Tayla Scott 3369152
‘The first step in the evolution of ethics is a sense of solidarity with other human beings.’ -Albert Schweitzer
Professional and ethical development played a major role in my clinical practice as a fourth year physiotherapy student. This development began in first and second year where we were introduced to the words ‘professionalism’ and ‘ethics’. Whilst reflecting on my third and fourth year clinical practice experiences, I came to the realization that my professional and ethical development has grown tremendously over the past year, compared to my third year. I focused a lot more on my professionalism and ethical decision-making this year. This was extremely challenging and it made me realize how many ethical dilemmas we are faced with throughout clinical practice, as health professional students. As health professionals, we are responsible for our own professionalism and ethical decision-making process. According to Cross (1995) it is important to determine if our quality of professional skills qualify ourselves as competent physiotherapists in the clinical environment.
Professionalism consists of independent decision making and judgement-based practice. Professionalism compromises more than just rules because it is a fluid concept, which is dependent on context. Professionalism cannot be mastered and it cannot be seen as being accountable against a set of rules. Professionalism needs to be seen as a responsibility by the health care professional to make judgments and decisions in the context of practice. Professional identity formation means becoming aware of what matters most in practice, and what values and interests shape decision making (Trede, 2012). With that being said, professional identity formation boils down to a common word used in all health professions; experience. Over the past year of clinical practice experience I have learnt what professionalism is, how to practice professionalism and what matters most in clinical practice when it comes to professionalism. I have identified my personal values and interests that shape my professional decision making in the clinical environment. As stated above, professionalism cannot be mastered. However, it can be improved and I am held responsible for the formation and shaping of my professional identity in the working environment.
The term “profession” means “a dedication, promise or commitment publicly made”. To be a good health care practitioner, requires a life-long commitment to professional and ethical practices and an overriding dedication to the interests of one’s fellow human beings and society (HPCSA, 2008).
When reflecting on my professional and ethical growth throughout the year, there was a specific clinical scenario that came to my attention. This scenario caught my attention as it occurred more than once and it was a challenging struggle for me. This clinical scenario was based on motivation. At the beginning of the year it came to my attention that I was not treating all my patients fairly, equally and to the best of my ability. I asked myself the common question, ‘Why’? The answer was fairly straight forward. If the patient was not motivated and interested in physiotherapy treatment, I was not motivated and interested in treating them. According to Branch (2000) all patients are to be treated fairly and equally. This was an extremely unprofessional and unethical act made by myself as a health professional student. Professional misconduct includes failing to maintain a standard of practice of the profession or contravening a standard of practice of the profession as set out in the by-laws (Ontario Professional Foresters Association, n.d.).
When I reflect back and look at my growth with regards to this aspect over the past year, I see improvement. According to Davies, Naik & Lee (2001) motivation can be influenced by personal factors such as age, gender, personality, health status, family and lifestyle, and/or environmental factors, such as the people around you. Therefore, I was an environmental factor and if I was not motivated the patient would not be motivated. I changed my attitude and the way I interacted with my patients. I became motivated, I set goals for myself and the patient, and I attended each and every patient with a positive and energizing attitude regardless of their motivation. Why should I as a health professional expect my patient to change in order to motivate me? I needed to be the change and that is what I did.
The relationship between clinical decision-making and ethical decision-making in the clinical practice of physiotherapists is important. Health professionals need to conceptualize certain clinical issues such as, informed consent and resource allocation, as ethical issues rather than matters of clinical judgement (Edwards, Braunack-Meyer & Jones, 2005). When faced with ethical problems or scenarios in clinical practice, the alternatives to ethical reasoning are, in one direction, that we follow rules or codes of behaviour without being able to apply them to patients’ speciﬁc circumstances, while in the other, we go by our own personal beliefs or values which, if unreﬂected upon or unchallenged, could at times also be our prejudices. The purpose of integrating ethical reasoning into a broader clinical-reasoning framework is that it allows health professionals to use similar principles of inquiry, decision-making and validation in understanding and making decisions regarding ethical problems (Edwards, Braunack-Meyer & Jones, 2005). This is where morality and ethics come into play within the clinical environment. As health professionals we are responsible for ethical decision-making in clinical practice. Once again, this comes with experience.
