Navigating crisis: a qualitative exploration of medical social workers' responses to ethical issues during COVID-19

Medical social workers' (MedSWs) roles and responsibilities expanded during the COVID-19 pandemic. They experienced larger caseloads, restrictive protocols, new policies, and work outside of their professional scope, despite limited access to resources, support, or hazard compensation. As a result, MedSWs faced complex ethical situations, which they had to address in accordance with the profession's guiding principles.

We conducted qualitative semi-structured interviews with 54 MedSWs about their professional experiences during the pandemic and used the National Association of Social Worker's Code of Ethics (service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence) as a deductive coding guide to describe MedSWs' navigation of and responsiveness to ethical situations across healthcare settings. We defined ethical situations as threats to values and ethical actions as attempts to resolve the threat in a way that aligns with professional standards. Our methodology was informed and documented via the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

From MedSWs' interviews, we identified six major ethical situations that aligned with the six values and ethical principles in the Code: inadequate addressing of patients' social determinants of health by healthcare institutions (service), social injustices negatively impacting patients' and providers' healthcare experiences (social justice), de-prioritization of patients' wishes in high stakes situations (dignity and worth of the person), social isolation and related distress resulting from social distancing policies (importance of human relationships), encroachment on social workers' scope of practice boundaries (integrity), and lack of preparedness among social workers for emergency COVID-19 situations (competence). We also identified several ethical actions, aligning with the six ethical principles, that MedSWs took to address these situations.

The ethical situations and actions that MedSWs discussed in this qualitative study align closely with the experiences of other healthcare workers during the pandemic. Despite uncertain situations, MedSWs relied on their innate understanding of social work principles to guide ad hoc decision-making. Results from this analysis indicate the need for more robust administrative and institutional support structures that would allow MedSWs to practice self-care, maintain their scope of practice boundaries, and access additional emergency preparedness training.