title: Ethical perspective on quality of care: the nature of ethical dilemmas identified by new graduate and experienced speech pathologists.
abstract: BACKGROUND
  Speech pathologists are confronted by ethical issues when they need to make decisions about client care, address team conflict, and fulfil the range of duties and responsibilities required of health professionals. However, there has been little research into the specific nature of ethical dilemmas experienced by speech pathologists and whether the nature of ethical conflict changes as they acquire experience in the professional workforce. Speech pathologists' perceptions of ethical issues provide insight into factors impacting upon quality of care in contemporary healthcare settings.
  
  
  OBJECTIVE
  To describe, compare, and contrast the nature of ethical dilemmas identified by new graduate and experienced speech pathologists.
  
  
  METHODS
  A narrative methodology was used to explore the ethical dilemmas that participants experienced in the professional work place. Primary data were collected through in-depth interviews with ten new graduate and ten experienced speech pathologists in their work settings. During these interviews, participants were asked to 'tell the story' of ethical dilemmas they identified at work.
  
  
  RESULTS
  An ethical story was constructed for each participant based upon keywords and concepts from interview transcripts. These keywords and concepts were coded into group themes that reflected the nature of ethical dilemmas experienced by new graduate versus experienced speech pathologists. Comparing the results of thematic analysis for both groups of participant revealed similarities and differences in ethical dilemmas identified by new graduate and experienced health professionals.
  
  
  CONCLUSIONS
  Participants identified ethical dilemmas in the professional practice areas of client management, professional relationships, service delivery, and personal/professional identity. Themes from new graduates' ethical dilemmas included: making safe choices; avoiding conflict, following service delivery rules, and building professional identity. Experienced speech pathologists' themes included: life choices, adapting policies, and professional status. Supporting client autonomy, managing risk taking, adopting fair service delivery policies, and supporting health professionals' ethical practice are part of ethical quality care. The results support the need for an increased focus on ethical practice in the workplace and further support for speech pathologists experiencing ethical conflict in response to service delivery policies.
authors.affiliation: Speech Pathology, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia. B.Kenny@usyd.edu.au
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Kenny
authors.forename: Michelle
authors.initials: M
authors.lastname: Lincoln
authors.forename: Katrina
authors.initials: K
authors.lastname: Blyth
authors.forename: Susan
authors.initials: S
authors.lastname: Balandin
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000941:ethics*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D026690:Ethics, Clinical; D004995:Ethics, Professional; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D011787:Quality of Health Care; D013066:Speech-Language Pathology / Q000941:ethics* / Q000592:standards; D055815:Young Adult