Social work intervention with Mrs. Ozdemir: diabetes, isolation, and cultural barriers

Social Work Scenario

Mrs. Ozdemir (Mrs. O.) has been referred to our agency because she is having trouble communicating with her physician, assessing transportation and health related services in the community, and requires assistance and linguistic translation services. Her doctor hoped that we would be able to put a plan together to allow Mrs. O. To communicate more honestly with medical personnel, and feel more comfortable getting the help she needs.

Client, Mrs. O., is a 35-year-old wife and mother of four children and has been in the country, an immigrant from Turkey, for seven years. Mrs. And Mrs. O. live in a small rental in Melbourne, where Mr. O. works as a truck driver. Mrs. O. was once very active, but has no current driver's license, and finds it difficult to get around using public transportation. Complaining of excessive fatigue, she visited Dr. Simon Cross, a GP, six years ago. After several tests, Dr. Cross diagnosed Mrs. O. with Type 2 Diabetes Mellitus.

Some days, Mrs. O. finds it incredibly difficult to get around, manage the household and children, and even leave the home. She has recently been experiencing urinary incontinence, here "waterworks" as she calls it, which makes her feel even more trapped since exercise and activity seem to aggravate the issue. Because of this lack of activity, Mrs. O. is gaining weight, which is contributing to the cycle of her discomfort. She does not mention her issues to Dr. Cross out of embarrassment and cultural discomfort at talking about personal issues with a man. Finally, Mrs. O. does not speak much English, only enough to get by at some of the shops. She does appear to be manifesting additional symptoms of depression.

Background:

Part 1 -- Introduction of self, background, personal details -- YOU WILL NEED TO COMPLETE.

Part 2 -- Empathy, genuiness, respect, permission

Social work requires that the person giving the interview or assessing the situation uses a genuine set of skills to both assess and objectively identify the individual situations for the client. Understanding the client's worldview and cultural frame of reference is essential -- empathy for the situation. While it is not easy to put oneself into another's cultural or value system, simply asking for permission to use probative questions often helps. Empathy with the situation is not the same as believing humans are the same, it is simply a technique used so that the social work is grounded within the human experience and that the social worker's behaviors send messages of respect and understanding in a variety of situations (Greene and Kropf, 2009).

Part 3- Appropriate use of questions/probes

There are a number of differences in the worker-client relationship and the researcher-interview in social work. The social work interview is focused primary on establishing a helping relationship and eliciting data and information designed to increase understanding of a particular issue or overall view of the client. Appropriate use of questions and probes are designed to not only allow for greater information but to change and develop the relationship with the client. In this case, Mrs. O. is feeling ostracized, out of touch, and unable to cope with issues. The appropriate use of questions and probes would be designed to communicate the purposes of the interview while at the same time probing (how did this happen, with whom have you spoken, are there others with whom you have confided, how does this impact you, how is this impacting your family, etc.) the nature of the issue (Grinnell & Unrau, 2011).

Part 4 -- Use of rephrasing/paraphrasing

The use of rephrasing and paraphrasing in communication is a powerful tool for increasing understanding. The social worker acts as a guide, but also takes into considering the style of communication from the client. Rephrasing ensures that all parties understood exactly what process and roles are necessary within the context of the situation; paraphrasing ensures that one repeats back to the client so that they have the opportunity to agree or disagree with the stated objected. Mrs. O., I heard you say xxxxx, or, "Mrs. O., it seems that you are saying, yyyyyy." Then, it is very important to look for signals and valid feedback. "Yes, Mrs. O., I do understand this is what you mean." Paraphrasing provides feedback indicating that the social worker has completely grasped the content of the client's message (Hepworth, et.al., 2009).

Part 7 -- Plan for future action

One of the clear issues so apparent after interviewing Mrs. O., is one of transcultural barriers and a feeling of helplessness, loneliness and lack of resources that understand and can effectively deal with her issue. Culture is an important factor that can make the greatest difference in promoting wellness, preventing illness, restoring health, facilitating the coping mechanism, and even enhancing the quality of life for all individuals, families, and communities. Out of a needed response to this trend comes transcultural care, quite relevant in the contemporary world in any area in which there is an immigrant or divergent population base. With a transcultural focus, the social or healthcare professional must think about differences and similarities among people regarding their special needs and concerns -- and develop a different rubric to assist clients. The transcultural model asks the professional to look beyond the surface of the client and try to uncover what may be hidden because of cultural values and norms. This model focuses more in removing barriers to communication in order to improve care. Ironically, this uncovering also has the added benefit of uncovering insights about their own specific cultural issues and needs (Narayanasamy, 2007; Papadoupolos, 2006).

The social work plan for Mrs. O. is threefold: 1) Investigate translation services for medical care; 2) Help with transportation training through Turkish speaking social workers; 3) Engage as a liaison with medical care to provide transcultural care paradigms.