TITLE: WORK EXPERIENCES OF MEDICAL SOCIAL

WORKERS IN A SARAWAK GENERAL HOSPITAL

BY:

MIKE HUDSON ANAK SANGU

A Mini Thesis Submitted in Partial Fulfillment of the

Requirement for Bachelor of Social Work Degree

Faculty of Social Sciences

University Malaysia Sarawak
2009
 DECLARATION

I, Mike Hudson anak Sangu (16636) hereby declare that this mini thesis is my own work

done under the guidance of Dr. Prashant Talwar. All the sources that I have used in this

work are quoted, and have been indicated and acknowledged by means of complete

references. This work has not been submitted before for any other degree at any other

university.

Mike Hudson anak Sangu (16636) Dr. Prashant Talwar, Ph.D

15 April 2009 Research Guide.
Lecturer in Faculty of Social Sciences
University Malaysia Sarawak
 ACKNOWLEDGEMENT

First and foremost, I want to say my thankful to the God because I have finally finished

my mini research after I struggled to make it success for almost four months. I am very

thankful as I can see the results of my effort now. I feel satisfied as I can finish it within

the period of time that had been given to me by my supervisor.

I also want to express my big appreciation to Dr. Prashant Talwar for all his guidance and

support to me in doing this mini research under his supervision for all this while; and also

not forgetting so much thank you and lots of love to both of my parents for their entire

support and guidance that always become my strength while I am studying in UNIMAS.

I also want to I also would like to thank to my friends that always help me in giving

support and advices for the whole semester. I hope this Academic Writing can give a

little bit of contribution in improving the function of the medical social work profession.

Finally, I want to thank both of my respondents who are very kind to spend their time in

order to give me information regarding this study.

Thank you.
 ABSTRACT

The medical social worker is the profession underpinning the social work profession. It

deals with the patients who come from the different cultural and ethnic background. The

roles of medical social worker in the hospital are important in part to the realization of the

psychosocial aspect of the patient. Aims of this research are to study the work

experiences of medical social worker in Sarawak General Hospital. The function and the

issue that faced by the medical social worker also had been study. This study was done

based on the work experiences of one male and one female medical social worker in

Sarawak General Hospital. The work experiences of medical social worker vary from the

setting of the hospital which it include the changing of environment in the hospital itself.

Based on the findings also, medical social work plays multiple role in helping the patient

to cope with their problem and illness. The role such as the discharge planner and

facilitate treatment are important in order to give a better services to the patients.
 INDEX

Page Number

DECLARATION i
ACKNOWLEDGEMENT ii
ABSTRACT iii

CHAPTER ONE : INTRODUCTION

1.1 Background of the study 1
1.2 What is Social Work? 2
1.3 What is Medical Social Work? 3
1.4 Statement of the Problem 4
1.5 Objective of the Study 5
1.6 Importance of the Study 6
1.7 Summary 7

CHAPTER TWO : REVIEW OF LITERATURE

2.1 Introduction 8
2.2 Social Work 8-11
2.3 Social Work and Health Care 11-13
2.4 Medical Social Work 13-14
2.5 Historical Development of Medical Social Work 15-16
2.6 The Role of Medical Social Work 16-18
2.7 The Work Experiences of Medical Social Work 18-19
2.8 Medical Social Work in Malaysia
2.8.1 History of Medical Social Work 19-20
2.8.2 Medical Social Work Unit, Sarawak General Hospital 20-21
2.9 Summary 21

CHAPTER THREE : RESEARCH METHODOLOGY

3.1 Introduction 22
3.2 Research Design of the Study 22-24
3.3 Scope of the Study 24
3.4 Sample Selection of the Study 25
3.5 Tools of Data Collection 25-26
3.6 Place of Data Collection 27
3.7 Data Analysis 27
3.8 Ethical Issue 27
3.8.1 Do No Harm 28
 3.8.2 Informed Consent and Voluntary Participation 29
3.8.3 Anonymity 29
3.8.4 Confidentiality 30
3.9 Limitation of the Study 30-31
3.10 Summary 31

CHAPTER FOUR : RESULT

4.1 Introduction 32
4.2 Monographic Profile of Respondent 32-33
4.3 Building Rapport 33-35
4.4 Experiences as Medical Social Worker 35-38
4.5 Function as Medical Social Worker 38
4.5.1 Facilitate Treatment 39
4.5.2 Discharge Planner 39-40
4.5.3 Request Material and Financial Assistance 40-41
4.6 Issue that Faced as a Medical Social Worker 41
4.6.1 Issue of Social Work Value and Personal Value 42
4.6.2 Issue of Authority 43
4.6.3 Work Overload 43-44
4.7 Summary 44

CHAPTER FIVE : DISCUSSIONS AND RECOMMENDATIONS

5.1 Introduction 45
5.2 Discussion 45-46
5.2.1 Medical Social Work – Challenging Profession 46-47
5.2.2 Medical Social Work – Profession of Many Faces 47-48
5.2.3 Medical Social Work – Issue in Practice 48-49
5.3 Recommendation 49-50
5.3.1 Recommendation on the Role of Medical Social Worker 50-51
5.3.2 Recommendation on the Social Work Value in Practice 51
5.3.3 Recommendation in Dealing with Work Overload 51-52
5.4 Summary 52

CHAPTER SIX : CONCLUSION 53-54

REFERENCES 55-58
 CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

We live in the challenging world as the introduction of new technology has

become advanced day by day. As people life together as a society, problem of

relationship and interaction with others emerged. The rapid changing in human life has

become the main issue related to the social problem such as poverty, drug and alcohol

abuse, crime and suicide, school dropouts and AIDS. Zastrow (1993:3) has stated that

“our rapidly changing society is a breeding ground for exacerbating former social ill and

creating new problems such as homeless people, higher crimes rate, recurring energy

crises, terrorism and the destruction of our environment”

When this problem become complex, there is a profession which are concern with

this issue which is social work. Social work is one of the professional profession that

dealing with human life. Social work has emerged as an important profession which it

has a professional knowledge and skills to promote changes into the society. Yet, social

work always associated with the connotation of “social work has many faces” which it

describe that social work profession work in different fields or practice areas with

multiple role. One of the fields or practice areas is in the health care area and social

workers who work in these fields are call as Medical Social Worker. Social worker who

works in the health care setting has an important role in helping patient in the hospital.
 Yet, health care and social work are sharing a same purpose which it concern with

the human being. This is stated by Butrym (1989:26) “health care and social work share a

concern for the wellbeing of individuals, families and social group”. In other words,

social worker not only working in term of social model but it also plays an important task

in the medical setting.

Further to this, medical social work share play an important role to give a service

to the patient in the hospital in generally. Medical social worker has emerged an

important profession in the health care setting where as it provide a medical and non-

medical services to the patient in the hospital. “Over the past twenty years, the demand

for medical social workers has grown exponentially, due in part to the realization that

both the medical and nonmedical needs of patients must be equally addressed and

treated” (Chechak, 2005:3).

1.2 What is Social Work?

Profession of social work become widely important in improve quality of life.

Yet, social work has the broader meaning. According to Skidmore et al (1991:6), social

work may be defined as “an art, a science, a profession that help people to solve personal,

group (especially family), and community problems ant to attain satisfying personal,

group and community relationship through social work practice”. In other words, social

work is part of the people life which it concern to help people to solve the problem.

In addition, social work concern to the individual or society needs to develop their

own potential in the social environment. It helps people to function in the best way in

their environment, deal with their relationships, and solve personal or society problems.
As stated by Pincus and Minahan (1973:9) “social work is concerned with the interaction

between people and their social environment which affect the ability of people to

accomplish their life tasks, alleviate distress, and realize their aspirations and values”.

Because social work concern to this problem, social work has to respond to the human

basic need which this basic need can improve human life. As a social worker, the

important is to identify human need because it is important this need meet what people

want in their life.

1.3 What is Medical Social Worker?

“Social work has many faces”. This is the connotation that always associates with

social work profession. Yet, one of the professions that embedded in the social work

practice is medical social worker. Medical social worker is one of the profession in social

work practice which the practice field or area are more focus in the hospital or health care

setting.

