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

"Passion to do the right thing": searching for the 'good' in physiotherapist practice

BACKGROUND

Practitioners' perspectives of what constitutes a 'good' physiotherapist have not been explicitly examined despite their potential implications for the future practice of physiotherapy. Physiotherapists' perceptions may inform professional priorities including education curricula, professional practices, competency profiles, and patient interactions.

PURPOSE

The purpose of this research was to examine physiotherapists' perceptions of what constitutes a 'good' physiotherapist. The context of the study was musculoskeletal practice (MSK).

METHODS

A hermeneutic phenomenological investigation was undertaken. Semi-structured interviews were conducted with twelve experienced MSK physiotherapists to examine their perceptions of what constitutes a 'good' physiotherapist.

FINDINGS

Seven themes were identified. Good physiotherapists were depicted as: 1) oriented to care; 2) integrating knowledge sources; 3) competent; 4) responsive; 5) reflective; 6) communicative; and 7) reasoning. To deepen the understanding of these themes, we discuss the findings in relation to Joan Tronto's ethic of care theory.

CONCLUSIONS

Physiotherapists' perceptions of what constitutes a 'good' physiotherapist highlight practices that may underpin an ethic of care including the pivotal role of person-centered and relational dimensions of practice. The findings call into question the profession's emphasis on a technical rationalist approach to education and clinical practice and invites conversation about future directions that balance technical competence with relational dimensions of practice.

"What their expectations could be": a narrative study of mothers and service providers in paediatric rehabilitation

PURPOSE

To better understand and visualise how and why mothers' and service providers' expectations for therapy can change over time spanning their journeys and careers in the paediatric rehabilitation system.

METHODS

Narrative analysis was used to construct two parallel collective stories that illustrate and explain phases and turning points of developing expectations. Five mothers and nine service providers participated in interviews discussing their expectations when new and more experienced with therapy.

RESULTS

Each collective story had five chapters illustrating how expectations became more relational, controllable, and informed. For mothers, the chapters were: (1) expecting therapy to be a saviour; (2) being turned away and alone; (3) expecting to advocate from necessity; (4) finding new solutions in the environment; and (5) expecting to combine mother and service provider expertise. For service providers, the chapters were: (1) expecting to rescue and fix; (2) searching for an alternative sense of professional worth; (3) expecting to lose control; (4) being the authentic self before expected self; and (5) expecting the unexpected.

CONCLUSIONS

Mothers' experiences with feeling alone and learning ways to modify their child's environments, and service providers' experiences with feeling inadequate and embracing authenticity, were essential to the developmental trajectories of expectations.Implications for Rehabilitation:Mapping expectations for therapy on a line graph shaped as a wave shows promise in reflecting the developmental trajectory of mothers' and service providers' expectations over time.Service providers should become aware of how to work with three distinct groups of mothers as determined by the phase of expectations for therapy they are currently experiencing (i.e., hyped, disillusioned, or enlightened).Therapy programmes can optimise expectations for therapy through redesigns that emphasise elements of networking, self-compassion, ethics, and authenticity.

Shared decision-making in physiotherapy: a cross-sectional study of patient involvement factors and issues in Japan

BACKGROUND

Evidence-based medicine education has not focused on how clinicians involve patients in decision-making. Although shared decision-making (SDM) has been investigated to address this issue, there are insufficient data on SDM in physiotherapy. This study aimed to clarify the issues concerning patient involvement in Japan, and to examine whether SDM is related to perceptions of patient involvement in decision-making.

METHODS

The study participants were recruited from among acute and sub-acute inpatients and community residents receiving physiotherapy outpatient care, day care, and/or home rehabilitation. The Control Preference Scale (CPS) was used to measure the patients' involvement in decision-making. The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) was used to measure SDM. In analysis I, we calculated the weighted kappa coefficient to examine the congruence in the CPS between the patients' actual and preferred roles. In analysis II, we conducted a logistic regression analysis using two models to examine the factors of patient involvement.

RESULTS

Analysis I included 277 patients. The patients' actual roles were as follows: most active (4.0%), active (10.8%), collaborative (24.6%), passive (35.0%), and most passive (25.6%). Their preferred roles were: most active (3.3%), active (18.4%), collaborative (39.4%), passive (24.5%), and most passive (14.4%). The congruence between actual and preferred roles by the kappa coefficient was 0.38. Analysis II included 218 patients. The factors for patient involvement were the clinical environment, the patient's preferred role, and the SDM-Q-9 score.

