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Ditwiler RE, Hardwick D, Swisher LL. "Definitely a Dark Time:" professional and ethical issues in post-acute care physical therapy during the COVID-19 pandemic. Physiother Theory Pract 2024:1-18. [PMID: 38420945 DOI: 10.1080/09593985.2024.2321216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Disproportionate effects of the SARS-CoV-2 (COVID-19) pandemic on older adults in post-acute care settings created many professional and ethical challenges for patients and healthcare providers. OBJECTIVE The purpose of this study was to examine the professional and ethical issues of physical therapists (PTs) and physical therapist assistants (PTAs) in providing facility-based post-acute care in residential settings (skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals) during the COVID-19 pandemic. METHODS A qualitative descriptive research design was used to explore professional and ethical issues during the COVID-19 pandemic. PTs and PTAs described their experiences during semi-structured interviews conducted virtually. Interview data was analyzed with reflexive thematic analysis. RESULTS Thematic analysis produced 4 themes: facility-wide battle against infection and death, doing the best you can to provide care amidst COVID-19 constraints, promoting ethical good and doing the right thing, and a dark intense time. CONCLUSIONS Professional and ethical constraints on providing care faced by PTs and PTAs during the COVID-19 pandemic can inform current and future clinical practice. Although some of the challenges faced by PTs and PTAs were unique to COVID-19, many problems represent preexisting systemic and organizational issues that were exacerbated by the pandemic.
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Affiliation(s)
- Rebecca Edgeworth Ditwiler
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Dustin Hardwick
- School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
| | - Laura Lee Swisher
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Coleman A, McLaughlin E, Floren M. Practitioner Burnout and Productivity Levels in Skilled Nursing and Assisted Living Facilities, Part 1: A Descriptive Quantitative Account. Am J Occup Ther 2024; 78:7801205090. [PMID: 38224353 DOI: 10.5014/ajot.2024.050341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
IMPORTANCE Understanding burnout among practitioners in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) while considering contextual factors may lead to practices that enhance therapist and patient satisfaction as well as quality of care. OBJECTIVE To examine productivity standards and burnout in the context of setting and role, as reported by therapy practitioners in geriatric settings, and to explore relationships between productivity standards and perceived ethical pressures. DESIGN Cross-sectional online survey with descriptive data. PARTICIPANTS Practitioners (N = 366) included occupational therapists, physical therapists, speech-language pathologists, and occupational and physical therapy assistants working in SNFs and ALFs in the United States. A survey integrating the Maslach Burnout Inventory: Human Services Survey for Medical Personnel (MBI-HSS) and questions addressing demographics and contextual factors was distributed via social media. RESULTS Of 366 practitioners, 20.5% were burned out, exhibiting extreme scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) on the MBI-HSS. Significant relationships between productivity requirements and EE, DP, and PA, after accounting for covariates, were evident. Significant relationships between productivity standards and five of the six ethically questionable behaviors existed. Role affected productivity requirements, specifically between therapists and assistants, whereas setting did not. CONCLUSIONS AND RELEVANCE Productivity standards and related pressures are associated with concerning aspects of burnout among practitioners working in geriatric settings. Advocating for change in defining productivity and incorporating positive support in the work environment may assist in reducing burnout and turnover rates and improve patient satisfaction and care. Plain-Language Summary: This research highlights the prevalence of burnout and perceived pressures related to productivity requirements among occupational therapy practitioners working in skilled nursing and assisted living facilities.
