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This workplace study examined the every day ethical dilemmas of a multidisciplinary team in one acute psychiatric setting and the social factors affecting their moral domain of practice. The research design was a case study involving both qualitative and quantitative data. The context that shaped the team's process of ethical dilemma identification was conceptualised for the purpose of this research within a systems theory framework of interrelated factors at a societal, organisational and clinical level with ethics theory pervading the entire scene. The findings indicated that dilemmas arose in situations concerning patient care, team strain, and limited resources with the most common dilemma across disciplines arising from lack of community resources. Further findings suggested that clinicians were aware of various forces shaping practice but these ideas were not well connected conceptually. Staff felt wary of identifying ethical dilemmas because they were unsure of the process and sensed a reticence in the unit's social processes around negotiation and problem solving. Important social factors that were perceived to affect their abilities around ethical dilemma identification included rational economics, professional socialisation, medical-legal monopoly with a concomitant use of the ethic of justice, and managerial strategies. The concept of transference and countertransference issues within the staffing group was explored. These results are useful for the team to understand the nature of their own particular dilemmas and what factors constrain and enhance their abilities to identify dilemmas. Other health care settings may find that replication of the research results in a similar way may raise awareness of their moral situation. Generalisability at a theoretical level contributes to the current research agenda in applied ethics about the effect of context in the ethical domain of clinical practice.

This research examines and describes the ways psychotherapists address ethical dilemmas through a hermeneutic analysis of how they responded to a portrayal of a therapy session represented in a television series. Interview transcripts were analyzed and assessed for both how therapists navigate difficult ethical terrain, and upon what, thematically, they tend to direct their thought and concern. Moreover, particular consideration is given to the role of imagination in the development of ethical meaning, intention, and understanding in the clinical context, which intersects with a critique of the American Psychological Association's ethics code and its underlying philosophical assumptions. Such theoretical underpinnings suggest a view of therapists as rational agents capable of applying ethical rules and codes to resolve dilemmas in a logical, formulaic manner, a view which is questioned for its failure to account for the empathetic, vitalizing, and hermeneutic value of imaginative thought, rehearsal, and reflection in practice. Finally, implications for therapy, pedagogy, and interpersonal understanding are explored. / McAnulty College and Graduate School of Liberal Arts; / Clinical Psychology / PhD; / Dissertation;

Although there is extensive literature on supervision in the human services, there is limited research specific to the stories from supervisors in child welfare, in particular in Canada. This inquiry sought to understand how child welfare supervisors navigated through ethical dilemmas in their practice and how their approach influenced decision making. In addition, specific attention was paid on whether these practitioners used critical reflection in their approach to decision making. Findings indicated that these child welfare supervisors relied primarily on their personal moral framework. They encountered frequent dilemmas in highly complex work environments. Further, they endured ethical tensions as a result of not being able to enact their ethics amid work place barriers. These ongoing tensions often resulted in leaving these supervisors depleted emotionally and physically. Critical reflection in action was used in some cases when examining the context of the family in the process of ethical decision making. As with recent studies, this inquiry found that child welfare supervisors often stepped away from reflection in action for self-preservation and relied more heavily on reflection on action. Implications for future studies and recommendations for child welfare practice are discussed. / Graduate

<p> </p><p>The number of hidden refugees in Sweden is estimated to be at least 15,000. The law, which only allows this group a very limited access to health care, can be considered to clash with the human rights and the ethical codes related to the health care professionals.</p><p>The aim of the study was to examine how the personnel in public health care may experience treating hidden refugees and which ethical conflicts that may be connected to this. The study, which is of a qualitative descriptive design, is based on eight semi-structured interviews. The interviewees were trained nurses and mid-wives in an emergency room, a maternity ward and a health care centre for asylum seekers.</p><p>The experience of treating hidden refugees amongst the informants was limited. The study proved that the knowledge of laws and guidelines regarding hidden refugees amongst the interviewed health care personnel was poor. The interviewees presumed that it would be mentally trying if the law impeded them from giving a patient the care needed.</p><p>The lack of knowledge of laws and guidelines that appeared from the interviews, may lead to an insecurity for the patient, as well as for the personnel. An increasing knowledge and accurate guidelines at the work place would improve the treatment of hidden refugees.</p> / <p> </p><p>I Sverige uppskattas att det finns minst 15000 gömda flyktingar. Lagstiftningen, som endast tillåter en begränsad vård för den gruppen, kan anses stå i konflikt med de mänskliga rättigheterna och sjukvårdspersonalens yrkesetiska koder.</p><p>Syftet med studien var att undersöka hur sjukvårdspersonal som arbetar inom landstinget kan uppleva vård av gömda flyktingar och vilka etiska konflikter som kan vara kopplade till detta. Studien, som är en intervjustudie med kvalitativ deskriptiv design, baseras på åtta semistrukturerade intervjuer. Informanterna utgjordes av sjuksköterskor och barnmorskor på akutmottagning, BB-avdelning och en vårdcentral för flyktingar.</p><p>Informanternas erfarenhet av att vårda gömda flyktingar var begränsad. Det framkom av studien att kunskapen om lagar och riktlinjer gällande vård av gömda flyktingar hos den intervjuade sjukvårdspersonalen var bristfällig. Informanterna förutsatte att det skulle vara psykiskt påfrestande om lagen hindrade dem att ge vård till en patient.</p><p>Den brist på kunskap om lagar och riktlinjer som framkom av intervjuerna, leder till en osäkerhet för både patienten och personalen. Ökad kunskap om lagar och ordentliga riktlinjer på arbetsplatsen skulle underlätta vården av gömda flyktingar.</p><p> </p>