Medical social workers are present in public health, acute and chronic care

settings providing a range of services including health education, crisis intervention,

supportive counseling, and case management. In response to critical incidents that are

both global and national, health care social workers are increasingly trained to provide

interventions to prepare for and respond to traumatic events and disasters. (National

Association of Social Workers, 2005)

In addition, Medical social work is a profession which it main task are consist a

health care and hospital setting. “Medical social work as specific forms of social case

work that focuses on the relationship between disease and social maladjustment”.
(Gehlert, 2006:14) In generally, medical social worker profession shares all the purposes,

concepts and philosophy as well as values and principles of social work.

The unique of medical social work may be stated in terms of problem, setting and

process. It is concerned with the social need and problems related to the illness and

medical care. In addition, it is practiced in collaboration with other professional as an

integral part of multi-discipline services in the health care setting. Further to this, the two

important aspects in medical social worker is the collaboration or interdisciplinary team

and managed care. (Beder, 2006)

1.4 Statement of the Problem

Social work plays a multiple role in different field or practice areas. In the health

setting, social workers are call as medical social worker. They play an important role in

the hospital in helping patient cope with their situation. Yet, medical social worker deal

with different kind of patient with different types of illness.

In addition, medical social workers not solely work with the individual but also

work with family of the patient. They work in different setting of units such as paediatric

units, surgical and medical units, orthopaedics units, HIV/AIDS, and cardiology units.

They also need to work with other profession such as doctors, nurses, occupational

therapy or nutritionists in the medical multidisciplinary team.

Further, based on the researcher experiences in the fieldwork at Medical Social

Worker Unit Sarawak General Hospital, medical social worker at there are seem to play a

multiple task. In other word, medical social workers at there are not only deal with the

many cases in different units but also they need to work out with the different profession.
This sometime can make the task of the medical social worker become complexes which

there are some overlapping argument between the medical social worker and other

profession. Yet, this indirectly can affect the efficiency of the medical social worker role.

1.5 Objective of the Study

This study is about the work experiences of medical social worker in the Medical

Social Worker Unit at the Sarawak General Hospital. This include what are the issue that

medical social worker faced when their deal with the client. It also consists about the

feeling of the medical social worker regarding their professions. Yet, the objectives of

this study are included:

a) To study the function of medical social worker in the hospital.

b) To study the issues faced by the medical social worker related to their

profession.

c) To suggest method to improve the functions of a medical social worker.

1.6 Importance of the Study

Generally, these studies are about the work experiences of the medical social

worker. Throughout this study, it is hope that the researcher can know what are the task

that medical social worker do in the hospital. Further to this, it hopefully can make

researcher understand what the main task of the medical social worker are and know what

are the experiences of medical social worker when dealing with the client.

Besides that, this study also can show that on how medical social worker practices

the social work value and principle as their need to deal with the different cases every

day. Yet, this are depend on the medical social worker itself because the work
experiences that they faced in their task as medical social worker can give us a better

picture on how their practice the social work value and principle in dealing with the

client.

Apart from that, this study also important as it can give us a good example about

the main practice of the social worker in the hospital setting. As we know, social work

who work in the hospital setting are dealing with the different cases such as sexual abuse

cases, domestic violence and also deal with the patient who are need of the psychosocial

support from the medical social worker. Thus, from this study, it can help the researcher

as well as the society to have a better understanding about the main task of the medical

social worker. This indirectly can give us an information about what are the cases that

been refer to the Medical Social Worker Unit.

Thus far, these studies are important to the society especially to the future medical

social worker as it can give an earlier exposure to them about the medical social worker

in term of the task, knowledge, and the most important is the experiences of the social

worker who are work in the hospital setting.

1.7 Summary

This study is about work experiences of medical social worker in the Medical

Social Worker Unit at Sarawak General Hospital. This study will include the experiences

of the medical social worker in dealing with the client. Yet, the problem statement lead

the purpose of this research which to study the function of medical social worker in

hospital and what are the issue that faced by them related to their profession.
 CHAPTER TWO

REVIEW OF LITERATURE

2.1 Introduction

This chapter will discuss about the concept of social work in general. Social work

and the health care setting also will be discussed in this chapter. It also discuss about the

history of the medical social work as well as history in Malaysia. In addition, this chapter

also will discuss about the role of medical social work in general and also in the Malaysia

context.

2.2 Social Work

Social work profession have emerged as an important profession. The social work

profession are important profession same as the other profession such as doctor,

engineering or teacher. It concern with the nature of human life and try to help those who

are need a help. Social work is the professional way in helping individual or society

overcome society problem. Yet, National Association of Social Workers (NASW) (in

Zastrow, 1992:6) has defined social work as “the professional activity of helping

individual, groups, or communities to enhance or restore their capacity for social

functioning and to create societal conditions favourable to their goals”

As mentioned by Ginsberg (2001:3) which stated that “social work is unique in

the helping or human service profession, which include many fields that are sometimes

more familiar to the general public than social work”. In the other word, social work is

the professions that help people in the professional way. Therefore, it is one of the

practices who are desired in helping people to solve their problem. Social work helps
people through their own professional practice which is guiding them to dealing with

many kind of human. Thus, social work is working with different people with the

different background.

In addition, Sayed A. Rahman Sayed Mohd (2005) has mentioned that the

profession of social work is one of the professions that promote social change, problem

solving in human relationships and the empowerment and liberation of people to enhance

well-being and standard of living. He added that social works intervenes at the points

where people interact with their environments by utilizing theories of human behaviour

and social systems. This is stated by Pincus & Minahan (1973:9) which is stated that,

“social work is concerned with the interaction between people and their social

environment which affect the ability of people to accomplish their life tasks, alleviate

distress, and realize their aspirations and values”. Because social work concern to this

problem, social work has to respond to the human basic need which this basic need can

improve human life.

Social work concern to the individual or society needs to develop their own

potential in the social environment. It helps people to function in the best way in their

environment, deal with their relationships, and solve personal or society problems. In

addition, social worker is the professions that are concerned with social problems, what

are their causes, what are their solutions and what is the impact of this to the individual or

society.

Thus far, social work dealing with many people such as with children, women,

men, elderly or either with disabled people. In other words, social work performs many

different tasks and carries out different activities with different people. In addition, social
worker has a broad and diverse set of roles and responsibilities. They work with people

throughout their life cycles. Their field of practice embraces health, mental health,

community development, criminal justice, school systems, family planning, labor

welfare, and employee assistance.

In carrying out these different task and activities, social work is guided by a body

of knowledge and an array of skills when working with this people from the different

cultures and ethnic background. Taking into this account, the knowledge and skills are

essential in the social work practice because it provide social worker with many way of

solving process when dealing with people.

According to Morales and Sheafor (1992:178) knowledge is “acquaintance with

or theoretical or practical understanding of some branch of science, art, learning, or other

area involving study, research, or practice and the acquisition of skills”. There are many

knowledge that social worker which is has gain from their own practice.

As a social worker, knowledge has the important tools when dealing with people.

This knowledge is consisting of theories such as sociology, psychology, economic and

politic. For example, when dealing with an older people who are over 60 years old, there

is a need of specific knowledge such as biology and psychology which it can provide

knowledge about the physical aging process. This will help the social worker in

understanding the need of elderly people. As Johnson (1992:37) stated that:

“Social work knowledge, particularly the foundation

knowledge used for understanding, is largely borrowed from
the social sciences, particularly psychology and sociology,
though anthropology, political science, economic, and history
as well as the natural science of biology and physiology
contribute as well”.
 Thus, social worker is the profession that is oriented to the social and

environmental, as well as individual which is the main task is change and improve the

quality of society life. Social workers are uniquely trained to help human to maximize the

opportunity for change in themselves and their situations. It has a wide variety of

knowledge and skills in order to working with people. Social work also has a value

principle to guiding them to work in better way as their main purpose is to help

individual, family, society and community to achieve their on social functioning capacity.