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Affiliation(s)
- Ashley Coleman
- Ashley Coleman, OTD, OTR/L, is Occupational Therapist, Virginia Beach, VA;
| | - Ellen McLaughlin
- Ellen McLaughlin, EdD, OTR/L, FAOTA, is Professor, Occupational Therapy Department, Misericordia University, Dallas, PA
| | - Michael Floren
- Michael Floren, PhD, is Assistant Professor, Data Analytics, University of North Alabama, Florence
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Sillero Sillero A, Ayuso Margañon R, Moreno-Segura N, Carrasco JJ, Atef H, Ayuso Margañon S, Marques-Sule E. Physiotherapists' Ethical Climate and Work Satisfaction: A STROBE-Compliant Cross-Sectional Study. Healthcare (Basel) 2023; 11:2631. [PMID: 37830668 PMCID: PMC10572859 DOI: 10.3390/healthcare11192631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
(1) Background: This study aimed to examine the relationship between Spanish physical therapists' perceptions of the ethical climate, their moral sensitivity (awareness of ethical issues), and job satisfaction. (2) Methods: the study analyzed descriptive correlational data on 104 physical therapists from three Spanish metropolitan hospitals. Respondents completed a demographic data form, an ethical climate questionnaire, a job satisfaction survey, and a moral sensitivity scale. This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. (3) Results: With a mean score of 4.2, physical therapists are typically content with their jobs. The mean scores for the moral sensitivity and ethical climate questionnaires are high, at 40.1 (SD 6.3) and 96.8 (SD 17.1), respectively. There is a significant positive correlation between job satisfaction and ethical climate (r between 0.59 and 0.79) but only a weak correlation between job satisfaction and moral sensibility (r between 0 and 0.32 for the three aspects measured). (4) Conclusions: Generally speaking, physical therapists reported that they had high job satisfaction, a positive workplace environment, and excellent management support. Despite a weak relationship with moral sensibility, there is a strong association between ethical behavior, hospital organization, and higher levels of job satisfaction. It is important to encourage the development of moral sensibilities to boost psychological well-being and therapeutic decision-making.
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Affiliation(s)
- Amalia Sillero Sillero
- Mar Nursing School (ESIMar), Parc de Salut Mar, University Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- Social Determinants and Health Education Research Group (SDHEd), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Raquel Ayuso Margañon
- Mar Nursing School (ESIMar), Parc de Salut Mar, University Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- Social Determinants and Health Education Research Group (SDHEd), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Noemí Moreno-Segura
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Intelligent Data Analysis Laboratory, University of Valencia, 46100 Valencia, Spain
| | - Hady Atef
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Staffordshire ST5 5BG, UK
- Department of Physical Therapy for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Cairo 11432, Egypt
| | - Sonia Ayuso Margañon
- Department of Public Health Nursing, Mental Health and Perinatal Nursing, Faculty of Medicine and Health Sciences, 08907 Barcelona, Spain
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Mármol-López MI, Marques-Sule E, Naamanka K, Arnal-Gómez A, Cortés-Amador S, Durante Á, Tejada-Garrido CI, Navas-Echazarreta N, Juárez-Vela R, Gea V. Physiotherapists' ethical behavior in professional practice: a qualitative study. Front Med (Lausanne) 2023; 10:1158434. [PMID: 37529240 PMCID: PMC10390221 DOI: 10.3389/fmed.2023.1158434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Background In health professions, ethics is considered a fundamental competence. The increase in clinical autonomy in the field of physiotherapy is associated with an increase in ethical situations in their clinical practice. Objective To explore the ethics of the clinical relationship between physiotherapists and patients, the ethics training received by physiotherapists, and if in the clinical context, physiotherapists identify the necessary attitudes and apply the ethical recommendations of the profession for the ethical situations they experience. Methods A qualitative exploratory and descriptive study was performed with physiotherapists. Data were collected through semi-structured interviews. The data were analyzed using content analysis, as proposed by Krippendorf. The study protocol was approved by the University of Valencia Ethics Committee of Human Research. Results This study included 15 physiotherapists (66.66% women, average age = 42.2 years), which was sufficient to reach data saturation. We identified four categories: (i) Ethics of the clinical relationship (ethical values, principles, and norms; type of clinical relationship), (ii) Ethics training received (during the physiotherapy studies; current training of students; low importance of ethics in the curriculum), (iii) Necessary attitudes for professional ethical practice (main attitudes were identified: personal attitudes and professional attitudes); (iv) Experiences from professional practice (general; public sector vs. private sector). Conclusion The ethics of the clinical relationship between physiotherapists and patients is determined by the attitudes of the practitioner, which are the result of his or her values and previous experiences; and are very centered on ethics of indication (founded mainly on the principles of Beneficence and Non-Maleficence). It is necessary to improve the ethical training received by physiotherapists, which is poorly focused on professional attitudes.
