Cementing my understanding of professionalism and ethics.

I might be wrong but don’t you think that there is a link between professionalism and ethics. The two concepts in my opinion work hand in hand to develop what is seen as a well-rounded professional. They both play a role in the decision making process of a professional in the clinical environment. If you think about it, the role that ethics plays is more about guidelines that have been cemented and are to be followed by a professional in the workplace. But when looking at professionalism this is more about your moral code and how your morality and values steers your thought process around what professionalism is.

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Professionalism in health care is a complex and forever developing concept. Professionalism has expanded from being based on specialist knowledge and skills, and a code of ethical and professional conduct, to include a strong focus on professional autonomy, reflective practice, communication, professional relationships, commitment to continuing professional development, and accountability to society and the profession (Grace & Trede, 2013).

In terms of professionalism for me, I identified it as who I am and how I was brought up and the morals and values that have been instilled into my life. According to Grace and Trede (2013), physiotherapy students tended to express their conceptions of professionalism in terms of their personal values. Which is exactly how I had always seen it. But if you honestly evaluate yourself you can see that professionalism is something that can be developed and taught.

The model for professionalism identifies honesty and integrity, responsibility and accountability, self-improvement, self-awareness and knowledge limits as ways of improving your professionality (Fornari, 2004).

It is said that moral virtues are teachable (Miller, 2005). Moral courage can only be developed and strengthened through regular application (Miller, 2005). This requires a continuous commitment to, and reflection upon personal values and moral behaviours that influence ethical decision making (Murray, 2010).

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As a student I often ask myself the question, what role does morality play in ethical decisions? My morals are based on personal upbringing, what is right and what is wrong. So I ask myself, does morality not guide professionalism in accordance to ethical principles? Healthcare organizations that acknowledge the importance of following ethical principles, can create an expectation that morally driven behaviour will occur when you face ethical dilemmas that threaten values that are relevant to the work environment (Murray, 2010).

As a professional I have often taken it upon myself to always give of my best towards my patients. If you look at ethical principles such as the quality of the service being provided or provided honest, competent and accountable professional service. Does this not give you a guideline for how you as a professional should act? Determining if our quality of professional skills, qualify us as competent physiotherapist in the clinical environment (McMillan, 2010). It is important to be able to apply your theoretical and practical skills towards a patient that is relevant to the patient’s diagnosis. As a clinician you should be able to apply what you have learnt theoretically in clinical context (Mcmillan, 2010). Determining if there is a relationship between conceptual learning/thinking and clinical reasoning (Mcmillan, 2010).

If you think about it, your professionalism relies heavily on ethical principles that have been set by a governing body. If you are truly a well-rounded professional you would make sure that you are constantly developing yourself in order to improve patient outcome levels. If you are not following ethical principles are you truly acting in a professional manner? Or are you simply just doing the job in the mind-set that you have a cemented moral and value code.

According to Medical Education (2011), professionalism is competency as behaviours ‘demonstrating a commitment to carrying out professional responsibilities and an adherence to ethical principles’

To bring this all into context from my point of view, here is a scenario that I was sitting slap bang in the middle of. I was at a rehabilitation center and I had received my six patients for the 6 weeks that I would be there for. Many of my patients were motivated and eager to do all the training and they worked hard to achieve the goals both I and them set up. But I very distinctly remember this one patient. In the beginning he attended his training sessions but after a week or so he just stopped. To be honest I did not mind as I did not like this patient in terms of his attitude and motivation towards his training. I had to make the decision to go find him and actually bring him to the gym for physiotherapy. When reflecting on this for no more than one day. I was tugged by my moral and ethical code. At the beginning of the year or even last year I might have just allowed the patient to be but as the year has gone by and I have developed my professionalism and ethical guidelines. I am more aware that I am there to provide an excellent service and at the same time I am there to learn and develop my clinical professionalism. Looking at moral courage, it generally occurs when individuals with high ethical standards face acute or recurring dilemmas that cause a person to act in a way that conflicts with their values (Miller, 2005).

