A Virtue-care Approach to Spiritually Sensitive Social Work.

Sensitivity to the importance of spirituality in social work practice has grown over the past thirty years (Kvarfordt, Sheridan, and Taylor, 2017; Oxhandler & Pargament, 2014). Research suggests that social workers often consider spirituality as an expression of cultural diversity, if not inherent to being human (Barker, 2007; Kvarfordt et al., 2017; Lun & Wai, 2015). Depending on how spirituality is defined or experienced, spirituality can be a source of strength or exacerbate suffering, particularly when a client is in crisis (Callahan, 2017). Social workers must be prepared to engage in spiritually sensitive social work (Cunningham & de Saussure, 2019; Callahan, 2017; Dudley, 2016). Professional ethics provide an essential foundation (Hodge, 2005, 2006, 2016; Rice & McAuliffe, 2009; Sherr, Singletary, & Rogers, 2009; Sheridan, 2010). The National Association of Social Workers ([NASW], 2017) Code of Ethics outlines professional values, principles, and standards. Additional NASW (2015) guidelines inform cultural competence. While professional duties and anticipated consequences can inform spiritually sensitive social work (Osma & Landau, 2006; Congress, 2000; Abramson, 1996), virtue ethics and ethics of care lend important insights as well (Banks & Gallagher, 2009; Chamiec-Case, 2007, 2013). This workshop will review ethical guidelines that clarify how participants may address spirituality in social work practice. A virtue-care approach will be the primary focus with opportunities for participants to practice application through case scenarios

Relational spirituality: An opportunity for social work in long-term care.

Aim Sandage and Shults (2007) suggest that “all spirituality can be viewed as relational” (p. 263). Likewise, according to Heyse-Moore (1996), “we exist to relate to each other and if we do not our spirit dries up within us like a desert” (p. 307). Spirituality reflects our “innate human yearning for meaning through intra-, inter-, and transpersonal connectedness” (Belcher & Griffiths, 2005, p. 272). If spirituality is the experience of meaningful relationships, then it is important to understand what relationships are meaningful to clients. These relationships are particularly important in long-term care. Background Long-term care involves a network of relationships associated with the experience of congregant life. Relationships become a way to respond to life limiting illness. Relationships with other residents enable clients to feel they are not alone. Relationships with certified nursing assistants enable clients to bathe themselves, put clothes on, and brush their teeth. Relationships with nurses enable clients to take their medications and receive additional health care. Relationships with family and friends help clients feel connected to the outside world. Therefore, relationships can help clients survive and, in some cases, thrive. Method Based on the author’s experience as a clinical social worker, a composite case study is used to demonstrate how relationships informed nursing home life for “Sue” (Callahan 2017b). Sue had a number of significant micro, mezzo, and macro level relationships. The provision of social work required sensitivity to how these relationships enhanced Sue’s life. Social work intervention helped Sue maintain these relationships and create more meaningful relationships as her needs changed. Results The death of Sue’s husband led to an emergent need for privacy to grieve. Sue’s questions about an afterlife also necessitated a referral to Sue’s pastor. She was initially uncomfortable about joining group activities that led to new efforts to engage in self-care through prayer. Mobility issues seemed to exacerbate Sue’s anxiety which required extra effort to connect with staff to shower after the morning rush. Sue’s need for a wheelchair further impacted engagement with the natural world. Although Sue could not garden anymore, she could still enjoy watching the seasons change and sitting in the sun. Conclusion In the end, Sue faced life challenges and met emergent needs through meaningful relationships. Sue’s experience lends insight into the potential therapeutic power of relational spirituality. Social workers must be sensitive to the spiritual importance of relationships that give life meaning and engage clients in efforts to help them grow (Callahan, 2017a). Given that people are different, so is the way relationships inform life meaning. The type of social work intervention is further relative to professional expertise (Hodge, 2016); however, the need to convey spiritual sensitivity remains as long as there is social work to do. References Belcher, A., & Griffiths, M. (2005). The spiritual care perspectives and practices of hospice nurses. Journal of Hospice and Palliative Nursing, 7(5), 271-279. Callahan, A. M. (2017a). Spirituality and hospice social work. New York: Columbia University Press. Available at http://cup.columbia.edu/book/spirituality-and-hospice-social-work/9780231171731 Callahan, A. M. (2017b, February). Relational spirituality. Social Work Today Web Exclusive. Available at http://www.socialworktoday.com/archive/exc_0217.shtml Heyse-Moore, L. H. (1996). On spiritual pain in the dying. Mortality, 1(3), 297-315. Hodge, D. R. (2016). Spiritual competence: What it is, why it is necessary, and how to develop it. Journal of Ethnic & Cultural Diversity in Social Work, 1-16. DOI: 10.1080/15313204.2016.1228093 Sandage, S. J., & Shults, F. L. (2007). Relational spirituality and transformation: A relational integration model. Journal of Psychology and Christianity, 26(3), 261-269