2.3 Social Work and Health Care

The constant growth, demands, and changes in health care have had a serious

impact on the viability and need for social workers in all areas and settings of health care.

(Guo & Company, 2007). Yet, social workers have been involved in the health care field

since the turn of the 20th century which in the earlier of the involvement in the health care

setting is it concerns much more on the making health care services for the poor and

improving social conditions that bred infectious diseases such as tuberculosis. (National

Association of Social Worker, 2005). As the social work role expanded, social workers

joined other health professions in the delivery of high quality services.

Further to this, the demand for social workers in the health care setting has

increased for the past twenty years. (Chechak, 2005). This is because the increases of

awareness that both the medical and nonmedical needs of patients must be equally

addressed and treated. There are several nonmedical needs that are often overlooked

which must be assessed. For example, it is the responsibility of the social worker, not the

physician or the doctor, to ensure that a patient capable to cope with his or her condition

and perform a full potential after been discharged from the hospital. As Beder (2006:11)
stated that “the central goal of discharged planning is for the social worker to fully

address the highly individualized needs of each patient and provide safeguards at home

for his or her care”.

Yet, social worker in the health care setting has played vital responsibilities in

reconstructing the health care system. Further to this, a few studies has been done which

show the social worker has given a contributing to the health care system. In Canada,

Globerman et al (2002) has conducted a study with the senior social worker in twelve

hospitals in the Ontario. They have found that all the twelve were in transition which is

moving from the traditional bureaucratic functional structures that included social wok

department to program management model.

In addition, the same study also has done in the United States. This study has

done by Berger et al (1996) which they has explored 340 hospital in the United States.

Berger and colleagues has examined the trend of health care reconstructing for the period

1992 to 1994. In their study, they have found that organizational structures were

changing from centralized bureaucratic structures to decentralized integrated delivery

system.

Thus far, the needs of the social work in the health care setting are very important.

Social worker plays an important role in the hospital to help people adapt to major life

event. It also concern for individuals reaching human potential at the optimum level.

Social work in the health cares also being concern for the social justice of the people and

they try to alleviate poverty through the delivery of equitable health services.
2.4 Medical Social Work

As in earlier chapter, the researcher has discussed a little about the medical social

worker. Yet, this study is focus about the work experiences of medical social worker. In

this discussion, the researcher will try to give a general picture about the medical social

work.

Generally, the medical social worker profession shares a same concept and

knowledge like social work profession. It concern with the human life as it try to help to

solve the problem by working together with people. Chack-Kie Wong et al (2000:495)

“the strange thing about medical social work is that it is an extension of medicine to the

practice of social work as well as an extension of social work to the practice of medicine”

Medical social work is an important profession for both social welfare and health care

systems, and this position has been justified in hospitals, mental health facilities, and

rehabilitation centres. (Chechak, 2005)

In addition, the task of medical social work involves the application of social

work values, purpose, knowledge and methods to the characteristics of the medical field

which include the various sets of values in relation to health and illness, and to sick

people, which exist in society. Furthermore, it involves the use of medical and other

relevant knowledge which is brought to bear on recovery treatment and the prevention of

illness and it entails the various services, institutions and professions which make up the

framework within which health is promoted and illness fought. (EvaYee-WahLiu, 1994)

The medical social work service is an essential and integral part of the on-line

hospital service delivery. By virtue of working in a multi-disciplinary team, the mission

of the medical social work service is to cooperate and collaborate with other professions,
such as medical, nursing and allied health professions, to provide total care for the whole

person. It can be stated that the medical social work are not concern with the illness but it

also concern for the social and emotional need of the people. Here, the inter-collaboration

or multidisciplinary team are important aspect in the medical social work practice.

In short, the purposes of medical social work practice in a health care setting are,

first, to recognise the social, psychological, economic, cultural and environmental

conditions which contribute to the aetiology of disease and the process of recovery; and

second, to assist the patient and his or her family to integrate the illness and its treatment

into their personal lives, in an effort to enhance the quality of life. (EvaYee-WahLiu,

1994)

2.5 Historical Development of Medical Social Work

Medical social work can be traced back to the mid-1800s, when social workers

entered the hospital setting with many intentions and tasks. (Chechak, 2005). In the first

beginning, forerunner of the contemporary hospital was the almshouse which served for

the poor, ill person, orphans, and mentally health. This is due to the huge number of

person immigrating to the United States. (Gehlert, 2006). Medical care was only

considered to be supplementary. During this time, medical social workers were formerly

known as almoners, which it bearing the charitable concept of the almshouse. (Gehlert,

2006)

Yet, the original concept of the medical social service was introduced in England.

Several doctors and medical personnel first recognized the importance of not just treating

patients physically or psychologically but also taking care of patients social needs.

Tuberculosis, syphilis, polio and pregnancies of unmarried women were the condition
that related to the health. All this required the need of the person to taking care of the

social need because both tuberculosis and syphilis need a long hospitalization and

aftercare need. (Beder, 2006)

Traditionally, in London, social work in the health care are known as hospital

almoner which is been introduced in the Royal Free Hospital in London in 1895.

(Gehlert, 2006). This occurred when the Royal Free Hospital came together with the

Charity Organization Society. It started in 1875, when the secretary of the London

Charity Organization Society, Charles Loch, collaborated with medical practitioners to

receive referrals from medical doctors for the purpose of investigating patient‟s financial

conditions. (Dziegielewski, 1998). Yet, the first social almoner in this hospital is Mary

Stewarts who was being hired in 1895. “She was stationed at its entrance because her

principal function at the hospital was to reviews applications for admission to the

hospital‟s dispensary and accept those who deemed suitable for care” (Gehlert, 2006:7)

In United Stated, social work in the health care began at the Massachusetts

General Hospital (MGH) in the early 1900s. During this time, the physician has realized

that the living condition and personal problem of patient were a factor in their illness and

recovery. (Beder, 2006). Here, the work of Dr. Richard Cabot, chief of medicine in MGH

has contributed to the establishment of social work in hospital. In 1905, Dr. Cabot has

appoint Garnet Pelton, a nurse to fulfil the first hospital social work and she was been

replaced by Ida Cannon in 1906. (Beder, 2006).

2.6 The Role of Medical Social Work

Medical social work plays many roles in the health care setting. It can be stated

that the role of medical social work are same like the role of the social work but the what

distinguished both of this profession is in term of its setting. Davis et al (2004:346) has

stated that “social workers perform many different functions in a hospital, such as

psychosocial assessment, education, discharge planning, advocacy, counseling, case

conferencing, crisis intervention and community outreach”

The role of social worker are essential in the health care setting as stated by

Browne (2006:27) “health is critical practice area for all social workers, both clinically

and on the macro level and social workers play an important role in each of these care

setting”. There are various roles that medical social work plays in the hospital or health

care setting.

The role of medical social worker is to provide an information and education for

the patient as well as their families. Medical social workers provide information and

education regarding community resources and options available to meet identified needs

of patients and families. Apart from that, medical social workers also facilitate referrals

to community agencies to ensure patient access to appropriate resources and continuity of

care across levels of care. Gadalla (2007:189) has stated that “Social worker can also

promote the exchange of information…such information can be the main focus of

educational intervention…”

Another important role of medical social work is as the discharge planners.

(Beder, 2006). Discharge planners are the central task of the medical social work because

it is the foundation of the medical social worker task. Hammer & Kerson (1997:239) has
stated that “social worker skills, value and resources make them able to act as discharge

planners because they advocate for clients, understand policy constraints and

organizational ethic, ensure continuity of care through relationship building and

community resources”

In coordination and consultation with the patient, family, physician, nursing staff

and other health care professionals, the medical social worker helps to identify patient

needs for continued care and recovery and helps the patient and family develop strategies

to meet the patient‟s ongoing needs.

