Examining Tension in the Provision of Palliative Care: Social Workers’ Experiences

This dissertation was a qualitative study that explored workplace tension experienced by social workers employed in palliative care settings in Ontario, Canada. Although work in palliative care can be a rewarding, it can also be challenging for a myriad of reasons, including the emotional labour of the work and organizational factors. While many of these challenges are common among most providers, social workers face unique difficulties. Social workers employed in palliative care settings are exposed to existential dilemmas, psychological quandaries, emotional distress, and confront institutional and professional challenges associated with working within the medical model and neoliberal ideologies that dominate many of these institutions. Although tension frequently appears in the palliative care literature, it has multiple and varying uses and defies a definition that fits every professional and every situation. Few research studies have attempted to understand workplace tension with a specific focus on how structural and relational forces conjoin and contribute to it, and even fewer sample social workers specifically. The purpose of this study was to gain a deep and rich understanding of workplace tension and identify its origins and the factors that perpetuate and sustain it. Using an interlocking theoretical perspective, the works of Foucault and Goffman were intertwined and juxtaposed to gain an understanding of the source of workplace tension in both the formation and structure of discourse and how it is expressed and experienced in face-to-face interactions. The following research questions were used to guide this study: 1) How do social workers employed in palliative care settings define and describe the term tension? 2) What are the individual, relational, and organizational sources of workplace tension? and 3) How do social workers in palliative care settings manage everyday workplace tension? The experiences of 13 social workers employed in palliative care settings are presented. The work was methodologically grounded in the theoretical paradigm of interpretive description and is informed by Foucault’s writings on power and discourse and Goffman’s theory of presentation-of-self. Data was collected using unstructured interviews. Participants understanding of tension was explored, and four overarching themes pertaining to sources of workplace tension emerged: (a) social workers’ perception of their own reality in palliative care settings; (b) social workers’ reflections of how others see them; (c) tension between these two perceptions of reality; and (d) managing and balancing tension. Participants described concerns regarding the minimization and misunderstanding of social work knowledge and training. Concerns were exacerbated by organizational hierarchies and the devaluing and disempowering of social workers in workplace settings. Participants also discussed role strain and role conflict that resulted from fulfilling several roles. Participants endeavoured to maintain a favourable impression with their colleagues, clients, and organization administration by practices such as using euphemisms, disarming techniques, role distancing techniques. The findings from this study highlight elements of power and social control and ways in which social contexts produce social practices and daily interactions. Study implications include the need to question, dismantle, and challenge the dominance of the medical model and reposition social workers employed in palliative care settings in order to reduce workplace tension.

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