Theories of Foucault and Agamben: the Issues of Borders and Sovereignty”

Michel Foucault and Giorgio Agamben have developed theoretical lenses for depicting how we should understand individuals in sovereign states, and the way in which these states interact with said individuals. Through an approach that assesses the framework of biology, race and ethnicity contribute to the notions of biopolitics and of ‘bare life,’ and exemplifies the constructs of how discrimination against the ‘other’ is embedded in western thought. These systematic processes are utilized through notions of biopower and the ‘state of exception’ as a means of maintaining hierarchical power structures. This paper will be assessing the role of the international in these processes of analysing borders, and humanitarian intervention in the promotion of western values. At the individual level, those who are classified under these ‘biopolitical’ or ‘bare life’ find themselves as victims of sovereign power; their existence is dependent on majoritarian and cultural feasibilities. Individuals are unpredictable, which makes them the target of norms and ideologies of the sovereign state, framing them as a threat and security risk to the western order

How Ethics Can Inform Spiritually Sensitive Social Work

Sensitivity to spirituality in social work practice has grown over the past thirty years; however, social work practitioners and educators express discomfort in addressing spirituality. This workshop provides an opportunity for participants to learn more about ethics-based practice models for the delivery of spiritually sensitive social work

Utilizing an Evidence-Based Treatment Program for Offenders with Mental Health Disorders to Demonstrate Interprofessional Social Work Practice

Sixty-four percent of jail offenders, 54% of state prisoners, and 45% of federal prisoners have a mental illness (Taylor, 2022). Mental illness increases the risk of recidivism. Individuals with mental illness have limited access to appropriate treatment. They are more likely to respond negatively to the prison environment. This can lead to infractions and solitary confinement. In addition, 51% of incarcerated individuals, whether they received mental health treatment or not, are likely to experience recidivism (Pflueger et al., 2015). The practice of interprofessional social work inside the American prison system is desperately needed. The following paper proposes an evidence-based treatment program that is coordinated by an interprofessional social worker. This includes an explanation of how interprofessional social work practice can be used to facilitate collaboration among diverse professionals for program effectiveness

Teaching students to be spiritually sensitive: Learning from a spirituality course evaluation.