Apart from that, medical social workers provide assessment of the patient and

family, as to the patient‟s illness, physical or cognitive functioning, mood, needs,

education, and occupational experiences, mental health history, and other relevant

information. The purpose of this assessment is to assist in the development of the

patient‟s treatment and discharge plans in concert with the physician, nursing staff and

other health care team members involved with the patient. (Davis et al, 2004)

Individual, family, and group counselling also one of the roles of medical social

worker which the aim is enhancing cognitive, emotional, interpersonal and social

functioning. Counselling may be focused toward increasing a patient and family

understands of an illness, treatment and the impact on self and family. Here, an

intervention by doing counselling is essential to help and encourage a patient or family in

adjusting to illness, disability and hospitalization in order to maximize potential of patient

in term of physical, psychological and social. Besides that, grief and loss counselling, and

support groups are also offered by the medical social worker.

2.7 The Work Experiences of Medical Social Work

As in the discussion earlier, medical social work plays various roles in their

practice. This multiple role has developed different experiences to the medical social

worker in dealing with the client. The experiences of medical social worker are varying

from time to time, individual to individual and the changes of the environment.

In the study that was done by Gearing et al. (2007) during the outbreak of SARS,

the environment has changes the medical social worker situation. They have found that

medical social worker experiences the impact of SARS and the infectious control

procedures in both their professional and personal roles.

The experiences of medical social worker also had been varying from century to

century. This is due to the changing system of hospital setting. (Globerman et al, 2002).

The changing in the system which include the changes in policy system and the change of

management in the department has influence the role and the function of medical social

worker.

Thus far, the medical social workers look at the person-in-environment, including

all of the factors that influence the total health care experience. Medical social workers

practice at the macro and micro level of health care and thus have the ability to influence

policy change and development at local, state, and federal levels and within systems of

care. Yet, social work research in health care benefits not only individuals and families,

but also the very existence, effectiveness, and validation of the profession. (National

Association of Social Workers, 2005).

2.8 Medical Social Work In Malaysia

2.8.1 The History of Medical Social Work

The social works profession has existed in this country for more than six decades.

(Sayed A. Rahman Sayed Mohd, 2005). Even though there are rarely discussions about

the emergence of medical social worker services in Malaysia, but the emergence of

medical social worker due to the war in the early 19th century. Yet, Medical social worker

in Malaysia was started during the early 19th century and was following the chaos of the

postwar year. The disease such as tuberculosis has speared and the need of the social

worker in the hospital was needed. (Ashencaen Crabtree, 2005)

The emergence of medical social worker services within the health system in

Malaysia has become important as the patient and family need both of medical and non-

medical assistant. By 1952, medical social workers were established in the larger hospital

where the first of the medical social worker services is in the Ipoh General Hospital.

(Sayed A. Rahman Sayed Mohd, 2005). After that, there are nine posts of medical social

worker which is in Penang, Alor Star, Taiping, Ipoh, Batu Gajah, Malacca, Johor Bharu

and 2 posts in the Kuala Lumpur.

In 1964, the first Medical Social Work Unit was formed in the Kuala Lumpur

Hospital. The local medical social worker mainly trained in Singapore in order to have

an adequate skills and knowledge. There were eight positions for medical social worker

in the beginning. Yet, the establishment of medical social worker post in government

hospital has increases. (Ashencaen Crabtree, 2005)

2.8.2 Medical Social Work Unit, Sarawak General Hospital

 Before, Medical Social Worker Unit in Sarawak General Hospital has known as

the Community Department which has been introduced in 1 January 1960. During that

time, the Medical Social Worker Unit has been managed by the outside officer which

known as expatriates until 1965. (Medical Social Work Unit Annual Report, 2007)

To date, the Medical Social Worker Unit consists of six medical social worker

officer which each of this officer has been specialised in the area of health setting. These

areas are including Obstetrics and Gynaecology, Paediatric, Orthopaedics, Medical and

Surgical, Psychiatric and geriatric services. The vision of this unit is to establish of the

social department which can provide a services for the patient and community in general.

2.9 Summary

This chapter has provided an overview regarding the medical social work

profession. The histories of medical social worker itself give brief information about the

emergent of medical social work profession. However, the researchers have his own

argument about the medical social work in Malaysia. Yet, the researcher has an opinion

where as there is a little research regarding the medical social work experiences in

Malaysia.

But yet, this literature review has provided helpful information and guidelines on

how to investigate or conduct a research on the related topic. It has pointed out useful

insights for the researcher to study the work experiences of medical social worker in the

Sarawak General Hospital. This will be discussed further in the following chapter.
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

This chapter discuss on how this study will be conduct. It will discuss about the

research design of the study, scope of study, sample selection of the study, tool of data

collection, place of data collection, data analysis, ethical issue and limitation of study.

Yet, this study is focus on the work experiences of the medical social worker at the

Medical Social Worker Unit, Sarawak General Hospital.

3.2 Research Design of the Study

Research design is a type of research that being used by the researcher on his or

her study to explain about the study of he or she want to design. In other words, it is the

ways being using by researcher to gets data or information from the respondent. Type of

research design must be suitable for the study in order to have a valid and reliable

finding.

The research design of this study is qualitative research. Qualitative research is

described by Merriam (1998:5) as “an umbrella concept covering several forms of

inquiry that help us understand and explain the meaning of social phenomena with little

disruption of the natural setting as possible.” Hancock (1998:2) also noted that

“qualitative research is concerned with developing explanations of social phenomena”.

The researcher use the qualitative research in this study because it suitable to gain the

data from the respondent.

 Besides that, these studies also use exploratory research because researcher would

ask a client opinion regarding this issue. According to Marlow (1993:24), “exploratory

research often determines study feasibility and raises questions to be investigated by

more extensive studies…it allows to add richness and depth to your investigation,

elements that may not be possible with some of the other strategies.” It is also important

to use exploratory questions because it helps the researcher gain more in-depth

information regarding the issue that arises from the respondent. In additions, it is useful

for the researcher to make an assessment and exploring more about the respondent

experiences as a medical social worker.

In addition, this is the case study of the medical social worker. Case studies have

been used in this research. According to McNamara (2008), case studies are particularly

useful in depicting a holistic portrayal of a client‟s experiences and results regarding a

program. Case studies are used to organize a wide range of information about a case and

then analyze the content by seeking patterns and themes in the data and by further

analysis through cross comparison with other cases. In addition, Rubin and Babbie (2005)

explain case study “is an idiographic examination of a single individual, family, group,

organization and society. It purpose is description, although attempts at explanation are

acceptable”.

To avoid any biased influences in the data collection, all data collected were

verified by participants of this study after the field notes were being transcribed. All the

data sources which were collected from the interviews were being analyzed. All the

emerging themes or issues of the different sources of data that appeared in more than two

sources were studied by researcher to examine its validity

3.3 Scope of the Study

As in the discussion earlier, social worker work in different field or area and one

of the area is in the health care setting. Social workers who work in the health care setting

are generally known as medical social worker. Medical social worker plays an important

role in the hospital as they provide services to the in-patient and out-patient of the

hospital.

Yet, in this study, it focuses on the medical social worker who works in the

Medical Social Worker Unit at Sarawak General Hospital. Researcher has an experiences

work with the medical social worker at Sarawak General Hospital during the fieldwork

placement and because of this researcher has develop an interest in doing this study. In

this study, researcher emphasizes on the experiences of the medical social worker, their

role as a social worker at the hospital and the issue that their faced in related to their

profession.

3.4 Sample Selection of the Study

The respondent of this study is mainly medical social worker who works in the

Medical Social Worker Unit at Sarawak General Hospital. There are six medical social

workers at Sarawak General Hospital but the researcher only select two of them which

consists one male and one female medical social worker.

Researcher only interviewed one male and one female medical social worker to

gain a different experience from the different gender and also to prevent bias in this

study. Nelson (2000) in Cournoyer & Klien (2000:27) commented that “Without any
additional information, we are not able to say that such inclusion operates to the benefit

or detriment of female client…” and that male participant also can give benefit

information as “…the quality of interventions, many of which are with women, we face

the likelihood of less effective practice and unethical insensitivity…” So, it is important

to balance between male and female participant so that researcher will get informative

information from both gender.

