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McGrath RL, Parnell T, Verdon S, Pope R. "We take on people's emotions": a qualitative study of physiotherapists' experiences with patients experiencing psychological distress. Physiother Theory Pract 2024; 40:304-326. [PMID: 36062922 DOI: 10.1080/09593985.2022.2116964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Previous research suggests that physiotherapists frequently engage with patients who experience psychological distress (e.g. feelings of depression and anxiety) and that physiotherapists find supporting these patients challenging. OBJECTIVE The aim of this study was to explore the experiences of Australian physiotherapists with patients they perceived were experiencing psychological distress. METHODS A 'Big Q' qualitative research approach was used. Twenty-three interviews with physiotherapists were conducted. The data were then analyzed using iterative thematic inquiry. RESULTS The analysis produced four interrelated themes: 1) encounters with patients in distress are common and varied; 2) becoming emotionally attuned with their patients meant that distress could invoke empathetic distress; 3) physiotherapists use emotional shields to protect themselves; and 4) physiotherapists found frequent encounters with patient distress to be emotionally exhausting. Viewed together, the themes highlight how patient distress can invoke transient empathetic distress in a physiotherapist; repeated experiences of empathetic distress may lead to empathetic distress fatigue. CONCLUSION While physiotherapists are sometimes viewed as 'physical' health professionals, the experiences of these physiotherapists suggest that patient psychological distress is highly relevant to physiotherapy practice. We recommend future research explores the relationships between patient distress, physiotherapists' empathy, and physiotherapists' wellbeing.
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Affiliation(s)
- Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Sarah Verdon
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Rodney Pope
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
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2
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Dholakia K, Hartman J. Transforming Society Through Critical Service-Learning: A Position for a Justice-Based Approach to Experiential Learning in Physical Therapy Education. JOURNAL, PHYSICAL THERAPY EDUCATION 2023; 37:264-270. [PMID: 38478780 DOI: 10.1097/jte.0000000000000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/17/2023] [Indexed: 06/25/2024]
Abstract
BACKGROUND AND PURPOSE In response to the numerous calls for the physical therapy profession to position itself as an equity and social justice-centered profession, we are called to provide aspiring physical therapists with the skills to dismantle inequities and injustice in their communities. Exposure to health inequity and injustice through conceptual and experiential learning alone does not prepare students to create positive change and may serve to perpetuate stereotypes and offer simplistic solutions to complex problems. POSITION AND RATIONALE We argue that a traditional service-learning model lacks transformative potential for bringing about social change. Therefore, we introduce critical service-learning, compare it with the traditional model in the context of physical therapy experiential learning, and provide rationale and guidance on transitioning to this educational approach. We believe critical service-learning is an action-oriented approach that works to identify the root causes of social and structural determinants and accept personal and shared responsibility for acting to ameliorate their effects. Critical service-learning experiences require critical reflection and call for intentional design including teacher training, rich community engagement, student assignments that challenge current paradigms, and use of evaluative measures that assess community goals. These aspects add to the historically practiced traditional model. DISCUSSION AND CONCLUSION We invite educators to shift to critical service-learning, an approach that has great potential for benefiting all interested parties in meaningful and long-lasting ways. Critical service-learning holds the opportunity for our profession to be better positioned to transform society.
