MSN 6218 DQ Resolving Ethical Issues in Professional Practice

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MSN 6218 DQ Resolving Ethical Issues in Professional Practice

MSN 6218 DQ Resolving Ethical Issues in Professional Practice

As a
professional nurse leader, you are tasked with applying current standards,
obtaining key stakeholder buy in to process change, and applying evidence-based
strategies to maximize patient safety and improve outcomes in an ethical and
culturally competent manner.

Thoroughly
describe an ethical situation or dilemma that you have experienced or are experiencing
in your workplace.

What is the
nature of the ethical issue?

Who are the
stakeholders?

What are
the facts of the case? Impartially present two or more different and distinct
perspectives on this ethical situation or dilemma, with sufficient detail,
support, and justification for each perspective, such that the reader cannot
determine what your own perspective might be.

What are
your knowledge gaps, unknown facts, missing information, unanswered questions,
or areas of uncertainty?

What are
the actual or potential effects on patient safety and outcomes?

Cite
standards or evidence-based strategies that could be applicable in this
situation.

How was the
dilemma resolved or what must be done before the dilemma can be resolved?

Note:
Remember to adhere to the requirements listed in the Faculty Expectations
Message for unit discussion posts and peer responses.

Response
Guidelines

Respond to
two colleagues’ posts. In your responses, consider the following:

Was your
colleague able to present the dilemma impartially (without favoring or
discounting any of the different perspectives); were you able to uncover their
personal perspective?

Suggest at
least one additional resource that could be helpful in resolving the issue.

Based on
the evidence presented by your colleague, how do you think the dilemma should
be resolved?

Learning
Components

This
activity will help you achieve the following learning components:

Determine
desired outcomes.

Identify
existing health care policies and their effects on current and future outcomes.

Ethical Decision-Making Framework
Introduction – Ethical Decision-Making and Social Work Practice
The CASW Code of Ethics (2005) sets forth the values and principles that guide social work
practice in Newfoundland and Labrador. Social workers uphold the following core values:
Value 1: Respect for the inherent dignity and worth of persons
Value 2: Pursuit of social justice
Value 3: Service to humanity
Value 4: Integrity in professional practice
Value 5: Confidentiality in professional practice
Value 6: Competence in professional practice
“Ethical behaviour comes from a social worker’s individual commitment to engage in ethical
practice. Both the spirit and the letter of this Code of Ethics will guide social workers as they act
in good faith and with a genuine desire to make sound judgements”.
CASW Code of Ethics (2005)
Ethical decision-making is an integral part of social work practice. On a daily basis, social
workers are faced with ethical dilemmas that require thoughtful reflection and critical thinking.
An ethical dilemma is a choice between two actions based on conflicting professional values;
both may be morally correct and professionally grounded. Both may be right or good. It is this
ambiguity that creates the dilemma for the social worker (Linzer, 1999).
As social workers grapple with ethical issues in practice, a review and reflection on the CASW
Code of Ethics (2005) and Guidelines for Ethical Practice (2005) is crucial. In addition, social
workers may find other strategies and resources helpful, including peer consultation, discussion
with a supervisor/manager, review of best practices and relevant standards, use of ethical
decision-making models and ethics consultations.

