This study investigates socialization and ideal expectations for the health professional role in the provision of quality terminal care. Guiding the research are role theory, socialization theory, and Talcott Parsons' (1951) pattern variables. The research was conducted in three phases. The first phase involved development of an analytical framework elaborating upon Parsons' five pattern variables, which were first conceptualized as dimensions describing the ways in which roles could vary. Specific indicators for each of the pattern variables were developed. Typologies characterizing (1) the medical, or conventional, model and (2) the holistic model (specifically, the hospice model) for the provision of health care based on these indicators then were developed. Using the analytical framework, the second and third phases consisted of: (1) a content analysis of the physician and nurse socialization literature to determine the role prescriptions learned by these health professionals; and (2) a content analysis of open-ended interviews with a group (N = 94) of terminally ill elderly patients (n = 17), family members (n = 38), and health professionals (n = 39) from 10 urban health care programs (five conventional and five hospice) to identify ideal role expectations for the health professional. Major findings were that: (1) Parsons' pattern variables, with elaboration, can provide a useful framework for role analysis; (2) physicians and nurses appear to be socialized to a number of role prescriptions consistent with the medical model, although there is evidence of conflicting socialization (to both models) for some role prescriptions; (3) respondents' expectations generally were consistent with those prescribed by the hospice model with some notable exceptions; (4) the role expectations of the three groups of respondents were more congruent than was expected, although subgroups' (conventional versus hospice) expectations tended to differ. Implications of the findings for: (1) role analysis; (2) socialization of health professionals to minimize role strain and conflict with patients and families; (3) continued implementation of conventional and hospice models for the provision of quality terminal care; (4) assessment of the quality of terminal care are explored; and (5) further research are explored.

This study explored social workers’ perceptions of their role in providing palliative care to patients with life-limiting illnesses in six hospitals across Namibia. A qualitative grounded theory approach was use in which in-depth interviews were conduct with twenty (20) social workers. Several key findings are presented: First, the emerging constructivist grounded theory of social workers’ multi-dimensional roles in providing palliative include identities of advocate, assessor, broker, counsellor, educator, facilitator, patient liaison, mediator, discharge planner and manager of in-country referrals. Second, several participants’ uncertainties of what palliative care entails offered insight that they are in need of palliative care education and training. Third, healthcare professionals do not understand the role of the social workers and therefore social workers receive inadequate support from them. Fourth, there is a lack of in-service training and continuous education in palliative care. Fifth, there are inadequate practice opportunities in palliative care for undergraduate social work students. Finally, the well-being of social workers is another concern with limited debriefing opportunities available. Further research needs to be conducted and policy guidelines established to identify ways to improve the field of palliative care social work. In achieving this, formal education and palliative care practice opportunities for social workers need to be established, providing continuing education and establishing a Centre of Excellence on palliative care provision. This study argues that the social work profession is well positioned to draw upon its values, culture and experiences (particularly from their clients) to get involved in creating a constructivist grounded theory of social workers’ roles in providing palliative care. / Sociology / D. Phil. (Sociology)