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Facilitation and Case Consultation
Patricia (Paddy) Rodney, RN, MSN, PhD
Associate Professor
& Undergraduate Program Coordinator,
UBC School of Nursing
Faculty Associate, UBC Centre for Applied
PHC Ethical Reflection Conference
April 2, 2009
Models of Consultation…
Principle based vs contextual
 Objective vs situated
 Hierarchical vs egalitarian
 Individual vs family/community focus
 A-historical vs historical
 Competitive vs collaborative
 Certainty vs exploration
 Single solution vs multiple strategies
 Prescriptive vs consultative
(Adapted from Fox, 2007; DeRenzo & Strauss, 1997)
A Positive Moral Community
A workplace where ethical values are
made clear and shared, where ethical
values direct action, and where
individuals feel safe to be heard
(Rodney & Street, 2004).
Levels of Application
MICRO: Individuals
MESO: Organizations
MACRO: Communities
Understanding the
health and illness story
within the
family and community context…
Understanding the team members’
perspectives and experiences
within the health care agency
The Use of Ethical Decision
Making Models
Ethical Decision Making
Collect Information and Identify the Problem
Specify a Range of Feasible Alternatives
Use Your Ethics Resources to Evaluate
Propose and Test Possible Resolutions
McDonald, 2000
Case Discussion
What do you think that you would feel
like in a situation such as this?
What assumptions might you or others
be inclined to make?
What further information do you need?
Negotiating Conflict
Reflect on your own position and feelings
 Ensure all parties are represented
 Structure appropriate meeting(s)
 Engage skilled facilitator(s)
 Agree upon goals and process
 Set parameters for what will be accomplished
 Ensure all viewpoints are heard
 Conclude with pointing out what has been
 Be clear re follow up/use of other resources
 Reflect on and evaluate the process
Implied promise
Authentic presence
Relational connections
Attentiveness to power dynamics
Equity of resources
Ongoing self-reflection
(Baier, 1994; Pellegrino et al, 1991;
Peter & Morgan, 2001; Rodney, 1997)
RESPONDING to Practice
Know the organizational structure
 Keep records (recognizing legal
implications) and gather support
 Bring forward an organized, objective
account of concerns
 Move up levels; informing each level
 Seek internal and external professional
 Know that external “whistleblowing” is a
last (and risky) resort
Organizational Action
Interdisciplinary Team Support
Participatory Decision Making
Thoughtful Resource Allocation
Creating a Sense of Moral Community
Policy Action
Ethical evaluation of existing policies
Attention to ethics in policy development
Authentic engagement of those affected by
Reflection and evaluation
• Expertise in Professional Practice
• Knowledge of Ethics
• Thoughtful Self-Reflection
• Conflict Resolution Skills
• Expertise in Group Leadership