Download Ethics Course Handout - Oklahoma Physical Therapy Association

4/1/2014
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
Step
Decide the &
right
thing to do:
the3.significance
implications
of such
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
[email protected]
#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/ContetDisplay.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.
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