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Affiliation(s)
- Kripa Dholakia
- Kripa Dholakia is an assistant professor in the Institute for Physical Therapy Education at the Widener University, Chester, PA 19013 ( ). Please address all correspondence to Kripa Dholakia
| | - Jeff Hartman
- Jeff Hartman is an assistant professor in the Doctor of Physical Therapy program in the Department of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health, Madison, WI
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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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Sturm A, Edwards I, Fryer CE, Roth R. (Almost) 50 shades of an ethical situation - international physiotherapists' experiences of everyday ethics: a qualitative analysis. Physiother Theory Pract 2023; 39:351-368. [PMID: 34983285 DOI: 10.1080/09593985.2021.2015812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Andrea Sturm
- Interuniversity College for Health and Development Graz, Leibnitz, Austria
| | - Ian Edwards
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | | | - Roswith Roth
- Interuniversity College for Health and Development Graz, Leibnitz, Austria.,Institute of Psychology, University of Graz, Graz, Austria
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Fleming P, Caffrey L, Belle SV, Barry S, Burke S, Conway J, Siersbaek R, Mockler D, Thomas S. How International Health System Austerity Responses to the 2008 Financial Crisis Impacted Health System and Workforce Resilience - A Realist Review. Int J Health Policy Manag 2022; 12:7420. [PMID: 37579453 PMCID: PMC10125082 DOI: 10.34172/ijhpm.2022.7420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/19/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The Great Recession, following the 2008 financial crisis, led many governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. METHODS A realist review identified legacies associated with austerity (proximal outcomes) and how these impact the distal outcome of health system resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007-May 2021), resulting in 1081 articles. Further theory-driven searches resulted in an additional 60 studies. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of context-mechanism-outcome configurations (CMOCs), alongside stakeholder engagement to confirm or refute emerging results. Causal pathways, and the interplay between context and mechanisms that led to proximal and distal outcomes, were revealed. The refined CMOCs and policy recommendations focused primarily on workforce resilience. RESULTS Five CMOCs demonstrated how austerity-driven policy decisions can impact health systems when driven by the priorities of external agents. This created a real or perceived shift away from the values and interests of health professionals, a distrust in decision-making processes and resistance to change. Their values were at odds with the realities of implementing such policy decisions within sustained restrictive working conditions (rationing of staff, consumables, treatment options). A diminished view of the profession and an inability to provide high-quality, equitable, and needs-led care, alongside stagnant or degraded working conditions, led to moral distress. This can forge legacies that may adversely impact resilience when faced with future shocks. CONCLUSION This review reveals the importance of transparent, open communication, in addition to co-produced policies in order to avoid scenarios that can be detrimental to workforce and health system resilience.
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Affiliation(s)
- Padraic Fleming
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Louise Caffrey
- School of Social Work and Social Policy, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | | | - Sarah Barry
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Jacki Conway
- Everlake, 5 Marine Terrace, Dun Laoghaire, Dublin, Ireland
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - David Mockler
- Library Reader Services, Trinity College Dublin, The University of Dublin, St James Hospital, Dublin 8, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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6
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Sturm A, Ager AL, Roth R. Western ideals and global realities – physiotherapists’ views on factors that play a role in ethical decision-making: an international qualitative analysis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2155240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Andrea Sturm
- Interuniversity College for Health and Development Graz, Leibnitz, Austria
| | - Amanda L. Ager
- Doctoral School of Life Sciences and Medicine, Gent University, Gent, Belgium
| | - Roswith Roth
- Interuniversity College for Health and Development Graz, Leibnitz, Austria
- Institute of Psychology, University of Graz, Graz, Austria
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Nordstrom T, Jensen GM, Altenburger P, Blackinton M, Deusinger S, Hack L, Patel RM, Tschoepe B, VanHoose L. Crises as the Crucible for Change in Physical Therapist Education. Phys Ther 2022; 102:6585155. [PMID: 35554600 DOI: 10.1093/ptj/pzac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/15/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
Abstract
This Perspective issues a challenge to physical therapists to reorient physical therapist education in ways that directly address the crises of COVID-19 and systemic racism. We advocate that professional education obligates us to embrace the role of trusteeship that demands working to meet society's needs by producing graduates who accept their social and moral responsibilities as agents and advocates who act to improve health and health care. To achieve this, we must adopt a curriculum philosophy of social reconstruction and think more deeply about the why and how of learning. Currently, health professions education places strong emphasis on habits of head (cognitive knowledge) and hand (clinical skills) and less focus on habits of heart (professional formation). We believe that habits of heart are the essential foundations of the humanistic practice needed to address health inequities, find the moral courage to change the status quo, and address imbalances of power, privilege, and access. A social reconstruction orientation in physical therapist education not only places habits of heart at the center of curricula, but it also requires intentional planning to create pathways into the profession for individuals from underrepresented groups. Adopting social reconstructionism begins with a faculty paradigm shift emphasizing the learning sciences, facilitating learning, metacognition, and development of a lifelong master adaptive learner. Achieving this vision depends not only on our ability to meet the physical therapy needs of persons with COVID-19 and its sequalae but also on our collective courage to address injustice and systemic racism. It is imperative that the physical therapy community find the moral courage to act quickly and boldly to transform DPT education in ways that enable graduates to address the social determinants of health and their systemic and structural causes that result in health disparities. To succeed in this transformation, we are inspired and strengthened by the example set by Geneva R. Johnson, who has never wavered in recognizing the power of physical therapy to meet the needs of society.