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Affiliation(s)
- María Isabel Mármol-López
- Research Group GREIACC, Health Research Institute La Fe (IISLaFe), Nursing School La Fe, Adscript Centre, University of Valencia, Valencia, Spain
| | - Elena Marques-Sule
- Physiotherapy in Motion, Department of Physiotherapy, Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Kati Naamanka
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
| | - Anna Arnal-Gómez
- Physiotherapy in Motion, Department of Physiotherapy, Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion, Department of Physiotherapy, Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Ángela Durante
- Department of Nursing, GRUPAC, Universidad de La Rioja, La Rioja, Spain
- Comprehensive Health Care Research Group (INCUiSA) Biomedical Research Center of La Rioja, La Rioja, Spain
| | - Clara Isabel Tejada-Garrido
- Department of Nursing, GRUPAC, Universidad de La Rioja, La Rioja, Spain
- Comprehensive Health Care Research Group (INCUiSA) Biomedical Research Center of La Rioja, La Rioja, Spain
| | - Noelia Navas-Echazarreta
- Department of Nursing, GRUPAC, Universidad de La Rioja, La Rioja, Spain
- Comprehensive Health Care Research Group (INCUiSA) Biomedical Research Center of La Rioja, La Rioja, Spain
| | - Raúl Juárez-Vela
- Department of Nursing, GRUPAC, Universidad de La Rioja, La Rioja, Spain
- Comprehensive Health Care Research Group (INCUiSA) Biomedical Research Center of La Rioja, La Rioja, Spain
| | - Vicente Gea
- Faculty of Health Sciences, Research Group Community Health and Care (SALCOM), Valencia International University, Valencia, Spain
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Essex R, Thompson T, Evans TR, Fortune V, Kalocsányiová E, Miller D, Markowski M, Elliott H. Ethical climate in healthcare: A systematic review and meta-analysis. Nurs Ethics 2023; 30:9697330231177419. [PMID: 37459590 PMCID: PMC10710009 DOI: 10.1177/09697330231177419] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Ethical climate refers to the shared perception of ethical norms and sets the scope for what is ethical and acceptable behaviour within teams. AIM This paper sought to explore perceptions of ethical climate amongst healthcare workers as measured by the Ethical Climate Questionnaire (ECQ), the Hospital Ethical Climate Survey (HECS) and the Ethics Environment Questionnaire (EEQ). METHODS A systematic review and meta-analysis was utilised. PSYCINFO, CINAHL, WEB OF SCIENCE, MEDLINE and EMBASE were searched, and papers were included if they sampled healthcare workers and used the ECQ, HECS or EEQ. ETHICAL CONSIDERATION Ethical approval was not required. RESULTS The search returned 1020 results. After screening, 61 papers were included (n = 43 HECS, n = 15 ECQ, n = 3 EEQ). The overall sample size was over 17,000. The pooled mean score for the HECS was 3.60. Mean scores of individual studies ranged from 2.97 to 4.5. For the HECS studies, meta-regression was carried out. No relationship was found between the country of the studies, the study setting (ICU v non-ICU settings) or the mean years of experience that the sample had. For the ECQ, sub-scales had mean scores ranging from 3.41 (instrumental) to 4.34 (law) and were all observed to have significant and substantial heterogeneity. Three studies utilised the EEQ so further analysis was not carried out. CONCLUSIONS The above results provide insight into the variability of scores as measured by the HECS, ECQ and EEQ. To some extent, this variability is not surprising with studies carried out across 21 countries and in a range of healthcare systems. Results also suggest that it may be that more local and context specific factors are more important when it comes to predicting ethical climate.
