Acknowledgement of client diversity and oppression in social work student supervision

An enduring theme of social work literature and education has been the need for workers to recognise and challenge oppressive structures and develop competence in working with diverse client groups. This paper reports the findings of a qualitative research project where student and field educator supervision sessions were recorded, with the view to examining how oppression and diversity were addressed in these sessions. The authors have used the term 'difference' to describe the breach between the student and client experiences. Examples of anti-discriminatory practice were identified in the recordings, however on occasions supervisors had difficulty in assisting students to acknowledge diversity and oppression in supervision. Four factors that related to addressing diversity emerged from the supervision material. These were: the struggle to unmask subtle themes of oppression; the use of questioning to raise student awareness and development of self-knowledge; using student biography to facilitate learning on 'difference'; and field educator use of self-disclosure during discussions on diversity. Successful approaches to anti-oppressive practice and responding to diversity are outlined.

Technological intimacy in haemodialysis nursing

Technology plays a major role in nursing care. Among the challenges for nurses is being able to maintain a patient focus while surrounded by highly complex technology. The provision of high quality nursing care in technologically complex environments is particularly challenging when nurses develop relationships with their patients over an extended period of time. In these environments the potential for intimate relationships can increase. This potential for intimacy is evident in the haemodialysis context where dialysis technology, nurses and patients interface. As nurses and patients can spend up to 20 hours per week together intimate relationships can develop. This paper identifies the challenges these dialysis nurses face and introduces the concept of technological intimacy. Technological intimacy can be defined as physical touching and self disclosure, associated with closeness and knowing, that is undertaken in the full view of others in a healthcare environment dominated by technology. In the haemodialysis context technological intimacy has been scarcely acknowledged and rarely researched. Further research will assist in guiding haemodialysis nursing practice.

Not one of us is without bias : identifying and challenging racism and homophobia

This article reviews a teaching process that aimed to prepare final year social work students for critical practice with diverse and marginalized populations. Alongside lecture input, in small group discussions and in the two sequenced written assignments students were encouraged to personalize questions of bias and stigma by recalling both their experiences of being “other-ed” as well as their participation in practices that “other-ed”, such as racist and homophobic imaging and acting. Feedback to the unit’s first iteration in 2004 was generally positive yet a significant minority of students were clearly dissatisfied. Whilst retaining the same formal content in 2005, greater attention was devoted to generating a supportive group process and a positive environment for “negative” self-disclosure. This milieu acted to contain and normalize the students’ struggle with internalized stereotypes, a stage associated with their greater preparedness to identify and challenge their own personal, cultural and ideological locations. Within the context of the unit remaining explicit about its value stance, by adopting an approach to the teaching / learning process that neither collided nor colluded, as teachers we believe the 2005 revision better achieved the units aims. First, the unit received broader positive appraisal from students and, second, it appeared that the unit more firmly promoted the prospects for students carrying forward a capacity for critical self review post graduation.

Who, and what, is odd here? De-naturalizing students' experiences of 'the other'

This paper reviews a teaching process that aimed to prepare final year social work students for critical practice with diverse and marginalized populations. Alongside lecture input, in small group discussions and in the two sequenced written assignments students were encouraged to personalize questions of bias and stigma by recalling both their experiences of being ‘other-ed’ as well as their participation in practices that ‘other-ed’, such as racist and homophobic imaging and acting. Feedback to the unit's first iteration in 2004 was generally positive yet a significant minority of students were clearly dissatisfied. Whilst retaining the same formal content in 2005, greater attention was devoted to generating a supportive group process and a positive environment for ‘negative’ self-disclosure. This milieu acted to contain and normalize the students' struggle with internalized stereotypes, a stage associated with their greater preparedness to identify and challenge their own personal, cultural and ideological locations. Within the context of the unit remaining explicit about its value stance, by adopting an approach to the teaching/learning process that neither collided nor colluded we believe the 2005 revision better achieved the units aims. First, the unit received broader positive appraisal from students and, second, it appeared that the unit more firmly promoted the prospects for students carrying forward a capacity for critical self review post graduation.

A randomised controlled trial of a social support intervention

Background: Much evidence has accumulated over the last three decades that low social support is related to both mental and physical health. Despite this large and convincing literature, reviewers have noted that there exists remarkably little evidence that social support can be increased by an appropriate intervention. This study reports on the development and evaluation of a new intervention for social support which takes account of the stress-buffering and direct effect models.

Method: Eighty-one individuals scoring low on social support were randomly allocated to the intervention or a waiting-list control condition. Treatment consisted of 10 weekly sessions administered in a group format, and 49 participants (nine males) completed assessments at the beginning and end of a 10-week period, and at 10-week follow-up (intervention condition only).

Results: The intervention proved to be successful at increasing functional support but not structural support. The intervention was also successful in increasing the social skill of self-disclosure, and decreasing depression. Gains made between pre- and post-treatment were maintained at 10-week follow-up.

Conclusions: Based on published analyses of the effects of social support on health, the results imply that the intervention would be useful for stress-buffering purposes, but not for the general health-promoting effects that are associated with good social integration.

Extending boundaries: clinical communication with culturally and linguistically diverse mental health clients and carers

We are often confronted with the dilemmas of interacting with people from different cultural backgrounds. How do we ensure that we meet their needs, if they have some barriers to communicating those needs? This project explores the communication mechanisms used by mental health clinicians, to explore how they modify their communication to reconcile cultural differences and promote self-disclosure. It also identifies the practical experiences that have enlightened clinicians' practice when interacting with culturally and linguistically diverse (CALD) groups. Through focus groups, mental health clinicians were probed about their experiences with CALD groups and the methods used to facilitate communication. Clinicians were working in either acute adult inpatient or community settings in a large metropolitan health service. Fifty-three clinicians formed 7 focus groups. In the focus groups, clinicians were asked about their perceptions of communication with CALD clients. Guided questions were used. All focus groups were audio-taped and transcribed. Two distinct themes emerged. They were ‘respect’ and ‘cultural understanding’. The clinicians recognized that showing and maintaining respect for the CALD client, and their families significantly impacted on the development of a therapeutic relationship. Showing cultural understanding and acceptance for difference also enhanced communication.

