Knowledge and skills

In health care institutions, social work knowledge is developed through constant interplay with the biomedical and multidisciplinary environment. In a study (Sub-study I), health social workers saw knowledge as both formal (theoretical knowledge), acquired through education, and informal (practical knowledge), acquired through work and life experience. Important knowledge was thought to include the ability to assess the limits of work task as well as the limits of the social worker’s own knowledge and competencies (self-regulating knowledge). The health social workers regarded professional competence as implying relational knowledge and skills, taking the time to listen and process with clients and giving them space and options. They also associated knowledge with professional identity and special competence of ‘knowing something other professionals do not know’ (p. 271).

Scholars of health social work have attempted to define the knowledge base (knowledge as object) and the competences needed in this particular work setting.

Joyce Lai-chong Ma (1997) sees the problems health social workers meet as essentially being ‘the psychosocial difficulties arising from or in association with illness and disease’ (p. 23); the workers have ‘to understand the psychosocial consequences of the particular illness on an individual, the family and on society’ (p. 23). Besides the social work discipline, health social work draws on many other disciplines as well, such as psychology, anthropology, sociology (ibid., 27), social policy, social psychology, pedagogy, health science, philosophy, law, administration, and economics (Lindén 1999, 53).

For many years, the education of Finnish health social workers developed separately from the education of municipality social workers. In the 1920s, when social work was first introduced into psychiatric, paediatric and surgical care (Hakola 1965), specific health social work education did not exist. The early health social workers were public health nurses or nurses specialised in the very medical field in which they worked (Åberg 1942, 9). In the 1940s, when the first school of social work was founded, developers of health social work felt that the planned education did not meet the needs of the health field. A short specialisation for trained nurses was then introduced, which was later extended to one school year (Ahla 1965).

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In 1975, social nursing education was discontinued, as it was considered no longer relevant. From then on, all social workers in Finland, regardless of where they work, have belonged to the same profession. In the 1980s, social work education was taken to the university level, and the formal competency for all social workers is now a Master’s degree in Social Science, majoring in Social Work. In 2001, a professional licentiate qualification was launched, and specialisation in rehabilitation and empowerment has been particularly popular among health social workers. Bachelors of social services, who graduate from Universities of Applied Sciences, are a newer group of professionals. They are social counsellors, whose tasks in health care institutions have not yet been clearly defined.

Thus, for several decades, Finland had health social workers of two different educations, almost different schools: on the one hand were social nurses, whose professional

knowledge was built mainly on caring and individual casework; and on the other hand were social workers from a school of social work, whose professional knowledge focused more on legislation, service systems and policy issues (Lehtinen 1986; Satka 1995).

The different views on the role of health social work caused occasional clashes, but also created opportunities for mutual learning and productive dialogue.

Today, the question is sometimes raised as to whether health social workers need more knowledge on health issues than that which social work education currently provides.

In the early days, knowledge on illness and nursing was evidently essential, and was a prerequisite for successfully collaborating with the medical profession (Åberg 1942; cf.

Healy 2014, 38). Later, a break with the nursing identity was needed, to allow a more social perspective. Now today, once again, reasonable competence in the medical field is considered indispensable special knowledge for social workers working in health care (Ma 1997; Metteri 2014; Morén et al. 2014).

As well as extensive knowledge in many different areas, social work assessments and interventions also require solid relational skills. A recent study of complaints filed by patients in a Finnish hospital (Palomäki & Vanhala 2016) showed that the most common complaint was that of not having been heard and believed by medical staff in general. In health social work, relational skills have since the beginning been considered essential knowledge for trying to help patients adjust to a new life situation.

In the 1940s and 1950s, Finnish health social workers studying in the US brought the social casework method to Finland (Toikko 2005, 160–165), and good communication skills still form the basis for social work practice.

35 As mentioned before, whether aware of it or not, social workers often use theoretical assumptions in their work, and they apply theory eclectically (Payne 2005, 30–32) or multi-theoretically (Forte 2014, 192–194). In later chapters, I will discuss some theories used in social work practice more in depth. In addition to these, other theories and concepts that have influenced health social work are, for example, social constructivist thinking, Bronfenbrenner’s (1979) ecological systems theory, social support, risk and protective factors, resilience, attachment, and coping (Forinder

& Olsson 2014); Gullacksen (2014) emphasises life adjustment in connection with chronic illness or disability as a process. In Finland, health social work has also been strongly influenced by concepts used in rehabilitation practice, such as social learning, life control, life management, empowerment (Järvikoski & Härkäpää 2004) and the biopsychosocial framework (Talo & Hämäläinen 1997).

Although social workers generally have been found to use research to a very limited extent (Trevithick 2008), Finnish health social workers show interest in research and want more collaboration with universities (Sub-study I). This might be due to the experienced need to strengthen their professional identity and knowledge base in a multidisciplinary environment. Health social workers often work quite autonomously (cf. Heinonen & Metteri 2005b) without much support from managers and social worker colleagues at the workplace; they draw more from supervision and in-service training. (Sub-study I.) This may increase their perceived need for research. The rapid development of electronic technology has meant a huge step forward in social workers’

access to various kinds of knowledge in the form of guides, scientific literature and so on. Consultation with colleagues has also become easier.

The requirements for ‘evidence-based practice’ in health social work have not been strong in Finland compared to, for example, Sweden (Heiwe et al. 2013; Udo et al. 2018).

One reason for this might be the high academic education of Finnish social workers, who assumingly are able to acquire the research-based knowledge they need with no external demands (cf. Hübner 2016). Another reason may have to do with how evidence-based practice is defined. In Finland, the discussions related to knowledge seem to be more about social work expertise (cf. Juvonen et al. 2018), in which knowledge is seen as multidimensional and consisting of, for example, contextual and client knowledge, relational and communication skills, a commitment to working with the client, reflective skills, and interprofessional skills. Social workers’ critical reflection and

research-mindedness are emphasised. (Pohjola 2007; Yliruka & Karvinen-Niinikoski 2013.)

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