Ethical Principles in Healthcare

Ethical Principles in healthcareIntroductionThe Department of health (DoH) (2003) highlighted the importance for all professions presently regulated by the Health Professions Council to demonstrate competence through continuing professional study (CPD). CPD is a systematic, ongoing, structured process that encourages the maturement and maintenance of knowledge, skills and competence that assists us in becoming better pr exerciseitioners ( hire Society of physical therapy (CSP), 2003). As a result of the Health Act (1999) and for registration with the Health Professions Council (HPC), CPD is a effective requirement (HPC Standards of Proficiency, 2007) that must be completed in accordance with the (HPC) Standards of Continuing Professional Development (HPC, 2006). This essay allows for demonstration of life-long reading using demo from clinical serve and critical evaluation to contribute to my CPD.Learning sequel 5 will be demonstrated throughout this essay. Throughout th is essay the reader is tell to the appendices to support theory with evidence of practice. I considered my motivations for undertaking CPD before writing this essay and reflected upon them again on completion (Appendix 1).Demonstrate professional behaviour with an savvy of the fundamental, profound and ethical boundaries of professional practice.Beauchamp and Childress (2001) identify four ethical principles Autonomy, Beneficence, Non-maleficence and Justice. These ethical principles can be utilise to morally reason whether an action or finale is office or wrong when used in conjunction with a set of guidelines (Kohlberg et al, 1983). Professional codes of conduct are certain within moral, ethical and legal frame calculates to help guide and regulate practice (Hope et al, 2008). Every practitioner has clinical autonomy, therefore they are professionally and legally accountable for their actions. The following will demonstrate the importance of take on and duty of care for both legal and ethical reasons with regards to case 1 (Appendix 2), encounterd on practice placement 6 (PP6).Rule 9 of the HPC standards of conduct, performance and ethics (2008) states you must gain valid consent from a patient for any treatment you may perform or else you could face footrace for assault, battery or negligence under civil or criminal righteousness (Hendrick, 2002). It is a fundamental ethical priniciple that every person has a right to exercise autonomy (Article 9 Human Rights Act, 1998) and is reflected in the Core Standards of Physiotherapy Practice (CSP, 2005). Performing a procedure without gaining consent, undermines the moral priniciple of respect for patients autonomy and tender dignity (Sim, 1986). However, inability for Patient X to conform to the Mental Capacity Act (2005) meant he was tough in his best intrest in adherance to section 1.5 of this act and Rule 1 of the HPC (2008) standards of conduct, performance and ethics.Assuming the medical direc tion of Patient X, a legal and professional duty of care was established (Rule 6 HPC, 2008). As part of this duty and in accordance with standard 2 of the CSP Core Standards of Physiotherapy, all interventions were explained to patient X despite his inability to consent. Had I not treated Patient X on the basis he had swine flu, this would crap been failing to do justice to him, acting outside of the Disability Discrimination Act (2005) which states everyone should have equitable access to and utilisation of answers regardless of disability and also Article 14 of the Human Rights Act (1998) in that no one should be discriminated against establish on their wellness status. The Bolam Test (1957, cited in Dimond, 1999) states if duty of care to a client is breached and subsequent harm to the patient occurs, professional standards have not been kept and therefore negligence can be assumed. Although not legally binding, the CSP rules of professional conduct efficaciously have the sam e status as law and failure to comply with them means they may not only be used in disciplinary hearings but also in legal operation as a civil case under the tort law of negligence (Dimond, 1999 Hendrick, 2002).In summary, a sound understanding of the legal implications surrounding consent and duty of care can help avoid unwanted litigation, and they should not undermine the ethical implications. Appendix 3 demonstrates how I have learnt from this experience. tax the needs of a range of value users and, with reference to current professional knowledge and relevant research, apply, evaluate and modified physiotherapeutic interventionA service users is anyone who utilises or is affected by a registrants service (HPC, 2008). The complex needs of a service user encompass a range of issues including social, environmental, emotional and health related, the extent of which varies from person to person. For the purpose of this essay, the physiotherapeutic management of two patients trea ted whilst on PP6 with differing severities of chronic obstructive pulmonary