Supporting ethical use of electronic monitoring for people living with dementia: Social work's role in assessment, decision-making, and review.

Walking outdoors supports health and well-being, but some people living with dementia are at increased risk of getting lost and of harm while missing. Electronic monitoring can potentially play an important preventative role by enabling the person's location to be continuously monitored by caregivers. However, there are considerable ethical concerns arising from electronic monitoring. This paper explores these thematically, drawing attention to its implications for autonomy and liberty; privacy; dignity; the rights and needs of caregivers and families; beneficence and nonmaleficence. Following from this, key questions for consideration in social work assessment are identified. The ethical issues necessitate assessment of the person's unique circumstances and preferences and that of their caregivers, and careful ethical deliberation in decision-making. Social work can play an important role in facilitating inclusive assessment and decision-making, leading to consensus on intervening with electronic monitoring. The need for the ongoing review following implementation is discussed to track whether decisions need modification in light of the experience of usage. In conclusion, while legislative instruments and professional codes of ethics frame social work practice responses, there is need for a nuanced debate about ethical use of electronic monitoring and specific guidance to inform assessment, decision-making, and review.

Moral distress as experienced by hospital social workers in South Korea and Australia.

This exploratory, qualitative research explored the ethical problems faced by hospital social workers in South Korea and Australia, and what and who influenced their decision making using a focus group design. Although dilemmas of boundaries, confidentiality, self-determination, and other complex scenarios found in practice were identified, moral distress, a consequence of the unresolvable conflicts, dominated participants' narratives. This was particularly the case for the Korean social workers in this sample. A thematic analysis of the data yielded three main themes: 'Under pressure-"It's very uncomfortable"'; 'Failing our patients'; and 'Coping and codes'.

What ethics for case managers? Literature review and discussion.

BACKGROUND: Little is known about case managers' ethical issues and professional values. OBJECTIVES: This article presents an overview of ethical issues in case managers' current practice. Findings are examined in the light of nursing ethics, social work ethics and principle-based biomedical ethics. RESEARCH DESIGN: A systematic literature review was performed to identify and analyse empirical studies concerning ethical issues in case management programmes. It was completed by systematic content analysis of case managers' national codes of ethics. FINDINGS: Only nine empirical studies were identified, eight of them from North America. The main dilemmas were how to balance system goals against the client's interest and client protection against autonomy. Professional codes of ethics shared important similarities, but offered different responses to these two dilemmas. DISCUSSION: We discuss the respective roles of professional and organizational ethics. Further lines of research are suggested.

Eating disorder therapists' personal eating disorder history and professional ethics: an interpretive description.

This qualitative study sought to explore and understand eating disorder (ED) therapists' perceptions of whether and how their personal ED histories had professional ethical relevance. Analysis of multiple interviews with 11 therapist-participants indicated that they perceived their personal ED histories as having substantial ethical relevance in their day-to-day practice with ED clients. The major categories of ethics experiences that emerged were: boundaries, therapist wellness, helpfulness of personal ED history, and openness regarding therapists' personal ED histories. The findings have practical utility for the education, training, and continuing education of ED-historied practitioners.

Keep your sunny side: a street-level look at homelessness.

This opinion piece considers my personal experiences of poverty, homelessness, loss, and physical disability in relation to recent discussions of social defeat and resistance among permanent supported housing tenants with physical and mental illnesses. By drawing attention to the onslaught of deprivation and humiliation that generally comes with the territory of poverty and homelessness in the United States, I hope to influence the ways in which clinicians, social service providers, and scholars think about specific instances of social defeat and resistance. My basic point is that any specific experience of resistance or defeat cannot be adequately understood in isolation. Rather, such experiences must be understood in relation to individual life histories of defeat and resistance, and to the symbolic and material sources of success and failure available to citizens who occupy a particular section of social space in a given society.

Ethical dilemmas faced by hospice social workers.

Ethical decision making is critically important in hospice social work. Through in-depth interviews, researchers explored ethical dilemmas faced by 14 hospice social workers and the processes they used to move toward resolution. The dilemmas were integrated into a framework focused on the sources of ethical conflict: the client system, the agency, and the profession. Processes involved in resolving ethical dilemmas included consulting with other professionals, weighing the pros and cons of options, and bringing about desired outcomes. Findings suggest that hospice teams should be provided with opportunities to meaningfully discuss ethical decision making. Further, the involvement of social workers in administrative leadership is recommended to increase the likelihood that discipline-specific perspectives are incorporated into formal policies and procedures that shape practice in ethically complex situations.

