s role during disasters (Bauwens & Naturale, 2017). This pandemic is the first disaster experience for many social workers, and the field may benefit by adopting guidelines or recommendations during disasters and by creating opportunities at conferences that exclusively allows social workers to disseminate best practices and shared experiences related to disasters. It is vital that social workers who provide care during the pandemic reflect on their experiences and the situations they already have and will likely encounter in the future during the remainder of the pandemic, or other future disasters. Creating disaster-specific tracts/sections and forums for research and practice sharing at conferences would present a golden opportunity for education of new and current social workers. References Bauwens J. , Naturale A. ( 2017 ). The role of social work in the aftermath of disasters and traumatic events [Editorial]. Clinical Social Work Journal , 45 , 99 – 101 . Google Scholar Crossref Search ADS WorldCat Bender A. E. , Berg K. A., Miller E. K., Evans K. E., Holmes M. R. ( 2021 ). “Making sure we are all okay”: Healthcare workers’ strategies for emotional connectedness during the COVID-19 pandemic . Clinical Social Work Journal , 49 , 445 – 455 . Google Scholar Crossref Search ADS WorldCat Chang J. ( 2017 , June 10). State child protection agency halts hiring, citing drop in turnovers. Austin American-Statesman. https://www.statesman.com/story/news/2017/06/10/state-child-protection-agency-halts-hiring-citing-drop-in-turnovers/10053192007/ Holmes M. R. , Rentrope C. R., Korsch-Williams A., King J. A. ( 2021 ). Impact of COVID-19 pandemic on posttraumatic stress, grief, burnout, and secondary trauma of social workers in the United States . Clinical Social Work Journal , 49 , 495 – 504 . Google Scholar Crossref Search ADS PubMed WorldCat Kranke D. , Gable A. R., Weiss E. L., Dobalian A. ( 2017 ). “I’m in a good place now”: A case study of empowerment of a combat veteran engaged in peer-led disaster relief . Social Work in Mental Health , 15 , 663 – 676 . Google Scholar Crossref Search ADS WorldCat Kranke D. , Mudoh Y., Gioia D., Alenkin N., Dobalian A. (under review). Social work providers’ strategies to facilitate emotional wellbeing during the COVID-19 pandemic. Kranke D. , Mudoh Y., Weiss E. L., Hovsepian S., Gin J., Dobalian A., Der-Martirosian C. ( 2021 ). ‘ Emotional preparedness’: A nuanced approach to disaster readiness among social workers . Social Work Education . Advanced online publication. https://doi.org/10.1080/02615479.2021.1900099 Google Scholar OpenURL Placeholder Text WorldCat Padgett D. K. ( 2008 ). Strategies for rigor. In Padgett D. K. (Ed.), Qualitative methods in social work research (2nd ed., pp. 179 – 188 ). SAGE . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC Ricci K. A. , Griffin A. R., Heslin K. C., Kranke D., Dobalian A. ( 2015 ). Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making . Prehospital and Disaster Medicine , 30 , 233 – 238 . Google Scholar Crossref Search ADS PubMed WorldCat Singh J. ( 2021 , September 20). Justifying a budget for physician wellness. Physician’s Weekly. https://www.physiciansweekly.com/justifying-a-budget-for-physician-wellness © 2022 National Association of Social Workers This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2022 National Association of Social Workers

Journal

Health & Social WorkOxford University Press

Published: Jun 12, 2022

There are no references for this article.