of care and provides a comprehensive range of topics to clinicians and academics. It certainly illuminates a diversity of aspects and dimensions necessary for best practice in contemporary end-of-life care. The book’s window opens up new opportunities for enriching our learning and challenging our critical perspectives for fresh insights and reflection. The symbol of the window reminds us that education is a twoway process – knowledge going out but also knowledge coming in.
Cicely Saunders started a revolution over fifty years ago (Monroe 2010). She opened St Christopher’s Hospice forty-six years ago, building the home around the window, having been inspired by David Tasma, the young man, Jewish, Polish, refugee dying of cancer in a London hospital. He left her £ 500 to be a window in your home. She advocated meticulous symptom control, family and community support and close liaison with all members in the patient’s team of professional caregivers, largely based around people with cancer. Her experience of working as a social worker herself was core to her profound understanding of patients’ needs, her philosophy, drive and advocacy in relation to their needs and those of their caregivers. It is important to continue to open up this philosophy and possibilities to increasing numbers of professionals and hence patients and carers. Education is the key. From the very beginnings of palliative care, Cicely Saunders saw the integration of that trinity of care, research and education as being important, one informing the other.
From pioneering days, social work has been important in the holistic, total pain, total care model advocated by St Christopher’s. When the first post of social worker was advertised in the seventies for a developing St Christopher’s, an experienced medical social worker, Elisabeth Earnshaw-Smith, working in London, contacted Dame Cicely Saunders to enquire about the post which was being offered at a very basic level (Earnshaw-Smith 2011). Miss Earnshaw-Smith was concerned that this new post should be at a senior level, sufficient enough to be able to negotiate with colleagues in the multi-professional team and to offer skilled practice. Miss Earnshaw-Smith was offered the job and the post was regraded!
From the early days of hospice and palliative care social work, Miss EarnshawSmith developed an emphasis on family care and a family-oriented service, away from one to one models, which echoed Cicely Saunders’ perspective: The modern hospice developed with its regard for the family as both the unit of care and, frequently, the caring team (Saunders 2001, S. 791–799):
• Members of the multi-professional team seeking to understand the family, rather than a narrow clinician/patient focus
• The team thinking families, e. g. family trees or genograms were introduced as a matter of common practice as an assessment and therapeutic tool
• Moving away from the temptation to label one member of a family as carrying the problem
• Using the understanding from, and the strategies of, family therapy and of systemic thinking, leading to one of the senior consultants training in basic family therapy as an adjunct to his strictly medical input
• All members of the team having an appreciation of family dynamics.
It took one experienced and skilled social worker in Elisabeth Earnshaw-Smith to recognise the potential of social work and what it could add to the range of skills of the multi-professional team. As the expanding perspectives of colleagues in the multi-professional teams developed, the biggest number of referrals to the growing social work team at St Christopher’s was for family issues, concerns over children and communication before the death and in bereavement.
Another area of work that emerged was recognising the impact of families, death and bereavement can have on staff and engaging colleagues in conversations on the effect of the work on them personally and professionally. Miss EarnshawSmith recalls how looking after MND/ALS patients was particularly challenging and ended the honeymoon period for many nurses working with dying patients. It was often a turning point when nurses recognised they needed support.
The extent of the emphasis on family work, with the psychological, social, emotional, financial and practical aspects being recognised and worked with, led to the sharing of these rapidly emerging experiences into formal education. From early days at St Christopher’s, social workers regularly joined doctors, nurses and allied health professionals on speaking on training courses and presenting at national and international conferences, employing interactive teaching methods, role play on different aspects of work with children and families and writing some of the earliest articles on social aspects of the care of dying people and families.
One of the biggest achievements of the early pioneers of social work and palliative care, led by Elisabeth Earnshaw-Smith and supported by Cicely Saunders, was to challenge the medical models of colleagues: seeing the patient as a normal human being approaching a normal life event and dying as a family, social and community experience. This is in contrast to approaching dying patients as individuals and looking for psychological problems as they approach the end of life. As a new social worker entering the field of palliative care, one of the first things Miss Earnshaw-Smith said to me was, it would be all about finding people’s strengths and resources. This mantra has continued to underpin the essential nature of social work in working not only with risk but with resilience and in supporting strengths-based approaches. Social workers work in partnership with patients and family carers to name areas of concern in their lives and identify resources in themselves, in their networks and via local services and communities.
As we say, the rest is history! These methods have now travelled around the globe as psycho-social assessment and intervention has evolved and adapted to different cultural, legislative and policy contexts. This is evidenced by the huge range of material covered in this excellent book. The editors and contributors are to be congratulated on their insights into current practice, education and research in the developing field of palliative care social work. The book testifies to the fact that the pain of end of life is in part a deeply relational experience and connections with family and friends as well as with one’s professional caregivers are crucial to the quality of care and quality of life. The book underlines that death, dying and bereavement is a social experience and that the social work profession is critical in helping support people with the stories and narratives they can live with.
| David OliviereDirector of Education and TrainingSt Christopher’s Hospice | London, March 2014 |
NB with thanks to Elisabeth Earnshaw-Smith for her sharing her insights and experience in the preparation of this foreword.
Welche große Wirkung so ein kleines Fragezeichen hat: Aus einer einfachen Feststellung wird dadurch eine rhetorische Frage, mit all den Effekten, die diese Frageform auslöst. Bei einer rhetorischen Frage erwartet man keine Antwort, sie dient vor allem dazu, eine Aussage stärker zu betonen, eine implizit dahinterliegende, nicht ausgesprochene Verneinung zu erzeugen oder gar das angesprochene Gegenüber zu manipulieren. In der antiken Rhetorik wurden rhetorische Fragen sogar vornehmlich zum Ausdruck von Unwillen, Verwunderung, Gehässigkeit oder Mitleid genutzt. Warum also zu Beginn eines Buchs zur Sozialen Arbeit in der Palliative Care eine rhetorische Frage zu deren Existenzberechtigung? Warum etwas infrage stellen, was mittlerweile eigentlich selbstverständlich sein sollte? Ist es das schon, oder doch nicht?
Allein, dass es dieses Buch gibt, ist schon ein Hinweis auf die mittlerweile in vielen Einrichtungen etablierte Beteiligung von Sozialarbeiterinnen und Sozialarbeitern in der Unterstützung von sterbenden Menschen und ihren Angehörigen. Es stellt sich also nicht mehr die Frage »ob«, sondern »wie« sich Soziale Arbeit im Kontext von Palliative Care einbringt. Allerdings ist Soziale Arbeit auch, wie Gian Borasio in seinem Geleitwort feststellt, »die vielleicht am meisten unterschätzte Profession in der Palliativversorgung.« Insofern drückt die rhetorische Frage vielleicht tatsächlich Verwunderung darüber aus, dass Soziale Arbeit im Feld der Palliative Care in Deutschland noch immer zu kämpfen hat, mit ihren Stärken und Chancen der professionellen Zugangs- und Arbeitsweisen wahrgenommen und unabdingbarer Bestandteil palliativer Versorgungsstrukturen zu sein. Dies larmoyant zu beklagen, ist allerdings nicht der Tenor und Zugang dieses Buchs – im Gegenteil. Dargestellt wird eine etablierte, bunte und kreative Landschaft verschiedenster Formen, Arbeitsweisen und Handlungskonzepte Sozialer Arbeit im Kontext von Palliative