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Affiliation(s)
- Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Trevor Thompson
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Thomas Rhys Evans
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Vanessa Fortune
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | | | - Denise Miller
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Marianne Markowski
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Helen Elliott
- Institute for Lifecourse Development, University of Greenwich, London, UK
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Sturm A, Roth R, Ager AL. Views of physiotherapists on factors that play a role in ethical decision-making: an international online survey study. Arch Physiother 2023; 13:3. [PMID: 36721251 PMCID: PMC9889242 DOI: 10.1186/s40945-022-00157-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is a lack of knowledge about the ways physiotherapists around the world learn about professional code of ethics and ethical decision-making frameworks. The profession has a gap in the understanding about physiotherapists' views on factors that play a role in ethical decision-making and whether these views differ between World Physiotherapy regions. METHODS An online survey study in English was conducted from October 2018 to October 2019. Participants included 559 physiotherapists located in 72 countries. The self-designed survey questionnaire contained 13 items asking about demographic information and means of learning about ethical codes and decision-making frameworks. A further 30 items were presented which included statements underpinned with individual, organisational, situational and societal factors influencing ethical decision-making. Participants were asked to express their level of agreement or disagreement using a 5-point-Likert-scale. RESULTS Participants' highest rated responses endorsed that the professional role of physiotherapists is linked to social expectations of ethical behaviour and that ethical decision-making requires more skills than simply following a code of ethics. A recognisable organisational ethical culture was rated as supporting good ethical decisions. Comparing responses by World Physiotherapy regions showed significant differences in factors such as culture, religion, emotions, organisational values, significant others, consequences of professional misconduct and professional obligations. Entry level education was not perceived to provide a solid base for ethical decision-making in every World Physiotherapy region. Participants reported multiple sources for learning about a professional code of ethics and ethical decision-making frameworks. What's more, the number of sources differed between World Physiotherapy regions. CONCLUSIONS Multiple factors play a role in physiotherapists' ethical decision-making internationally. Physiotherapists' ethical knowledge is informed by, and acquired from, several learning sources, which differ in both quality and quantity amongst World Physiotherapy regions. Easily accessible knowledge and education about professional codes of ethics and ethical decision-making can foster continuing professional development for physiotherapists. The establishment of constructive ethical cultures in workplaces can improve ethical decision-making, and should acknowledge the influence of individual, organisational, situational and societal factors. The establishment of collaborative learning environments can support knowledge translation which acknowledges practice-based methods of knowing and learning.
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Affiliation(s)
- Andrea Sturm
- Interuniversity College for Health and Development Graz, Castle of Seggau, Seggauberg 1, A-8430 Leibnitz, Austria
| | - Roswith Roth
- Interuniversity College for Health and Development Graz, Castle of Seggau, Seggauberg 1, A-8430 Leibnitz, Austria ,grid.5110.50000000121539003University of Graz, Institute of Psychology, Universitaetsplatz 2, 8010 Graz, Austria
| | - Amanda Louise Ager
- grid.5342.00000 0001 2069 7798Doctoral School of Life Sciences and Medicine, Gent University, Campus UZ Gent, Corneel Heymanslaan 10, B3, ingang 46, 9000 Ghent, Belgium
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Ditwiler RE, Swisher LL, Hardwick DD. Doing things you never imagined: Professional and ethical issues in the U.S. outpatient physical therapy setting during the COVID-19 pandemic. Musculoskelet Sci Pract 2022; 62:102684. [PMID: 36356408 PMCID: PMC9617680 DOI: 10.1016/j.msksp.2022.102684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite being the most prevalent physical therapy practice setting in the United States, no literature to date has examined the professional and ethical issues faced by outpatient physical therapists during the COVID-19 pandemic. The purpose of this study was to explore professional and ethical issues experienced by outpatient physical therapists in the United States during the COVID-19 pandemic. DESIGN An explorative semi-structured interview study using reflexive thematic analysis METHODS: Virtual semi-structured interviews explored physical therapists' experiences during COVID-19 in the OP setting. Data was analyzed using reflexive thematic analysis as described by Braun and Clarke. RESULTS Respondents worked predominantly with patients with orthopaedic impairments. Six primary themes and associated subthemes were identified: 1) Disruption of routine professional and personal life. 2) Negative impacts on health and wellbeing (physical, mental, and social). 3) Barriers to relationships, communication, and providing quality care. 4) Telehealth as a safe option to increase access with opportunities and challenges. 5) Discomfort practicing in an environment of misinformation, mistrust, and divisiveness. 6) New & pre-existing ethical issues in the COVID-19 context. CONCLUSIONS Results of this study indicate that physical therapists in the outpatient setting wrestled with critical questions regarding outpatient physical therapy practice during the COVID-19 pandemic: the role of touch in professional identity, challenges to the therapeutic alliance, effect of productivity and fiscal expectations and whether outpatient physical therapy is essential during public emergencies.