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Affiliation(s)
- Terry Nordstrom
- Samuel Merritt University, Department of Physical Therapy, Oakland, California, USA
| | - Gail M Jensen
- Creighton University, Department of Physical Therapy, School of Pharmacy and Health Professions, Omaha, Nebraska, USA
| | - Peter Altenburger
- Indiana University, Department of Physical Therapy, Indianapolis, Indiana, USA
| | - Mary Blackinton
- Rehab Essentials, enTandem DPT, Columbia Falls, Montana, USA
| | - Susan Deusinger
- Washington University in St Louis, Program in Physical Therapy, St Louis, Missouri, USA
| | - Laurita Hack
- Temple University, Department of Physical Therapy, Philadelphia, Pennsylvania, USA
| | - Rupal M Patel
- Texas Woman's University, School of Physical Therapy, Houston, Texas, USA
| | - Barbara Tschoepe
- Educational Consultant and Physical Therapy Learning Institute, Boulder, Colorado, USA
| | - Lisa VanHoose
- Ujima Institute and Foundation, Monroe, Louisiana, USA
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8
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Smeltz L, Lee KH, Bettger JP. Integrating rehabilitation and social care: opportunities for advancing research, training, practice, and policy. Arch Phys Med Rehabil 2022; 103:1886-1890. [PMID: 35644217 DOI: 10.1016/j.apmr.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/25/2022] [Accepted: 04/30/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Lydia Smeltz
- Penn State College of Medicine, Hershey, PA USA; Trinity College of Arts & Sciences, Duke University, Durham, NC USA.
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9
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Physiotherapy Students' Experiences about Ethical Situations Encountered in Clinical Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168489. [PMID: 34444233 PMCID: PMC8391809 DOI: 10.3390/ijerph18168489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: It is important to explore the ethical situations that physiotherapy students encountered in their clinical practices. (2) Methods: Qualitative, explorative, descriptive study. The participants included third-year physiotherapy students. They had to write five narratives about ethical situations encountered in their clinical practices. Krippendorff’s method for qualitative content analysis was used to cluster units within the data to identify emergent themes. The study protocol was approved by the authors’ University Ethic Committee of Human Research (H1515588244257). (3) Result: 280 narratives were reported by 64 students (23.34 ± 4.20 years, 59% women). Eight categories were identified from the qualitative analysis of the data: (a) professional responsibility, (b) professional competence, (c), beneficence, (d) equality and justice, (e) autonomy, (f) confidentiality, (g) respect for privacy, and (h) sincerity. All participants were informed and provided written informed consent. (4) Conclusions: Ethical principles were frequently violated in physiotherapy. Experiences of physiotherapy students must be examined to tailor educational interventions prior to their initiation into practice. Ethics education is needed in workplaces and should be increased in basic education. Facilitating the ethical awareness of future physiotherapists is a challenge for university teachers who provide ethical competence training.