CONCLUSIONS

The patients in Japan indicated a low level of decision-making involvement in physiotherapy. The patients wanted more active involvement than that required in the actual decision-making methods. The physiotherapist's practice of SDM was revealed as one of the factors related to perceptions of patient involvement in decision-making. Our results demonstrated the importance of using SDM for patient involvement in physiotherapy.

Physiotherapists' ethical behavior in professional practice: a qualitative study

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.

Views of physiotherapists on factors that play a role in ethical decision-making: an international online survey study

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.

(Almost) 50 shades of an ethical situation - international physiotherapists' experiences of everyday ethics: a qualitative analysis

INTRODUCTION

Different cultures and societal structures influence the ethical experiences of physiotherapists.

OBJECTIVE

The study aimed to discover and describe contextual shades of ethical situations experienced by physiotherapists in their global practice.

METHODS

This paper reports the qualitative analysis of responses to an optional open question in an internationally distributed online survey (ESPI study) with 1,212 participants from 94 countries. All responses were coded to five categories describing the data's relationship to the survey list of ethical situations. Data that described new ethical situations were analyzed thematically.

RESULTS

Three hundred and fifty four individual responses to the optional survey question reported 400 ethical issues. Three hundred and seventy-eight of these issues were associated with the original survey questions. Twenty-two responses raised four new themes of ethical issues: lack of regulatory and/or accreditation policy and infrastructure, lack of recognition of the role and position of physiotherapists in healthcare, economic factors driving the conduct of practice, and political threats.

DISCUSSION

Local contexts and pressures of workplaces and societies in which physiotherapists practice make it almost impossible for some practitioners to comply with codes of ethics. Physiotherapists need support and preparation to respond to local affordances and the complexity, ambiguity, and sometimes messiness of ethical situations encountered in their practice.

CONCLUSION

The findings highlight the relevance of cross-cultural research in the field of physiotherapy, and the necessity of investigating and bridging the gap between professional ethics theory and practice in diverse settings.

Professional values and perception of knowledge regarding professional ethics in physical therapy students: A STROBE compliant cross-sectional study

Undergraduate students start the acquisition of a professional identity, and begin to achieve professional values and consciousness of an ethical behavior as future health professionals. The aim of this study was describe professional values and perception of knowledge regarding professional ethics of physical therapy students. A cross-sectional study was performed. A total of 351 students participated in the study. Professional values and perception of knowledge regarding professional ethics were assessed. Ethical approval was obtained from the University Ethics Review Board. The most important value was equity, while the least one was abnegation. The second educational year showed higher scores in importance of scientific quality (P = .010 vs first year), the third year in respect for life (P = .041 vs first year, respectively), and the fourth year in respect to patient's autonomy (P = .033 vs first year). First-year students showed lower scores in perception of knowledge regarding professional ethics (P < .001 vs second, third, and fourth year), while second-year students had higher scores (P < .001 vs first and third; P = .006 vs fourth year) and no differences between third- and fourth-year students were found. Those professional values highly considered by the students were mainly shared professional values, with equity ranked highest and abnegation lowest. Furthermore, second-year students had a well-established perception of knowledge regarding professional ethics, showing significant higher scores when compared to the rest of the educational years. This is the first cross-sectional study that describes these variables among physical therapy students and it is a starting point for future. Physical therapy educators might want to take into account these findings when teaching and guiding students in developing awareness for their professional values and perception of knowledge regarding professional ethics.

Patterns of ethical issues and decision-making challenges in clinical practice among Ghanaian physiotherapists

Objectives

To determine the patterns of ethical issues and decision-making challenges encountered by practicing physiotherapists in Ghana.

Design

This is a cross-sectional study in which the stratified sampling technique was adopted to sample the participants.

Setting

The study involved physiotherapists at the private healthcare setting and from different levels of public healthcare facilities.

Participants

Eighty-two duly registered physiotherapists who were practising in Ghana participated in the study.

Interventions

Participants completed a 30-item questionnaire related to ethical issues and challenges encountered in making ethical decisions. Data analysis was premised on the frequency of occurrence of ethical tensions and difficulty in decision making which were dichotomized as ‘high’ and ‘low’ issues, and ‘extreme’ and ‘low’ difficult decisions, respectively.

Results

The age range of the participants was 21–49 years (mean 31.5 ± 1.4years). 18 (22%), 31 (37.8%) and 33 (40.2%) physiotherapists practice in the primary, secondary and tertiary healthcare settings respectively. 56 (68.3%) and 43 (52.4%) of the participants affirmed that ‘establishing priorities for patient's treatment amidst limited time resources’ was the most frequently encountered and the most extremely difficult ethical issue to make a decision on respectively. Whereas, limiting physical therapy services for personal or organizational gains sub-theme was the least occurred issue which was also the least difficult to make a decision on as indicated by the respective 16 (19.5%) and 18 (22.0%) physiotherapists.

