Sexual boundaries between physiotherapists and patients are not perceived clearly: an observational study

The prevalence of harassment of diagnostic radiography and radiation therapy students whilst on clinical placement in the Republic of Ireland

OBJECTIVE

To determine if student radiographers and radiation therapists experience harassment (verbal, physical or sexual) while on clinical placement and their awareness of policies in place to report such incidents.

METHODS

An online questionnaire developed from the World Health Organisation's questionnaire on workplace violence in healthcare and the higher education authority (HEA) national survey of student experiences of sexual violence and harassment in Irish HEIs was used. Undergraduate and postgraduate diagnostic radiography and radiation therapy students in the Republic of Ireland to be included and have completed a minimum of four weeks of clinical placement. Our of 256 students, 98 filled out the survey.

RESULTS

Forty-one per cent (n = 40) of students reported experiencing at least one incident of harassment. Thirteen per cent reported experiencing two forms of harassment, and 2 students reported experiencing verbal, physical and sexual harassment. Verbal harassment (n = 33) and sexual (n = 16) were the most common form of harassment while physical harassment was experienced 7 participants. Ninety-one per cent (n = 88) of participants reported they don't believe they have received sufficient training in dealing with incidents of physical, verbal or sexual harassment.

CONCLUSION

Harassment of student radiographers and radiation therapists is occurring while on placement. Male patients are the modal perpetrator, and most incidents go unreported. Students are not empowered to report an incident of harassment and are sometimes unaware of how to report harassment.

Gender Issues in Physiotherapy in Quebec, Canada

Purpose

This study examines gender differences in the physiotherapy (PT) profession in the province of Quebec regarding: (1) areas of practice; (2) roles associated with the advancement of the profession; (3) formal disciplinary complaints; and (4) interests and competency perceptions of PT students.

Methods

We collected data from the Canadian Institute of Health Information, the Quebec Professional Order of Physiotherapy, Quebec university public Internet sites, and PT associations. We also surveyed PT students at the Université de Montréal.

Results

The PT workforce in Quebec was 76.6% women. The presidents of the four main PT associations were men. In the five university programmes, the percentage of male and female physiotherapists in tenure track positions was 46% and 54%, respectively. There were more sanctioned complaints of sexual misconduct and not maintaining continuing education for male physiotherapists, while more women were sanctioned for problems with documentation and billing. Among students, men were more interested in becoming administrators, but neither men nor women had a strong interest in research.

Conclusions

Male physiotherapists make up 23.4% of the PT workforce in Quebec but are more involved in leadership positions in the profession than women.

Disciplinary complaints concerning transgressive behaviour by healthcare professionals: an analysis of 5 years jurisprudence in the Netherlands

OBJECTIVES

To study the frequency of observed cases of disciplinary law complaints concerning transgressive behaviour in Dutch healthcare by analysing disciplinary cases handled in Dutch disciplinary law.

DESIGN

Retrospective review of complaints in the Dutch disciplinary law tribunals from the period 1 January 2015 to 1 January 2020.

SETTING

Dutch healthcare.

METHOD

Descriptive retrospective study. All judgements at regional disciplinary tribunals in the first instance from the period 1 January 2015 to 1 January 2020 concerning transgressive behaviour were investigated. The following was studied: year of judgement, number and nature of complaints, type of complainants, profession of defendant.

RESULTS

Over the study period, 139 complaints about transgressive behaviour were handled, 90 of which involved sexual behaviour. 66/139 complaints were submitted by patients themselves (47.5%). Most complaints were directed against physicians (44.6%; n=62), followed by nurses (30.2%; n=42), psychologists (11.5%; n=16) and physiotherapists (7.9%; n=11). 80.6% of the complaints were directed against a male healthcare professional (OR 4.25; 95% CI 1.7590 to 10.2685; p=0.0013). 104/139 of the complaints originated from an outpatient work setting and about half of the complaints originated from mental healthcare. Of the 90 disciplinary cases in which the complaint was related to sexually transgressive behaviour, 83.3% (n=75) were ruled to be substantiated (5 of which partially) with a measure imposed in all cases: 6 formal warnings (8%), 11 reprimands (14.7%), 10 denials (partial suspension) (13.3%), 26 temporary suspensions (34.7%) and 22 cancellations of the licence to practice (29.3%).