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Affiliation(s)
- Rebecca Edgeworth Ditwiler
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA.
| | - Laura Lee Swisher
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Dustin Dean Hardwick
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, USF Health Morsani College of Medicine, Tampa, FL, USA,School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
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Naamanka K, Suhonen R, Tolvanen A, Leino-Kilpi H. Ethical competence - exploring situations in physiotherapy practice. Physiother Theory Pract 2022; 39:1237-1248. [DOI: 10.1080/09593985.2022.2039817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kati Naamanka
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
| | - Anna Tolvanen
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science/Turku University of Applied Sciences, University of Turku, Turku, Finland
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Fryer C, Sturm A, Roth R, Edwards I. Scarcity of resources and inequity in access are frequently reported ethical issues for physiotherapists internationally: an observational study. BMC Med Ethics 2021; 22:97. [PMID: 34284762 PMCID: PMC8290210 DOI: 10.1186/s12910-021-00663-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Little is known about the ethical situations which physiotherapists encounter internationally. This lack of knowledge impedes the ability of the profession to prepare and support physiotherapists in all world regions in their ethical practice. The purpose of the study was to answer the following research questions: What types of ethical issues are experienced by physiotherapists internationally? How frequently are ethical issues experienced by physiotherapists internationally? Can the frequency and type of ethical issue experienced by physiotherapists be predicted by sociodemographic, educational or vocational variables? METHODS An observational study was conducted in English using an online survey from October 2018 to May 2019. Participants were 1212 physiotherapists and physiotherapy students located internationally which represented less than 1% of estimated number of physiotherapists worldwide at that time. The survey questionnaire contained 13 items requesting demographic detail and knowledge of ethical codes and decision-making, and 46 items asking what frequency participants experienced specific ethical issues in four categories: (A) Physiotherapist and patient interaction (19 items), (B) Physiotherapist and other health professionals including other physiotherapists (10 items), (C) Physiotherapists and the system (5 items) and (D) Professional and economic ethical situations (12 items). RESULTS The two most frequently experienced ethical issues were 'Scarce resources and time affecting quality of physiotherapy treatment' and 'Physiotherapy not accessible to all people in society who need it'. These items were experienced, on average, more often than monthly. Interprofessional practice also presented frequent ethical issues for participants. Ethical issues related to the context of 'Physiotherapists and the system' were most frequently experienced for all world regions. Working longer years in physiotherapy and learning about ethics in basic physiotherapy education was associated with participants reporting lower frequencies of ethical issues across all contexts. CONCLUSION This study provides the first global profile of ethical issues experienced by physiotherapists. Societal and cultural systems are key influences on physiotherapists' ethical practice. Physiotherapists globally need support from their work organisations, academic institutions and professional associations, and robust ethical training, to assist them to be active moral agents in their practice.
