Social Work Intern Logs: An Effective Learning Exercise for Reflecting on a First Hospice Experience
By: Katie J. Mailloux, BSW, and Ronald B. Whitten, MSSW, LCSW, BCD
Students entering field education are faced with a myriad of ambiguous feelings and preconceptions. They are challenged to suspend personal values, hold emotions in check, and incorporate critical thinking as a hallmark of professional practice. As social work educators, we have designed an integrated field education experience that seeks to reinforce these principles. One of the traditional means by which students are expected to self evaluate and analyze their internship performance is through weekly written logs of their activities. Although logs serve a purpose of providing accountability, more importantly, they are a reflective and analytical exercise intended to review the practice experience and promote the integration of academic learning. Students’ writing styles, abilities, and motivations will inevitably vary, as well as their understandings of the potential value of the logging assignment for learning purposes. Anecdotal review of written logs suggests that students who choose to journal a more holistic examination of themselves and their practice can potentially improve self-evaluation and expand their person/environment insights.
An example of one refreshing journalistic approach and style is provided in the following internship encounter for a BSW student. The shared introspection mixed with a panoramic view of the encounter enables revealing insights for the intern and the reader. By way of introduction, this intern is having her first client encounter in her very first week in a hospice setting.
Student Intern Log
As I walk through the hallway, my vision becomes saturated with a wide variety of lifeless gray-haired elderly sitting in wheelchairs, lying in beds, or ever-so-cautiously pushing themselves down the hallways. The sounds of the nursing home, from the incessant ringing of telephones to the individual cries of patients, reverberate off the pastel pink walls and bury themselves in my ears. I pass a group of women reclined in customized wheelchairs gathered around a noisy television airing Oprah, on a channel no doubt chosen by the staff, and I wonder how I ever thought I would find inspiration in hospice care. Depressing thoughts begin to bombard my mind, such as, What am I supposed to do with these lifeless people? I begin to panic, thinking I have made a terrible internship choice, a decision I will regret for the upcoming nine months. Following closely behind my field supervisor, I study each room number carefully while trying to unsuspectingly peer into every doorway. Finally, we arrive at door 355, adorned with a nametag bearing the client’s name. As we proceed into the room, my face immediately cringes in reaction to the permeating smell.
My supervisor had warned me that today’s patient suffered from jaundice, but I had not prepared myself properly for the fragile little yellow woman that lay before me. Scattered around her tiny room were family photos from the eighties, puppy calendars, and balloons celebrating her recent 94th birthday.
Today, we have the pleasure of providing this patient with pet therapy. After introductions, the woman explains in her frail voice how excited she has been in anticipation of our visit, and how it has been so long since she has pet a dog. Soon, a colleague with the hospice program enters with her happy little cocker spaniel, Izzie, beside her.
After the initial excitement caused by Izzie's appearance, two staff members clad in bright purple scrubs enter the room, and with apparent ease, move the tiny little woman into her seemingly huge wheelchair. Others take notice of Izzie and smile as we wheel the patient through the halls and outside into the refreshing afternoon air. Her yellow skin glistens in the outdoor light, even more noticeably than it had as she lay in her bed. My supervisor pushes her wheelchair out onto a grassy area with plenty of shade, protecting her from the heat of the day.
The patient and I take turns throwing the ball to delightful little Izzie, while exchanging personal pet stories. The silver haired woman recalls all the pets she had while growing up and shares with me how each of their names came to be. I am disheartened to see how frustrated she is that her frail little body cannot throw the ball far beyond her wheelchair. She laughingly comments that her tosses are not much of a workout for little Izzie. Before long, it is apparent that the patient has grown tired from the bright afternoon sunshine. When we ask if she would like to return to her room, it is obvious that she is embarrassed about becoming fatigued. She simply replies, “I’m fine doing whatever, but I might like a nap soon.” We all understand what is implied, and begin to push her toward the cool air-conditioned building. We take her back to her room and wait as she is carefully placed back into her bed. The hospice chaplain asks her if she would like us to say a prayer. Slowly the words seem to creep out of her mouth. She wants to thank God for good friends, Izzie, and for help to ease her fear of dying. I close my eyes as the chaplain prays; the words of this tiny woman resonate in my head. I am so sad to know that she fears nearing death.