As the professional I understand the implication following a stroke. I know better and for that reason I had to put aside my moral code of conduct that stated why should I be responsible and make the patient put in the hours and I had to reveal those ethical principles that state that you should provide accountable and competent services to your patient. At this stage I was not being accountable or responsible towards my patient. He was not refusing treatment but rather just slacking on his attendance therefor I had the responsibility to act professionally and under an ethical oath towards my patient.

When looking at the two words accountability and responsibility to me they meant the same thing but if you actually think about these two concepts. Accountability requires health professionals to justify their actions against rules and regulations. Accountability can absolve practitioners from taking responsibility for their actions, whereas responsibility requires them to justify their actions, their professional reasoning and ethical framework (Schuck, Gordon, and Buchanan 2008).

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I think what I do differently now in terms of what I did at the beginning of the year, is that it is not always about what the clinician can do for me in terms of learning and skills to help mold me into a better professional but rather what can I do for myself. This has been a huge changed in my mind-set as it is your own responsibility to take your own growth to becoming a better professional into your own hands. I have also made that link between ethics and morality and how they do play a role in holistic decision making. There will always be a moment when something challenges your morality but ethical principles are just as important in a work environment. The ethical principles are there to guide and develop your professional growth but at the same time I try not forget who I am and what I stand for, I do not deal with unethical dilemmas.

What has led to these changes have just been my own personal growth, by coming to the realization that at the end of this year I am no longer a student and will be responsible and held accountable for all my actions made as a professional and that I am governed by the ethical guidelines. I have reflected on who I am, what I stand for and what I want to achieve as a professional. When making a decision I do not forget my morality and only follow the ethical principles but as a professional I use the ethical principles with my morality to make a well-educated decision on what is the right thing to do.

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In my opinion professionalism is about development and growth. You should want to be great and not mediocre. Professionalism is about putting in the extra hours to learn and expand your knowledge, to reflect and be self-motivated. According to Delany and Watkin (2008), critical reflection is fast becoming an important framework to help understand the intricate nature of the health system (Delany & Watkin, 2008). In terms of my learning to becoming an improved but forever developing professional, reflection has been a major part in my learning. It has helped me to look at how I was acting and how I should be acting in a work environment. If you look at how I reacted to certain scenarios in terms of third and fourth year. In third year it was about not taking responsibility but rather following and being an undercover professional. Where now I am more focus on improving myself, reflecting and observing and taking hold of constant opportunities to be a better professional.

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It is about observing other professionals and trying to depict for yourself what professionalism is. It is said that professionalism is developed in the work place (Trede, 2012). Whereas ethical principles are things that are already set and are there to guide you, these principles do not change but you have the ability to have an effect on your standard of professionalism.

I have come to the conclusion that professionalism, morality and ethics are all interlinked. The one cannot work without the other. Yes sometimes ethical principles are more dominant and need to be part of our already existing foundation of morality. But it’s about learning and discovering ways in which you are able to use your morality to help guide your ethical decisions and visa-versa. This leads to growth and a well-rounded professional.

Reference:

Delany, C., & Watkin, D. (2008). A study of critical reflection in health professional education. ‘Learning where others are coming from’.

Fonari, A. (2004). Promoting professionalism through ethical behaviours in the academic setting. Journal of the American Dietetic Association104(3), 347-349.

Grace, S., & Trede, F. (2013). Developing professionalism in physiotherapy and dietetics students in professional entry courses. Studies in Higher Education38(6), 793-806.

Miller, R. (2005). Moral courage definition and development. Retrieved on the 3 August 2016 from http://ethics.org/files/u5/Moral_Courage_Definition_and_Development.pdf.

Murray, J.S., (Sept 30, 2010) “Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk” OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 2.

Schuck, S, Gordon, S, and Buchanan, J. (2008). What are we missing here? Problematizing wisdoms on teaching quality and professionalism in higher education. Teaching in Higher Education. 13(5), 537–47.

Trede, F. (2012). Role of work-integrated learning in developing professionalism and professional identity. Asia-Pacific Journal of Cooperative Education13(3), 159-167.

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