Rationale The way educators address spirituality can create a sense of community or social isolation. This necessitates a spiritually sensitive approach that enables students to build spiritual competence. Spiritual competence reflects an understanding of how spirituality shapes human behavior, how spiritual diversity manifests and can lead to risk for discrimination, and how to communicate spiritual sensitivity in professional relationships (NASW, 2008, 2007). Research shows that educators have helped students explore themselves and others spiritually (Barker & Floersch, 2010; Johnston, Mamier, Bahjri, Anton, & Petersen; 2008), but more research is needed on how self-reflection informs spiritual competence (Hodge & Derezotes, 2008). Methodology This presentation examines the experiences of 37 undergraduate students in an online spirituality social work course. After course completion, students were asked to rate their assignments based on level of meaningfulness. “Meaningful course work” was defined as course work that had significance, value, or purpose. Survey respondents identified the most meaningful assignment as a self-reflection paper that required each student to develop a conceptual framework for spiritually competent practice. The authors independently analyzed each student self-reflection paper based on Braun and Clarke’s (2006) methodological approach to thematic analysis. The second author, who was not the course instructor, further consolidated the data to determine overarching themes described as the final results. Results A number of themes emerged with the most common being the importance of spiritual sensitivity in the building of spiritual competence. Every student described a number of personal and relational qualities as being characteristic of spiritual sensitivity. Students also reflected on how intrinsic spiritual awareness and their own spiritual well being had the potential to influence and be influenced by clients. Students emphasized the need for self-preparation including personal growth to internalize particular qualities to be spiritually sensitive such as being understanding, compassionate and accepting of different spiritual and religious views. The importance of spiritual diversity was another common theme reported by students. Students indicated that this course helped them realize that spirituality and religion could be experienced separately and could be experienced differently be each person. Although there were students who admitted discomfort with spiritual diversity, students expressed awareness of the need to overcome discomfort in order to help clients address spiritual concerns and reduce spiritual distress. Hence, client-centered quality, holistic care was believed to require sensitivity to client spirituality. The final theme was the importance of self-efficacy. Spiritual and religious concerns were said to be challenging to assess in others, primarily due to fear of risking offense. One way students said they gained confidence was to focus on being spiritually sensitive. For example, students often linked spiritual sensitivity to self-awareness; the more aware students were of their own thoughts and feelings related to spirituality and religion, the more confidence they said they had in their ability to address spirituality with clients. Students expressed a desire for education, observation, practice and supervision to continue building spiritual competence. Conclusions This course was designed to help students recognize how spiritual sensitivity can inform spiritual competence. More specifically, course activities were expected to help students reflect on their own spirituality and consider how they might best respond to the spirituality of others. The results suggest that students gained new insights about spirituality through meaningful coursework. The process of self-reflection heightened spiritual sensitivity, which demonstrates how spiritual competence begins. In this way, students began to recognize spirituality as an intrinsic, rather than an overlooked dimension of diversity. References Barker, S. L., & Floersch, J. E. (2010). Practitioners’ understandings of spirituality: Implications for social work education. Journal of Social Work Education, 46(3), 357-370. DOI: 10.5175/JSWE.2010.200900033 Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi:10.1191/1478088706qp063oa Hodge, D. R., & Derezotes, D. S. (2008). Postmodernism and spirituality: Some pedagogical implications for teaching content on spirituality. Journal of Social Work Education, 44(1), 103-123. Johnston, E. T., Mamier, I., Bahjri, K., Anton, T., & Petersen, F. (2008). Efficacy of a self-study programme to teach spiritual care. Journal of Clinical Nursing, 18, 1131-1140. DOI: 10.1111/j.1365-2702.2008.02526.x National Association of Social Workers. (2007). Indicators for the achievement of the NASW standards for cultural competence in social work practice [Brochure]. Retrieved from https://www.socialworkers.org/practice/standards/naswculturalstandardsindicators2006.pdf National Association of Social Workers. (2008). Code of ethics of the national association of social workers. Retrieved from https://www.socialworkers.org/pubs/code/code.as

Diaphragm weakness in mechanically ventilated critically ill patients

INTRODUCTION: Studies indicate that mechanically ventilated patients develop significant diaphragm muscle weakness, but the etiology of weakness and its clinical impact remain incompletely understood. We assessed diaphragm strength in mechanically ventilated medical ICU patients, correlated the development of diaphragm weakness with multiple clinical parameters, and examined the relationship between the level of diaphragm weakness and patient outcomes. METHODS: Transdiaphragmatic twitch pressure (PdiTw) in response to bilateral magnetic stimulation of the phrenic nerves was measured. Diaphragm weakness was correlated with the presence of infection, blood urea nitrogen, albumin, and glucose levels. The relationship of diaphragm strength to patient outcomes, including mortality and the duration of mechanical ventilation for successfully weaned patients, was also assessed. RESULTS: We found that infection is a major risk factor for diaphragm weakness in mechanically ventilated medical ICU patients. Outcomes for patients with severe diaphragm weakness (PdiTw \u3c10 \u3ecmH2O) were poor, with a markedly increased mortality (49%) compared to patients with PdiTw ≥10 cmH2O (7% mortality, P = 0.022). In addition, survivors with PdiTw(12.3 ± 1.7 days) than those with PdiTw ≥10 cmH2O (5.5 ± 2.0 days, P = 0.016). CONCLUSIONS: Infection is a major cause of severe diaphragm weakness in mechanically ventilated patients. Moreover, diaphragm weakness is an important determinant of poor outcomes in this patient population

Diaphragm weakness and mechanical ventilation – what\u27s the critical issue?