The number of hidden refugees in Sweden is estimated to be at least 15,000. The law, which only allows this group a very limited access to health care, can be considered to clash with the human rights and the ethical codes related to the health care professionals. The aim of the study was to examine how the personnel in public health care may experience treating hidden refugees and which ethical conflicts that may be connected to this. The study, which is of a qualitative descriptive design, is based on eight semi-structured interviews. The interviewees were trained nurses and mid-wives in an emergency room, a maternity ward and a health care centre for asylum seekers. The experience of treating hidden refugees amongst the informants was limited. The study proved that the knowledge of laws and guidelines regarding hidden refugees amongst the interviewed health care personnel was poor. The interviewees presumed that it would be mentally trying if the law impeded them from giving a patient the care needed. The lack of knowledge of laws and guidelines that appeared from the interviews, may lead to an insecurity for the patient, as well as for the personnel. An increasing knowledge and accurate guidelines at the work place would improve the treatment of hidden refugees. / I Sverige uppskattas att det finns minst 15000 gömda flyktingar. Lagstiftningen, som endast tillåter en begränsad vård för den gruppen, kan anses stå i konflikt med de mänskliga rättigheterna och sjukvårdspersonalens yrkesetiska koder. Syftet med studien var att undersöka hur sjukvårdspersonal som arbetar inom landstinget kan uppleva vård av gömda flyktingar och vilka etiska konflikter som kan vara kopplade till detta. Studien, som är en intervjustudie med kvalitativ deskriptiv design, baseras på åtta semistrukturerade intervjuer. Informanterna utgjordes av sjuksköterskor och barnmorskor på akutmottagning, BB-avdelning och en vårdcentral för flyktingar. Informanternas erfarenhet av att vårda gömda flyktingar var begränsad. Det framkom av studien att kunskapen om lagar och riktlinjer gällande vård av gömda flyktingar hos den intervjuade sjukvårdspersonalen var bristfällig. Informanterna förutsatte att det skulle vara psykiskt påfrestande om lagen hindrade dem att ge vård till en patient. Den brist på kunskap om lagar och riktlinjer som framkom av intervjuerna, leder till en osäkerhet för både patienten och personalen. Ökad kunskap om lagar och ordentliga riktlinjer på arbetsplatsen skulle underlätta vården av gömda flyktingar.

This PhD by published work consists of: • two single authored articles in refereed journals; • four jointly authored articles in refereed journals; • one jointly authored editorial; • one jointly authored book, including four single authored chapters; They were published in the period 2003-2013. Philip Gilligan submitted the jointly written publications as part of his submission for the award of Degree of Doctor of Philosophy by Published Work in 2013. This thesis identifies substantive findings, theoretical insights, new questions and practice/policy implications arising from the published work. The body of work has and continues to stimulate debate about the need to recognise and appreciate the significance and relevance of religion and related belief in the lives of people accessing health and social care services in the UK. It outlines the general relevance and impact of religion and related belief and explores questions and research concerned with the extent to which social work takes these matters into account in its practices, polices and professional training. It prompts practitioners to reflect on their own and others’ religious beliefs by providing a framework of nine related principles to assist them in their professional practice. One key finding is the need for service providers and policy makers to develop new services that are more responsive to the diverse needs of people living in the UK today by recognising and adopting some of the diverse helping strategies employed and imported by different communities.

This PhD by published work consists of: • two single authored articles in refereed journals; • four jointly authored articles in refereed journals; • one jointly authored editorial; • one jointly authored book, including four single authored chapters; They were published in the period 2003-2013. Philip Gilligan submitted the jointly written publications as part of his submission for the award of Degree of Doctor of Philosophy by Published Work in 2013. This thesis identifies substantive findings, theoretical insights, new questions and practice/policy implications arising from the published work. The body of work has and continues to stimulate debate about the need to recognise and appreciate the significance and relevance of religion and related belief in the lives of people accessing health and social care services in the UK. It outlines the general relevance and impact of religion and related belief and explores questions and research concerned with the extent to which social work takes these matters into account in its practices, polices and professional training. It prompts practitioners to reflect on their own and others’ religious beliefs by providing a framework of nine related principles to assist them in their professional practice. One key finding is the need for service providers and policy makers to develop new services that are more responsive to the diverse needs of people living in the UK today by recognising and adopting some of the diverse helping strategies employed and imported by different communities. / The full text of the published articles submitted with this PhD thesis are not available in full text in Bradford Scholars due to copyright restrictions.