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Üzar Özçetin YS, Sarıoğlu G. The relationship between resilience, moral sensitivity, and cultural competence among nurses. PSYCHOL HEALTH MED 2021; 27:1672-1681. [PMID: 33870817 DOI: 10.1080/13548506.2021.1916955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to examine the relationships between resilience, moral sensitivity, and cultural competence among nurses. A descriptive correlational design was employed. The study comprises 120 nurses. The resilience total scores and most of its domain scores were significantly and positively associated with the cultural competency total and domain scores. Additionally, the resilience total scores and some of its domain scores were significantly in relation to the moral sensitivity total and domain scores. Resilience total and domain scores were significantly and positively related to the moral sensitivity total and domain scores. The emergent correlations underscore the role that resilience plays in nurses' moral sensitivity and cultural competence. The emergent correlations underscore the role that resilience plays in nurses' moral sensitivity and cultural competence. The present findings suggest that nurse managers should develop delivery models that nurture resilience in nurses.
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Affiliation(s)
| | - Gizem Sarıoğlu
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey.,Hatay Antakya State Hospital, Turkey
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Sviland R, Martinsen K, Nicholls DA. Løgstrup’s thinking: a contribution to ethics in physiotherapy. Physiother Theory Pract 2020; 38:1-13. [DOI: 10.1080/09593985.2020.1741051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Randi Sviland
- Faculty of Health and Social Sciences, Department of Health and Function, Western Norway University of Applied Sciences (HVL), Bergen, Norway
| | - Kari Martinsen
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - David A Nicholls
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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12
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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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13
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Dahl-Michelsen T, Nicholls DA, Groven KS. Approaching intimacy, sexuality and ethics in the professional training of physiotherapy students in Norway. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1619833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - David A. Nicholls
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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14
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Boyczuk AM, Deloyer JJ, Ferrigan KF, Muncaster KM, Dal Bello-Haas V, Miller PA. Professional Values: Results of a Scoping Review and Preliminary Canadian Survey. Physiother Can 2019; 71:134-143. [PMID: 31040509 DOI: 10.3138/ptc.2017-70.e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose : Physiotherapists in Canada do not have an agreed-on list of core professional values. The purpose of this study was to identify physiotherapy values using a scoping review and to preliminarily identify the core professional values important to Canadian physiotherapists. Method: We undertook (1) a comprehensive scoping review of the primary and grey literature and (2) a cross-sectional survey of Canadian physiotherapists attending the 2016 Canadian Physiotherapy Association Congress. We conducted Ovid MEDLINE, Ovid EMBASE, and CINAHL database and Internet searches to identify peer-reviewed and grey literature. Survey participants were asked to list two professional values that guided their practice. Thematic and content analyses were used to analyze the results of both activities. We combined the results of the scoping review and the survey. Results : A total of 23 Web sites and 11 primary articles were retained from the search; 88 physiotherapists participated in the survey. A final list of 10 professional values (accountability, advocacy, altruism, compassion and caring, equity, excellence, integrity, patient and client centred, respect, and social responsibility) was drawn up after analyzing the scoping review and survey. Conclusions: This study describes the first steps in the process of identifying a set of core professional values for Canadian physiotherapists. Although many of values identified in this survey aligned with values published in the literature, some were unique, and further investigation is required.
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Affiliation(s)
- Alana M Boyczuk
- School of Rehabilitation Sciences, McMaster University, Hamilton.,Vancouver General Hospital, Vancouver Coastal Health, Vancouver
| | - Jamie J Deloyer
- School of Rehabilitation Sciences, McMaster University, Hamilton.,Sports Medicine and Rehabilitation Centre, Barrie, Ont
| | - Kyle F Ferrigan
- School of Rehabilitation Sciences, McMaster University, Hamilton.,MSK Centre: Rehabilitation and Sports Medicine, Waterloo, Ont
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de Vries K, Banister E, Dening KH, Ochieng B. Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy. Nurs Ethics 2019; 26:1946-1954. [PMID: 30943848 DOI: 10.1177/0969733019833130] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.