While animal studies indicate that controlled mechanical ventilation (MV) induces diaphragm weakness and myofiber atrophy, there are no data in humans that confirm MV per se produces diaphragm weakness. Whether or not diaphragm weakness results from MV, sepsis, corticosteroids, hyperglycemia, or a combination of these factors, however, is not the most important issue raised by the recent study from Hermans and colleagues. This study makes an important contribution by providing additional evidence that many critically ill patients have profound diaphragm weakness. If diaphragm weakness of this magnitude is present in most mechanically ventilated patients, a strong argument can be made that respiratory muscle weakness is a major contributor to respiratory failure

Hyperglycemia-Induced Diaphragm Weakness is Mediated by Oxidative Stress

INTRODUCTION: A major consequence of ICU-acquired weakness (ICUAW) is diaphragm weakness, which prolongs the duration of mechanical ventilation. Hyperglycemia (HG) is a risk factor for ICUAW. However, the mechanisms underlying HG-induced respiratory muscle weakness are not known. Excessive reactive oxygen species (ROS) injure multiple tissues during HG, but only one study suggests that excessive ROS generation may be linked to HG-induced diaphragm weakness. We hypothesized that HG-induced diaphragm dysfunction is mediated by excessive superoxide generation and that administration of a specific superoxide scavenger, polyethylene glycol superoxide dismutase (PEG-SOD), would ameliorate these effects. METHODS: HG was induced in rats using streptozotocin (60 mg/kg intravenously) and the following groups assessed at two weeks: controls, HG, HG + PEG-SOD (2,000U/kg/d intraperitoneally for seven days), and HG + denatured (dn)PEG-SOD (2000U/kg/d intraperitoneally for seven days). PEG-SOD and dnPEG-SOD were administered on day 8, we measured diaphragm specific force generation in muscle strips, force-pCa relationships in single permeabilized fibers, contractile protein content and indices of oxidative stress. RESULTS: HG reduced diaphragm specific force generation, altered single fiber force-pCa relationships, depleted troponin T, and increased oxidative stress. PEG-SOD prevented HG-induced reductions in diaphragm specific force generation (for example 80 Hz force was 26.4 ± 0.9, 15.4 ± 0.9, 24.0 ± 1.5 and 14.9 ± 0.9 N/cm2 for control, HG, HG + PEG-SOD, and HG + dnPEG-SOD groups, respectively, P \u3c0.001). PEG-SOD also restored HG-induced reductions in diaphragm single fiber force generation (for example, Fmax was 182.9 ± 1.8, 85.7 ± 2.0, 148.6 ± 2.4 and 90.9 ± 1.5 kPa in control, HG, HG + PEG-SOD, and HG + dnPEG-SOD groups, respectively, P \u3c0.001). HG-induced troponin T depletion, protein nitrotyrosine formation, and carbonyl modifications were largely prevented by PEG-SOD. CONCLUSIONS: HG-induced reductions in diaphragm force generation occur largely at the level of the contractile proteins, are associated with depletion of troponin T and increased indices of oxidative stress, findings not previously reported. Importantly, administration of PEG-SOD largely ablated these derangements, indicating that superoxide generation plays a major role in hyperglycemia-induced diaphragm dysfunction. This new mechanistic information could explain how HG alters diaphragm function during critical illness

Diaphragm weakness and mechanical ventilation - what's the critical issue?

While animal studies indicate that controlled mechanical ventilation (MV) induces diaphragm weakness and myofiber atrophy, there are no data in humans that confirm MV per se produces diaphragm weakness. Whether or not diaphragm weakness results from MV, sepsis, corticosteroids, hyperglycemia, or a combination of these factors, however, is not the most important issue raised by the recent study from Hermans and colleagues. This study makes an important contribution by providing additional evidence that many critically ill patients have profound diaphragm weakness. If diaphragm weakness of this magnitude is present in most mechanically ventilated patients, a strong argument can be made that respiratory muscle weakness is a major contributor to respiratory failure