Who I was a year ago, I am no longer today!

As a University student, I often mimic the expectations of me with regards to my ethical development and professionalism. Moral values is defined by Reference (2016) as values that refer to a set of principles that guide an individual on how to evaluate right versus wrong. People generally apply moral values to justify decisions, intentions and actions, and it also defines the personal character of a person. An individual with high moral values typically displays characteristics of integrity, courage, respect, fairness, honesty and compassion. Ethical values is defined by the National Defense University (2016) as individually or organizationally, values determine what is right and what is wrong, and doing what is right or wrong is what we mean by ethics. To behave ethically is to behave in a manner consistent with what is right or moral. In my understanding, ethical values is a set of rules that a health professional needs to abide by and moral values are more on a personal level.

Some of the ethical principles include, respecting patients and their autonomy in considering their opinions and choices concerning their own lives, as well as their close family and friends; while refraining from preventing their choices unless they are somewhat detrimental to other individuals (Gracyk, 2012). According to Gracyk (2012), another ethical principle is what we know as beneficence. We, as health care professionals have the obligation to do well in our profession by not increasing potential harm but rather to decrease possible harm. Justification is another basic ethical principle whereby health care professionals are obliged to provide patients with equal and fair treatment (Gracyk, 2012). An injustice occurs when a patient’s benefits are denied without good and acceptable reasoning from a health care professional (Saint Mary’s College, 2016).  The traditional triad of principles- beneficence, autonomy and justice is familiar to anyone studying in the health field.

The expectation of health care professionals in practice are to uphold these ethical principles which are there to help think logically through patient moral situations and medical decision making (Limentani & Kent, 1999). In particular occasions, this may cause conflict with one another and may not result in a moral basis as one would hope for. The benefits of abiding by these ethical principles in health ethics combined a common component of issues which bring together concerns in health care (Limentani & Kent, 1999).

According to Branch (2000), the ethics of caring for the patient may enhance the application of other principles which may be suitable in the health environment. Furthermore, the ethics of caring emphasizes the moral values and beliefs of health professionals. Our natural urge to care for our patients on a personal level comes from compassion. Though Branch (2000) believes that true caring incorporates reasoning, it cannot be limited to problem solving. Philosophers have termed caring for patients as a moral orientation, in which ethical behavior of the health professional results not only from ‘moral reasoning’ but also from ‘moral sensitivity.’ Branch (2000) defines moral sensitivity as the ability to recognize a moral problem when it exists. Moreover, a moral orientation of caring brings upon attentiveness, honesty, patience, respect, compassion, trustworthiness, and sensitivity into all aspects of moral behavior (Branch, 2000).

In the clinical setting, I often get emotionally invested in my patients and care for them immensely.  This affects the physiotherapy treatment and rehabilitation sessions as I get carried away with trying to improve their condition. This can be a good and bad thing. It is a good thing in that the patient is getting good health service as their physiotherapist, and it could be bad as I may push them over their limits, and in turn, causing potential harm. I have changed my approach to managing the moral compromise by focusing on the ethical values of the patients’. I am trying not to get emotionally invested or learn a lot more about my patient personal lives than I should. This aids me on getting on with the physiotherapy treatments and rehabilitation as expected of me.

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I have been faced with many situations where I had to question whether I should stick with my moral beliefs and values or ethically do the right thing according to the law. Many of my patients refused treatment and did not cooperate with me during our physiotherapy sessions. Morally I would have liked to have forced the patient to cooperate and perform in the sessions but ethically, I am obliged to respect the patient’s wish.  According to Barnitt, (1998) the substantial literature on medical dilemmas for physiotherapists include conflict of patient wishes and refusals of treatment, as well as decision making and professional judgement (Barnitt, 1998). Students, in the wards often feel pressured to relinquish their ethical values as considerations of these values might hinder their decision making  (Barnitt, 1998).

Often, individuals who identify as a professional think of themselves not only as knowledgeable and skilled in their career field, but also rational and objective. Health care professionalism describes the skills, attitudes, values and behaviors common to those working in the medical field (Blackmer, 2007).  In a medical setting, a healthcare professional must set the tone for the interaction with their patients by providing excellent services through communication, appropriate body language and professional appearance (Britt, 2013). What I constantly find difficult is to stay confident in my body language with patients. Many cases, my approach comes off as nervousness or ‘all over the place,’ and this unfortunately influences the thoughts of my patients about me. I often think that some of them may feel unsafe with me as their physiotherapist. I doubt myself in the clinical setting and this in turn makes my patients question my capabilities of making their conditions improve.

“Professionalism shouldn’t be defined by a persons paycheck, role or title. It should be defined by a persons work ethic” Janna Cachola

Health care professionals have the careers in which many individuals depend upon to survive in life, and it is with the utmost importance that every health care professional understands their role and acts upon their responsibilities when seeing to patients. It is important to be kind and empathetic toward your patient and their condition as it helps in gaining the patient’s confidence in you as their health professional. A visit to the doctor or attending a consultation with a new health professional can be stressful enough without having to deal with unfriendly, inattentive, and disorganized medical staff.