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Jose S, Khare N, Buchanan FR. Customer perceptions of CSR authenticity. INTERNATIONAL JOURNAL OF ORGANIZATIONAL ANALYSIS 2018. [DOI: 10.1108/ijoa-08-2017-1213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to look at corporate social responsibility (CSR)-related actions to see whether they relate to clients’ perception of CSR.
Design/methodology/approach
Ninety-nine bank customers in Brisbane, Australia were surveyed by mail in a cross-sectional field study.
Findings
Not all CSR-related behaviors of the organizations were influential to perceptions of social responsibility. Big picture actions for the betterment of humanity were found to be influential to the perception of the firm’s CSR. However, respondents did not relate the firms’ profit and revenue initiatives to social responsibility, other than negativity toward false and misleading practices.
Research limitations/implications
Results are limited to one industry in Australia.
Practical implications
Actions for human betterment were found to be influential to the perception of the firm’s CSR. Also the uses of dishonest marketing schemes were seen as detrimental to CSR perceptions of the firm. However, respondents did not connect the firm’s business actions affecting profitability with customers, to their perceptions of its CSR. Thus, the authors conclude that altruism from a “big picture” standpoint has value in shaping CSR perception, but the organization may not always find it necessary to deprioritize profit, or to attempt to weave CSR actions into every aspect of their business.
Originality/value
The inquiry takes a novel approach to CSR, capturing an unexplored aspect of how CSR is perceived and valued by stakeholders.
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VanderKaay S, Letts L, Jung B, Moll SE. On-line ethics education for occupational therapy clinician–educators: a single-group pre-/post-test study. Disabil Rehabil 2018; 41:2841-2853. [DOI: 10.1080/09638288.2018.1473510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Sandra VanderKaay
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Bonny Jung
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Sandra E. Moll
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Areskoug-Josefsson K, Kjellström S. Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice. Physiother Theory Pract 2018; 35:1015-1026. [PMID: 29723127 DOI: 10.1080/09593985.2018.1470209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients' overall health.
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Affiliation(s)
- Kristina Areskoug-Josefsson
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University , Jönköping , Sweden
| | - Sofia Kjellström
- School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University , Jönköping , Sweden
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VanderKaay S, Letts L, Jung B, Moll SE. Doing what's right: A grounded theory of ethical decision-making in occupational therapy. Scand J Occup Ther 2018; 27:98-111. [PMID: 29673278 DOI: 10.1080/11038128.2018.1464060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Ethical decision-making is an important aspect of reasoning in occupational therapy practice. However, the process of ethical decision-making within the broader context of reasoning is yet to be clearly explicated.Objective: The purpose of this study was to advance a theoretical understanding of the process by which occupational therapists make ethical decisions in day-to-day practice.Method: A constructivist grounded theory approach was adopted, incorporating in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings and years of experience. Initially, participants nominated as key informants who were able to reflect on their decision-making processes were recruited. Theoretical sampling informed subsequent stages of data collection. Participants were asked to describe their process of ethical decision-making using scenarios from clinical practice. Interview transcripts were analyzed using a systematic process of initial then focused coding, and theoretical categorization to construct a theory regarding the process of ethical decision-making.Findings: An ethical decision-making prism was developed to capture three main processes: Considering the Fundamental Checklist, Consulting Others, and Doing What's Right. Ethical decision-making appeared to be an inductive and dialectical process with the occupational therapist at its core.Conclusion: Study findings advance our understanding of ethical decision-making in day-to-day clinical practice.
