Everyday ethics in case management : experiences of moral distress by professionals in a community health care setting / by Kristen Dawn Jessiman.

Academic research has recognized and explored ethical issues and experiences of moral distress in acute care settings for many years now. The same cannot be said for ethical issues in the community care setting. Perhaps more than ever, as treatments and care are shifted out of institutions and into the home, today’s health care professionals face unique and difficult ethical issues. The purpose of this study was to examine experiences of moral distress related to everyday ethical issues by analyzing data collected from a cohort of professional case managers working in a community health care setting in northern Ontario, Canada. The objectives of the study were to investigate the nature of ethical issues in the community health care setting; explore experiences of everyday ethical issues and moral distress; identify barriers to ethical practice and evaluate the available resources. Quantitative and qualitative data were gathered using an original, selfadministered questionnaire developed by the researcher. This questionnaire was distributed to case managers employed at North West (Thunder Bay and region) and North East (Sudbury and region) Community Care Access Centres. The response rate to the questionnaire was 31%, representing 66 participants from a pool of 215 potential participants. The results showed that everyday ethical issues were prevalent in this professional setting, often encountered on a weekly basis. Participants described a moderate to high level of confidence to identify, address, and resolve everyday ethical issues in their practice. Ethical issues were described as a combination of the theoretical categories of autonomy, beneficence, nonmaleficence, and justice, therefore representing complex, multi-factorial scenarios. Experiences of moral distress were described as occurring with moderate to high frequency and intensity, most commonly expressed with emotional symptoms. The most influential coping strategies were identified as ‘talking to colleagues’ and utilizing ‘supportive leaders’. Barriers to ethical practice included the lack of resources, restrictions based on policy and regulations, and issues related to conflict and communication. Experiences of moral distress were closely related to a lack of resources and time constraints. Recommendations for further research include the need to identify interventions to increase ethical competence and to provide opportunities to encourage healing from experiences of moral distress. The researcher recommends that community agencies adopt strategies which foster opportunities to identify and discuss experiences of everyday ethical issues and moral distress. Avenues which may increase capacity for ethical competence may include; formal educational opportunities; agency commitment to the ongoing development of an active ethics committee; informal collaboration among colleagues, supervisors, and organizational leaders; and attention to maintaining or improving the work environment to encourage successful coping, enhanced confidence and empowerment. While issues of increased workload, lack of time, and inadequate resources are unlikely to ever be resolved in the near future, opportunities to problem solve and share strategies provide much needed support for health care professionals working in the community care setting. Further studies using qualitative methodologies of storytelling and reflection will provide further insight into experiences of moral distress and its unique manifestation in the community care setting in northern Ontario. Study area : Northwestern Ontario (Thunder Bay region) and Northeastern Ontario (Sudbury region)