101. Case: Chatting About Hopes and Goals

You are a social worker who is part of a rehab team.  During lunch, the conversation turns to one of the patients that you and your team is working with. The patient was in a scooter accident and suffered multiple fractures. They are struggling to regain their ability to walk and can often be heard expressing their frustration. Some around the table are concerned that the patient is giving up and that they seem to have “no hope for the future” – despite the expectation that they should be able to walk again. One of your team members turns to you and says, “You seem to have a good rapport with this patient, why don’t you talk to them about this?”  This is not the first time you’ve received such a request, and you appreciate that your colleagues have recognized your skill at building rapport. But there is no extra time, or any other resources provided to you to acknowledge the contribution you are making.  How will you respond to this request?  And how might you raise this at the next team meeting?


You are 23 years old and you were in a collision while riding your scooter and are now in rehab recovering after multiple serious fractures. Rehab is a lot of effort and you aren’t experiencing the improvements you expected.  Your friends have stopped coming by to visit and you feel lonely and isolated in the hospital.  You know that the health care providers are trying their best, but you find it hard not to take your frustration out on them when they’re the only people you see most days. How will you respond the next time a team member encourages you to keep trying?


Discussion Questions:

  • How did your response to the case shift when you read about it from a different perspective?
  • What do you see as the most important values for each person involved in the conversation?
  • What are some of the values that might be in tension for the social worker in thinking through the situation?
  • What types of support might make it easier for the social worker to take on the work of having difficult conversations?
  • How do health care providers build the skills that help difficult conversations go well?

References:

Canadian Physiotherapy Association. Ethics and professionalism toolkit. https://physiotherapy.ca/ethics-and-professionalism-toolkit

Forbes Coaches Council. 14 Ways To Approach Conflict And Difficult Conversations At Work https://www.forbes.com/sites/forbescoachescouncil/2017/07/17/14-ways-to-approach-conflict-and-difficult-conversations-at-work/#698346ac3cfd

Woelk, C.J. 2008. Management of Hope. Can Fam Physician; 2008 Sep. 54(9): 1243-1245 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553443/

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87. Case: Considering Alternatives

Jessie Rockford is an 8-year-old with a history of developmental delay, significant cognitive deficits, and symptoms of cerebral palsy. She is her parents’ only child and they are very loving, attentive, and concerned–they never miss a medical appointment and have carefully followed the care plan drawn up for their daughter.

However, with the passing of time they have grown increasingly concerned about her muscle spasms and contractions that seem to be causing her significant discomfort. They have consulted a local homeopath as well as a massage therapist who have both become involved with Jessie’s ongoing care.

At a regular clinic visit her parents tell the clinician about these new developments and add that they believe the treatments are helping. When the sessions are explored with Jessie, she shows no concern and seems quite content.

The health care team has some questions about this development and has called you to find out how they should respond to Jessie’s parents. Should they be supportive or discouraging of the parents’ decision?

36. CASE: Fee-For-Service Care (Complementary/ Alternative Practices)

A registered nurse is also a registered massage therapist and runs a private practice out of her home.  Physicians often refer patients to her privately for massage therapy, but have also begun asking this RN to provide massage services while on duty in the hospital. She feels uncomfortable about this and after speaking with her manager and director, requests an ethics consult.

  • What are the main ethics issues to think about in this situation?
  • What other issues need addressing in this case?
  • How would your committee respond to this request?


Some Values and Ethics Issues to Consider

  • Compliance with policy
  • Resource allocation
  • Health care provider relationships
  • Organizational culture
  • Overlapping roles and responsibilities
  • Professional boundaries