Conclusion

A wide range of primary and secondary ethical issues were reported by the sampled physiotherapists, which tend to pose difficulty during the decision-making process in practice.

Funding

The research work was self-funded by the authors.

Attitudes towards learning professional ethics in undergraduate physiotherapy students: A STROBE compliant cross-sectional study

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.

Knowledge and practice of informed consent by physiotherapists and therapy assistants in KwaZulu-Natal Province, South Africa

BACKGROUND

Informed consent is a doctrinal prerequisite in accordance with the National Health Act 2003 and professional ethical guidelines. Current regulations stipulate that healthcare professionals obtain informed consent from patients prior to treatment. Misconduct charges relating to inadequate information disclosure have been recorded against South African physiotherapists.

OBJECTIVES

This study evaluated knowledge and barriers to informed consent practice among physiotherapists and assistants at Ethekwini District public health institutions.

METHODS

This cross-sectional study utilised self-administered questionnaires. Statistical Package for Social Sciences was used to analyse variables. Significance level and attitude correlation was determined using chi-squared tests, Pearson's correlation and Spearman's coefficient.

RESULTS

Forty-nine respondents (43 physiotherapists, 3 technicians, 3 assistants) completed this study. Mean age and professional experience of respondents were 38 and 14 years, respectively. The majority were female (93%); 56% spent 5 to 10 min obtaining informed consent, mostly verbally (89%); while 47% correctly identified age of consent to routine treatment (12 years). Information provided to patients by respondents included treatment benefits (100%), common risks (81%) and 'all material risks' (31%). Fifty per cent of respondents showed positive attitudes to informed consent.

CONCLUSIONS

Some practising physiotherapists and assistants in KwaZulu-Natal public healthcare institutions had only partial knowledge of informed consent regulations and local laws. Barriers to informed consent included language and excessive workload.

CLINICAL IMPLICATIONS

Patient-centred care is quality healthcare, and adequate informed consent knowledge improves clinical outcomes, respects patients' dignity and autonomy. Continued professional education on healthcare law and ethics should be provided to practising physiotherapists and assistants.

Physical Therapists' Ethical Dilemmas in Treatment, Coding, and Billing for Rehabilitation Services in Skilled Nursing Facilities: A Mixed-Method Pilot Study

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.

Rehabilitation culture and its impact on technology: unpacking practical conditions for ultrabilitation

Purpose: It has been proposed that rehabilitation practice expand its aims beyond recovery to "ultrabilitation," but only if certain biological, technological, and psychosocial conditions are met. There is thus an opportunity to connect ultrabilitation, as a concept, to adjacent literature on assistive technology and sociotechnical systems.Method: We draw on insights from sociology of technology and responsible innovation, as well as concrete examples of neural devices and the culture of rehabilitation practice, to further refine our understanding of the conditions of possibility for ultrabilitation.Results: "Assistive" technologies can indeed be re-imagined as "ultrabilitative," but this shift is both psychosocial and technological in nature, such that rehabilitation professionals will likely play a key role in this shift. There is not, however, sufficient evidence to suggest whether they will support or hinder ultrabilitative uses of technology.Conclusion: Advancing the idea and project of ultrabilitation must be grounded in a nuanced understanding of actual rehabilitation practice and the norms of broader society, which can be gained from engaging with adjacent literatures and by conducting further research on technology use in rehabilitation contexts.Implications for rehabilitation"Assistive" technologies can be conceptually re-imagined as "ultrabilitative" technologies, expanding their utility from recovery to enhancement and flourishing.Actual development and use of ultrabilitative technology is both a technical and psychosocial challenge, and its success depends on the cultural context in which technology is situated.Further empirical research is needed on the ways in which rehabilitation culture and the norms of broader society might impact or even inhibit the use of ultrabilitative technology.

