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Cortés-Amador S, Arnal-Gómez A, Marques-Sule E, Hernández-Guillén D, Tolsada-Velasco C, Espí-López GV. Development of Advanced Competencies in Physiotherapy: Impact of a Single-Blinded Controlled Trial on Ethics Competence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10590. [PMID: 36078306 PMCID: PMC9518481 DOI: 10.3390/ijerph191710590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Innovation in the training of future physiotherapy professionals through the use of collaborative learning could be an effective method for developing advanced competencies such as professional ethics. This study aimed at comparing the effects of cooperative learning and individual learning on the knowledge of professional ethics, the perception of knowledge regarding professional ethics, the teaching quality assessment and satisfaction in future physiotherapy professionals. METHODS A prospective, assessor-blinded, controlled trial was performed. A 12-week program was carried out with future physiotherapy professionals. The cooperative learning group was based on group activities, while the individual learning group performed the same activities with an individual approach. Knowledge, perception of knowledge regarding professional ethics, teaching quality and satisfaction were assessed. RESULTS A total of 216 participants completed the study (cooperative group n = 106; individual group n = 110). The cooperative learning group showed higher knowledge and perception of knowledge regarding professional ethics compared to the individual learning group (p < 0.001 and p < 0.001, respectively). Additionally, the cooperative learning group reported higher scores in the teaching materials, attitude towards future professionals and the teacher's global score. CONCLUSIONS Cooperative learning showed a positive impact on developing advanced competencies such as knowledge and perception of knowledge regarding professional ethics. Both methodologies showed adequate results in the assessment of teaching quality and satisfaction.
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Affiliation(s)
- Sara Cortés-Amador
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- UBIC Research Group, Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Anna Arnal-Gómez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Physiotherapy in Motion, Multispeciality Research Group (PTin MOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Elena Marques-Sule
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Physiotherapy in Motion, Multispeciality Research Group (PTin MOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - David Hernández-Guillén
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Group of Physiotherapy in the Aging Process: Social and Health Care Strategies (PT_AGE), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Catalina Tolsada-Velasco
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Gemma V. Espí-López
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Exercise Intervention for Health (EXINH), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Quain A, Mullan S, Ward MP. “There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members. Front Vet Sci 2022; 9:922049. [PMID: 35923822 PMCID: PMC9339959 DOI: 10.3389/fvets.2022.922049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Clinical ethics support services (CESS) are employed in healthcare to improve patient care and help team members develop skills to recognize and navigate ethically challenging situations (ECS). The objective of this study was to evaluate the impact of ethics rounds, one form of CESS, on veterinary team members. An anonymous, online mixed-methods survey incorporating a 15-item instrument designed to assess the outcomes of moral case deliberation originally developed for human healthcare workers (the Euro-MCD 2.0), was developed. The survey was administered to veterinary team members prior to and following participation in a 90-min virtual ethics rounds session. A total of 23 sessions of virtual ethics rounds were held. In total, 213 individuals participated, and 89 completed both surveys (response rate 41.8%). Most respondents were female (n = 70, 81%). Most were veterinarians (n = 51, 59%), followed by other veterinary team members (practice manager, animal attendant) (n = 18, 21%), veterinary nurses or animal health technicians (n = 10, 12%) and veterinary students (n = 8, 9%). Age ranged from 20 to 73 (median 41, IQR 32–52, n = 87). While there was no statistically significant difference between overall modified Euro-MCD 2.0 scores between T1 and T2, there were statistically significant changes in 7 out of 15 Euro-MCD 2.0 items in the domains of moral competence and moral teamwork. Reflexive thematic analysis of free-text responses identified themes including the types, impact and barriers to resolving ECS, the impacts of ethics rounds on veterinary team members and constraints preventing veterinary team members from speaking up in the face of ECS. While participants largely described the impact of ethics rounds as beneficial (for example, by facilitating clarification of thinking about ECS, allowing participants to see ECS from the perspective of others and providing a safe space for discussion), reflecting on ECS could be stressful for participants. Active participation in ethics rounds may be inhibited in the context of power imbalance, or in settings where bullying occurs. Overall, carefully facilitated ethics rounds has the potential to improve the ability of veterinary team members to identify and navigate ECS, and potentially mitigate moral distress.
