My ethical journey of development and growth.

Owning my place in the workplace has changed from behaving and thinking like a lost, out of place student to a confident team member in the interdisciplinary team. It was always clear that going to different hospitals for clinical practice was to learn and gain experience. At the beginning of clinical practice my focus was more on learning and development of my physiotherapy skills. As time passed, my knowledge expanded and this changed my response to different situations in clinical practice. I only noticed a change during final year, as I critically reflected on my physiotherapy journey. I relate the change by owning my responsibility as a health care practitioner and by incorporating humility into my clinical practice and morale building (Delany et al, 2010). My approach is to not look at the patient as a condition but to remember that the patient is human, with feelings and emotions. The patient deserves to be treated with dignity and play an active role in their own management, with the concept of clinical reasoning (Nortje & Esterhuyse, 2015). The image below is an illustration of the Patient Rights Charter.

At first I was a student learning using paper patient cases. I focused more on the condition of the patient and did not fully grasp the concept that patients are human (Sheehan at al., 2015). However, after entering the clinical setting I realized that compassion is necessary and vital. Speaking to patients triggered an understanding that their lives have been drastically altered and, I have the opportunity as a physiotherapy student to play a meaningful role in their recovery process by being helpful, compassionate and supportive (Nortje &de Jongh, 2015).

compassion

We are taught and guided by the HPCSA to treat all our patients equally, and with respect and dignity. There was an instance during my third clinical block this year were I received a referral for a patient who needed palliative care. My observations lead me to believe that this patient generally received poor quality treatment and medical attention. However, my patient management is not based on lifespan. Therefore, I treated the patient as I would any other and based my management on improving the patient’s quality of life (Carpenter, 2010).

During an ethics class we discussed the topic of physiotherapy student’s motivation in clinical practice, and this made me think back to when I first started physiotherapy. I recall initially having only intrinsic qualities that influenced my motivation. As time progressed in my journey as, a physiotherapy student I noticed a change in these influencing factors. As time passed the work load increased and test dates, assignments, due dates, deadlines and grading’s became overwhelming and more important (Fischer et al, 2013). Therefore, this forced my intrinsic motivation to be pushed back causing the extrinsic factors to play a more dominant role in my motivation. After intensely discussing the topic in the class, I then decided to bring forward my initial intrinsic motivation. I also began to realize the importance of nurturing a balanced life whilst embarking on a clinical journey as a physiotherapy student. I remembered to practice what I preach during a patient’s management and to encourage and promote a balanced, healthy life.

motivation

Whilst analyzing my progress this year I thought about comparing a situation I was in last year with a similar situation I experienced this year. These situation explore management of a convict or coming into contact with dozens of “gangsters” through clinical practice which can be considered a moral dilemma. Due to a low amount of patients on that particular day, a colleague and I treated the patient (a convict) together. In the introduction with the patient, it was evident that he was affiliated with a gang, due to his the body markings (prison tattoos). My colleague’s response was of utter shock and his jaw literally dropped. In witnessing my colleague’s involuntary response, I felt the need to prevent the patient feeling judged. I decided to set aside thoughts around criminal involvement and rather prioritize the medical purpose that the patient was there for (Bruckner, 1987).

gangStatistics show that gangsterism in the Western Cape is still prevalent to the area, today. It’s a social issue of significance. “One of the most pressing issues in the urban ghettos of the Cape Flats is that of gangsterism and the discourse of power and powerlessness that is its lifeblood. Media coverage over the past two years was littered with news on gangsterism as the City of Cape Town struggles to contain what some labelled a pandemic. It is a pandemic that is closely tied to a deprivation trap of poverty, marginalisation, isolation, unemployment and, ultimately, powerlessness” (Bowers Du Toit, 2014).

In accordance with the patients’ rights charter, fair treatment is a priority for all. I apply the same logic to all instances as I am there to intervene in the patient’s health. I am not there to judge a patient’s lifestyle choice, sexual orientation or economical status etc. Patients are vulnerable especially when considering the fact that physiotherapy applies a hand’s on intervention with their patients. Respect, for me, is important to be at the forefront of management because sometimes there is a need for patients to be inappropriately exposed (Branch, 2000).

My greatest challenge was having a block at a special needs school. I have always been aware of the fact that I do not like children and would not specialize in this field. I avoided pediatrics by all means last year and I even swapped the block to avoid an uncomfortable situation. This year I was once again placed at a pediatric block. However, I did not swap this block in order to avoid this uncomfortable situation. I decided to rather follow through with it and get out of my comfort zone which gave me the opportunity to grow (Poulis, 2007).

I felt out of place and highly uncomfortable when an eighteen year old with the mental development of a six year old jumped on me and put my hand in her mouth. I had to bear in mind that I was there to promote health and development. A harsh retaliation towards this child’s actions were unnecessary and should never be an option for health care professionals. After critical reflection on this scenario I learnt that due to this child’s special needs, this girl could not filter or understand the concept of personal space and boundaries. I was required to display a willingness to learn special means of communication in order to enhance better communication between me and the children to intercept, interact and deliver effective patient care (Hammond et al, 2016). In an attempt to grow from this clinical block experience I remained calm by having empathy in that situation. Not to see the disability but to remember that every child is entitled to the same human rights.   The following link provides information on disability rights movement globally

This video on disability rights and opinions in Africa:

