1. Ethics Education 2016

2. Agenda Ice Breaker Activity Introduction to Ethics Gaining Ethical Strategies Working Through Ethical Dilemmas Assessment and Application Video

3. Ice breaker discussion  Introduce yourself (Name, Program you work for, Years of Service )  What is one thing you would like to learn from this session?  What does ethics mean to you?  In your opinion, what is the biggest problem concerning ethics at work?  Do you feel you can teach values and ethics after a person has reached adulthood? If not, why? Or, if so, why?

4. What we Hope to Accomplish  Understand how to act when our own and others’ (VHA, clients, etc …)values conflict.  Learn concepts related to ethics.  Identify ethical dilemmas  Gain resources to assist in approaching and solving ethical issues.  Foster positive work environment.

6. Introduction to Ethics in Healthcare

7. Definition Ethics Noun plural I eth-ics I ‘e-thiks\  1: a branch of philosophy dealing with what is morally right or wrong  2: the rules of moral behavior governing an individual or a group http://www.merriam-webster.com/dictionary/ethics In the context of work: Upholding the highest level of professional standards for your specific role- College of Nurses of Ontario

8. Philosophical Theories Four Basic Principles Autonomy The right to act freely with a self chosen plan Self-rule or self- governance respect others Beneficence To “do good” Different perceptions of the good exist make things better Non- Maleficence First “do no harm” An act of abstaining Justice Procedural justice Distributive justice Fairness Equity v Equality be fair Others? Veracity (truth telling)? Do not lie? be loving

10. Decisions, Decisions Balancing Competing Values THE CLIENT YOU VHA CAREGIVERS STAFF FAMILY SOCIETY REPUTATION LAW

11.  https://www.youtube.com/watch?v=NkQVvS3hFLM https://www.youtube.com/watch?v=NkQVvS3hFLM

12. How can you use ethics in decision making? ConsequencesActionDilemma I encounter an ethical issue ex. client asks to pour them an alcoholic drink even though I feel they are overstepping a limit I do the action ex. pour the alcoholic beverage BEST: They will not complain, the client will be happy, I go on with my day WORST Damaging health, alcohol coma, mediator to harm when leaving that patient intoxicated Do not take action ex. do not pour the drink and explain why BEST Do not cause patient further physical harm, do not take responsibility if something happens to that client, respect own boundaries WORST Client complains, do not build on trust worthy relation ship

13. The Client Values and Preferences

14. Setting Boundaries and Saying No  When you are presented with a dilemma at work, there are times when it might be helpful to either give yourself time to process your options/choices, or say no in a helpful, non-argumentative way.  You have the right to refuse requests, but it is necessary to do so in a respectful way.

15. The Professional Relationship

16. IDEA framework Step 1: I dentify the Facts Identify what is known versus what is not known.  Medical Indications  Client Preferences  Quality of Life, and  Contextual Features, Think of everyone involved Step 2: D etermine Ethical Principles in Conflict Identifying the ethical principles in conflict will not provide solutions; however, this step will assist in further clarifying and articulating the issues. Common ethical principles to consider:  Autonomy  Beneficence (or doing good)  Non-maleficence (or doing no harm) or  Justice Step 3: E xplore Options Brainstorm different alternatives and to consider the potential outcomes and impacts of each one Do the options fit with the patient’s preferences? Do the options comply with corporate policy, regulations, and the law? Step 4: A ct and Evaluate Develop and document the action plan in the patient’s chart and obtain consent. Evaluate the plan. Were the intended results obtained, or is additional follow-up and/ or action required? Self-evaluate your decision. What have you learned?

17. Break

18. Group Discussion

19. Scenario 1 Client receives care for light housekeeping. HSW arrives to find client has been incontinent. She has a PSW certificate, but is aware that she is not visiting the client in that capacity, and assistance with personal care is not part of the service plan. She feels pressured to assist the client to get cleaned up because she knows the client will not be able to help himself, and nobody else will visit that day to assist.

20. Scenario 2 PSW brought her child to client’s home. When asked, she explained that her childcare arrangements fell through at the last minute and she knew the office would not be able to find a replacement for the client that day. She also rationalized that the visit brought great joy to the client

21. Scenario 3 a) ACW reveals personal information to the client about a marriage break-up and subsequent financial difficulties. Client offers worker a small monetary loan. b) ACW gives client a birthday gift; when asked about it, she explained it was only a small gesture, an inexpensive box of chocolates.

22. Extra Scenarios  Client requesting additional services not included on the service plan. If the PSW refuses, s/he is concerned that client will complain and request a new worker. PSW is desperate to keep the hours she currently has.  As an AVON representative, HSW was distributing magazines and collecting sales. When asked, she explained that her one client was isolated and home bound and expressed appreciation for the service.  PSW provides client with his cell phone since it is so much easier to coordinate visits without the office staff’s interference. (Background: we employ Scheduling Coordinators in the office who are responsible for arranging visits, changing schedules to accommodate appointments/sick calls, and ensuring the database schedule is up-to-date for payroll).

23. Now what? The after math of ethical dilemmas  When in doubt, consult with your supervisor.  If not resolved at this level, the ethicist can be contacted.  Josh Landry, Regional Ethicist, joslandry@toh.on.ca  Mentorship support from senior staff  Liaison Committee, Ethics Committee  Service educator  Resources  VHA website  VHA agenda: IDEA framework Page 2,3  Today’s presentation notes

24. Assess your learning

25. Questions? Comments?

26. Thank you and congratulations on completing VHA’s Ethics Training.