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Affiliation(s)
- Anne Quain
- Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Anne Quain
| | | | - Michael P. Ward
- Faculty of Science, Sydney School of Veterinary Science, University of Sydney, Sydney, NSW, Australia
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Richards L, Coghlan S, Delany C. "I Had No Idea That Other People in the World Thought Differently to Me": Ethical Challenges in Small Animal Veterinary Practice and Implications for Ethics Support and Education. JOURNAL OF VETERINARY MEDICAL EDUCATION 2020; 47:728-736. [PMID: 32053051 DOI: 10.3138/jvme.2019-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although veterinarians encounter ethical challenges in their everyday practice, few studies have examined how they make sense of and respond to them. This research used semi-structured interviews and a qualitative methodology (phenomenological and constructivist/interpretivist approaches) to explore ethical challenges experienced by seven small animal city veterinarians and their ethical decision-making strategies. Thematic analysis of the interview transcripts identified four broad ethical issues: The first concerned disagreements about the best interests of the animal; the second centered on clinical uncertainty about the most appropriate treatment for the animal; the third involved factors influencing ethical reasoning and decision making; and the fourth concerned how ethics education might prepare veterinary students for future ethical decision making. An overarching theme identified in the analysis was one of enormous personal distress. Furthermore, a sense of veterinarians being interested in how others might think and feel about ethical challenges came through in the data. The results give insight into how veterinarians experience and respond to ethical challenges. The research also provides empirical information about everyday practice to inform future education in ethics and ethical decision making for veterinary students.
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Kulju K, Suhonen R, Puukka P, Tolvanen A, Leino-Kilpi H. Self-evaluated ethical competence of a practicing physiotherapist: a national study in Finland. BMC Med Ethics 2020; 21:43. [PMID: 32471504 PMCID: PMC7257238 DOI: 10.1186/s12910-020-00469-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background Patients have the right to equal, respectful treatment. Nowadays, one third of patient complaints concern health care staff’s behavior towards patients. Ethically safe care requires ethical competence, which has been addressed as a core competence in physiotherapy. It has been defined in terms of character strength, ethical awareness, moral judgment skills in decision-making, and willingness to do good. The purpose of this study was to analyze the ethical competence of practicing physiotherapists. Method A self-evaluation instrument (Physiotherapist’s Ethical Competence Evaluation Tool) based on an analysis of a concept “ethical competence” was constructed in 2016 and physiotherapists (n = 839), working in public health services or private practice responded to the questionnaire. Results Based on the results, most of the physiotherapists evaluated themselves highly ethically competent in all areas of ethical competence, subscales being Strength, Awareness, Skills and Will. Willingness to do good was evaluated as highest, while character strength, including the strength to support ethical processes and speak on behalf of the patient, was evaluated the lowest. Physiotherapists most commonly consult a colleague when encountering an ethical problem. Other methods for problem solving are not very familiar, neither are the international or national ethical codes of conduct. Conclusions This was the first attempt to assess all aspects of ethical competence empirically in a clinical environment in physiotherapy, using a novel self-evaluation instrument. Even if physiotherapists evaluate themselves as competent in ethics, further exploration is needed for ethical awareness. Also the patients’ viewpoints about ethically competent care should be considered, to better ensure ethical safety of the patient.
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Affiliation(s)
- Kati Kulju
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
| | - Riitta Suhonen
- Department of Nursing Science/ Turku University Hospital and City of Turku, Welfare Division, University of Turku, Turku, Finland
| | - Pauli Puukka
- National Institute for Health and Welfare, Turku, Finland
| | - Anna Tolvanen
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, Turku University Hospital, University of Turku, Turku, Finland
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Delany C, Edwards I, Fryer C. How physiotherapists perceive, interpret, and respond to the ethical dimensions of practice: A qualitative study. Physiother Theory Pract 2018; 35:663-676. [PMID: 29589806 DOI: 10.1080/09593985.2018.1456583] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for "in the moment" ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.
