Ethics Resolution Assignment

Students in the group: Miranda Anderson, Amber Darlington, Shelley Braithwaite, Kenzie St. Clair, Tim
Harker.

Name of scenario: Abandonment of Care

You are the therapy manager for an in-patient rehab unit. A speech pathologist has discontinued
treatment with a patient who had a stroke three weeks ago. The therapist states that no progress can
be documented in the last ten days. The program manager, who is a nurse, is threatening to file an
abandonment of care complaint with the state Division of Public Licensing if treatment is not resumed.

Framework for ethical decision-making: Answer the following questions in your group. In each of the
scenarios, you are the manager and will need to think about how the approach you take will affect all
parties.

List all of the involved parties: Make sure you consider the whole scope of the problem and list everyone
who may be affected by any decision you make.

Client, Speech therapist, nurse, program manager, client family, neuro doctor, rehabilitation team

Consider the OT ethical standards: Review the ethical standards and create a bullet list of the principles
that apply to the main parties (you do not need to write an explanation of your choices).

● Nonmaleficence
● Beneficence
● Justice
● Autonomy

Frame the problem: As the manager, you will need to explain the problem to the main involved parties
from the standpoint of their own involvement. Select the main 2-3 people involved and write a
paragraph framing the problem to each of them. Consider each of their unique perspectives and explain
the problem in factual and non-blaming terms.

Client: We want to ensure you receive the amount of care you are entitled to so you can make a better
recovery. Currently, management and therapy staff are working to plan how much speech therapy you
will be receiving while here. I apologize for how this is currently affecting your treatment. We also want
your input in making this decision. What are your thoughts for future SLP sessions?

Nurse/program manager: We believe that the client is unable to progress further at this time because of
the severity of their condition. Their other symptoms are currently preventing progression in speech. At
this time, it would be better to use our time to address the other conditions that are impacting her
speech development.

SLP: We are concerned that the client is not receiving the amount of care that they deserve. We
understand that 10 days of no progress is a good indication that changes need to be made but we are
not sure that discontinuation of services is the proper route. We would be interested in knowing what
kind of intervention strategies you are using with this client.

What do you know, what do you need to know, and what resources can you use to supplement your
understanding: It is important to make as informed a decision as possible. Make a bullet list of the facts
you know, then make a two-column table with a line item list of the information you need and a source
you could go reference to get the information.

What we know:

● Client is 3 weeks post stroke.

● Setting is inpatient rehab for 3hrs of therapy
● SLP claims no progress in past 10 days
● Disagreement or misunderstanding between nurse and SLP regarding abandonment of care
● Lack of communication on team
● Stroke is complicated

Need to know Source of info

-what interventions the SLP has used -SLP

-other conditions that may be impacting client’s -doctor, chart, observation

ability to make progress

-amount of time SLP is spending with client -SLP

-progress made in other areas -progress chart. Goals chart. Documentation from
other professions.

-professional opinion of another SLP -another SLP

-relationship between client and SLP -SLP and client

Make a decision: What course of action will you choose and why. Give details about how each of the
interested parties will be affected by your decision. This will not be a short answer J As the manager,
you will have to help all parties get “on board” with your decision to the extent that you can. This is the
crux of being a good manager. The ability to communicate difficult decisions to all parties and help
them understand the whole picture (at the appropriate level). Write up the course of action you will
take and then write a paragraph to each of the main interested parties, explaining your decision as it
relates to them.

Course of action:

● Talk to client and involved parties

● Review documentation
● Have team meeting
● Keep client informed and involved
● Make decision
● Reassess and alter plan as needed

How interested parties will be affected:

● Client: Treatment plan will be directly impacted, recovery will be impacted based upon the
determined amount of speech therapy, and daily schedule may be altered.
 ● SLP: May need to change intervention strategies or courses of action. This may require them to
back up their plans with evidence and be able to explain this evidence to the parties involved.
● Nurse/Program Manager: Will have a better understanding of what the SLP is doing and why.
This will help them make a more informed decision about if and when there is an issue with
abandonment of care.

For the SLP and the nurse: We would want to have a team meeting. During this meeting, we will be
trying to keep the focus on what is best for the patient. By keeping this frame of mind, it will be easier to
make this meeting feel less like an attack on anyone's previous decisions and more like constructive
feedback and decision making. We would want to have a meeting with the involved parties to gain
various input on the current situation. It would be important to come prepared to the meeting with a
documentation review to see what efforts have already been made in order to discuss any potential
changes or avenues that have not yet been explored. We will discuss EBP along with the prognosis to
help guide our decisions. Our end goal is to determine whether or not what is happening between the
SLP and the patient is appropriate and what the next route of action should be for them. This could be
changing intervention strategies, therapy time, or possibly discontinuation of services from the current
therapist.

For the client: Myself and the rest of the therapy team will be holding a meeting later today to discuss
your case and your future speech therapy. Our goals for this meeting will be to determine whether a
change in therapy or therapist is needed, what your path of recovery is likely to look like, and if you
need further speech therapy. We will communicate the results of that meeting with you after it is
concluded. Is there anything else you want us to discuss in that meeting on your behalf?