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Affiliation(s)
- Sandra VanderKaay
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Bonny Jung
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Sandra E Moll
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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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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Nesbit KC, Jensen GM, Delany C. The active engagement model of applied ethics as a structure for ethical reflection in the context of course-based service learning. Physiother Theory Pract 2017; 34:1-12. [DOI: 10.1080/09593985.2017.1368759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kathryn C Nesbit
- Department of Physical Therapy, University of the Pacific Stockton, CA, USA
| | - Gail M Jensen
- Graduate Studies and Department of Physical Therapy, Creighton University, Omaha, NE, USA
| | - Clare Delany
- Department of Medical Education, University of Melbourne, Victoria, Australia
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López Barreda R, Trachsel M, Biller-Andorno N. Towards a broader understanding of agency in biomedical ethics. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2016; 19:475-483. [PMID: 27142686 DOI: 10.1007/s11019-016-9706-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
With advances in medical science, the concept of agency has received increasing attention in biomedical ethics. However, most of the ethical discussion around definitions of agency has focused either on patients suffering from mental disorders or on patients receiving cutting-edge medical treatments in developed countries. Very little of the discussion around concepts of agency has focused on the situation of patients suffering from common diseases that affect populations worldwide. Therefore, the most widely-used definitions of agency may be not appropriate to analyse common diseases among large populations. The branch of social sciences known as development studies draw on their own definitions of the term agency that may provide a more applicable and accurate way of referring to common and general cases than the definitions currently used in bioethics. Moreover, the psychological Self-Determination Theory may improve the usefulness of these definitions in common situations. This article explains the characteristics and the shortcomings of current bioethical definitions of agency when they are applied to common medical conditions worldwide. A new, value-based concept of agency, informed by development studies, is proposed as more accurate and useful for biomedical ethics.
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Affiliation(s)
- Rodrigo López Barreda
- Institute of Biomedical Ethics and History of Medicine, University of Zürich, Winterthurerstrasse 30, 8006, Zurich, Switzerland.
| | - Manuel Trachsel
- Institute of Biomedical Ethics and History of Medicine, University of Zürich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zürich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
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Delany C, Fryer C, van Kessel G. An ethical approach to health promotion in physiotherapy practice. Health Promot J Austr 2016; 26:255-262. [PMID: 26502179 DOI: 10.1071/he15052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/17/2015] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED With increased emphasis on reducing the global burden of non-communicable disease, health professionals who traditionally focused on the individual are being encouraged to address population-level health problems. While physiotherapists are broadening their clinical role to include health promotion strategies in their clinical practice, the ethical foundations of this practice focus have received less attention. METHODS We use a physiotherapy clinical scenario to highlight different physiotherapeutic approaches and to analyse underpinning ethical values and implications for practice. RESULTS We suggest there are potential harms of incorporating health promotion into physiotherapy management of individuals if the population-based research does not resonate with an individual's particular circumstances, capacity to change or view of what counts as important and meaningful. We propose that critical reasoning and ethical judgment by the physiotherapist is required to determine how health promotion messages applied in primary care settings might work to benefit and enhance a client's well being rather than impose burdens or cause harm. CONCLUSION We suggest four ethical reasoning strategies designed to assist physiotherapists to frame and understand fundamental ethical principles of beneficence, harm, autonomy and justice when implementing health promotion and self-management approaches in clinical practice.
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Affiliation(s)
- Clare Delany
- Children's Bioethics Centre, Royal Children's Hospital, 50 Flemington Road, Parkville, Vic. 3052, Australia
| | - Caroline Fryer
- International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Gisela van Kessel
- International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, SA 5001, 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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Øberg GK, Normann B, Gallagher S. Embodied-enactive clinical reasoning in physical therapy. Physiother Theory Pract 2015; 31:244-52. [PMID: 25585515 DOI: 10.3109/09593985.2014.1002873] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Clinical reasoning is essential in physical therapy practice. Instrumental approaches and more recent narrative approaches to clinical reasoning guide physical therapists in their understanding of the patient's movement disturbances and help them to plan strategies to improve function. To the extent that instrumental and/or narrative models of clinical reasoning represent impairments as mere physical disturbances, we argue that such models remain incomplete. We draw on a phenomenologically inspired approach to embodied cognition (termed "enactivism") to suggest that the dynamics of lived bodily engagement between physical therapist and patient contribute to and help to constitute the clinical reasoning process. This article outlines the phenomenologically informed enactive perspective on clinical reasoning, with special reference to clinical work that addresses impairments as sequelae of neurological diseases.