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Affiliation(s)
- Clare Delany
- a Department of Medical Education, School of Medicine , University of Melbourne , Melbourne , Australia
| | - Ian Edwards
- b School of Health Sciences , University of South Australia , Adelaide , Australia
| | - Caroline Fryer
- b School of Health Sciences , University of South Australia , Adelaide , Australia
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Delany C, Richards A, Stewart H, Kosta L. Five challenges to ethical communication for interprofessional paediatric practice: A social work perspective. J Interprof Care 2017; 31:505-511. [PMID: 28287850 DOI: 10.1080/13561820.2017.1296419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In paediatric clinical care, what is said to a parent or carer as well as when, where, and how it is said, directly advances or diminishes parents' capacities to understand available options and to contribute to decisions about treatment for their child. This makes interprofessional and patient communication an ethical endeavour. Social workers are uniquely situated to observe, participate in, and provide an active link in the communication between families and other health team members. This article reports phenomenological research exploring ethical issues encountered by social workers in their everyday practice communicating with families and other health professionals in a paediatric hospital context in Australia. Data were collected via semi-structured interviews with nine social workers and analysed thematically. Participants described two main communication-based roles: to support families through information provision and to contribute collaboratively to the interprofessional team involved in caring for a child and family. We grouped participants' descriptions of conflict between these roles into five main "communication challenges": (1) holding troublesome knowledge; (2) the need for diplomacy; (3) conciliation; (4) every man and his dog in family meetings; and (5) systems and processes presenting a brick wall. The five communication challenges provide empirically derived examples of how communication occurring within interprofessional health teams and between individual clinicians and parents can act to diminish or enhance parents' experience of care for their hospitalised child. Identifying these challenges may help to inform how communication within interprofessional teams and between clinicians and patients can benefit children and their parents.
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Affiliation(s)
- Clare Delany
- a Children's Bioethics Centre , Royal Children's Hospital , Melbourne , Victoria , Australia.,b Medical School , The University of Melbourne , Melbourne , Victoria , Australia
| | - Angela Richards
- c Social Work , Royal Children's Hospital , Melbourne , Victoria , Australia
| | - Helen Stewart
- c Social Work , Royal Children's Hospital , Melbourne , Victoria , Australia
| | - Lauren Kosta
- d Department of Social Work , The University of Melbourne , Melbourne , Victoria , Australia
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Hudon A, Perreault K, Laliberté M, Desrochers P, Williams-Jones B, Ehrmann Feldman D, Hunt M, Durocher E, Mazer B. Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators. Disabil Rehabil 2016; 38:2244-54. [PMID: 26750086 DOI: 10.3109/09638288.2015.1123308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods. METHOD Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation. RESULTS Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. CONCLUSION The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.
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Affiliation(s)
- Anne Hudon
- a Rehabilitation Sciences, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada ;,b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada
| | - Kadija Perreault
- c Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Québec , Canada
| | - Maude Laliberté
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,d Department of Social and Preventive Medicine, École De Santé Publique , University of Montreal , Montreal , Québec , Canada
| | - Pascal Desrochers
- e Department of Physical Therapy, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada
| | - Bryn Williams-Jones
- d Department of Social and Preventive Medicine, École De Santé Publique , University of Montreal , Montreal , Québec , Canada
| | - Debbie Ehrmann Feldman
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,e Department of Physical Therapy, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada
| | - Matthew Hunt
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
| | - Evelyne Durocher
- f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
| | - Barbara Mazer
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
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Abstract
BACKGROUND Sharing information and decisions with children and their parents is critical in pediatric rehabilitation. Although the ethical significance and clinical benefits of sharing decisions are established, approaches for implementing shared decision-making in clinical practice are still developing. AIM To explore the ethical challenges of sharing information and decisions with one family in pediatric occupational therapy. METHOD We used a single qualitative in-depth interview with an occupational therapist to examine the ethical dimensions of sharing decisions. RESULTS We found that asking what was ethically at stake in the information-sharing process, highlighted how timing and style of information sharing impacts on understanding and collaboration within the therapeutic relationship. Using ethics-based questions assisted in drawing out the complexity of implementing the ideals of sharing information and decisions in pediatric practice. CONCLUSION Reflecting on ethical dimensions of communication with families assists to identify approaches to shared decision-making in clinical practice.
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Affiliation(s)
- Clare Delany
- The Children's Bioethics Centre, The Royal Children's Hospital Melbourne , Parkville, Melbourne, VIC , Australia
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