powerpoint presentation · 2018. 4. 3. · 4/1/2014 4 professionalism in physical therapy: core...
TRANSCRIPT
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CLINICAL REASONING!!
• The Pew Health Commission's Profession Commission’s Final Report: Recreating Health
Professional Practice for a New Century(1998)
• The Commission on Accreditation of Physical Therapy Education Criteria (2011)
• The American Physical Therapy Association's Clinical Performance Instrument standards (2006)
Clinical Reasoning/
Problem Solving
Components include:
*Critical Thinking
*Reflection
Huhn et al, 2013
The active process of continous and deliberate thought relating to a belief or action.
“Reflection in Action”
(Schon)
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Reflection raises the maturity level of ethical decision making!!
(Jensen 2000, Purtillo 2000)
…So what’s a therapist to do??
• Put the patient’s best interests first.
• Be aware of & strive to uphold
Professional Duties
• Be aware of & strive to uphold Legal Duties
• Reflect upon & trust your instincts to do what’s right
Proverbs 11:3 “The integrity of the upright guides them.”
Why are YOU here?
Anything in practice
causing a feeling of
uneasiness/uncertainty?
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Ethical Distress????
• #1. Legal ?
• #2. Stench?
• #3. Front Page?
• #4. Mom?
• #5. Professional Violation?
Kidder RM. How Good People Make Tough Choices: Resolving the Dilemmas of Ethical Living. New York, NY: Fireside. 1995
Reflection “THE MORE FAITHFULLY YOU LISTEN TO
THE VOICE WITHIN YOU, THE BETTER YOU WILL HEAR WHAT IS SOUNDING OUTSIDE.” DAG HAMMARSKJOLD (1905-1961) SWEDISH DIPLOMAT, UN SECRETARY-GENERAL &
1961 NOBEL PEACE PRIZE
The Ethos of Practice
“Our contract with society”
Our credibility rests on our ability to make sound clinical judgment that includes ethical reasoning and decision making.
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PROFESSIONALISM IN PHYSICAL THERAPY: CORE VALUES BOD P05-04-02-03
Accountability
Altruism
Compassion/Caring
Excellence
Integrity
Professional Duty
Social Responsibility
“What is more, sir," his lordship went on, "I believe I have a good idea of what you mean by 'professionalism.' It appears to mean getting one's way by cheating and manipulating. It appears to mean serving the dictates of greed and advantage rather than those of goodness and the desire to see justice prevail in the world. If that is the 'professionalism' you refer to, sir, I don't care much for it and have no wish to acquire it.” ― Kazuo Ishiguro, The Remains of the Day
“Eagerness to do what is right with transparent motives”
Unknown
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Moral Distress in Physical Therapy
“..knew the right choice to make but did not have sufficient ____________ to make that choice”
Moral Potency
…bridge from moral thought to moral action
…the capacity to generate responsibility & motivation to take moral action in the face of adversity & persevere through challenges
Moral Potency
• Developed over time by experience
• Observing others whom one respects
• Enhanced by authentic & ethical leadership & the ethical culture of the organization
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Moral Potency Construct (Hannah, Avolio, &
Walumbwa 2011)
Three moral capacities that underpin moral potency:
1. Moral Ownership – capacity to feel & show a sense of responsibility to take action when faced with ethical issues.
2. Moral Efficacy – confidence in personal capabilities to develop solutions to ethical issue &/or confront peer or superior once has #1.
3. Moral Courage – to commit to personal moral principles in order to act ethically or resist pressure to act unethically as required to maintain those principles
EXAMPLE:
Moral ownership
Example:
Moral efficacy
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EXAMPLE:
Moral Courage
MORAL THRESHOLD
A bar below which one will NOT compromise.
To compromise below this is to compromise ones personal integrity.
Ethical decisions involve moral behavior that are:
Personal
Situational
…a “narrative process”
(Rest 1999)
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Situation
• Issue/Problem
• Dilemma
• Distress
• Temptation
• Silence
Issue/Problem
Important values are present & may be challenged
Dilemma
“Right versus right decision”
Two viable courses of action may be taken
Requires moral judgment & deliberation before taking action
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Distress
You know the right course of action but are not authorized or empowered to do so.
Often identified in the implementation phase of ethical decision-making (..”the doing”)
?Organizational/Societal barriers to doing what is “right”?