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Affiliation(s)
- Gunn Kristin Øberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway , Tromsø , Norway
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Edwards I, Jones M, Thacker M, Swisher LL. The Moral Experience of the Patient with Chronic Pain: Bridging the Gap Between First and Third Person Ethics. PAIN MEDICINE 2014; 15:364-78. [DOI: 10.1111/pme.12306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dean E, Dornelas de Andrade A, O’Donoghue G, Skinner M, Umereh G, Beenen P, Cleaver S, Afzalzada D, Fran Delaune M, Footer C, Gannotti M, Gappmaier E, Figl-Hertlein A, Henderson B, Hudson MK, Spiteri K, King J, Klug JL, Laakso EL, LaPier T, Lomi C, Maart S, Matereke N, Meyer ER, M’kumbuzi VRP, Mostert-Wentzel K, Myezwa H, Fagevik Olsén M, Peterson C, Pétursdóttir U, Robinson J, Sangroula K, Stensdotter AK, Yee Tan B, Tschoepe BA, Bruno S, Mathur S, Wong WP. The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases. Physiother Theory Pract 2013; 30:261-75. [DOI: 10.3109/09593985.2013.856977] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Matthew R Hunt
- School of Physical and Occupational TherapyMontreal, Que., Canada
- Centre for Interdisciplinary Research in Rehabilitation, McGill University, Montreal, Que., Canada
| | - Franco A Carnevale
- Centre for Interdisciplinary Research in Rehabilitation, McGill University, Montreal, Que., Canada
- School of NursingMcGill University, Montreal, Que., Canada
- Pediatric Ethics Committee Montreal Children’s Hospital, Montreal, Que., Canada
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Edwards I, Kessel GV, Jones M, Beckstead J, Swisher LL. The development of moral judgment and organization of ethical knowledge in final year physical therapy students. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Elwyn G, Tsulukidze M, Edwards A, Légaré F, Newcombe R. Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item. PATIENT EDUCATION AND COUNSELING 2013; 93:265-271. [PMID: 24029581 DOI: 10.1016/j.pec.2013.08.005] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/28/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To propose a revised Observer OPTION measure of shared decision making. METHODS We analyzed published models to identify the core components of a parsimonious conceptual framework of shared decision making. By using this framework, we developed a revised measure combining data from an observational study of clinical practice in Canada with our experience of using Observer OPTION(12 Item). RESULTS Our conceptual framework for shared decision making composed of justifying deliberative work, followed by the steps of describing options, information exchange, preference elicitation, and preference integration. By excluding items in Observer OPTION(12 Item) that were seldom observed or not aligned to a robust construct, we propose Observer OPTION(5 Item). CONCLUSION Although widely used, Observer OPTION(12 Item) did not give sufficient attention to preference elicitation and integration, and included items that were not specific to a core construct of shared decision making. We attempted to remedy these shortcomings by proposing a shorter, more focused measure. PRACTICE IMPLICATIONS Observer OPTION(5 Item) requires evaluation; we hope that it will be useful as both a research tool and as a formative measure of clinical practice.
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Affiliation(s)
- Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA; Cochrane Institute for Primary Care and Public Health, Cardiff University, UK.