Social work, technology, and ethical practices: a review and evaluation of the national association of social workers' technology standards.

Information and communication technologies (ICTs) are becoming essential to social work practice by providing increased treatment possibilities and reducing barriers to service. While recognizing the importance of ICTs in practice, social work practitioners have had concerns about ethical use. In response, NASW compiled the Standards for Technology and Social Work Practice. While the guidelines set the groundwork, they were not embedded in a process that would allow them to adapt to the swift pace of ICT changes. This article reviews the current Standards, evaluates how these have been implemented by practitioners, and offers suggestions for updates.

Continuing education in ethical decision making using case studies from medical social work.

Medical social workers have needs for training in ethics that is specific to dilemmas that arise while providing service to patients who are very ill, mentally compromised, or in a terminal condition. A social work department developed a continuing education training to educate social workers in bioethics related to determining decisional capacity and understanding standards of ethical decision making. Case studies are used to illustrate ethical conflicts and the role of social workers in resolving them. The benefits of case study training are discussed.

Social media and social work education: understanding and dealing with the new digital world.

Accompanying the multiple benefits and innovations of social media are the complex ethical and pedagogical issues that challenge social work educators. Without a clear understanding of the blurred boundaries between public and private, the potentially limitless and unintended audiences, as well as the permanency of the information shared online, social work students who use social media can find themselves in difficult situations in their personal and professional lives. In this article, we present three scenarios that illustrate issues and complexities involving social media use by social work students, followed by a discussion and recommendations for social work educators.

Clinical social work practice and technology: personal, practical, regulatory, and ethical considerations for the twenty-first century.

The world that social work exists in is no longer defined by traditional physical settings and boundaries, such as schools, agencies, or even offices. With the advent of the Internet and digital communications, social work now exists in a far more complex reality, with clients and social workers engaging across multiple platforms, and sometimes even unintentionally and without one another's awareness. The implications of this can be ethical, practical, regulatory, and personal. This article explores these areas of concern and suggests strategies professionals can use to navigate these complex issues related to technology and clinical practice.

Case management and the new nephrology social worker.

Case management is thought to be an effective way to offer counseling services and integrate the coordination of other services 4 into an efficient care delivery model. Through communication, collaboration and outcome-driven interventions, nephrology social workers can make a difference in health risk behaviors through case management.

Economic and demographic challenges for social care.

PURPOSE: The purpose of this paper is to analyse the impact of reforms designed to address economic and demographic challenges in England with reference to the authors' own empirical work providing a critique of their impact and suggesting a way to improve the quality of social care for older people. DESIGN/METHODOLOGY/APPROACH: The research was a qualitative study conducted in a participatory manner in which older people were positioned as co-creators of the research study. This involved setting the scope of the study and identifying and refining the themes used in the analysis of an inquiry board and interviews. FINDINGS: The research findings highlight the threat of recent moves that emphasise "independence" and "self-management" particularly as they risk marginalising some groups of older people and reducing the quality of care. An alternative approach drawn from the ethics of care is suggested. RESEARCH LIMITATIONS/IMPLICATIONS: The research study focused on a narrow selection of older people and future work will wish to explore concepts of "care" and "independence" in additional contexts and of reforms in other geographies. PRACTICAL IMPLICATIONS: The researchers argue that the current reform agenda threatens the quality of care services and suggest improvements to the way in which services might be organised and presented. SOCIAL IMPLICATIONS: It is intended that the research will contribute to social policy debates and particularly those that focus on social care. The study also looks to contribute to current work in the fields of critical gerontology, feminist ethics and the management of public services more generally. ORIGINALITY/VALUE: The paper presents a novel and critical viewpoint of current social care policy in England and will therefore be of interest to policy-makers and to professionals.

The intensity and frequency of moral distress among different healthcare disciplines.

INTRODUCTION: The objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals. METHODS: Participants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant's discipline. Higher scores reflected greater intensity and/or frequency of moral distress. RESULTS: More than 2,700 healthcare professionals responded to the survey (response rate 18.14 percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists. CONCLUSIONS: Moral distress has previously been described as a phenomenon predominantly among nursing professionals.This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it.

Exploring professional boundaries in end-of-life care: considerations for hospice social workers and other members of the team.

Hospice social workers and members of the interdisciplinary team develop close therapeutic relationships with patients and families as they journey toward death. During this process, situations can develop that challenge professional boundaries and blur the line between a professional and personal relationship. This article will examine professional boundaries within the context of hospice care through case studies identifying challenges that hospice social workers and members of the interdisciplinary team may encounter with recommendations for how to manage boundary concerns.