Temptation
Involves a choice between a “right” and a “wrong” course of action
Often involves benefitting from doing the wrong thing
No need to weigh the merits of two alternative actions when one is clearly wrong
Silence Ethical values are challenged but no one is
openly expressing this
May be the course of someone experiencing Ethical Distress
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Implementing the RIPS Model:
Step 1. Recognize & Define the Issues: “quick screen” of the situation at hand
Step 2. Reflect: interpretation of facts and the significance & implications of such Step 3. Decide the right thing to do: resolution of issues at hand (involves ethical approaches to solving when dilemma present)
Step 4. Implement, evaluate, re-assess:
Dialogue!! (Swisher 2005)
Components of the RIPS Model
Realm Individual Situation Process
Individual Moral Sensitivity Issue/Problem
Organizational/Institutional Moral Judgment Dilemma
Societal Moral Motivation Distress
Moral Courage Temptation
Silence
Case Examination
--Informal Poll of DCE/ACCE’s from PT & PTA programs in Kansas, Oklahoma, Missouri & Arkansas Clinical Education
Consortium
--March 2014
N = 18 people providing 37 examples of:
“situations which created ethical distress for a student &/or yourself once you learned of it via a student…”
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POLL SUMMARY:
#1. Fraudulent Billing Practices (10)
#2. Inappropriate Utilization of Personnel (8)
#3. HIPPA Violations including social media (7)
#4. Inappropriate CI behaviors with students (6)
#5. Student supervision (5)
#6. Questionable clinical judgment resulting in fracture (1)
CASE EXAMINATION
APTA 2010 Code of Ethics
The Principles/Standards can be divided into the following categories:
Principle/Standard 1 - Duty to all individuals Principle/Standard 2 - Duty to patients/clients Principle/Standard 3 - Accountability for sound judgments Principle/Standard 4 - Integrity in relationships Principle/Standard 5 - Fulfilling legal and professional obligations Principle/Standard 6 - Lifelong acquisition of knowledge, skills, and abilities Principle/Standard 7 - Organizational behaviors and business practices Principle/Standard 8 - Meeting health needs of people FAQs: 2010 Updates to the 'Code' and 'Standards’. Available at: http://www.apta.org/AM/Template.cfm?Section=Ethics_and_Legal_Issues1&Template=/CM/HTMLDisplay.cfm&ContentID=64208 Accessed 2/22/14
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Reflection raises the maturity level of ethical decision making!!
(Jensen 2000, Purtillo 2000)
…So what’s a therapist to do??
• Put the patient’s best interests first.
• Be aware of & strive to uphold
Professional Duties
• Be aware of & strive to uphold Legal Duties
• Reflect upon & trust your instincts to do what’s right
Proverbs 11:3 “The integrity of the upright guides them.”
THANK YOU!!!
Peggy DeCelle Newman, PT, MHR
#405-682-1611 x7749
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“We must adjust to changing times & still hold to unchanging
principles.” Jimmy Carter
References:
American Physical Therapy Association. Professionalism in Physical Therapy: Core Values. American Physical
Therapy Association, Alexandria, VA; August 2003
(www.apta.org/documents/public/education/professionalism.pdf)
Carey JR, Ness KK: Erosion of professional behaviors in physical therapy. Journal of PT Education. 2001; 15
(3): 20-22.
Check D, Conroy C. Development of critical thinking in physical therapy education: challenging assumptions, while increasing inductive and deductive clinical reasoning skills. Physiother. 2007;93(S1):S410.
Code of Ethics. American Physical TherapyAssociation. Available at
http://www.apta.org/AM/Template.cfm?Section_Ethics_and_Legal_Issues1&Template_/CM/Contet-
Display.cfm&ContentID_63686. Accessed 2/22/14.
Commission on Accreditation in Physical Therapy Education. Evaluative criteria for accreditation on education programs for the preparation of physical therapists. In: CAPTE Accreditation Handbook. Alexandria, VA: APTA; 2011
Glaser JW. Three Realms of Ethics: Individual, Institutional, Societal. Lanhan, MD: Rowman & Littlefield: 1994
Hannah,S, Avolino B: Moral potency: building the capacity for character-based leadership. Consulting
Psychology Journal: Practice & Research. 2010; 62(4):291-310.
Jensen G, Resnik L, Haddad A. Expertise and clinical reasoning`. In: Higgs J, Jones M, Loftus S, Christensen N, eds. Clinical Reasoning in the Health Professions. 3rd ed. London: Elsevier; 2008: 123 - 133. Kidder RM. How Good People Make Tough Choices: Resolving the Dilemmas of Ethical Living. New York,
NY. Fireside, 1995.
Kirsch N, Hinton C: Managing Ethical & Legal Issues in Education: I know what I saw, now what do I do? APTA
CSM Presentation, Las Vegas, 2/4/14.
Kish-Ghephart, Harrison, Trevino: Bad Apples, bad cases & bad barrels: meta-analytical evidence about
sources of unethical decisions at work. Journal of Applied Psychology. 95(1):1-31, 2010.
O’Neil EH, and the Pew Health Professions Commission. San Francisco, CA: Pew Health Professions Commission. December 1998.
Roach KE, Frost JS, Francis NJ et al. Validation of the revised physical therapist clinical performance instrument (PT CPI). Version 2006. Phys Ther. 2012;92(3):416-428.
Swisher LL, Arslanian L, Davis C: The RIPS Model of Ethical Decision-Making. HPT Resource. 2005; 5 (3) 3-8.