Before we leave, the patient asks all of us to sign her puppy calendar, the one that displays the names of all her visitors. As I add my name, I notice some days are filled leaving barely any room to write, while other days are blank. We all promise to return soon, knowing that we will be back the next week.
As I leave the nursing home, I realize its image has been transformed in my mind. I suddenly find myself connected to these people that, only two hours ago, I viewed as lifeless. I now see that their life experiences and fears are, perhaps, not too far from my own. I begin to think about the faces of the strangers in each of those rooms into which I peered, and find myself formulating ways to ease their minds and improve their quality of life.
Student Intern Afterthoughts
It was most significant to my internship in hospice care that my first patient encounter be with this woman. My initial intake of the patients in the nursing home, and the nursing home itself, took me aback and made me rethink my commitment to hospice work. However, after meeting the patient, I felt more of a connection to her as a human being than as a social worker. I understood her love for dogs and the pleasures they bring to life. While we spoke, I thought, perhaps if I live to be 94, this is what I will want to talk about and remember, my beloved pets and how they brought me so much happiness throughout the years.
Not too long after my initial meeting with this patient, I learned of her passing. My thoughts immediately returned me to that hot summer afternoon, sitting with her in the cool shade. I wanted so much to let her know that I would never forget what she gave me that day. She allowed me to see that all people are kindred spirits of the human race, and by her words and actions, she lit a spark of passion in me for the hospice field. Her candid sharing of personal thoughts let me relate to the patient’s fear of death, and I began to see our commonalities as human beings. After spending time with her and beginning to understand her situation, my sympathy for her was replaced by a strong sense of respect. As I continue my journey through hospice care and social work, that initial spark of compassion flickers within me. I often call upon my interaction with her to re-ignite my drive to overcome obstacles. She taught me that there is so much to learn about what unites us as a human race, not only from the social work perspective, but also from all walks of life.
Upon revisiting my first log, I conjure up memories of how petrified I was entering an unknown arena full of intimidating nurses, doctors, and other social workers. This documentation of my first day allows me to now recognize what tremendous growth I have made throughout my internship and how much of my classroom teachings were integrated with hands-on experience. The documented self-evaluations proved to be a guide for me along the learning path as I processed emotion, confusion, and an eventual sense of extreme accomplishment. Without this log, I might not have been able to accurately and appropriately recognize the feelings that so often interact with caring for the terminally ill. As my internship comes to a close, I am no longer intimidated by health professionals speaking in what once seemed to be a foreign tongue. Yet, thanks to my candid accountings, I can recall these moments of angst at any time. Most valuable to me, however, is this first log, which allows me to revisit the frail yellow woman who forever changed the way I view the people who reside within those bright pink walls.
Faculty Liaison Reflections
Social work interns may have neither the interest, motivation, nor the ability to create written logs with such descriptive and introspective details as exemplified in this example. However, students would be prudent to consider the benefits of investing in a journalistic process that would encourage them to self evaluate in the context of the “whole experience.” Social work educators may find it helpful to provide examples of logging techniques that would both challenge and inspire students to utilize like or similar mediums for a more effective learning exercise. Such models hold the promise of contributing significantly to student interns’ self-awareness and a more astute dual focus (person and environment) understanding for the new and becoming social worker.
Katie J. Mailloux received her BSW from Georgia State University, where she completed her field education in a hospice setting. She is now seeking an MSW degree from Georgia State University.
Ronald B.Whitten, MSSW, LCSW, BCD, is an Emeritus Professor at Emory University, Department of Psychiatry and Behavioral Sciences, and a part-time instructor in the School of Social Work, BSW Program, Georgia State University, where he teaches field education.