Characterising the extent of misreporting of high blood pressure, high cholesterol, and diabetes using the Australian Health Survey

BACKGROUND: Measuring and monitoring the true prevalence of risk factors for chronic conditions is essential for evidence-based policy and health service planning. Understanding the prevalence of risk factors for cardiovascular disease (CVD) in Australia relies heavily on self-report measures from surveys, such as the triennial National Health Survey. However, international evidence suggests that self-reported data may substantially underestimate actual risk factor prevalence. This study sought to characterise the extent of misreporting in a large, nationally-representative health survey that included objective measures of clinical risk factors for CVD.

METHODS: This study employed a cross-sectional analysis of 7269 adults aged 18 years and over who provided fasting blood samples as part of the 2011-12 Australian Health Survey. Self-reported prevalence of high blood pressure, high cholesterol and diabetes was compared to measured prevalence, and univariate and multivariate logistic regression analyses identified socio-demographic characteristics associated with underreporting for each risk factor.

RESULTS: Approximately 16 % of the total sample underreported high blood pressure (measured to be at high risk but didn't report a diagnosis), 33 % underreported high cholesterol, and 1.3 % underreported diabetes. Among those measured to be at high risk, 68 % did not report a diagnosis for high blood pressure, nor did 89 % of people with high cholesterol and 29 % of people with high fasting plasma glucose. Younger age was associated with underreporting high blood pressure and high cholesterol, while lower area-level disadvantage and higher income were associated with underreporting diabetes.

CONCLUSIONS: Underreporting has important implications for CVD risk factor surveillance, policy planning and decisions, and clinical best-practice guidelines. This analysis highlights concerns about the reach of primary prevention efforts in certain groups and implications for patients who may be unaware of their disease risk status.

Being trustworthy: going beyond evidence to desiring

If educators are to educate they must be accorded some level of trust. Anthony Giddens claims that because trust is not easily created, it is now being replaced with ‘confidence’ because this latter disposition is much easier to give and is more convenient. It is argued in this paper that this shift from trust to confidence stifles education because emphasis is placed solely upon qualifications and competence, and is neglectful of disclosing one’s motives and desires—which are considered to be essential elements for relationships and communities which depend upon trust. Therefore, educators ought to seek to become more trustworthy by going beyond evidence-based practices and codes of ethics, towards articulating a developed personal philosophy of education outlining the ultimate end-purposes to which they aspire. Through such a philosophy, educators identify their ultimate desires and commitments and this self-disclosure can make trust-giving more likely. Demonstrated evidence of achievements and qualifications encourage confidence and this has some value. In addition to these artefacts of evidence, it is argued here that educators must also articulate what they actually desire. This can be understood as John Dewey’s virtue of ‘genuine interest’ which he characterises as being wholehearted, persistent and impartial. For educators, this is often represented in our personal philosophy of education and because it is personal, it is also existential in the sense that it pertains to giving sense, meaning and purpose to all of our activities and way of life for which we are individually responsible and passionately committed to as professionals. As a consequence of being existential, our philosophy and our commitment to it has an intellectual and moral aspect and because it reaches to the very depths of our raison d’être, it pertains to our passion as described by Søren Kierkegaard. This paper shall draw upon Dewey’s notion of wholeheartedness and Kierkegaard’s notion of purity of heart, to make the case that if educators embrace these in their practices, we may become more trustworthy.

Effects of sexually transmitted infection status, relationship status, and disclosure status on sexual self-concept

Research has indicated that having a sexually transmitted infection (STI) such as genital herpes and genital human papilloma virus (HPV) can have a negative impact on an individual's sexuality. The current study was designed to evaluate the effect of STI status, relationship status, and disclosure status on various dimensions of sexual self-concept. A questionnaire that evaluated the above variables was completed by 117 individuals with genital herpes, 82 individuals with HPV, and 75 individuals with no STI. The results demonstrated that having herpes or HPV had a significant negative impact on aspects of sexual self-concept. It does not appear that an individual's relationship status is a factor associated with the impact of having an STI on the sexual self-concept. Respondents who had disclosed their STI to their partners, however, had significantly more positive feelings about aspects of their sexual self-concept than those who had not disclosed their STI to their partners. The implications of these research findings for health practitioners are discussed.

The role of a self-report measure in athlete preparation

Athlete self-report measures (ASRM) are a common and cost-effective method of athlete monitoring. It is purported that ASRM be used to detect athletes at risk of overtraining, injury or illness, allowing intervention through training modification. However it is not known whether ASRM are actually being used for or are achieving these objectives in the applied sport setting. Therefore the aim of this study was to better understand how ASRM are being used in elite sports and their role in athletic preparation. Semi-structured interviews were conducted one-on-one with athletes, coaches and sports science and medicine staff (n=30) at a national sporting institute. Interview recordings were transcribed and analysed for emergent themes. Twelve day-to-day and seven longer-term practices were identified which contributed to a four-step process of ASRM use (record data, review data, contextualize, act). In addition to the purported uses, ASRM facilitated information disclosure and communication amongst athletes and staff and between staff, and improved the understanding and management of athlete preparation. These roles of ASRM are best achieved through engagement of athletes, coaches and support staff in the systematic, cyclic process.