This guide, which is grounded in the CASW Code of Ethics (2005) and professional literature, is
intended as a resource for social workers to use as they navigate ethical complexities in practice
and make sound ethical decisions. An ethical decision-making model is outlined and the
document covers areas where critical thought and reflection is encouraged. The material can
be incorporated into discussions with peers, managers and supervisors, and can be used by
social workers providing field instruction to social work students.
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Components of Ethical Decision-Making
The resolution of ethical dilemmas in practice is rarely black and white. As a profession we
have come to appreciate uncertainty and ambiguity. We embrace the opportunity to step back
and reflect on ethical dilemmas from different vantage points. Antle (2005) developed a model
outlining the components of ethical decision-making that social workers may find helpful as a
reflective framework.
Risk Tolerance
When resolving ethical dilemmas in practice, risk tolerance is a concept that should be
incorporated. Risk tolerance can be defined as one’s comfort level with risk. This includes risk
for oneself and on behalf of another (e.g. clients) to achieve a goal or purpose. As professionals
we can make arguments for and against risk; from no risk to high risk. Our tolerance for risk,
which is part of the broader ethical framework, can fall along this continuum.
It might be helpful to reflect on the following questions as they pertain to specific ethical
dilemmas in practice:
 What factors primarily inform my tolerance for risk?
 Is my personal and professional tolerance for risk similar or different?
 How comfortable am I with uncertainty and ambiguity?
 Am I guided by deontological principles (rules) or utilitarian principles (consequences)?
 What other theories inform my practice?
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 Are there times when my risk tolerance may have been too high? Too low? What were
the contributing factors?
Ethical Decision-Making Model
Social workers are encouraged to use ethical decision-making models that promote critical
thinking and reflection. A multitude of ethical decision-making models exist. The following
model, or ethical decision-making steps, is an accumulation of aspects from the models
included in the literature and is based on a best practice approach. Social workers may find this
helpful in working through ethical dilemmas in practice.
Ethical Princies Screen
1) What is the ethical dilemma? Clearly articulate the professional values that are in
conflict. What personal values if any may be influencing my decision making? Is
there a conflict between my personal and professional values?
2) What is my immediate reaction or instinct for the best way to address the ethical
dilemma?
3) Consult the CASW (2005) Code of Ethics and Guidelines for Ethical Practice. Does the
Code provide direction and guidance? Identify the sections from the Code of Ethics
and Guidelines for Ethical Practice that are applicable to the dilemma.
4) Consult applicable agency policies and best practice standards (e.g., NLASW
Standards for Technology Use in Social Work Practice).
5) Are there legal considerations? Consult relevant legislation where necessary.
6) What are some of the cultural considerations?
7) Was this issue addressed through informed consent?