The challenge I face within me is the lack of self- confidence I need in patient interaction. A reason for this is that I have experienced an incident where I was discouraged and humiliated by a senior physiotherapist. This incident was by far the most difficult part of my student career. One of the most daunting feelings as a physiotherapy student is taking on the responsibility of treating another human being. I pride myself on being a hardworking, soft spoken and socially conscious individual in the work place. I had no idea that these qualities made me a prime target for emotional and verbal abuse from my senior. On one occasion, going about my daily routine of treating patient after patient, I see the senior physiotherapist walking toward me from the corner of my eye. Her approach was very aggressive and abrupt in the ward. She confronted me about a mistake in my SOAP notes that I had made the previous week. She raised her voice countless times and called me careless and indirectly said I was stupid. She went as far as to say that she does not know why I chose this career as it does not suit me. This made me feel very discouraged and humiliated. I had never felt so low or bad about myself the way she made me feel.

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If I am not mistaken, her role as my superior is to uplift me, encourage me, and teach me. Instead she did the opposite. She discouraged me and tormented me. I would often go home crying because she made my stay at the hospital almost as though a nightmare. On another occasion, we were all in the physiotherapy department, presenting our patients to the senior physiotherapist as it was accustom. When it was my turn, she asked many difficult questions and told me I am not ready to be a qualified physiotherapist and she does not understand how I made it to third year. That last comment made me very worthless and I classify incidents like these as emotional and verbal abuse. This is a big part of why I am so insecure of myself in the clinical setting. Emotional and verbal abuse affects primarily a person’s emotional well-being and physical health. Depending on the severity and time of the occurrences, as well as how resilient an individual may be, these individuals may suffer from psychological and physical symptoms such as occasional sleep difficulties, nervous breakdowns, feelings of irritability or depression, become anxious and panic more frequently (Zanolli, 2016).

“Low self-confidence isn’t a life sentence. Self-confidence can be learned, practiced, and mastered–just like any other skill. Once you master it, everything in your life will change for the better.” Barrie Davenport

I struggle to believe in myself as I feel I still lack a lot of theory knowledge and skills to be the best physiotherapist that I can be. What led to me feeling this way was the fact that I had experienced many individuals questioning and tormenting my abilities as a physiotherapist, as an example mentioned above. By overcoming this struggle, I have tried to study as much as I possibly can, researching for journal articles on the many body structures and functions; as well as the role of physiotherapists. I have tried to overcome this insecurity and unconfident feeling by viewing my patients as individuals who are there to help me. This was successful because I spoke to a few of them about my struggles as a physiotherapist and they encouraged me to believe in myself more.

Improving my clinical reasoning is a challenge for me. Clinical reasoning is a difficult process to cover, and being a physiotherapy student, there are many principles to work by and remember. Many students find clinical reasoning difficult to accomplish. To overcome this challenge, I have practiced clinical reasoning as much as possible with different scenarios and patients; and read many journal articles that relate to clinical reasoning. This has helped me improve my ability to reason in the clinical setting.

Overall, reflecting on my ethical and professional development, I realize how much I have grown as a student physiotherapist. My confident and clinical reasoning has improved enough to qualify as planned. Who I was a year ago, I am no longer today!

 

References

Barnitt, R. (1998). Ethical dilemmas in occupational therapy and physical therapy: a survey of practitioners in the UK National Health Service. Journal of Medical Ethics24, 193-199. Retrieved from https://www.jstor.org/stable/27718110?seq=1#page_scan_tab_contents

Blackmer, J. (2007). Professionalism and the Medical Association. World Medical Association. Retrieved from http://www.wma.net/en/30publications/35whitepapers/White_Paper.pdf

Branch, W. T. (2000). The Ethics of Caring and Medical Education. Academic Medicinfe75(2), 127-132. Retrieved from https://docs.google.com/document/d/1KJ74DTSCsdV3ejVIi0zDM4NFRXOZOAg6owmB2RYHq48/edit

Britt, D. (2013). Healthcare Professionalism: How Important is Proper Bedside Manner? Retrieved May 31, 2016, from http://source.southuniversity.edu/healthcare-professionalism-how-important-is-proper-bedside-manner-132067.aspx

Gracyk, T. (2012). Four fundamental ethical principles. Retrieved August 15, 2016, from http://web.mnstate.edu/gracyk/courses/phil%20115/Four_Basic_principles.htm

Limentani, A. E., & Kent, E. (1999). The role of ethical principles in health care and the implications for ethical codes. Journal ofMedical Ethics25, 394-398. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC479265/pdf/jmedeth00006-0032.pdf

National Defense University. (2016). Values and Ethics. Retrieved September 28, 2016, from http://www.au.af.mil/AU/AWC/awcgate/ndu/strat-ldr-dm/pt4ch15.html

Reference. (2016). What are moral values? Retrieved September 28, 2016, from https://www.reference.com/world-view/moral-values-357e4ae84df08fa3#

Saint Mary’s College. (2016). Basic Ethical Principles. Retrieved August 15, 2016, from http://www.stmarys-ca.edu/institutional-review-board/basic-ethical-principles

Zanolli, N. (2016). When Conflict In The Workplace Escalates To Emotional Abuse. Retrieved October 18, 2016, from http://www.mediate.com/articles/davenport.cfm

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