Inclusion of Social Workers in End-of-Life Discussions in Intensive Care Units

Clinical social workers have roles in providing end-of-life care in the United States. Although clinical social workers are present in the intensive care unit (ICU) setting and have expertise to address end-of-life care dynamics, social workers are not consistently included in end-of-life discussions in the ICU setting. The purpose of this action research study was to explore the barriers that prevent clinical social workers from being included in end-of-life discussions in the ICU and how clinical social workers perceive their roles in end-of-life discussions in the adult ICU setting. Open-ended questions were used to gather data by facilitating 4 focus groups with 17 clinical social workers employed at a Florida hospital. This study was guided by complexity theory, which is concerned with complex systems and how systems can produce order while simultaneously creating unpredictable system behavior. A thematic analysis coding technique was used to analyze the data collected. Three themes emerged from data analysis: the ICU setting as chaotic, complex, and unpredictable; role ambiguity; and lack of confidence of social workers to perform expected roles in end-of-life discussions. The implications of this study for social work practice and social change relate to closing the gap between the patient, family members, social workers, and the medical team by developing protocols that consistently include social workers in end-of-life discussions, including education for the multidisciplinary team in the ICU on the skill set and role of clinical social workers in end-of-life discussions and formal training and education for clinical social workers regarding end-of-life care