The professional and ethical journey, with experiences in problem solving, resulting in life long lessons learnt.

According to Grace & Trede (2013), Professionalism has expanded from narrow constructs of professional competence 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. Fornari’s (2004) model for professionalism that identifies honesty and integrity, responsibility and accountability, self-improvement, self-awareness and knowledge limits, collaboration, respect for others, compassion and empathy as professional behaviours.

Our values influence how we actually present ourselves in the workplace, so if we can understand what bias we have based on our values, and how we have been raised then it is something that we can be mindful of when we are trying to be professional.

According to Delany & Watkin (2009), Critical reflection skills are recognised as a way of thinking and a process for analysing practice, that facilitates practitioners and students to learn from, and redevelop their practice in an ongoing way.  PHT 402 ethics has allowed me to reflect on aspects of Fornari’s model for professionalism in my clinical practice experiences. Prior to discussions and writing pieces of ethics and professionalism I hardly ever approached the clinical setting with that in mind. Although being unethical and unprofessional was not part of my clinical practice approach. When professional behaviours are taught out of context their relevance to practice is questionable; they need to be learned and challenged within practice contexts (Grace & Trede, 2013). PHT 402 Ethics has given me the opportunity to put ethics and professionalism in the context of my clinical practice.  In my attempt to constantly approach my clinical practice experience with this ethical and professional knowledge, there were struggles and challenges that came up. runaway-radical-when-doing-good-goes-bad-bookreview-giveaway

According to Delany & Watkin (2009),  in physiotherapy, critical reflection has been defined as ‘‘the higher order intellectual and affective activities in which physiotherapists engage to critically analyse and evaluate their experiences in order to lead to new understandings and appreciate the way they think and operate in the clinical setting’’

When the topic of integrity came up in ethics, it made me ponder on a clinical experience I previously posted titled Attended not treated. I was handed a patient, to continue treatment, from the clinician, who had already seen the patient. According to the patient his first physiotherapy session with me was the first actual physiotherapy treatment he had ever received. Previously the physiotherapist just came to his bedside and made notes in his file. My integrity was challenged after arriving at block and I started feeling ill. I did not want to pay back days so I decided to stay and work throughout the day. I had reached a patients bedside and I started feeling really ill, to a point where I thought I was going to pass out. With this situation at hand I had to make a decision based on my integrity. Two thoughts came to mind, do I stand there, draw the curtains and just make notes in the patients file as if they were treated, then lean on the bedside table until I feel better and continue that way throughout the day whenever I was not feeling well. The other thought was do I inform my clinician that I am not feeling well and ask if I could be allowed to take some time out until I feel better to continue working on that specific day. Here I had two options, one which would have left the patient not being treated, and the other where the patient would be seen by me when I am feeling better or by someone else. Health professionals, not just students, need to refer to frameworks of ethical principles to inform their decisions and actions, to ensure the continued integrity of their professions and to maintain the trust of their communities (Kass, 2001). Within a technically and rationally driven practice model the practice of honesty, integrity and commitment to self-improvement, for example, can be interpreted operationally in an objective, detached manner as manifestations of professional codes of conduct, whereas, within a practical and patient-empowered practice model, these very same professional behaviours are understood to be products of personal qualities mediating a focus on interpersonal relationships (Trede and Higgs, 2008). It is important that we constantly remind ourselves of these principles in case we forget. Being mindful of my integrity at that point in time, allowed me to ensure that I give the patient the care possible. It is now my responsibility to continually refresh and update my knowledge of these principles moving forward in order to ensure that my clinical practice is at all times approached ethically and professionally. Skills which foster professional growth include: ongoing engagement in reflective self-assessment, values clarification, and professional identity formation (Shapiro, Kasman, & Shafer, 2006). The video by Kevin Lott, sums up integrity  https://www.youtube.com/watch?v=Ps6-3zyXWus .

As a student in clinical practice I had the constant pressure from clinicians about covering the patient load for the day. Often when feedback was given and treatment was not done, a cross question process would arise. Considering a post I previously mad about human rights titled Wordless Considerations, thoughts of infringing on patients’ rights had occurred based on this particular experience. After encountering a similar situation where all the clinician wants is for you to see patients, it was challenging at first because the same cross-questioning process came up and it made me feel intimated as if I wasn’t hard enough on this particular patient. I have grown to learn that while our role in a patients treatment and hospital stay is important, it is important that we exercise the our role of referring a patient to other health care professionals, who form part of the multi-disciplinary team. According to Grace & Trede (2013), Professionalism has also been associated with taking responsibility for one’s actions. This means making consistent professional judgements based on overarching professional values, rather than automatically applying predetermined rules of conduct in every case simply as a matter of procedure. Dealing with patients of this nature has allowed me as Delany & Watkin (2009) states, to be attentive to personal and professional values and understanding underpinning health care practice.

