1. Facilitation and Case Consultation Patricia (Paddy) Rodney, RN, MSN, PhD Associate Professor & Undergraduate Program Coordinator, UBC School of Nursing Faculty Associate, UBC Centre for Applied Ethics PHC Ethical Reflection Conference April 2, 2009

2. Models of Consultation…  Principle based vs contextual  Objective vs situated  Hierarchical vs egalitarian  Individual vs family/community focus  A-historical vs historical  Competitive vs collaborative  Certainty vs exploration  Single solution vs multiple strategies  Prescriptive vs consultative (Adapted from Fox, 2007; DeRenzo & Strauss, 1997)

3. STRENGTHENINGETHICALPRACTICEIn HEALTH CARE

4. A Positive Moral Community A workplace where ethical values are made clear and shared, where ethical values direct action, and where individuals feel safe to be heard (Rodney & Street, 2004).

5. Levels of Application MICRO: Individuals MESO: Organizations MACRO: Communities

6. Understanding the patient/client/resident health and illness story within the family and community context… Understanding the team members’ perspectives and experiences within the health care agency context…

7. The Use of Ethical Decision Making Models Utility Drawbacks

8. Ethical Decision Making Collect Information and Identify the Problem Specify a Range of Feasible Alternatives Use Your Ethics Resources to Evaluate Alternatives Propose and Test Possible Resolutions McDonald, 2000

9. Case Discussion  What do you think that you would feel like in a situation such as this?  What assumptions might you or others be inclined to make?  What further information do you need?

10. Negotiating Conflict  Reflect on your own position and feelings  Ensure all parties are represented  Structure appropriate meeting(s)  Engage skilled facilitator(s)  Agree upon goals and process  Set parameters for what will be accomplished  Ensure all viewpoints are heard  Conclude with pointing out what has been achieved  Be clear re follow up/use of other resources  Reflect on and evaluate the process

11. TRUST……  Implied promise  Respect  Authentic presence  Relational connections  Attentiveness to power dynamics  Equity of resources  Ongoing self-reflection (Baier, 1994; Pellegrino et al, 1991; Peter & Morgan, 2001; Rodney, 1997)

12. RESPONDING to Practice Concerns  Know the organizational structure  Keep records (recognizing legal implications) and gather support  Bring forward an organized, objective account of concerns  Move up levels; informing each level  Seek internal and external professional support  Know that external “whistleblowing” is a last (and risky) resort

13. Organizational Action Interdisciplinary Team Support Interdisciplinary Team Support Participatory Decision Making Participatory Decision Making Thoughtful Resource Allocation Thoughtful Resource Allocation Creating a Sense of Moral Community Creating a Sense of Moral Community

14. Policy Action Ethical evaluation of existing policies Ethical evaluation of existing policies Attention to ethics in policy development Attention to ethics in policy development Authentic engagement of those affected by policies Reflection and evaluation Reflection and evaluation

15. Leadership Expertise in Professional Practice Knowledge of Ethics Thoughtful Self-Reflection Conflict Resolution Skills Expertise in Group Leadership