The impact of an evolving profession on the frequency and perceived difficulty of ethical encounters among physical therapists in the clinic

Background: Ethical decision making is situated within dynamic contexts specific to practice standards and environments, contemporary policy, and responsive educational systems. Reflecting on an evolving profession lends insight into the role of ethical codes of conduct. Objective: The purpose of this study was to gather information about the frequency and perceived difficulty physical therapists (PTs) experience with common ethical situations within contemporary clinical practice. Methods: PTs within the United States were invited to participate in an online questionnaire replicating a 1980 study. Subjects were 336 PTs from a variety of practice environments. Results: Just 1 item was reported as moderately/extremely difficult by contemporary respondents, compared to 16 items in the 1980 study. The number of items meeting moderate/high encounter frequency was similar between the two groups (2015 = 16/19; 1980 = 15/19). Conclusions: While today's PTs report that they encounter ethical situations at a frequency similar to PTs in 1980, these same PTs report these ethical challenges as minimally difficult when compared to PTs responding to the 1980 survey. It is proposed that a move toward autonomous practice, the elevation of the entry level professional degree, and changing health care policy and environments have been influential in shaping these changes over time.

A blended-learning programme regarding professional ethics in physiotherapy students

BACKGROUND

In the university context, assessing students' attitude, knowledge and opinions when applying an innovative methodological approach to teach professional ethics becomes fundamental to know if the used approach is enough motivating for students.

RESEARCH OBJECTIVE

To assess the effect of a blended-learning model, based on professional ethics and related to clinical practices, on physiotherapy students' attitude, knowledge and opinions towards learning professional ethics.

RESEARCH DESIGN AND PARTICIPANTS

A simple-blind clinical trial was performed (NLM identifier NCT03241693) (control group, n = 64; experimental group, n = 65). Both groups followed clinical practices for 8 months. Control group performed a public exposition of a clinical case about professional ethics. By contrast, an 8-month blended-learning programme regarding professional ethics was worked out for experimental group. An online syllabus and online activities were elaborated, while face-to-face active participation techniques were performed to discuss ethical issues. Students' attitudes, knowledge and opinions towards learning professional ethics were assessed.

ETHICAL CONSIDERATIONS

The study was approved by the University Ethic Committee of Human Research and followed the ethical principles according to the Declaration of Helsinki.

FINDINGS

After the programme, attitudes and knowledge towards learning professional ethics of experimental group students significantly improved, while no differences were observed in control group. Moreover, opinions reported an adequate extension of themes and temporization, importance of clinical practices and interest of topics. Case study method and role playing were considered as the most helpful techniques.

CONCLUSION

The blended-learning programme proposed, based on professional ethics and related to clinical practices, improves physiotherapy students' attitudes, knowledge and opinions towards learning professional ethics.

Exploring the characteristics of capable healthcare professionals

Background: In order to negotiate complex clinical environments successfully, healthcare professionals must be more than competent – they must demonstrate an ability to adapt to dynamic situations and continually improve performance. However, emphasis on knowledge and skills alone may ignore opportunities for professional development that enables students to become practitioners.Objectives: The aim of this study was to ascertain what clinical experts believe are the essential characteristics of capable healthcare professionals that go beyond academic and technical competencies.Method: This study used a nominal group technique (NGT) to gather data from a panel of South African and international clinical experts, using open-ended questions and qualitative data analysis to determine emergent themes. The NGT is an interpretive research method that can be used to explore poorly defined topics, in this case to develop an understanding of the characteristics of health professionals that go beyond knowledge and technical skill.Results: Panel members highlighted the importance of knowledge and skills for competent practice, but also explored other aspects of the learning process as part of developing professional identity. These included self-evaluation as part of professional development,building relationships with patients, and the importance of acknowledging students’emotional responses to the clinical environment. Panel members also discussed the challenge of inappropriate role-models in the clinical context, who may have a negative influence on the development of professional practice.Conclusion: By including the concept of capability alongside competency in undergraduate healthcare curricula clinical educators can help students develop a sense of being that emphasises professional growth alongside knowledge and technical skills.

Theoretical frameworks used to discuss ethical issues in private physiotherapy practice and proposal of a new ethical tool

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.

Developing occupational therapy students’ practice habits via qualitative inquiry education

Background

Accreditation standards and practice competencies underscore the importance of research for occupational therapy practice, but they do not guide how occupational therapy education addresses research. Despite the prominence of qualitative research in the health professions, there exists a need to articulate how and why qualitative inquiry is taught in occupational therapy education.

Purpose

We discuss how qualitative inquiry education can develop habits of reflection and reflexivity, criticality, and active engagement in preparation for occupational therapy practice.

Key Issues

We hold that our students’ professional abilities to practice in a well-reasoned, ethical, and responsive manner are enhanced by experiences with qualitative inquiry and suggest that there is potential in linking qualitative inquiry experiences to professional habit formation in occupational therapy education.

Implications

In addition to teaching research for its own sake, we suggest that educators can adopt a broader view of how qualitative inquiry functions within occupational therapy education.

