Facilitation and Case ConsultationFacilitation and Case Consultation

Patricia (Paddy) Rodney, RN, MSN, PhDPatricia (Paddy) Rodney, RN, MSN, PhD

Associate Professor Associate Professor

& Undergraduate Program Coordinator,& Undergraduate Program Coordinator,

UBC School of NursingUBC School of Nursing

Faculty Associate, UBC Centre for Applied Faculty Associate, UBC Centre for Applied Ethics Ethics

PHC Ethical Reflection ConferencePHC Ethical Reflection Conference

April 2, 2009April 2, 2009

Models of Consultation…Models of Consultation… Principle based vs contextualPrinciple based vs contextual Objective vs situatedObjective vs situated Hierarchical vs egalitarianHierarchical vs egalitarian Individual vs family/community focus Individual vs family/community focus A-historical vs historicalA-historical vs historical Competitive vs collaborative Competitive vs collaborative Certainty vs explorationCertainty vs exploration Single solution vs multiple strategiesSingle solution vs multiple strategies Prescriptive vs consultativePrescriptive vs consultative

(Adapted from Fox, 2007; DeRenzo & Strauss, 1997)(Adapted from Fox, 2007; DeRenzo & Strauss, 1997)

STRENGTHENING STRENGTHENING

ETHICALETHICAL

PRACTICEPRACTICE

InIn

HEALTH CAREHEALTH CARE

A Positive Moral CommunityA Positive Moral Community

A workplace where ethical values are A workplace where ethical values are made clear and sharedmade clear and shared, where ethical , where ethical values values direct actiondirect action, and where , and where individuals individuals feel safefeel safe to be heard to be heard

(Rodney & Street, 2004).(Rodney & Street, 2004).

Levels of ApplicationLevels of Application

MICRO: IndividualsMICRO: Individuals

MESO: OrganizationsMESO: Organizations

MACRO: CommunitiesMACRO: Communities

Understanding the Understanding the patient/client/resident patient/client/resident health and illness storyhealth and illness story

within the within the family and community context…family and community context…

Understanding the team members’ Understanding the team members’ perspectives and experiencesperspectives and experienceswithin the health care agency within the health care agency

context…context…

The Use of Ethical Decision The Use of Ethical Decision Making ModelsMaking Models

Utility

Drawbacks

Ethical Decision MakingEthical Decision Making

Collect Information and Identify the ProblemCollect Information and Identify the Problem

Specify a Range of Feasible AlternativesSpecify a Range of Feasible Alternatives

Use Your Ethics Resources to Evaluate Use Your Ethics Resources to Evaluate AlternativesAlternatives

Propose and Test Possible ResolutionsPropose and Test Possible Resolutions

McDonald, 2000McDonald, 2000

Case DiscussionCase Discussion

What do you think that you would feel What do you think that you would feel like in a situation such as this?like in a situation such as this?

What assumptions might you or others What assumptions might you or others be inclined to make?be inclined to make?

What further information do you need?What further information do you need?

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

TRUST……TRUST……

Implied promiseImplied promise RespectRespect Authentic presenceAuthentic presence Relational connectionsRelational connections Attentiveness to power dynamicsAttentiveness to power dynamics Equity of resourcesEquity of resources Ongoing self-reflectionOngoing self-reflection

(Baier, 1994; Pellegrino et al, 1991; (Baier, 1994; Pellegrino et al, 1991; Peter & Morgan, 2001; Rodney, 1997)Peter & Morgan, 2001; Rodney, 1997)

RESPONDING to Practice RESPONDING to Practice ConcernsConcerns

Know the organizational structureKnow the organizational structure Keep records (recognizing legal Keep records (recognizing legal implications) and gather supportimplications) and gather support Bring forward an organized, objective Bring forward an organized, objective account of concernsaccount of concerns Move up levels; informing each levelMove up levels; informing each level Seek internal and external professional Seek internal and external professional supportsupport Know that external “whistleblowing” is a Know that external “whistleblowing” is a last (and risky) resort last (and risky) resort

Organizational ActionOrganizational Action

Interdisciplinary Team SupportInterdisciplinary Team Support

Participatory Decision MakingParticipatory Decision Making

Thoughtful Resource AllocationThoughtful Resource Allocation

Creating a Sense of Moral CommunityCreating a Sense of Moral Community

Policy ActionPolicy Action

Ethical evaluation of existing policies Ethical evaluation of existing policies

Attention to ethics in policy developmentAttention to ethics in policy development

Authentic engagement of those affected by Authentic engagement of those affected by policiespolicies

Reflection and evaluationReflection and evaluation

LeadershipLeadership

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