Realising Values: Experiencing and Negotiating Value Demands in Health Social Work Practice

Abstract

Values are an abstract concept, being numerous, interrelated and hard to discern in practice. Social work values represent the profession’s fundamental beliefs about what is important, and they serve to guide actions and practice perspectives. This research involved an examination of how social work practice is enacted within District Health Boards in Aotearoa New Zealand in order to locate the influence of professional values in practice. The research specifically investigates how health social workers working with newborn infants, and their whānau, experience and negotiate professional and contextual value demands. This constructivist grounded theory research involved two phases of semistructured individual interviews. A critical incident technique was utilised initially with 15 participants to discern the realities of health social work practice. The participants were then re-interviewed to collaboratively explore the emerging theory derived from their collective critical incidents about how value demands are negotiated in the complex landscape of health social work practice. The theoretical knowledge developed from this research is that health social workers endeavour to control the middle ground of a very complex practice environment riven with competing value demands. Within this practice context, the participants felt that their role was often misunderstood and under-recognised. Health social workers’ unique professional perspective situates them within the middle ground, between medical professionals and patients, and attending to issues of social need. They work predominantly within the mesosystem to generate space and voice to enhance the way that patients and their whānau navigate the health system, courageously working to ensure that rights and obligations are upheld, and that voices are heard. The place of social justice as the primary organising value that underpins social work practice is affirmed by this research The research findings suggest that health social workers practise in a hectic, crisisridden environment, which means that macro-oriented social justice action was very restricted and secondary to reacting to unfolding urgent demands and organisational requirements. Health social workers with newborn infants hold a unique skillset and body of knowledge that is suited to managing complexity and juggling competing demands. This is partly due to a critical understanding held by them about systems-in-action. Strengthening health social workers collective voice and identity through a focus on the profession’s values would allow them to have a stronger influence on future policy directions. If enabled through community outreach, they are well placed to manage the middle ground between hospital and home, and be crucial lynchpins between whānau, child protection services and DHB services to effectively address the systemic drivers of health inequities.