3.5 Tools of Data Collection

Tool of collection refers to method used in collecting data from respondent. In

this study, in-depth interviewing is used to understanding respondent perspectives

through their own lives experiences and encourages expressing their own words. In

depth-interview used in the qualitative research where the interviewer establishes a

general direction for the conversation and pursues specific topics raised by respondent

(Rubin & Babbie, 2005).

Yet, Merriam (1998:72) stated that interviewing is essential “when we cannot

observe behaviour, feelings, or how people interpret the world around them.” She noted

that interview is also important in gathering information of past events that are

impossible to repeat. In depth interviewing also have a potential to yield valuable insights

into people‟s life experiences, attitudes, opinions and aspirations.

Researcher use in-depth interviews in this study to gain the data and information

from the respondent regarding their own experiences as a medical social worker in the

Sarawak General Hospital. The data gathered through the interview are include

information on the experiences as the medical social worker, roles of the medical social
worker in the hospital setting, the problem faced in related to their profession and their

own opinion on how to improve their function as a medical social worker.

Before the interview, it is important for the researcher to build rapport with the

respondent. Further to this, building rapport with respondent is important to gain trust and

acceptance for respondent. Researcher interviewed respondent in person and by face-to-

face to make sure that building rapport can be practiced and in addition it is easier for

researcher to collecting primer data from the respondent itself.

3.6 Place of Data Collection

The place that researcher collect the data regarding this study is in the Medical

Social Worker Unit at the Sarawak General Hospital. The researchers choose this

Medical Social Worker Unit as a place to collect data because researcher has an

experience working at this unit during the fieldwork placement and researcher also know

the respondent.

3.7 Data Analysis

Data analysis in qualitative studies is an ongoing process. The data analysis was

done manually by comparing and matching the findings from different data sources.

Findings are generated and systematically built in the process of gathering data. The

researcher begins analyzing the data in the early part of the research process. In other

words, data analyzing process begin while the researcher is in the process of collecting

the data. Through the interview, researcher could collect number of relevant data from
the views of respondents. This method enables researcher to interpret the various view of

the respondents as they are free to express their perceptions on this problem.

3.8 Ethical Issues

Ethic in doing research is very important for the researcher as well as social

worker. Marlow (1993) stated that social workers need to be acknowledgeable about

research for ethical reasons. We must be accountable for our practice. Social workers are

ethically responsible for providing the best possible services to the clients. In researcher

opinion, it is essential for any professional to be ethical and this includes social worker in

order to promote the rights of every human being.

3.8.1 Do No Harm

The researcher make sure that the interview process is not harm during the

interview sessions in terms of physical or mentally. The respondent might be tired during

the interview session as the respondents also need to deal with their own job. The

question that may asks by the researcher also sometime can make the respondent feel

uncomfortable because it might raise some sensitive issue related to their experience. Yet,

the researcher must be aware of this issue by ask relevant question to the respondent

without make any harm to the respondent.

Besides, any reports and publication of data revealed would be anonymous so it

won‟t harm the respondent. The researcher needs to be aware that this study is only for

the academic purpose. Yet, the main purpose of this ethics is to make sure that the

respondent is not harm during or after the study.

3.8.2 Informed Consent and Voluntary Participation

Informed consent is one of the important ethics in doing research. Cournoyer &

Klien (2000) said that it is important to seek information from the participation of the

research or studies. They said that informed consent involves “…securing a research

subject‟s consent to participate in the research, after he or she has been informed with

respect to the nature of participation.” (2000:27). It is important that the participant give

their full support to ensure that every research that we made can give positive findings.

The respondent is explained about the purpose of the study, and how the data is

obtained. This is to secure the respondent consent to participate in the research only after

the respondent had been informed with respect to the nature of the participation.

Therefore, the respondent could withdraw at any time during interview period without

any penalty. Also, the information provided by respondent will be held in confidences

and the risks and benefits of the participation of respondent are completely disclosed.

3.8.3 Anonymity

Anonymity is one of the ethics that become an issue for this study. “Anonymity

means that the researcher cannot identify a given response with a given respondent”

(Marlow; 1992: 94). This is very important to prevent harm to the respondent. In this

study, the name of the respondent cannot be identified and researcher changes the name

to the other name to maintain the anonymity.

3.8.4 Confidentiality

Researchers have a responsibility to report their findings and they cannot do so if

the data of their finding are confidentiality. Thus, what researchers can do is to ensure

that researcher does not disclose identifiable information about participants and to try to

protect the identity of research participants through various processes designed to

anonyms them. (Wiles et al, 2006)

Only the agreed information that is mutually agreed between the researcher and

respondent is showed in the study. Even though it lessens the quality of the study, but

ethics of researching must be emphasizing at all stages of research in order to protect

respondent confidentiality from any circumstances.

3.9 Limitation of the Study

These study is qualitative study where as it have its own limitation. Data of this

study is only relying on the interview between the researcher and the respondent. So, the

information regarding this study is limited and cannot represent as the whole population.

There also might be some bias in doing the interview.

Time constraint also one of the limitation of this study. The respondent only can

be interviewing during the week days or only when the respondent on the lunch time.

This is because the respondents are work only during the week days. Researchers also

have a limited time to do interview because of other commitment such as going for class.

This is a small-scale research project thus does not have enough time and resources to

conduct intensive study. Yet, this will be overcome through pre-planned research, where
the researcher should know to divide the time properly and also efficiently so that it could

be followed accordingly.

3.10 Summary

Methodology is very important as a part of this writing. The methodology

determines the goal and objectives of this study. Yet, the design of this study is found to

be appropriate for the study. Data collected from the interviews were able to provide

findings for this study. Being a qualitative study, the researcher had to be well organized

and disciplined in contacting and following up with participants, transcribing data and

ensured that all the data are being audited. The data analysis was tedious. It required

focus and understanding of the issues to accurately analyse the data collected with

category construction and triangulation.

The discussions of the findings required skills to synergise the results of data

collected with reviews of this study and current issues that are related to the medical

social workers experiences. The researcher is thankful to have an experienced supervisor

to critique his work at every stage of the research. The careful auditing of this study by

the supervisor who is an expert in research and knowledgeable of the issues in this study

has helped to strengthen credibility and authenticity of this study.

 CHAPTER FOUR

RESULT

4.1 Introduction

The data collected in this study has provided an overview about the experiences

of the medical social worker in the Sarawak General Hospital. Both male and female

medial social worker has contributes a useful information regarding this study. This

chapter reports the findings and analysis of the data that have been transcribed and

validated by the respondents.

The researcher managed to interview two times with the respondent in Sarawak

General Hospital. As some sensitive issues were discussed with the respondent, the

researcher tried making respondent as comfortable as possible in the discussions. As to

enhance the communication between the researcher and respondent, researcher calls the

respondent first in order to make an appointment. This is a study that highlighted an

experience of medical social worker in Sarawak General Hospital.

4.2 Monographic Profile of Respondent

The respondent of this study consist of one male and one female medical social

worker. The male medical social worker, Mr. Ahmad (not a real name) is a Malay man

and he was from the Peninsular Malaysia. He has experiences in the social work field for

16 years. He works as a medical social worker in the Sarawak General Hospital since 4

years ago. He has been works in the different hospital in Malaysia before he was been

post to the Sarawak General Hospital. Mr. Ahmad has a degree in social work. Mr.

Ahmad has a lot of experiences working with different client with the different cases. In
the Sarawak General Hospital, Mr. Ahmad more deals with the cases which refer by the

paediatric ward. Paediatric is the areas which deal with the children.

Meanwhile, the female medical social worker, Mdm Nadia (not a real name) is an

Iban1 who has converted into Islam. She has been work as a medical social worker for 10

years and has a lot of experiences working in different hospital in Malaysia. She works in

Sarawak General Hospital since 3 years ago. Even though Mdm. Nadia has a degree

holder in human development but she has a lot of experiences in dealing with different

cases. She has deal with the cases such as child abuse cases and domestic violence cases.

