Theoretical Application to a Culturally Sensitive Practice Situation Theoretical Application to a Culturally Sensitive Practice Situation “Social workers help people deal with problems ranging from personal relationships to lack of resources to blatant discrimination” (Kirst-Ashman & Hull, 2009, p. 29). Using the scenario involving Soledad and her family I will conduct a theoretical application to her culturally sensitive situation. I will complete this application by conducting a self reflection including my awareness of the situation as well as the sensitive issues, and my values and beliefs that may challenged by this case.
I will also discuss the systems and ecological theories and how they are illustrated in the case. This will be followed by my empowerment approach and client engagement. Self Reflection Awareness After reviewing the case I understood the client, Soledad, is a homosexual woman, recently divorced with two children, and living with her domestic partner, Cecile. She has just been seriously injured in a car accident caused by a drunk driver, and is currently in the Intensive Care Unit (ICU). She is in and out of consciousness and calling for Cecile to be by her side.
Soledad’s sister and parents have come to the hospital after learning of the accident. Her relationship with her sister is stable however; her relationship with her parents has been estranged for some time as a result of their feeling about her homosexuality and her African American partner. Soledad and her domestic partner Cecile has been in a stable committed relationship and identifies themselves as having a legal domestic partnership. Hospital policy prevents Soledad’s partner and children from visiting her in her room.
This policy also prevents nurses and other medical staff from reporting any medical information regarding Soledad to her partner because the health care system does not legally recognize Cecile as Soledad’s family member. However, Soledad’ medical information and any medical decisions will be reviewed by her parents and sister. Cecile strongly believes that her legal domestic partnership with Soledad should allow her to visit her and ask questions about her current status and should also allow her to make medical decisions on her behalf.
As a result of the distant relationship between Soledad and her parents it could be assumed that they may not share Soledad’s medical information with Cecile, leaving her in the dark about a person she cares deeply for. I believe that many organizational policies may not have caught up with our society’s current way of life. This causes serious situations, such as this one, to become more complicated and traumatic for the client. Values and Beliefs Social workers have to be consciously aware of their personal values and beliefs that may not agree with client’s choices in order to better assist them.
As a result of my religious background I believe that marriage should take place between a man and women. With this union two people possess rights and privileges that unmarried people do not have. One example would be for one spouse to make medical decisions on behalf of the other. However, in this situation Cecile and Soledad’s domestic partnership is not a legal “marriage” therefore according to my personal beliefs Cecile should not be able to be involved in medical decisions for Soledad.
However, as a social worker my interest is in helping Soledad and her family gets through this situation, by providing them with the support and resources they may need to move forward. I am conscious of my beliefs but I am going to do what is necessary so that this family receives the help they need. Although my personal values may be challenged by this case I must uphold my responsibility for social justice. In this situation I will evaluate what is good and desirable for Soledad by listening to her wants and needs and working from there.
I must remember that this is not about me; it is about helping the client. Sensitive Issues When faced with this situation there are several issues that I must be sensitive to. The first is the client’s current medical condition during her ICU stay as well as her family support during her recovery. It is also important to be aware of Soledad’s sexual orientation and domestic partnership with Cecile. Understanding that in today’s society this lifestyle may be accompanied with discrimination that, as a couple, they deal with on a daily basis.
In a medical situation Soledad and Cecile do not share the same rights as heterosexual couples. Forcing them to not only deal with Soledad being in the ICU, but also with the fact that Cecile will not be informed or make medical decisions on Soledad’s behalf. Another sensitive issue in this situation is Soledad’s children and their exposure to the family not communicating while their mom is in the ICU. They are also being exposed to the discrimination Cecile is experiencing and may be wondering how their mother is doing.
It is also important for me to be sensitive to Soledad’s parent’s feelings about her lifestyle choices. Even though I may not agree with them, I will acknowledge their feelings and respect how strongly they feel about the situation. I also understanding that her parents are against the homosexual lifestyle and are not accepting of Soledad’s partner being African American. Compare and Contrast Systems There are many systems in this case including the patient, her family, which includes her partner, children, her parents and sister, and also the Roman Catholic religion which is part of the family’s belief system.