indisposition (COPD) exacerbations (Appendix 4) will be discussed.The study Institue for Health and Clinical Excellence (NICE) guidelines (NICE, 2004) in conjuntion with the guidelines for physical therapy in respiratory care (British Thoracic Society (BST), 2008) advocates the use of active cycle of breathing technique (ACBT) with expiratory vibrations on the chest wall for the treatment of COPD to help aid airway clearance.Inability for patient A to comply with ACBT indicated the use of manual hyperinflation (MHI) to passively inflate the lungs and aid mucocillary transport (Ntoumenopoulos, 2005). As identified by Finer et al (1979), atelectasis is a common problem observed in mechanically air out patients for which MHI has been found to be beneficial in reducing it in a well controlled clinical trial by Stiller et al (1996), scoring a PEDro valuation of 6/10.Absence of a cough reflex in patient A, resulted in sputum retention and the increased risk of infection indicating the use of suctioning (Pryor and Prasad, 2002) by which, copious amounts of viscous secretions were cleared. Shorten et al (1991) supports the use of saline instilation to loosen secretions prior to suctioining however, conflicting arguments by Blackwood (1999) and Kinloch (1999) question its effectiveness. Patient Bs complaisance with ACBT replaced the need for MHI and suctioning.Patient A developed bilateral shoulder subluxations due to his lengthy intubation for which subluxation cuffs were applied, as suggest by Zorowitz et al (1995) with positive effect. disdain this study being on stroke patients, the results can be generalised to other patient groups as proved.The importance of mobilising patients with regards to respiratory function is highlighted by Ciesla (1996), however mobilisation of critically ill patients is restricted as they are often non-ambulatory. A high quality, randomised control tri al using fifty-six participants by Mackay et al (2005), identified mobilisation as superior to other respiratory techniques, therefore Patient B was encouraged to sit out and treated using a graduated walking program. In the case of Patient B, mobilisation constitutes any change in position therefore the use of postural drainpipe positions and positioning into the cardiac chair setting on the bed were used (BTS, 2008).The range of problems service users present with means practitioners need to be adaptable, drawing on current evidence, professional knowledge from diametric fields of physiotherpy practice and experiences through CPD to deliever indiviualised patient-centred care.Appraise self management of a caseload and modify practice accordingly, demonstarating effective teamwork and communicating skillsCaseload management typically refers to the number of cases handled in a certain timeframe by an individual for which they have a duty of care towards (Scottish Executive, 2006). It is the management of time effectively through purloin priority-setting, delegation, and allocation of resources to meet the service demand of its users (Curtis, 2002). Self-management of a caseload and adaptability to changing circumstances is expected of a registrant (HPC, 2008).Well developed time management skills can make a workload more manageable and improve the effectiveness of treatments and quality of time with patients. Prioritising patients to the order in which they will be seen establish on their needs is encouraged by SARRAH (2010), however Nord (2002) argues whether it can be justified to prioritise those in most need if their potential benefit may not be as great as those in less need. In my experience prioritisation is dependant on a variety of factors for example, the trust where PP6 was completed, implemented protected meal times which did not run alongside staff meal times. Therefore, to prevent there being a void in the day, patients were cool it prioritise d according to need but considertation had to be given to see patients that would be eating first and treat those that would not be during protected meal times.It is inbred to consider that a therapists workload includes not only patient care, but also admistrative and research tasks in which delegation to others can be a worth(predicate) stratergy to assist with workload mangement. Curtis, (1999), identifies the need for practioners to show greater awareness of other disciplines competancies so delegation can be more effective. Feedback systems should be enforced to determine task completion and objectives are being met (Curtis, 2002).Inter-professional coaction refers to the process by which different disciplines work together to improve health care (Zwarenstein et al, 2009). Poor collaboration amongst healthcare professionals contributes to problems in quality of patient care and consequently poorer outcomes (Zwarenstein and Byrant, 1997). Liaison with members of the multi-di sciplinary team (MDT) is encouraged by Shortell and Singer (2008) as practitioners are less likely to work off their own autonomy, ensuring patient safety, as demonstrated during