In Sarawak General Hospital, Mdm. Nadia deals with the unmarried mother cases which

refer by the maternity ward.

4.3 Building Rapport

Building rapport is most essential part in doing an interview with the respondent.

The main objectives during the first meeting with the respondent are to build rapport.

Even though researcher has an experiences working with the respondent during the

fieldwork placement but building rapport are important because this study might reveal

some issue that are confidential

Here, researcher had use communication skill for making the both the researcher

and respondent to trust each other. Communication skills consist of non-verbal and verbal

where both played part in enhancing the communication level between both of the party.

Researcher and respondent will be more comfortable in building the relationship with

each other.

1
Iban is one of the ethnic groups in Sarawak.
 Even though non-verbal communication is very important, verbal also plays a part

in enhancing the communication level as well as building trust and understanding of both

parties. Besides, communication is also to help respondent to express their problem and

researcher could use communication in understand the condition or situation that the

respondent is currently in.

Therefore, a good communication skill is in need in order to obtain valuable

information about respondents even though it is only the first meeting. If problem in

communication had existed, it could confused and miscommunication could be

happening, therefore, research would make sure that clear statements and understandable

language is used during the interview sessions.

Thus, building rapport is important to researcher in order to gain useful

information from the respondent. Building rapport can help the researcher to gain a trust

from the respondent. Here, communication skills are the essential skill for the researcher

to build rapport with the respondent. Communication skills are involve verbal and non-

verbal communication which it can enhance the level of communication between the

researcher and respondent.

4.4 Experiences as Medical Social Worker

Medical social worker is a part of the health team in the hospital. They work with

the different cases which involve the medical and non-medical aspect. They have a

different experience as they working with the different ward or department in the

hospital.

“Since I work here, I faced with many patients, with many different
cases. They come with many kind of problem such as financial
 problem where they cannot pay the hospital bill. Here, I can say that a
task as a medical social worker is challenge whereas we need to deal
with people ... I also had seen patients who were dying, families with
elderly relatives needing placement, one man needing cardiac
rehabilitation, and finally I facilitated a meeting in the Intensive Care
Unit (ICU).” (Mr. Ahmad)

Mdm. Nadia also has different experiences since she start to work in Sarawak

General hospital. She mentioned that the important aspect to become a medical social

work is the emotional aspect. She said that:

“To become a medical social worker, we need to make sure that our
self is ready especially in term of emotional...this is because we deal
with the people who come from the different background of race, come
from different illness and problem” (Mdm. Nadia)

In the Mr. Ahmad experiences as a medical social worker in Sarawak General

Hospital, his client is from the paediatric ward. He explains that in the paediatric ward,

the patients are the children who are suffer with the different illness such as cancer and

heart disease. The paediatric ward according to him is one of the important ward in the

Sarawak General Hospital which this ward need more professional medical team. He

further explains that:

“The most profound professional experiences take place here. Patient

form the paediatric ward are the children who I most concern with
because children is one of the minority group and some of them do not
know what actually happened to them. I can say that this is the centre
of human “drama” and I am a part of that experience for the child
and parent” (Mr. Ahmad)

As a paediatric medical social work, Mr. Ahmad has deal with many cases with

involves with many client or patient. He has to apply the skills and knowledge in social

work to deal with the client. Skills such as communication and counselling skills are
important when dealing with the children and the parents. In addition, Gearing et al

(2007) mentioned that communication pattern change when the environments of the

hospital change. Human anatomy and epidemiology of the disease is one of the

knowledge that an important for the medical social worker in dealing with the patient.

These further explain by Mdm. Nadia:

“I also have been with the children before I come here...At the
paediatric ward, I think the most important when working with the
children is we must know about the disease as well as the causes and
the effect of the disease. We also need to have a good communication
because we not only work with the children but we also work with the
parent. In my experiences, I deal with the parent who are come from
the rural area...they do not know so much about the illness that their
son have and I need to explain to them with the simple word” (Mdm.
Nadia)

Social work in the health care setting has different experiences with other social

worker in other setting. This is because the sizes of clientele are consisting of the in-

patient and out-patient of the hospital. The in-patient are the client who are get the

treatment from the hospital and they come to medical social worker to ask some help in

term of the financial assistant and for the discharge of the patient. Out-patient is the

patients who are have a follow-up treatment from the hospital after they have been

discharge. According to Mr. Ahmad, the sizes of clientele make the medical social

worker profession unique from other profession.

“Client of the medical social worker is from the patient of the hospital
itself. Out-patient who is needs the follow-up treatment also comes to
us. I think profession of medical social worker is interesting and it
different from other profession as it gives it services to all society”
(Mr. Ahmad)

Mdm. Nadia also has a same opinion with the Mr. Ahmad. As she said that:
 “My work has a medical social worker is very challenging. I feel that
medical social worker is important profession to the hospital as well
to the other organisation. As we know, we as medical social worker
deal with the patient who has different problem and illness...but
sometime we also need to do the follow-up referral because some of
the patient still need a help from us” (Mdm. Nadia)

Yet, the important aspect of the social work who are work in the health care or

hospital setting is the interdisciplinary team. Here, interdisciplinary is one of the

collaboration between the medical social worker and other health medical team such as

doctor, nurse, occupational therapy and nutritionists. According to Mr. Ahmad

interdisciplinary is important to the medical social work because all the staff in the

hospital involves in the team and discuss about the treatment and recommendation about

the patient. He added that the rationale for collaboration and interdisciplinary teamwork

is that multiple kinds of knowledge and skill need to be involved and applied to best

service the patient as well the family.

“I have been work with many staff in the hospital such as doctor,
nurses and other medical health team. We sit together in every week to
discuss about the best treatment for the patient and family. Here, all
the medical model and social model are been discuss. Thus,
interdisciplinary is the important area for the medical social worker”
(Mr. Ahmad)

Thus far, researcher has quoted some of the theme from the issue that bringing up

by the respondent regarding their own experiences as a medical social worker. The

themes that rise up by the respondent are being recognised by the researcher in term of

their own experience in dealing with the client.

4.5 Function as Medical Social Worker

 There many functions that medical social worker plays in the hospital. In the

interview that was done, researcher had identified several function that medical social

worker plays in the Sarawak General Hospital. The functions are including:

Facilitate treatment

Discharge Planner

Request material and financial assistance

4.5.1 Facilitate Treatment

Facilitate treatment is one of the function of medical social worker the Sarawak

General Hospital. Mr. Ahmad and Mdm. Nadia has expressed that the function of

medical social worker in hospital are often associated to the patient treatment. Medical

social worker plays an important role to assist the patient to gain a treatment. In the

Sarawak General Hospital, medical social workers are involved with the arrangement for

child care and act as mediator between patient and employer. Apart from that, they also

help in relieve patient and family‟s anxiety over treatment. They also arrange for patient‟s

treatment outside Sarawak.

“We as medical social worker play an important role in helping the

patient to cope with their illness and problem. Here, I help the patient
to get a treatment and also give counseling to their family” (Mdm.
Nadia)

Therefore, it is important for the medical social worker in helping the patient to

gain the better treatment from the hospital. Medical social worker task in helping the
patient are not only to give a basic counselling but also play a role as mediator in give a

better service.

4.5.2 Discharge Planner

As in the chapter two, researcher has discussed about the discharges planner in the

medical social work practice. In the Sarawak General Hospital, medical social workers

are the important person in discharge the patient. Mr. Ahmad has stressed out that the

discharge planner that plays by the medical social worker are the core task in every

hospital in Malaysia. He further explains that:

“In order to discharge the patient, medical social worker needs to

study and make an assessment regarding the patient socio-economic
background and the resources that available to the patient as well as
to the family. This is important because to ensure that there is
adequate social support outside that after the patient had been
discharge” (Mr. Ahmad)

Mdm. Nadia also point out that discharge planning is an aspect of the

professional activity which help patient to cope with their illness and its effects. She also

mentioned that in Malaysia hospital, the unmarried mother who just delivered their baby

need to meet the medical social worker for ask the legal permission to discharge their

baby. This is because every mother who delivered baby need to give their marriage

certificate to the hospital in order to discharge their baby. Thus, by looking into this

situation, the discharge planners are the central function of the medical social worker.
4.5.3 Request for Material and Financial Assistance

In this function, the medical social worker has an important role to help patient

who are need the medical equipment. In Mr. Ahmad point of view, he look that the

medical social workers have a task to help the patients who are cannot effort to buy the

medical equipment. He added that the medical social worker help the patient who are

need the assistance with purchase prosthesis or implants. Most of the patient who are

need this are involved in accident. Mdm. Nadia also mentioned that medical social

worker help the patient in term of the pay for special laboratory tests, medications and

food allowance.