Patients refusing treatment is a moral dilemma that many physiotherapy students are faced with (Barnitt, 1998). As a physiotherapy student it is my duty to promote health. This particular patient, a patient with a complete spinal cord injury that did not want to accept his condition, refused treatment before I was able to educate him on the benefits of the treatment.  He also had additional personal problems leading to depression and therefore refused to participate in treatment.  Sometimes just talking to a patient will lead to a great change (Appelbaum, 2007). According to Sheehan et al (2015: 2042) , “[i]t is of paramount importance for doctors to be capable of sophisticated ethical and moral reasoning, as this promotes a consideration of patients on an individual level and the adoption of a holistic approach to their care. The resultant concordance of doctor and patient may increase the likelihood of mutually satisfactory decisions, patient compliance and beneficial clinical outcomes”. What I learnt is that looking at the patient holistically can be beneficial to their well-being

moral-dilema

In my previous blog post, “Secrets a Bruise Holds”, I discuss the concept of abuse with relation to a personal clinical experience. The research done in this blog post guided me in the approach to the situation which I will further elaborate on. I was in a similar situation both last year and this year where I treated a patient that is a minor who was being abused by a parent. Last year I faced the dilemma of a mother verbally and physically abusing her son. I wasn’t aware of the circumstances but I took note of this situation. Of course I was stunned because this was happening in public, in the Physiotherapy waiting area. I went to my clinician and asked her to ask the mother to leave the area.

Similarly, this year, I was faced with the dilemma of witnessing a father physically abuse his daughter in public. I was not certain of the circumstances but I understood that such behaviour is not right and unacceptable. I went over and politely asked the father to leave and wait at the general waiting area until his daughter was finished.  I think that my actions changed from the previous year in comparison to this year. I personally took action and intervened because I felt more a part of the team rather than a student doing practical  (Shapiro et al, 2006; Langlois & Lymer, 2016). https://pmg.org.za/committee-meeting/17477/

Reference list

Appelbaum, P. (2007). Assessment of patients’ competence to consent to treatment. The New England journal of medicine, Iss. 357, No. 18.

 

Barnitt, R. ( 1998). Ethical dilemmas in occupational therapy and physical therapy: a survey of Practioners in the UK National Health Service. Journal of Medical Ethics, Vol 24.

Bowers Du Toit, N. (2014). Gangsterism on the Cape Flats: A challenge to ‘engage the powers’. HTS, Vol. 70, No. 3.

Branch, W. (2000). Supporting the moral development of medical students. JGIM, Vol 15

Bruckner, J.(1987). Physical therapists as double agents: ethical dilemmas of divided loyalties. Physical therapy. Vol. 67, No. 3.

Carpenter, C. ( 2010). Moral distress in physical therapy practice.  Physiotherapy Theory and Practice. Vol. 26, No 2.

Delany, C., Edwards, I., Jensen, G., Skinner, E. (2010). Closing the gap between ethics knowledge and practice through active engagement: an applied model of physical therapy ethics. Physical therapy, Vol. 90, No. 7.

Disability rights: The new defenders. Retrieved November, 4, 2016 from https://www.google.co.za/url?sa=t&rct=j&q=&esrc=s&source=video&cd=5&cad=rja&uact=8&ved=0ahUKEwiQspjdjpTQAhXKCMAKHRrrAZYQtwIIPjAE&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DbE0ta93FuKQ&usg=AFQjCNHJPMV1pudvOhfJMsNvaOI-PXOgrA

Fischer, M., Mitsche, M., Endler, P., Mesenhall-Strehler, E., Lothaller, H., Roth, R. (2013). Burnout in physiotherapists: use of clinical supervision and desire for emotional closeness or distance to clients. International Journal of Therapy and Rehabilitation. Vol. 20, No. 11.

Hammond, R., Cross, V., More, A. (2016). The construction of professional identity by physiotherapists: a qualitative study. Physiotherapy, Vol. 102.

Langlois, S & Lymer, E. (2016). Learning professional ethics: student experiences in a health mentor program. Education for Health. Vol.  29, Iss. 1.

HCPC – Health and Care Professions Council Continuing professional development (CPD). (2016). Hpc-uk.org. Retrieved November, 4, 2016, from http://www.hpc-uk.org/registrants/cpd/

Nortje, N., de Jongh. (2015). Ethical dilemmas experienced by occupational therapy students- the reality. AJHPE, Vol.7, No 2.

Notje, N & Esterhuyse, K. (2015). Changing students’ moral reasoning ability- is it at all possible? AJHPE, Vol. 7, No. 2.

Poulis, I. ( 2007). Bioethics and physiotherapy. Journal of medical ethics, Vol. 33, No. 8.

Shapiro, J., Kasman, D., Shafer, A. (2006). Words and wards: a model of reflective writing and its us3s in medical education. Journal of Medical Humanities, Vol. 27.

Sheehan, S., Robbins, A., Porter, T.,Manley,J. (2015). Why does moral reasoning not improve in medical students?  International journal of Medical Education. Iss. 6.

The disability rights movement. Retrieved Noveber,4 , 2016 from https://www.google.co.za/url?sa=t&rct=j&q=&esrc=s&source=video&cd=1&cad=rja&uact=8&ved=0ahUKEwiQspjdjpTQAhXKCMAKHRrrAZYQtwIILDAA&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DVggPdNEa760&usg=AFQjCNEw9mTNW3bhEXmozkLk0Ry6q8Vkhg

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