The frustration I experienced and reflected on through a post titled Moral Distress, dealing with the topic of morality and ethics led me to an understanding that through writing, learners think about other people’s situations, including patients,’ and contemplate their own reactions in relation to those situations from a subjective, personal, and indefinite vantage point (Shapiro, Kasman, & Shafer, 2006). Various frustrating experiences in clinical practice that had made me feel violated as a student, presented me with challenging situations. It was particularly hard to keep quiet as a student and watch how ridiculous patient loads were handed to us on a daily basis, because if we were to speak up that would result in a poor block report or even more patients getting added to your load. Amidst these situations post discussions in ethics has allowed me to adapt as Rusin (2012) states an openness of mind, where a physiotherapist by having an open mind is interested in new things, is prepared for changes in viewpoint and the assimilation of new ideas. The verification of formulated views requires courage, yet this is not perceived as an expression of weakness. Internal discipline, referred to as‘having backbone’. Using these frustrating situations to become as Rusin (2012) states, someone who constantly develops themselves, acquires new professional skills, becomes acquainted with new technologies and methods of treatment, gives up on pleasures and constantly heads towards their goals. They are able to undertake long-term mental and physical exertion, create a plan of action to which they subject themselves, they are always disciplined in the name of something.

Do unto others as you would want them to do unto you. Conflict often arises from approaching a situation in the wrong manner. How we treat other people says a lot about how we think about ourselves.

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A clinical experience I previously posted about titled Handle It Better about the topic of ethics and professionalism, and many clinical experiences on that specific clinical rotation made me think about the very same thing that Grace & Trede (2013), states students learn a great deal about professionalism from their clinical supervisors. It was challenging to deny myself from giving the exact same approach that I was being given throughout this block. It has taught me well how to suppress that behaviour and handle situations better. As Shapiro, Kasman & Shafer (2006) states writing gives students a chance to examine their emotions fully, experiment with different ways of expressing emotions, and explore various meanings. In the shaping of a personality, mechanisms of imitation play a large part, while those responsible for creating the model of a modern physiotherapist are chiefly academic lecturers and physiotherapists looking after students while they see medical practice (Rusin, 2012). In my experience it could have shaped my personality in a negative way, but instead it has allowed me shape my professionalism in a positive way. A physiotherapist in possessing perfectionist aspirations improves themselves, their working methods as well as influencing the community in which they work and live. They are able to make moral choices if involved in a conflict of rights, they search for ways to resolve conflict situations. The ability to decide and make decisions is totally conditioned by having a definite hierarchy of values (Rusin, 2012). It has taught me to be tolerant. Working in a therapeutic team a physiotherapist should respect others’ needs and at the same time be able to oppose that which is considered to be bad and which occurs in their immediate working environment. Being tolerant is to be a person able to eliminate bad impulses and not to oppose that which by nature is different, for ‘different’ does not always mean ‘bad’. A tolerant physiotherapist is a person respecting the opinions and views of their work colleagues and patients, one prepared to understand matters within defined boundaries and not subjecting themselves to personal prejudices, accepting themselves, showing understanding for their patients (Rusin, 2012).

According to Rusin (2012) a physiotherapist should be courageous, proclaim their convictions, express their views, even when this puts them at the risk of human unkindness, slander and sometimes even the loss of their job. Being this courageous as Rusin (2012) states has been the most challenging throughout my clinical experience, with the fear of being marked down or treated unfairly, unprofessional and unethically. Moving forward in my career approaching the stage of being a qualified physiotherapist I will be mindful as Higgs, McAllister & Whiteford (2009) pointed to the importance of students and professionals developing the capacity to make good judgements and decisions in uncertain and diverse situations. In conclusion professionalism is complex and multifaceted, and evolves with ongoing learning. We believe values cannot be simply assimilated, but will mature with practice experiences accompanied by collective discussion and debate (Grace & Trede, 2013).

References

Delany, C., & Watkin, D. (2009). A study of critical reflection in health professional education: “learning where others are coming from.” Advance in Health Science Education14(1), 411–429.

Fornari,  A. (2004). Promoting professionalism through ethical behaviours in the academic setting. Journal of the American Dietetic Association , 104( 3),  347–49.

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

Higgs, J.,  Mcallister, L., & Whiteford, G. (2009). The practice and praxis of professional decision-making. In Understanding and researching professional practice. Rotterdam: Sense Publishers.

Kass, N.  (2001). An ethics framework for public health. Public Health Matters,  91(11), 1776–82.

Rusin, M. (2012). Personality model of the contemporary physiotherapist. Medical Rehabilitation16(3), 27–32.

Shapiro, J., Kasman, D., & Shafer, A. (2006). Words and Wards: A Model of Reflective Writing and Its Uses in Medical Education. Journal Medical Humainity27(1), 231–244.

Trede, F., & Higgs, J. (2008). Clinical reasoning and models of practice. Clinical reasoning in the health professions. Amsterdam: Elsevier Butterworth Heinemann.

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