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Affiliation(s)
- Caroline Fryer
- UniSA Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Andrea Sturm
- Interuniversity College for Health and Development Graz, Castle of Seggau, Seggauberg, Austria
| | - Roswith Roth
- Interuniversity College for Health and Development Graz, Castle of Seggau, Seggauberg, Austria
- University of Graz, Universitaetsplatz 2/III, 8010, Graz, Austria
| | - Ian Edwards
- UniSA Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
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Marques-Sulé E, Arnal-Gómez A, Cortés-Amador S, de la Torre MI, Hernández D, Aguilar-Rodríguez M. Attitudes towards learning professional ethics in undergraduate physiotherapy students: A STROBE compliant cross-sectional study. NURSE EDUCATION TODAY 2021; 98:104771. [PMID: 33529858 DOI: 10.1016/j.nedt.2021.104771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Ethics is a key competence to be acquired by physiotherapy students to ensure quality care. However, students may not be aware of the importance of ethics for the development of their clinical practice, in the same way that their attitudes towards Professional Ethics are unknown within their curriculum. OBJECTIVES The aim of this study was to identify the attitudes towards learning Professional Ethics among undergraduate students of Physiotherapy Degree and compare the attitude between the educational years. DESIGN A cross-sectional study was carried out. SETTINGS Physiotherapy Degree at the University of Valencia, Spain. PARTICIPANTS In the study 340 physiotherapy students participated. METHODS This was a quantitative study with a cross-sectional observational design. The students of the different years of the Physiotherapy Degree had to complete the Attitudes Questionnaire towards Professional Ethics in Physiotherapy in order to analyse the study objective. RESULTS The four educational years' scored 3.80 or more in the questionnaire. Second-year students scored the highest (4.25 ± 0.35) and had significantly more favourable attitudes towards learning ethics in relation to the rest of the years (p = 0.007 vs. first; p < 0.001 vs. third and fourth). First-year students (4.09 ± 0.37) obtained a significantly higher score than third (3.86 ± 0.35) and fourth years (3.80 ± 0.33) with p < 0.001 vs. both third and fourth. Finally, in relation to the 3 categories of the items' questionnaire the mean scores showed significant differences between the second year and the rest of the years. CONCLUSIONS The attitudes towards learning Professional Ethics among students of the Physiotherapy Degree at the university is favourable, although it varies depending on the academic year, with the students in the academic year in which Ethics is taught (i.e. second year students) being the ones with better attitudes.
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Affiliation(s)
| | - Anna Arnal-Gómez
- Department of Physiotherapy, University of Valencia. Valencia, Spain
| | | | | | - David Hernández
- Department of Physiotherapy, University of Valencia. Valencia, Spain
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Cantu R. Physical Therapists' Ethical Dilemmas in Treatment, Coding, and Billing for Rehabilitation Services in Skilled Nursing Facilities: A Mixed-Method Pilot Study. J Am Med Dir Assoc 2019; 20:1458-1461. [PMID: 31378703 DOI: 10.1016/j.jamda.2019.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Reimbursement in skilled nursing facilities (SNFs) is driven by the number of minutes a patient receives rehabilitation. Physical therapists' (PTs) clinical decisions in evaluation and appropriate treatment of patients drive the dosing of rehabilitation services. Many times these 2 dynamics clash. The purpose of this study was to determine how PTs in SNFs viewed their ethical work environment, what primary issues drove their views, and what potential solutions were identified for the issues. DESIGN This was a mixed-methods, cross-sectional survey study. SETTING AND PARTICIPANTS An organizational ethics survey along with 2 open-ended questions were sent to a random sample of 1200 PTs in the state of Georgia; 340 surveys were returned, and the respondents were categorized into 9 typical PT work settings. Twenty eight participants (8.2%) reported they worked in SNFs. MEASURES The Ethics Environment Questionnaire was the quantitative measurement tool used for the study. In addition, 2 open-ended questions were asked regarding ethical concerns and possible solutions to those concerns. RESULTS Of the 9 workplace settings, therapists working in SNFs had the lowest perceptions of ethical work environment. They were also the only group that scored below the survey cut-off point for positive ethical work environment. Their primary concerns were overutilization issues, productivity standards, and billing and coding issues. The 2 primary themes regarding solutions were allowing PTs to be autonomous in their decision making and decreasing productivity standards. CONCLUSIONS/IMPLICATIONS The current Medicare reimbursement system rewards quantity of rehabilitation over quality. PTs are trained to deliver quality care that is dosed appropriately, and this may conflict with organizational objectives. The primary implication in this study is that clinicians and administrators should engage more in open, honest dialogue on how to share responsibility and balance organizational goals with clinical ethics.
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Affiliation(s)
- Roberto Cantu
- Department of Physical Therapy, Brenau University Ivester College of Health Sciences, Gainesville, GA.
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