Ethical Dilemmas Among Nurses as They Transition to Hospital Case Management

Abstract

1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

What ethics for case managers? Literature review and discussion

“…Five studies present this balancing task as burdensome. They estimate that case managers' lack of power 40,43 jeopardizes their ability to protect clients' best interests and can lead to frustration for case managers who cannot implement their own values in actual care. 39,40 Conversely, two studies conclude that case managers have enough skills and power to make adequate resource allocation decisions 32 and to advocate efficiently 34 for the client.…”

“…The results are summarized in Table 1. In these nine articles, the analysis is based on principles of biomedical ethics in two, 4 three mainly focus on the classic social work dilemma of the case manager's role in the system, 39,40,43 two are based on nursing ethics concepts and theories (advocacy 34 or relational ethics 32 ) and the last two do not discuss any theoretical framework.…”

La gestion de cas en gérontologie

“…Les gestionnaires de cas sont ainsi décrits comme ayant une double mission : accompagner la personne malade et défendre ses droits d'une part, préserver l'équilibre financier du système de soins d'autre part. Certains auteurs justifient cette double mission par le fait qu'elle correspond à la défense de l'intérêt général [1,23], compris comme la somme des intérêts particulier s. Des études de terrain [24,25] montrent cependant que ces deux missions entrent souvent en conflit, et qu'il s'agit même d'une des principales questions éthiques auxquelles sont confrontés les gestionnaires de cas aux États-Unis. En France, certains gestionnaires de cas réalisent les évaluations médico sociales qui conditionnent le montant de l'allocation personnalisée d'autonomie [26].…”