“Patient who is need the assistance will go to us to ask some financial

assistance which sometime they cannot pay the hospital bill. Here, we
use the TBP (Tabung Bantuan Perubatan)2 to help patient to continue
their treatment. We also help the patient by asking some financial
assistance from the MAKNA (National Council of Cancer). (Mdm.
Nadia)

Thus, medical social workers are the essential profession to help the patients who

have a financial problem. Medical social worker concern with the patient condition and

try to help them and their family with the available resources.

4.6 Issue that Faced as a Medical Social Worker

As medical social worker, they work with many patients which come with the

different problem. In their practice as a medical social worker, Mr. Ahmad and Mdm.

Nadia faced some issue which it related to their profession. The issue that their faced in

2
Tabung Bantuan Perubatan (TBP) also known as Medical Funding Assistance which this is funding that
provide by the government to help patient in term of financial.
their profession are related to the problem that their encounter in dealing with the patient.

The issue that they faced in their profession as medical social worker are including:

Issue of social work value and personal value

Issue of authority

Issue of Work overload

4.6.1 Issue of social work value and personal value

Medical social work also applies the value and principle of social work in their

practice. The social work value is essential for the medical social work because it guide

them on how to deal with the patient. The value such as acceptance, non-judgemental and

self-determination are often associated with the medical social work practice. But, in the

same time, these values are clash with personal value. Mr. Ahmad and Mdm. Nadia have

express out their own personal value when dealing with the patient.

“Medical social worker also a human. They just like others and have
their own intrinsic value as a human. I have been work with many
patient which sometime I also have my own judgmental attitude
towards them. Sometime I feel some of the patient just to come to us
for asking some sympathy and I feel like that I cannot accept them.
Values of acceptance are importance here but when I dealing with
some patient who are over demanding, I think that they are too
dependent to us” (Mr. Ahmad)

Mdm. Nadia also point out the same issue regarding the social work value and her

own personal value towards the patients.

“Even though my education background is not from the social work

studies but my colleague has explain me about what is social work
value. I also read some social work value regarding this issue. But, in
my practice here, I also have my personal value. For example just now
I deal with the unmarried mothers which have six children outside
marriage. Here, why such person did this kind of behaviour? But, I
 need to be aware that the value of acceptance and non-judgmental are
important in dealing with such cases” (Mdm. Nadia)

The issue of social work value and personal value that raise up by the respondent

has show that in the medical social worker practice, they not only to deal with the patient,

but in the same time they need to deal with their own personal feeling towards the

patient.

4.6.2 Issue of Authority

Medical social worker in Sarawak General Hospital also faced some issue of

authority. This issue is often related to the decision making of the medical social worker.

The issue of authority have influence the decision making among the medical social

worker. Some of the cases like the child abuse cases need to follow the guideline in how

to deal with them. Apart from that, the power of medical social worker also limited

within the hospital only because after the patient have been refer to the welfare

department they are not longer to deal with the patient. Mr. Ahmad has argue with this

and point out some issue.

“My work as medical social worker here a only in the hospital. Here,
we need to follow the organisation role and regulations which this has
limit our own power. This have influence my decisions making” (Mr.
Ahmad)

4.6.3 Work Overload

Work overload among the medical social worker also associated to their

profession. In the Sarawak General Hospital, there are only six medical social worker and

according to Mr. Ahmad this number of medical social worker are not adequate to the

cases that been refer. The number of cases that been refer in one day are more than 50
cases and sometime the cases can be done in one day only which it need to do follow up.

Mdm. Nadia also expresses her own concern regarding this issue. She mentioned that the

work overloads can indirectly affect the effectives of their services.

“In one day, I need to manage and deal with many cases. Sometime I
deal with over 20 cases in one day. Too many case works in one day
make me stress and sometime some patient scold me because I cannot
fulfil their needs” (Mdm. Nadia)

“Sometime I need to go outside to settle some document that needs to

be referring to other department. At the same time, I also need to do
some home visit to the patient home” (Mr. Ahmad)

Yet, the many case work that been refer to the medical social worker has

influence the way of the medical social worker task. In other words, the work overloads

among the medical social worker at the Sarawak General Hospital have slow down the

efficiency of the services. The medical social worker need to deal with many patients in

one day because the patient in Sarawak General Hospital itself consist people which

come from the entire Sarawak region.

4.7 Summary

The result of this study has identified the experiences of medical social worker in

Sarawak General Hospital. The experience of medical social worker has been discussed

which they come across with many experiences since they work as medical social

worker. It also discovered about the function or role of medical social worker related to

their profession which the function as discharge planner are the central role of medical

social worker. Related to this, medical social worker also faced some issue such as the
social work value and work overload. This indirectly influenced the function as medical

social worker.
 CHAPTER FIVE

DISCUSSIONS AND RECOMMENDATIONS

5.1 Introduction

In this chapter, researcher point up some discussion based on the findings. The

result of the work experiences of medical social worker in Sarawak General Hospital

come with the different experiences which it depends on how low long that they served

has a medical social worker. The function and issue that their faced are related to the

work experiences of the medical social worker.

In this study, researcher has identifies three core function that medical social

worker in the Sarawak General Hospital plays which is facilitate treatment, discharge

planner and request material and financial assistant. Besides that, researcher also

identifies three issues that medical social worker faced. These issues include: Issue of

social work value and personal value, Issue of authority and issue of work overload.

5.2 Discussion

Medical social work in Sarawak General Hospital has experiences with many

cases and deal with the different patient. The patients itself are come from the different

background of races, ethnic and problem. Marlow (1993:6) has stated experiences as

“firsthand, personal participation in events that provides a basis of knowledge…these

experiences vary from the individual to individual and according to the type of situation”.

Further, the researcher develops some aspect of medical social worker which based on

the findings. These aspects are including medical social as a challenging profession, the
concept of profession of many faces and the issue in practice in the medical social work.

This aspect will further explain at the next discussion.

5.2.1 Medical Social Work – The Challenging Profession

In the medical social work experiences, the respondents come with different

aspect of work experiences. As they have been work in different hospital in Malaysia,

they has been work with many kinds of hospital setting. This has influence of the medical

social work profession become challenging. Yet, the challenging that faced by the

medical social worker as described by Silverman (2008) come into three area which

include the work environment, the traditional branding of the social work profession and

resistance towards change. The medical social workers in Sarawak General Hospital

experience the challenging task as they need to deal with many cases.

The work environment of medical social worker has made the profession itself

challenging. The work environment such as the changes of head department, the different

hospital setting and the size of the clientele has influence the medical social work

profession. (Gou & Company, 2007). Yet, the medical social work is the profession

underpinning the social work practice in the health care setting.

The medical social worker that been interview has their own opinion regarding

the medical social work profession. The respondent has agreed that the medical social

worker profession is challenging profession as it deals with the emerging of disease. As

noted by Auslander (2001: 204):

“Social work in health care was faced with numerous challenges

during this period … Like other professionals in the health field, social
 workers have had to deal with the ramifications of epidemics of new
diseases, such as AIDS, the reappearance of old diseases, like
tuberculosis, the occurrence of environmental catastrophes and man-
made disasters around the world”

5.2.2 Medical Social Work – “Profession of Many faces”

Bearing in mind, the connotation of “profession of many faces” always associated

with the social work practice. But, here, researcher also expresses this idea to the medical

social worker profession. This is because medical social worker also plays many roles in

their profession even though it only concern with the health care setting.