I also identified the health care system as a system, which includes the hospital and its policies; another system is the legislation that has established laws pertaining to the legal rights of couples. These laws do not recognize the domestic partnership between Soledad and Cecile. Policy states that the patients can only be seen by family members twelve years and older, which does not allow Cecile to see Soledad or make a medical decisions for her. However, the hospital will allow Soledad’s parents and sister to visit her nd make any necessary decisions related to her medical care. Soledad and her parents have been estranged because of her parent’s strong opposition of both her homosexuality and the fact that her partner is African American. This does not allow Cecile to be informed of Soledad’s condition because that information is only given to her family which does not communicate with Cecile, causing her to be upset with the health care system at the policies they implement. Systems Impact on Each other
Cecile believes that she has a legal right to be informed of Soledad’s condition because their legal domestic partnership. Despite this, hospital policy only informs Soledad’s parents of her condition. As a result of Soledad’s domestic partnership not being honored she continues to request Cecile’s presence during her recovery in the ICU but request is denied because legally Cecile cannot enter. I believe that it is safe to assume that his devastation could negatively affect her recovery and the well being and strength of the family through this unfortunate circumstance.
Soledad is in a critical situation as she lay in recovery in and out of consciousness in the ICU. Her unstable relationship with her parents and the policy that does not allow Cecile to be in the room leaves her alone during this traumatic experience. The dysfunctional dynamics of Soledad’s family as a group is negatively impacting her recover process as well as her children’s state of mind. Her children have been through a divorce and are now living with their mother and her African American female partner.
They are also aware of the fact that they are not only no longer living with their father but they do not see their grandparents as a result of this drastic lifestyle change. Soledad’s parents no longer have solid relationship with their daughter or grandchildren because of her lifestyle choice. Soledad and her domestic partner are constantly exposed to discrimination for their biracial homosexual relationship. Now even through this tragedy there are experiencing the same discrimination from the healthcare system that does not honor their legal domestic partnership.
The healthcare system and legislation has established a hospital policy that does not allow Cecile to be recognized as Soledad’s legal domestic partner. This discrimination in turn affects Cecile’s ability to be by Soledad’s side and advocate for her medical needs. This policy does allow Soledad’s parents to be involved in their daughter’s medical decisions and not include Cecile in the process. Within the legislative and law making community homosexual marriage has not been recognized in all states in this country.
As a result of this many homosexual couples are discovering that they do not have the same legal rights as heterosexual couples. Systemic and Ecological Concepts There are many systemic and ecological concepts that apply to this situation. The systemic concept of system shows us that Soledad, Cecile, and her two children are individual elements which are interrelated that together function are one (Kirst-Ashman & Hull, 2009). In contrast another systems concept is the hospital which is composed of the nurses and the policies they implement that work together to treat the patients.
Another systemic concept is Soledad’s accident which changed the interaction between her and her parents. Before the accident there was little to no communication between them but when they were informed the accident they made the decision to visit her at the hospital. This also changed the interactional patterns which forces the parents to not only interact with their estranged daughter but also to see their grandkids as well as their daughter’s domestic partner in a time a crisis. The ecological perspective “is a foundation of the empowerment approach” (Lee, 2001, p. 39).
This perspective includes the concept of the social environment, which includes the circumstances and human interactions in which people live. In this situation Soledad and her domestic partner, Cecilia, live in an environment in which they are not allotted the same privileges as married heterosexual couples even though they have a legal domestic partnership. As a social worker in this situation it is important to understand the person-in-environment concept in order to truly view a person “where they are” and help them come to a solution to their problem (Kirst-Ashman & Hull, 2009).
In this situation both Soledad and her partner are in an environment where their partnership is not acknowledged and is negatively affecting the client that is in the ICU calling out for her domestic partner to be by her side. As the social worker implementing a coping strategy to help the family deal with the situation is important to assist every involved party get through the situation as Soledad recover. Empowerment Approach To empower someone is to increase their personal or interpersonal power so individuals can take action to improve their life situation by concentrating on their strengths (Lee, 2001).
When confronting this case I would first concentrate on the client, Soledad. I would begin by communicating with the nurses on her health status and connecting her with resources to assist her in making medical decisions and possibly helping her to communicate with her family. I could also get more information on visitation and next of kin policies for the hospital so that I could provide Soledad with the proper information so that she can decide how to move forward.
When working on her communication with her parents I would first acknowledging their religious beliefs and any concerns they have to get a better understanding of their position in this situation. I would also try to better understand their desire to see their grandchildren more and use that as a guide for motivating them to find a common ground. I understand that for my approach to be effective I have to empower Soledad’s entire support system. The individual client cannot be totally understood unless viewed as part of a dynamic social context which influences them, which in this case is her family (Stren, 1974, p 185).
When working with Cecile I would encourage her to contact the necessary resources to get the rights she feels she deserves in reference to her legal domestic partnership if she feels her voice is not being heard at the hospital. I would also remind her of the importance of supporting Soledad’s children during this difficult time because the children live with her they may be looking to her to determine how they should feel about the situation. It may also be beneficial to encourage her to communicate with Soledad’s sister to find out information on her medical status.