Do nurses and social workers have different values? An exploratory study of the care for older people.

This study explored the different values of staff from two care homes for older people in which the managers had different qualifications (social worker vs. nursing). Their views were examined to explore whether the values of the staff might reflect any value difference originating in the professional backgrounds of the managers. There was little evidence of awareness in either home of the ethical principles underlying day-to-day decisions. However, a distinction based on care qualification did appear with "care-qualified" staff (defined in terms of qualification requirements for this care work) demonstrating a more reflective response and fewer ageist assumptions than their non-care-qualified colleagues. The study found no difference in values between the nursing and social worker-led homes. All respondents, regardless of the profession of their manager, were keenly aware that they have a "duty of care" and overwhelmingly they defined that as their duty to keep the resident safe, as opposed to allowing her to exercise autonomy. The study results suggest that value base constitutes a commonality between professions involved in the care of older people rather than a barrier to collaboration, as is sometimes posited.

Moral learning in an integrated social and healthcare service network.

The traditional organizational boundaries between healthcare, social work, police and other non-profit organizations are fading and being replaced by new relational patterns among a variety of disciplines. Professionals work from their own history, role, values and relationships. It is often unclear who is responsible for what because this new network structure requires rules and procedures to be re-interpreted and re-negotiated. A new moral climate needs to be developed, particularly in the early stages of integrated services. Who should do what, with whom and why? Departing from a relational and hermeneutic perspective, this article shows that professionals in integrated service networks embark upon a moral learning process when starting to work together for the client's benefit. In this context, instrumental ways of thinking about responsibilities are actually counterproductive. Instead, professionals need to find out who they are in relation to other professionals, what core values they share and what responsibilities derive from these aspects. This article demonstrates moral learning by examining the case of an integrated social service network. The network's development and implementation were supported by responsive evaluation, enriched by insights of care ethics and hermeneutic ethics.

Promoting recovery through peer support: possibilities for social work practice.

The Recovery Approach has been adopted by mental health services worldwide and peer support constitutes one of the main elements of recovery-based services. This article discusses the relevancy of recovery and peer support to mental health social work practice through an exploration of social work ethics and values. Furthermore, it provides an exploration of how peer support can be maximized in groupwork to assist the social work clinician to promote recovery and well-being. More specifically, this article discusses how the narrative therapy concepts of "retelling" and "witnessing" can be used in the context of peer support to promote recovery, and also how social constructionist, dialogical, and systemic therapy approaches can assist the social work practitioner to enhance peer support in recovery oriented groupwork.

Ethical dilemmas in social work practice with disabled people: the use of physical restraint.

This article discusses the use of restraint with disabled adults and children and uses a case study of one particular child to explore issues related to the use of restraint, including the consent of the person subjected to restraint, their human rights, and the balancing of these rights with the need to reduce the risk of harm. The case study involves a young woman who requested to be restrained in a particular way and the challenges this posed to the staff caring for her. The article concludes that in many complex situations there is no clearly right approach to take, and each situation involving restraint must be considered on an individual case-by-case basis.

Undressing the Emperor? On the ethical dilemmas of hierarchical knowledge.

The title refers to Hans Christian Andersen's fairytale "The Emperor's New Clothes". It indicates how hierarchies of power dominate what we see and how we act - in short, our ethical interaction. The author considers collaboration to be a prerequisite for improving quality in the arenas of health and social work, in persons as well as systems. She argues that a radical change in the direction of understanding knowledge and competence as co-creational is required. This again calls for a redefinition not only of the role of professions, of what it takes to be a professional, but also of the role of the user. Consequently, the author's approach challenges the institutional framework of health and social work, as well as the content and methodology of teaching.

HIV diagnosis disclosure: stigma management and stigma resistance.

This article reports diagnosis disclosure decision comments arising serendipitously in five focus group discussions with 34 HIV-infected New Yorkers over age 50. Three overarching disclosure themes demonstrate the complexity of diagnosis disclosure decision-making: (a) hiding or selectively disclosing, or stigma management; (b) partial disclosure because of the perception of partial control of the information; and (c) widespread or complete voluntary diagnosis disclosure, representing stigma resistance. Social workers and other human services practitioners should remember the diversity in the HIV population, the aging population, and the HIV-positive aging population. Experiences of HIV stigma and choices about diagnosis disclosure and stigma management or resistance are individual, reciprocal, and dynamic.