Further to this, Valios (2008) has stated that medical social worker have a

distinctive role in the health care setting. Medical social worker plays multiple roles in

their profession. Based on the findings, medical social worker in Sarawak General

Hospital has three core roles which are facilitate treatment, discharge planner and request

for material and financial assistant. In facilitate treatment, there are not only the tasks of

medical staff but yet the roles of medical social worker are essential because they provide

the basic counselling to the patient and family. (Beder, 2006). Another important function

of medical social worker in Sarawak General Hospital is discharge planner. Medical

social worker work with others medical team to plan about the need and social support of

the patient before been discharge.

But, there are some arguments on the role of medical social worker. The issue of

role ambiguity rise because of different expectations arising from misunderstanding or

misinterpretation. (Chack-Kie-Wong, 2000). It seems that role ambiguity exists in

situations where there are differences in expectation without clarification. Perhaps this

role ambiguity is partly caused by differences in expectation, and partly arises from a
conflict of interests in the hospital setting which is often hierarchically structured.

(Chack-Kie-Wong, 2000).

Another issue is the medical social worker haven‟t achieved their professional

status where as another disciplines in the hospital have been successful in establishing

their professional status. (Davis et al., 2004). This is because the medical social worker

continues to be concerned about the lack of understanding of the social work role among

other medical staff. (Globerman et al., 1996)

5.2.3 Medical Social Work – Issue in Practice

In the hospital, medical social work deal with the patient and work with other

medical team. The multidisciplinary team are the core component in the medical social

worker task. In other words, the collaboration with others hospital staff are important in

assessing and planning the needs of the patients. Yet, in the medical social work practice

there are some issue that been arise in their profession.

Based on the findings, the medical social worker faced the issue of social work

value where this value is the essential aspect in dealing with the patient. The social work

values such as non-judgmental and self-determination are important value in the practice.

But, it sometime was overlapping with personal value. Ashencaen Crabtree (2005) has

identified that the value of self-determination among the medical social worker in both in

United Kingdom and Malaysia are not been fully apply in the practice.

Another issue in practice are related to the power within the medical social

worker. The medical social worker are faced some of the authority also become an issue

in the practice of medical social work. Yet, Davis et al (2004) suggested that the scarcity
in autonomy experienced by medical social workers creates a strain because their

involvement in cases is dependent on other medical professionals.

The work overloads among the medical social worker also become an issue in the

practice. Based on the findings, medical social worker faced this issue because they deal

with many cases and patient in one day. The work overloads have influence in the job

efficiency and it might affect the work performance of medical social worker.

5.3 Recommendations

The medical social work has become important profession in the hospital. The

growth in medical technology has offered hope and improved quality of life to many

people. Yet, the advances in technology have also raised health care costs and introduced

social, legal, and ethical dilemmas for individuals, families, and health care providers.

These psychosocial implications of health care are what social workers are trained to

address. (National Association of Social Workers, 2005).

Because of these situations, some recommendation should be taking up to

improve the function of medical social worker in the hospital. Further to this, there are

some recommendation that been suggested by the researcher which it related to the

earlier discussion in this chapter.

5.3.1 Recommendation on the Role of the Medical Social Worker

As in the earlier discussion, issue of role ambiguity are still the problem that faced

by the medical social worker in hospital. In other words, the role conflict between the

others medical profession such as doctors or nurses might occur. Medical social workers

in the hospital setting have a consistently uncomfortable sense that their roles are
misunderstood and misinterpreted by other health care professionals. (Chack-Kie-Wong,

2000). Yet, the recommendation can be done in order to improve the situation. Here, the

government can set the standard role of medical social worker in Malaysia. To date, most

of the medical social worker in Malaysia is guide by the standard that been provide by the

National Association of Social Workers (NASW). Here, the standard might be not

applicable in the Malaysian context where as the cultural context might be not taking into

consideration.

So, the government should taking into this account and set the standard that can

be applicable in the Malaysian context. The standard should take into consideration of the

cultural differences because Malaysian population are consisting of multi-ethnic.

Documentation of the standard should be done in order to improve the function of

medical social worker. Thus fur, in order to deal with such problems in the hospital,

social workers must clearly define their role, document what they do well, and let

administrators know their worth in the hospital setting. (Globerman et al., 1996).

5.3.2 Recommendation on the Social Work Value in the Practice

Social work values are the core aspect in the medical social work practice. It

served the guideline for the medical social worker in dealing with the cases. But,

sometime the social work values are overlapping with the personal value. Over

judgmental toward patients and the lack of self-determination is one of the values that

less been applied in the practice.

Here, the basic solution to improve this situation is come from the medical social

worker itself. In other words, medical social worker should be aware of their personal
value. The concept of self-awareness is most important to overcome of this issue.

Medical social worker need to deal with their own personal value first before they deal

with the patient.

5.3.3 Recommendation in dealing with Work Overload

Work overload are another issue that faced by the medical social worker. The

medical social worker needs to deal with many cases and patient and sometime they need

to fulfil their commitment towards the hospital. These work overloads have made them

feel stress and burnout. The inadequate numbers of the staff also contribute to this

problem.

The recommendation can be taken up to overcome this problem. To overcome the

work overload, the medical social worker needs to manage their work in the right way.

Yet, the head of department also play an important role by give a full responsible in assist

the staff through motivation and empowerment of their staff. (Gou & Company, 2007).

Beside, the government also plays an important role in provide a adequate

medical social worker in every hospital in Malaysia. The size of the social work staff

shall represent the scope and the complexity of the organization and the nature and

numbers of the populations served. (National Association of Social Workers, 2005)

5.4 Summary

The discussion of the chapter has discuss about the three different aspect which

including medical social as a challenging profession, the concept of profession of many

faces and the issue in practice in the medical social work. Researcher has made an

argument for each aspect. The profession of medical social worker become challenging
due to the environment factor such has the changing of hospital system and the outbreak

of disease. The role of medical social worker also been the issue where by the role has

expanded through the advancement of new technology. Yet, the researcher also has made

some recommendation in order to improve the function of medical social worker. The

recommendation has been taken up to strengths the medical social work profession.
 CHAPTER SIX

CONCLUSIONS

Medical social work is an important profession in the health care systems. This

position has been justified in hospitals, mental health facilities, and rehabilitation centres.

Over the past twenty years, the demand for medical social workers has grown

significantly, due in part to the realization that both the medical and nonmedical needs of

patients must be equally addressed and treated. There are several nonmedical needs that

are often overlooked, and must be assessed. The nonmedical need here means the

medical social worker asses the patient need by using the social model rather than

medical model.

Yet, this study has been done at the Medical Social Work Unit at Sarawak

General Hospital. The findings of this study are based on the work experiences two

medical social worker officer. The work experiences of medical social worker vary from

the setting of the hospital which it include the changing of environment in the hospital

itself. Based on the findings also, medical social work plays multiple role in helping the

patient to cope with their problem and illness. The role such as the discharge planner and

facilitate treatment are important in order to give a better services to the client.

The issue in the practice also become an aspect of this study. The testimonies of

Mr. Ahmad and Mdm. Nadia showed that the medical social worker faced some issue in

their practice. The issue such as the overlapping of social work value and personal value,

the role conflict and the work overload are been express out by the Mr. Ahmad and

Mdm. Nadia. This issue has influence the job performance which it can indirectly affect

the services of medical social worker.

 Some of the recommendation also been discussed in order to improve the function

of medical social worker. In general, government and the non-governmental organisation

plays a vital role in improve the function of medical social worker. Government should

increases the educational program of medical social work in university courses. The

positions of medical social work in hospital also should be adequate to the size of the

patient in the hospital.

Wrapping this, the medical social worker profession is one of the professions that

uphold the value and principle of social work. It shares the concept and purposes of the

social work practice. In general, medical social work in Malaysia has continued the uphill

struggle to achieve recognition and the professional status. Yet, it is to be hoped that

medical social worker in Malaysia can achieved their professional standards in their

professional practice.
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