When working with Soledad’s sister I would discuss her relationship with both her parents as well as her sister. I would let her know that her involvement could be beneficial for everyone involved. She could possibly be a bridge between her parents and Cecile ensuring that everyone can be involved in Soledad’s recovery. As a social worker, I would work to help her to understand how important her involvement in the situation could be in helping everyone get through this process, and more importantly helping her sister get well and be released from the hospital.
By empowering Soledad’s parents, sister, and Cecelia the children could then be in an environment where they feel acknowledged from all parties involved helping them cope with their mother’s situation. It is important that they do not blame themselves for everyone being upset and that they feel compassion around them when they are unable to be around their mother. It may also be worth looking into their father’s location because he may be a comfort for the children at this time. Providing them with child friendly activities and snacks and also giving them praise for their good behavior may also make them feel empowered.
Client Engagement I will begin my engagement assessing the client–in-situation and identify issues (Hull, 2009, p 36). As a social worker, I understand that my sole purpose is to help my client improve her circumstances with the support of the people she loves. I would begin this process at the micro level exploring the micro aspects of the situation. In this case I would begin by speaking with medical staff to determine Soledad’s medical status so that I have an idea of where she is so that I can begin working with her.
I would also begin asking questions such as, how does her current situation impede her ability to make her own medical decisions? I can then determine how involved her family needs to be in making her medical decisions for her ensuring that her health is the number one priority. In addressing Soledad’s individual needs I would also have to address the fact that her inability to see her domestic partner may negatively affect her recovery. I would further investigate her feeling of seeing her parents after being estranged under these circumstances and its effect on her recover.
From my experience I have learned that often times when working with an individual it is imperative that you involve the family unit in the treatment. In this case Soledad’s family is involved in many aspects of her recovery and treatment. Engaging Soledad at the mezzo level of intervention allows me to concentrate on the group dynamics that are taking place around her. I would begin by prioritizing problems surrounding the client and her family as a group. I understand that she is unable to interact with her legal partner and her children at this point.
However, she has been able to see her sister and parents since her arrival. Cecile is very concerned about Soledad but she is having a difficult time interacting with Soledad’s family and nursing staff to get information of Soledad’s medical status. The kids seem to be having difficulties interacting with their family members because of the separation taking place within their family between their mother and grandparents. I would utilize Soledad’s sister’s relationship with all the parties involved.
She could possibly be a bridge between family members so everyone could be involved in supporting Soledad and her recovery process. At this point I can begin to establish goals with the family that they would like to work on to help the client. Soledad’s parents have displayed their love for their daughter because rushed to the hospital when they heard of the accident. Understanding that dynamic allows me to work with them to support their grandchildren during this process. I could also suggest or implement group counseling to enhance their existing relationship with their grandchildren and their daughter.
Their grandchild and children could also benefit from counseling to better understand their parents and grandparents point of view. I would also set in motion the idea of Soledad benefiting from becoming a member of a support group others that are in a domestic partnership and have been denied access to their partners during medical emergencies. Macro level intervention promotes changes that could be made to the hospital policies allowing the patient to ask for their partner when they are in a critical situation.
As a social worker, I can work with hospital administration to better understand what this couple can do to be recognized as legal domestic partners so that Cecile can be by Soledad’s side and make medical decisions for her. I would also advocate for my client to gather information about family members of patients being able to inform hospital staff of legal domestic partnerships. I would begin researching questions such as; can the legal system give domestic partners the same rights as married couples in situations like this?
Should the health care system be more involved in the overall treatment of their patients including looking into who they live with and what their lifestyle is? I would also investigate if the hospital is required to provide therapeutic interventions for children whose parents are in the ICU. Conclusion I realize that in order to successfully assist Soledad in her recovery and moving forward in her life I must include her family in the treatment process. This process forces me to me mindful of my personal morals and values when addressing the client’s issues.
After conducting a theoretical application to her culturally sensitive situation, I was also able to complete this self awareness by addressing the sensitive issue brought up by this case. After examining the systems and ecological theories and how they are illustrated in the case I was able to develop an appropriate case plan for my client. This allowed me to also develop an empowerment approach and client engagement for Soledad and her family. References Kirst-Ashman, K. K. , & Hull, G. H. (2009).
Understanding Generalist Practice (5th ed. ). Belmont, CA: Brooks/Cole. Lee, J. A. (2001). The Empowerment Approach to Social Work Practice: Building the Beloved Community (2nd ed. ). New York, Chichester, West Sussex: Columbia University Press. Stren, H. S. (1974). The Social Worker as Psychotherapist. Metuchen, N. J. : The Scarecrow Press, Van Wormer, K. , Wells, J. , & Boes, M. (2000). Social Work with Lesbians, Gays, and Bisexuals: A Strength Perspective. Needham Heights, MA: A Pearson Education Company.