Personal morals and ethics have played a major role in my professional and ethical development over the past year. In one of my previous blog posts, ‘Right or Wrong? Mortality or Ethics?’, I spoke about a clinical scenario where I was treating specific patients with more empathy, emotion, compassion and dignity due to the patient’s presentation and history. I felt that this was unfair towards my other patients and I was not treating them equally. Ethically, all patients are to be treated equally and fairly. All patients are to be treated with the same amount of dignity and respect. All patients need to be treated with the same amount of empathy and compassion to some degree, in order to complete the professional relationship you are required to build with your patient (Branch, 2000). Morally, I am a human being, I am unable to control my emotions, and I am unable to switch my emotions on or off when stepping into the clinical environment. I feel that I generally don’t show enough compassion and empathy towards my patients, but on the same thought I feel that I have a good balance. Throughout the year I have had similar situations, including treating prisoners or patients that are part of a gang. Ethically speaking, in physiotherapy all patients should receive the same treatment (HPCSA, 2016).
About two weeks ago, I was given a patient that was part of a gang. The patient was shot by the police due to an escape and presented as a T5 paraplegic. I was extremely interested in the different gang groups and proceeded to discuss it with one of my family members following research. The first thing that they said to me was you should not be treating that patient, that patient does not deserve to be treated after what he has done. The first thing I responded with was no, each and every patient deserves to receive equal and fair treatment and rehabilitation regardless of who they are, what they have done and how they present. I followed my response up by saying, don’t make assumptions because none of us knew what crime the patient had committed. This shows growth in my ethical decision making and professionalism. I treated and respected my patient like any other patient. I treated him fairly and to the best of my ability as I did with each and every other patient. I did not think once that this patient doesn’t deserve treatment and rehabilitation. I did not treat him with any less emotion, compassion and empathy than anyone else. This time around, compared to the beginning of the year, the patient was a normal human being presenting with a condition that required rehabilitation.
This video speaks to a qualified physiotherapist who discusses different ethical scenarios within the clinical environment and how she responds and deals with each situation.
This video demonstrates unprofessional and unethical clinical scenarios that may occur within the working environment.
The past two years of my clinical practice experience as a student have consisted of a large amount of theoretical, practical, ethical and professional learning. This has assisted me, along many other things, in my growth to becoming a qualified physiotherapist. As my four years of being a student have gone by, I have been able to see how my professional and ethical development has evolved. This has made me feel more confident and competent going out into the open world as a qualified health professional. I have had many experiences and learnt a large amount of lessons that will follow me into my future clinical environments. Along with my personal characteristics, values, ethics and morals, these experiences and lessons will assit me in becoming the best possible physiotherapist I can be.
Branch, W. T. (2000). Supporting the moral development of medical students. J Gen Intern Med, 15(7), 503-508.
Cross, V. (1995). Perceptions of the Ideal Clinical Educator in Physiotherapy Education. Physiotherapy, 81(9), 506-513.
Davies, S., Naik, P., & Lee, A. (2001). Environmental factors in stroke rehabilitation. Being in hospital itself demotivates patients, 322, 1501-1502.
Edwards, I., Braunack-Mayer, A., & Jones, M. (2005). Ethical reasoning as a clinical-reasoning strategy in physiotherapy. Physiotherapy, 91(4), 229–236.
HPCSA. (2008). General ethical guidelines for the health care professions. Booklet 1. Retrieved on the 04 November, 2016 from: http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/conduct_ethics/rules
HPCSA. (2016). Professional Boards. Retrieved 06 November, 2016 from: http://www.hpcsa.co.za/PBPhysiotherapy
Ontario Professional Foresters Association. (n.d.). Professional Misconduct Defined. Retrieved on the 04 November, 2016 from: https://secure.opfa.ca/regulation-enforcement/regulation-profession/general-standards-guidelines-members/professional
Trede, F. (2012). Role of work-integrated learning in developing professionalism and professional identity. Asia-Pacific Journal of Cooperative Education, 13(3), 159–167.