handover in (Appendix 5).The schooling objectives on PP6 to develop MDT collaboration and caseload management have been achieved as demonstrated in the feedback from my educator (Appendix 6) which identifies that improvement in self confidence will allow further development of the skills discussed.Demonstrate partnership with more junior students and/or appropriate others through the development of mentoring skillsMentoring is a process aimed at transfering knowledge, skills and psycological support from a more experienced person to a less experienced person, where the desired outcome is for both persons to achieve personal and professional growth (Anderson, 1987). An effective mentor facilitates, guides and empowers the mentee in becoming an independent learner (Coles, 1996) in which the relationships dev eloped are based upon mutal respect, trust, confidentiality and shared beliefs and values (Lyons et al, 1990). The CSP (2005) acknowledges the importance of intergrating mentorship into CPD, in which the mentor develops a range of skills transferable to other CPD activities. This section focuses on peer mentoring as a concept, its practice and clinical application on an informal basis.Having identified the characteristics of a mentor (CSP, 2005), a SWOT analysis (Appendix 7) was completed to assist recognition of my personal learnedness needs.There are four stages to the mentoring life cycle (Appendix 8), in which the mentor needs to adopt and develop new skills to accommodate the mentee and guide them through the process.A qualitative study using a moderate sample size by Chan and Wai-Tong (2000) encourages the use of learning contracts (Appendix 9) to help establish rapports and facilitate autonomous learning which aids progression to stage two of the cycle. This is further suppo rted in a recent review of the literature by Sambunjak et al (2009).Gopee (2008) recognises the importance of analysing the mentees needs. Foster-Turner (2006) states that different people approach the learning process in different ways therefore, matching the learning styles of the mentor and mentee will produce a more productive and successful relationship (Mumford, 1995 Hale, 2000). Honey and Mumford (1992) suggested people tend to have a predominant learning style and can be classified as activists, reflectors, theorists or pragmatists (Appendix 10). Boud (1999) identifies raising self-awareness as an essential tool used in lifelong leaning and through analysis of learning styles using Honey and Mumfords (1992) questionnaire, this allowed for reflection on the style of learning that would best suit the mentee to help meet their learning needs (Foster-Turner, 2006) (Appendix 11).As identified by the learning style inventory, the mentee and myself were both pensive learners, the refore we arranged sessions where we could dreflect on a clinical experience and discuss how new learning could be applied to future events.A feedback form from the mentee (Appendix 12) an a SWOT analysis (Appendix 13) demonstrates how through increased self-awareness and review of the literature, I have developed a better understanding of the mentoring process, the skills required and its application in into clinical practice. Developing others is central to current and desired practice (DoH, 2000a, 2000b, 2001, 2002) in which mentorship offers all the key attributes to the process. Preparation of an individual for this role, through self assessment, is central to its success, in which the skills developed are lifelong and can enable development into management and leadership roles later on in life.Demonstrate skills of career-long learningLifelong learning is used synonymously with CPD and is concerned with practitioners critically reviewing their skills and knowledgebase with the ultimate goal of providing a better standard of care to all service users (French and Dowds, 2008). A recent inquest into a practitioner who did not maintain his competencies, demonstrates the possible consequences of poor CPD (Appendix 14). Appendix 15 details a range of formal and informal activities that can be undertaken to contribute towards CPD, evidence of which can be documented in a portfolio.The importance of staff development is recognised by the DoH documents (2000a, 2000b, 2001, 2002) which sets out the Governments vision of an NHS that prepares consort health professionals with the skills to take advantage of wider career opportunities and realise their potential. By using the competency based framework The NHS Knowledge and Skills Framework (2004), physiotherapists can participate in development reviews which identify development opportunities and contribute to the fulfilment of personal development plans.ReferencesAnderson, E. (1987) Definitions of Mentoring Unpubl ised Thesis, cited in Anderson, E. Shannon, A. (1988) Towards a Conceptualisation of Mentoring Journal of Teacher Education. 29 (1) 38-42.BBC News (2010) Patients inquest focuses on overseas locum care online. 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