Coping Mechanisms of Social Workers Managing the Guardianship Process of Hospitalized Senior Citizens

Social workers in hospitals are often required to deal urgently with the appointment of a guardian regarding the patient's body when the patient is required to give an informed consent for treatment, but his physical or mental condition does not allow to receive his consent or refusal of medical treatment as required in "patient rights low" (Ministry of Health, 1999). In addition, the appointment of a guardian is required when a patient needs routine medical care or needs institutional arrangement but his physical or mental condition does not allow him to perform actions or agree to perform them (Ministry of Health, 2006).

The professional literature expresses the importance of the involvement of the social worker in the guardianship process with an emphasis on preserving the independence and rights of the individual (Crampton, 2004). However, the literature criticizes the functioning of the social worker in the process. It has been argued that the Legal Guardianship Regulations do not require special training for the purpose of issuing the medical certificate or the social report accompanying the application for the appointment of a guardian (Doron, 2010). It was also found that in the medical and social diagnoses submitted to the court for the purpose of appointing a guardian, there is insufficient coverage of all aspects of the ward's needs, and the social report finds it difficult to make the ward's voice be heard effectively (Barel, Doron and Striar, 2015). A study of the attitudes of social workers involved in appointing guardians for adults with dementia found that social workers face ethical dilemmas and conflicts regarding responsibility, protection of rights and protection of the adult (Mills, 2017). It has been suggested that social workers involved in court decisions may not receive adequate training or may give up their professional values ​​in favor of the medical model (2011, Gibson).

The need to examine the coping of social workers in the health system regarding their handling of the appointment of a guardian arises from professional studies and from field experiences. Despite the research's reference to the social worker's position in the procedure for appointing a guardian and his role, in the field of health there is insufficient reference to the hospital's social worker's handling of this procedure. Thus, the research question is how social workers in hospitals cope with their role in the process of appointing an adult guardian in hospital based on their attitudes, experiences, the tools they use, and their professional knowledge. Due to the paucity of research in this field, a qualitative research method was chosen, in order to expose the personal experiences of hospital social workers in dealing with the guardianship appointment procedure for adults.

The study included sixteen social workers from five general and geriatric hospitals, who deal with the appointment of guardians for elderly patients. The interviews were conducted using a semi-structured questionnaire, and the data were analyzed according to a thematic analysis. From the interviews, subcategories and categories were constructed, of which three main themes emerged: role perception, role dilemmas, and tools for managing dilemmas. The themes revealed three prototypes of hospital social workers dealings with the appointment of a guardian for an adult patient: social workers with a reflective approach, social workers with a systematic approach and social workers with a systemic approach. Each type differs in terms of role perception, dilemmas, and tools employed when navigating dilemmas. First, social workers who work with a reflective approach have a value-focused perception, they experience value dilemmas that are sometimes accompanied by emotional difficulty, and they utilize reflective tools that assist them in managing dilemmas. Next, social workers with a systematic approach, have a process oriented perception, either view dilemmas in a pragmatic way, or do not experience dilemmas at all. Third, social workers who adopt a systemic attitude, have a work-value perception, experience practical dilemmas in a way that is oriented towards solutions, and focus on the practical tools to solve these dilemmas.

The importance of the study is reflected in its findings, which help us understand the different aspects of the hospital social workers' coping in fulfilling their role in appointing a guardian for an adult patient, and may deepen our knowledge of the social workers' needs in fulfilling their role. In addition, identifying of the three prototypes enables the provision of assistance to be tailored to the needs of each social worker. Based on the findings of the study, it is possible to recommend practical steps to improve the functioning of the social workers in the process of appointing a guardian for an adult in hospital - creating a uniform and clear work process to help social workers fulfill their role, expand the social workers' knowledge, and training professional advisory staff. In addition, Future research should focus on the needs of social workers in the process and should examine assimilating relevant legal alternatives.