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8) What are some of the available options or choices for resolving the dilemma?
Analyze the risk and benefits of each option. What steps do I need to take to
minimize risk and not compromise my ethical responsibilities?
9) Consultation with a peer, manager or supervisor can be extremely helpful.
10) Does the context of practice make a difference?
11) Discuss the dilemma with the client where appropriate.
12) Consider the impact on the therapeutic relationship.
13) What other resources might be helpful in my decision-making?
14) Document the ethical decision-making process. For additional information refer to
the NLASW Standards for Social Work Recording (2014).
15) Monitor and evaluate the impact of the decision and modify if necessary.
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When consulting the Code of Ethics, there may be times when the Code will not specifically
address the dilemma, or when the Code provides conflicting guidance. In these instances,
social workers may find it helpful to use the Ethical Principles Screen developed by Dolgoff,
Loewenberg, & Harrington (2005).
The ethical principles screen involves the ranking of ethical principles. For example, in this
model, the protection of life supersedes privacy and confidentiality.
As with any ethical decision-making tool, social workers must use professional judgment when
using these tools and consult with a colleague or supervisor as needed. For a detailed
description of the Ethical Principles Screen, please see Dolgoff, Loewenberg, & Harrington
(2005). Ethical decisions for social work practice. Thomson Brooks/Cole.
Critical Reflection and Professional Judgment
“Social work is a multifaceted profession. As professionals, social workers are educated to
exercise judgement in the face of complex and competing interests and claims. Ethical decisionmaking in a given situation will involve the informed judgement of the individual social
worker”(CASW 2005, p. 3).
In critically reflecting on ethical dilemmas in practice, some questions that you might want to
consider include:
 Am I placing the client first? Am I motivated by my own needs?
Protection
of Life
Equality and
inequality
Autonomy and
freedom
Least harm
Quality of Life
Privacy and Confidentiality
Truthfulness and full disclosure
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 Are professional boundaries being challenged? Have I set clear boundaries with my
client?
 Is this situation/dilemma creating a blend between my personal and professional life?
 Would I consider it to be reasonable for another social worker to make a similar decision
given the facts and circumstances?
 Can I explain the rationale for my decision and link it to my professional code of ethics?
 Are there other influences (that have little to do with my professional role) that may be
influencing my decision-making?
Ethical Considerations
Ethical decision-making is a key component of professional social work practice. On a daily
basis, social workers in all areas of practice throughout NL will be working through the
resolution of ethical dilemmas. These dilemmas may pertain to the following:
 Self-disclosure
Should social workers disclose personal information about themselves to clients? How
much personal information is appropriate to share with clients? Are there times when
self-disclosure is unavoidable and if so, how should these be handled? What is the
impact of self-disclosure on the social worker-client relationship?
 Personal/professional boundaries
How should social workers respond when a client offers them a gift or complimentary
services/products? Should social workers engage in physical contact with clients (e.g.,
hug a client)? How should social workers respond when meeting a client in the
community who asks for advice? Should social workers develop friendships with clients
or former clients? Should social workers accept clients as friends or contacts on social
media sites such as Facebook, Twitter or LinkedIn?
 Privacy and confidentiality
How should social workers respond when a client sends them an e-mail with personal
information? Who should have access to client information? Is it ethically appropriate
for social workers to post non-identifying client information on social media platforms?
 Conflicts of Interest
How should social workers respond when they find out that a new client is a relative of a
current client and both have requested therapy for the same family issue, yet neither
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client is aware of the social-worker client relationship with each other? How should
social workers employed with an organization respond when a client of that
organization requests to see them in their private practice? How should social workers
respond when a client wants to donate to a charity with which the social worker is
affiliated?
Conclusion
Social work is a profession committed to improving the health and social well-being of
individuals, couples, families and communities. Accountable, Competent, Professional and
Ethical: social workers are employed in diverse areas of practice throughout Newfoundland
and Labrador and use our skills, knowledge and professional judgments to ensure that clients
receive the highest quality services. Social work practice is grounded in a code of ethics that
sets forth values and principles that provides a common ethical framework. Ethical decisionmaking is a core component of social work practice. It is anticipated that this document will be
a useful resource to social workers as they navigate ambiguity and make sound ethical
decisions.
References/Resources
Antle, B. (2005). Components of Ethical Practice. Presented at Canadian Association of Social
Workers’ Code of Ethics Internal Training, Ottawa, Ontario.
Canadian Association of Social Workers (CASW). (2005). Code of Ethics. Ottawa, ON: Author.
Canadian Association of Social Workers (CASW). (2005). Guidelines for Ethical Practice. Ottawa,
ON: Author.
Canadian Association of Social Workers (CASW). (2014). Social Media and Social Work Practice.
Ottawa, ON: Author.
Congress, E. (2000). What social workers should know about ethics: Understanding and
resolving practice dilemmas. Advances in Social Work, 1(1), 1-25.
Dolloff, R., Liebenberg, F., & Harrington, D. (2005). Ethical decisions for social work practice
(7th ed.). Belmont, CA: Brooks/Cole – Thomson Learning.
Linzer, N. (1999). Resolving ethical dilemmas in social work practice. Needham Heights, MA:
Allyn and Bacon.
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Mattison, M. (2000). Ethical decision making: The person in the process. Social Work, 45(3),
201-212.
Miller, P. (2007). Ethical decision making in social work and counselling. Toronto, ON:
Thomson Nelson.
Newfoundland and Labrador Association of Social Workers (NLASW). (2014). Standards for
social work recording. St. John’s, NL: Author.
Newfoundland and Labrador Association of Social Workers (NLASW). (2012). Standards for
technology use in social work practice. St. John’s, NL: Author

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