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Lützén K, Ewalds-Kvist B. Moral distress and its interconnection with moral sensitivity and moral resilience: viewed from the philosophy of Viktor E. Frankl. JOURNAL OF BIOETHICAL INQUIRY 2013; 10:317-324. [PMID: 23856882 DOI: 10.1007/s11673-013-9469-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 01/25/2013] [Indexed: 06/02/2023]
Abstract
The interconnection between moral distress, moral sensitivity, and moral resilience was explored by constructing two hypothetical scenarios based on a recent Swedish newspaper report. In the first scenario, a 77-year-old man, rational and awake, was coded as "do not resuscitate" (DNR) against his daughter's wishes. The patient died in the presence of nurses who were not permitted to resuscitate him. The second scenario concerned a 41-year-old man, who had been in a coma for three weeks. He was also coded as "do not resuscitate" and, when he stopped breathing, was resuscitated by his father. The nurses persuaded the physician on call to resume life support treatment and the patient recovered. These scenarios were analyzed using Viktor Frankl's existential philosophy, resulting in a conceivable theoretical connection between moral distress, moral sensitivity, and moral resilience. To substantiate our conclusion, we encourage further empirical research.
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Affiliation(s)
- Kim Lützén
- Department of Neurobiology, Health Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden,
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Praestegaard J, Gard G, Glasdam S. Practicing physiotherapy in Danish private practice: an ethical perspective. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:555-564. [PMID: 23160855 DOI: 10.1007/s11019-012-9446-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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'.
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Affiliation(s)
- Jeanette Praestegaard
- Division of Physiotherapy, Health Sciences Center, Lund University, Box 157, 221 00 Lund, Sweden.
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Townsend A. Negotiating mixed methods in physical therapy research. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Crane J, Delany C. Physiotherapists in emergency departments: responsibilities, accountability and education. Physiotherapy 2012; 99:95-100. [PMID: 23219643 DOI: 10.1016/j.physio.2012.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 05/25/2012] [Indexed: 10/28/2022]
Abstract
Emergency physiotherapy roles have evolved within the UK and are increasingly being adopted in Australia in response to a need for greater workforce flexibility and improved service provision to meet growing patient demand. This paper discusses the need for the physiotherapy profession to develop evidence-based regulatory, ethical and educative frameworks to keep pace with the changing clinical environment and service delivery in emergency departments. Definitions of Emergency Physiotherapy as either advanced practice or extended scope of practice are identified, and the implications for both regulation of practice and education are highlighted. Suggestions for education in areas of clinical skills, ethical understanding and legal and professional knowledge are highlighted as important areas to support physiotherapists moving into this area of practice.
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Affiliation(s)
- Jacqueline Crane
- Emergency Department Austin Health, Heidelberg, Victoria 3084, Australia.
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Edwards I. Resolving tensions between philosophical, professional and social conceptions of ethical issues: a therapist – patient conundrum. PHYSICAL THERAPY REVIEWS 2012. [DOI: 10.1179/1743288x12y.0000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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New perspectives on the theory of justice: implications for physical therapy ethics and clinical practice. Phys Ther 2011; 91:1642-52. [PMID: 21885447 DOI: 10.2522/ptj.20100351.10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent revisions of physical therapy codes of ethics have included a new emphasis concerning health inequities and social injustice. This emphasis reflects the growing evidence regarding the importance of social determinants of health, epidemiological trends for health service delivery, and the enhanced participation of physical therapists in shaping health care reform in a number of international contexts. This perspective article suggests that there is a "disconnect" between the societal obligations and aspirations expressed in the revised codes and the individualist ethical frameworks that predominantly underpin them. Primary health care is an approach to health care arising from an understanding of the nexus between health and social disadvantage that considers the health needs of patients as expressive of the health needs of the communities of which they are members. It is proposed that re-thinking ethical frameworks expressed in codes of ethics can both inform and underpin practical strategies for working in primary health care. This perspective article provides a new focus on the ethical principle of justice: the ethical principle that arguably remains the least consensually understood and developed in the ethics literature of physical therapy. A relatively recent theory of justice known as the "capability approach to justice" is discussed, along with its potential to assist physical therapy practitioners to further develop moral agency in order to address situations of health inequity and social injustice in clinical practice.
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