CONCLUSION

This study describes jurisprudence of disciplinary cases about transgressive behaviour of healthcare professionals in the Netherlands. The results of this study can be used to monitor trends in observed cases of transgressive behaviour.

Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice

Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients' overall health.

Ethical issues raised by private practice physiotherapy are more diverse than first meets the eye: recommendations from a literature review

PURPOSE

Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues.

METHOD

After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed.

RESULTS

A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized.

CONCLUSIONS

The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported-through education, research, and good governance-in providing the best possible care for their patients.

Physical therapists' perceptions of sexual boundaries in clinical practice in the United States

BACKGROUND

Physical therapists' perceptions of sexual boundaries in clinic settings in the United States have not been studied. Given the magnitude of potential consequences of sexual boundary violations, examination of this topic is imperative.

OBJECTIVE

The purpose of this study was to describe the perceptions of sexual boundaries among licensed physical therapists in the United States.

METHODS

Licensed physical therapists from Arkansas, Kansas, Maine, Ohio, and Oregon were contacted by email and asked to complete a sexual boundaries questionnaire via Survey Monkey™; 967 surveys (7.3%) were returned.

RESULTS

While most physical therapists practice within the profession's Code of Ethics, there are practitioners who date current and former patients, and condone patients' sexual banter in the clinic. Almost half (42%) of the participants acknowledged feeling sexually attracted to a patient. While gender differences were seen throughout the analyses, generally, the demographic and professional variables did not account for meaningful variance. Results were similar to previous research on physiotherapists in other countries.

CONCLUSIONS

Sexuality is part of the physical therapy practice environment and physical therapists' understanding of sexual boundaries is ambiguous. These data can inform professional conversation on sexual boundaries in physical therapy practice leading to greater understanding and decreased potential for violations.

Providing therapies to the opposite sex: views of complementary therapists working in clinical and private practice settings

AIM

The study explored the experiences of working with the opposite sex as a therapists in a cancer care centre (CCC).

METHODOLOGY

Therapists (n = 17) participated in three focus groups. Audiotapes were transcribed verbatim and analysed.

RESULTS

Themes and sub-themes were identified; these related to maintaining safety, the relevance of location to how safe therapists felt when working with men, the therapeutic relationship, safety precautions and being vigilant.

LIMITATIONS

The participants were from one cancer care centre in the North West of England. Only two males participated.

CONCLUSION

This exploratory study identified that the majority of the participants in this study had concerns about safety related to the gender or sex of their patient or client. This was more of an issue in private practice with concerns centred on inappropriate sexual responses from male clients. This has implications for training and safety in establishing and maintaining a practice.

Closing the gap between ethics knowledge and practice through active engagement: an applied model of physical therapy ethics

Physical therapist practice has a distinct focus that is holistic (ie, patient centered) and at the same time connected to a range of other providers within health care systems. Although there is a growing body of literature in physical therapy ethics knowledge, including clinical obligations and underlying philosophical principles, less is known about the unique ethical issues that physical therapists encounter, and how and why they make ethical decisions. As moral agents, physical therapists are required to make autonomous clinical and ethical decisions based on connections and relationships with their patients, other health care team members, and health institutions and policies. This article identifies specific ethical dimensions of physical therapist practice and highlights the development and focus of ethics knowledge in physical therapy over the last several decades. An applied ethics model, called the "active engagement model," is proposed to integrate clinical and ethical dimensions of practice with the theoretical knowledge and literature about ethics. The active engagement model has 3 practical steps: to listen actively, to think reflexively, and to reason critically. The model focuses on the underlying skills, attitudes, and actions that are required to build a sense of moral agency and purpose within physical therapist practice and to decrease gaps between the ethical dimensions of physical therapist practice and physical therapy ethics knowledge and scholarship. A clinical case study is provided to illustrate how the ethics engagement model might be used to analyze and provide insight into the ethical dimensions of physical therapist practice.