Being a hospice social worker: A multiple case study on hospice social work in China

This thesis focuses on the ways Chinese hospice social workers make sense of the situations around them to decide on interventions. Case study methodology was applied to capture the contextual conditions of hospice social workers’ daily practice. Data was collected in three hospice units located in the eastern, central, and western regions of China. A total of 36 interviews were conducted with three social workers, three doctors, three nurses, and six clients. Four observations were conducted of the social workers undertaking groupwork sessions. Relevant documents such as case reports and groupwork plans were gathered. Data analysis results indicate that social workers live in an unsupportive working environment where they experience dysfunctional feelings and develop defence strategies to respond in day-to-day practice. A variety of approaches are identified, through which social workers form their identities towards clients. It is recommended that for social workers to gain recognition from their clients, an important element needed is congruence between outward expressions and internal good feelings they have for clients.

The Chinese indigenous concepts of guanxi and renqing are used to examine the way in which participants justify their professional authority that is supposed to be conferred by institutional disciplines. Classical debates regarding guanxi, renqing, and face in both Chinese and Western scholarship are reviewed. Based on the empirical data and sociopsychological perspectives, theoretical formulations relating guanxi, renqing, and face are generated. Drawing mainly on Fei’s differential mode of association and Simmel’s inquiries on social forms and social boundaries, guanxi is explained as an ego-centric configuration of interpersonal relationships. Insights regarding Liang’s moral reasoning and the psychological development of an individual’s self in attachment theory contribute to the understanding of renqing that is a common interest underlying the formation of guanxi. The major theoretical and philosophical influence on the interpretation of face, which symbolises individuals’ identities recognised by related others, is Honneth’s tripartite conceptualisation of recognition.

This thesis concludes that the cultural resilience of guanxi allows it to soften the dehumanisation in the social worker-client relationship driven by managerialism in professionalisation. As long as guanxi remains effective in meeting people’s needs and obtaining expected outcomes in their everyday encounters, it will not be and therefore should not be effaced as the professionalisation of social work in China progresses. Drawing on findings from this research, it is suggested that there is an urgent need for Chinese social work scholars to undertake quality practice-based research. Empirical materials require a thorough and critical examination incorporated with existing theoretical sources, through which knowledge can be generated to nourish and enlighten practice and education.