Implementation of shared decision making in physical therapy: observed level of involvement and patient preference

BACKGROUND

Shared decision making (SDM) reduces the asymmetrical power between the therapist and the patient. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been previously considered.

OBJECTIVE

The objective of this study was to examine the status of SDM in physical therapy, patients' preferred levels of involvement, and the agreement between therapist perception and patient preferred level of involvement.

DESIGN

This was an observational study of real consultations in physical therapy.

METHODS

In total, 237 consultations, undertaken by 13 physical therapists, were audiorecorded, and 210 records were analyzed using the Observing Patient Involvement (OPTION) instrument. Before the consultation, the patient and therapist completed the Control Preference Scale (CPS). Multilevel analysis was used to study the association between individual variables and the level of SDM. Agreement on preferences was calculated using kappa coefficients.

RESULTS

The mean OPTION score was 5.2 (SD=6.8), out of a total score of 100. Female therapists achieved a higher OPTION score (b=-0.86, P=0.01). In total, 36.7% of the patients wanted to share decisions, and 36.2% preferred to give their opinion before delegating the decisions. In the majority of cases, therapists believed that they had to decide. The kappa coefficient for agreement was poor at .062 (95% confidence interval=-.018 to .144).

LIMITATIONS

Only 13 out of 125 therapists who were personally contacted agreed to participate.

CONCLUSION

Shared decision making was not applied; although patients preferred to share decisions or at least provide their opinion about the treatment, physical therapists did not often recognize this factor. The participating physical therapists were more likely to make decisions in the best interest of their patients; that is, these therapists tended to apply a paternalistic approach rather than involving the patient.

Practicing physiotherapy in Danish private practice: an ethical perspective

Despite an increasingly growth of professional guidelines, textbooks and research about ethics in health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive to practice physiotherapy. The empirical data consists of interviews with twenty-one physiotherapists. The interviews are analysed from a hermeneutic approach, inspired by Ricoeur's textual interpretation of distanciation. The analysis follows three phases: naïve reading, structural analysis and comprehensive analysis. Four main themes are constructed: Beneficence as the driving force; Disciplining the patient through the course of physiotherapy; Balancing between being a trustworthy professional and a businessperson; The dream of a code of practice. Private practice physiotherapy is embedded in a structural frame directed by both political and economical conditions that shape the conditions for practicing physiotherapy. It means that beneficence in practice is a balance between the patient, the physiotherapists themselves and the business. Beneficence towards the patient is expressed as an implicit demand. Physiotherapeutic practice is expressed as being an integration of professionalism and personality which implies that the physiotherapists also have to benefit themselves. Private practice seems to be driven by a paternalistic approach towards the patient, where disciplining the patient is a crucial element of practice, in order to optimise profit. Physiotherapists wish for a more beneficent practice in the future by aiming at bridging 'to be' and 'ought to be'.

Beyond knowledge and skills: the use of a Delphi study to develop a technology-mediated teaching strategy

BACKGROUND

While there is evidence to suggest that teaching practices in clinical education should include activities that more accurately reflect the real world, many educators base their teaching on transmission models that encourage the rote learning of knowledge and technical skills. Technology-mediated instruction may facilitate the development of professional attributes that go beyond "having" knowledge and skills, but there is limited evidence for how to integrate technology into these innovative teaching approaches.

METHODS

This study used a modified Delphi method to help identify the professional attributes of capable practitioners, the approaches to teaching that may facilitate the development of these attributes, and finally, how technology could be integrated with those teaching strategies in order to develop capable practitioners. Open-ended questions were used to gather data from three different expert panels, and results were thematically analysed.

RESULTS

Clinical educators should not view knowledge, skills and attitudes as a set of products of learning, but rather as a set of attributes that are developed during a learning process. Participants highlighted the importance of continuing personal and professional development that emphasised the role of values and emotional response to the clinical context. To develop these attributes, clinical educators should use teaching activities that are learner-centred, interactive, integrated, reflective and that promote engagement. When technology-mediated teaching activities are considered, they should promote the discussion of clinical encounters, facilitate the sharing of resources and experiences, encourage reflection on the learning process and be used to access content outside the classroom. In addition, educational outcomes must drive the integration of technology into teaching practice, rather than the features of the technology.

CONCLUSIONS

There is a need for a cultural change in clinical education, in which those involved with the professional training of healthcare professionals perceive teaching as more than the transmission of knowledge and technical skills. Process-oriented teaching practices that integrate technology as part of a carefully designed curriculum may have the potential to facilitate the development of capable healthcare graduates who are able to navigate the complexity of health systems and patient management in ways that go beyond the application of knowledge and skills.