The Fundamental Legal And Ethical Boundaries Nursing Essay
Professionalism defines what is expected of a professional and what it means to be a professional. It is important that physiotherapists follow professional codes set by regulatory bodies, such as the CSP and HCPC, to uphold standards of patient care (CSP, 2011a). The codes enable members to make decisions about professional and ethical issues that may be encountered in practice (CSP, 2011a). However, it is important to consider whether the codes are applicable to an individual case and that our own personal beliefs or unchallenged views are not portraying our own prejudices (Edwards et al, 2005). Acting contrary to professional codes could in turn be deemed as acting unprofessionally (Partridge, 2010) and may be given as evidence if a member's activity is in question (Dimond, 1999: p38).
The use of ethical reasoning by physiotherapists in everyday practice has appeared to be scarce within the research base (Swisher, 2002). This may be due to physiotherapists not seeing the importance of values and ethics in everyday practice (Clarkson, 1994).Yet, the CSP (2011a) "Codes of Members' Professional Values and Behaviours" are underpinned by four ethical principles to behave ethically, deliver an effective service, strive to achieve excellence and take responsibility for their actions. It is suggested by Partridge (2010) that physiotherapy undergraduate programs should instil more education on moral reasoning and other aspects of ethical practice to ultimately improve clinical performance. At the University of Birmingham ethical concepts are introduced during Developing as a Health Professional and Professional development modules however more research may be needed to analyse the effects on physiotherapy practice.
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From experience on placement 5, I found that the Professional development module prepared me for an incident I encountered (see Appendix 1). It was brought to my attention on my first week, that one of the patients who was noted as full hoist had been mobilising independently but was unsafe. After discussion with my educator, I decided to read through the patient's notes, where no documentation had been recorded for the patient for three weeks after her assessment. Reassessment and review should be a continuous process (Dimond, 1999: p4) and to maintain patient quality of care the CSP (2013b) agree that planned interventions and treatment goals should be constantly revaluated, both to ensure effectiveness and relevance to a patient's changing circumstances. The experience confronted me with some of the conflicting views that I am likely to face in the workplace, with regards to patient care (Partridge, 2010).
Keeping accurate and up-to-date documentation is a requirement of the HCPC (HCPC, 2008). Physiotherapists have a legal and professional obligation to record interactions with patients as physiotherapy documents can be called on for a variety of legal purposes (CSP, 2012a). Following the previous case I conducted a notes audit for physiotherapy documentation using the Quality and Assurance Audit Tool (CSP, 2012b). The results from the audit can be seen in Appendix 2. Toblin and Judd (1998) suggest audit can be used to evaluate the effectiveness of care, against agreed standards, with the sole aim of improving services for patients. A study by Gumery et al (2000), highlighted that documentation can be improved with audit. However, in-service training may need to be implemented to maintain standards. On the other hand, Toblin and Judd (1998) suggest that the reasons for resistance to change, by health professionals involved may need to be addressed. The audit carried out by me and another student illustrated the importance of maintaining high quality documentation and also some of the consequences for not following codes of conduct in practice.
LO2- Appraise self-management of caseload and modify practice accordingly, demonstrating effective teamwork and communication skills.
Effective caseload management requires a combination of skills in organisation, time management, and priority setting (Ervin, 2008). With increasing demands on physiotherapists to combat patient waiting times in an outpatient setting it is important to analyse service utilisation. It has been suggested by the CSP (2011b) that the longest wait time for outpatient services in 2011 was 30-40 weeks compared to 18 weeks in 2010, demonstrating the need for physiotherapists to prioritise patients and referrals to maintain a duty of care to patients. It is likely that these figures are also due to a result of increased referrals, self-referrals and changes to how services are run as a result of commissioning (CSP, 2011b).
As part of third year practice placements students are assessed on their ability to prioritise their own workload and reduce risks to quality of care. Before embarking, on placement 6 I conducted a SWOT analysis (See Appendix3) which highlighted my strengths in communication and working in a team, but reflected my lack of experience managing a caseload and prioritising patients. As part of my learning contract and discussion with my educator I highlighted this weakness and implemented it into my learning contract, (see Appendix 4) to be achieved by the end of placement. The criteria for me to meet this objective was for me to prioritise patients for follow up, use the computerised booking system for making appointments and to effectively communicate with MDT members if patients' needed to be discharged or required onward referral.
On PP6, in an outpatient setting, I had ownership of my own caseload and I was responsible for providing patients' care. Prioritising patients in an outpatient setting involves deciding when patients should be seen next, but also due to limited contact time, it is important to prioritise elements of an objective assessment. On reflection, at half way my educator gave me feedback that I needed to decrease my contact time I spent with a patient to ensure electronic notes were documented. Following discussion, it was highlighted I needed to prioritise the objective measures required to understand the cause of the patient's problem. Clarkson (1994) agrees that therapists must know precisely what to assess for each patient to conserve time. However Kempainen et al (2003) states that novice practitioners should be aware of cognitive biases towards a certain diagnosis and that pattern recognition only increases with clinical experience. Therefore, although it is important for me to conserve time, it was also necessary for me to collect relevant information to avoid errors and develop my clinical reasoning.
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There is limited research in how to effectively manage a caseload therefore I modified my practice by critically appraising my goals with patients and by learning from observation of other team members. I evidenced managing my own caseload by discharging patients if they did not attend or if treatment was complete, and also by referring patients on to other services if required see an example letter Appendix 6. My final appraisal confirmed that I had achieved this outcome following feedback from my educator (Appendix 5).
LO3- Demonstrating partnership with more junior students and/or appropriate others through the development of mentoring skills.
Mentoring involves the assistance by one person to another, in a relationship away from the immediate work environment, which helps the recipient learn, develop their abilities and enhance their potential to achieve personal objectives (NHS, 2013). As a mentor, it is important to establish roles and responsibilities at initial contact with a mentee. By discussing learning needs and expectations this can maximise student learning (Cole and Wessel, 2008). There are a variety of roles that enable and support learning in a practice setting however, there are differences in the scope and remit between roles which is important to identify (Gopee, 2011). Kerry and Mayes (1995: p29) identified a mentor should nurture, act as a role model, function (teacher, sponsor, encourager, counsellor and friend), enable professional development and sustain a caring relationship over time. However in some cases Delany and Bragge (2009) identified a lack of congruence between the roles of learning and teaching, for example student and clinical educator. Establishing roles and responsibilities enables each party to discuss what their expectations are of the experience.
It is important to incorporate the mentee's preferred learning style into the mentoring process. By matching learning and teaching this in turn can optimise learning and can be implemented into the planning, implementation and evaluation of teaching (Zoghi, 2010). Furthermore understanding student learning styles has been promoted to improve the learning process (Milanese et al, 2009). However, learners should be aware that to be an effective learner they must try to integrate all learning styles (Wessel et al, 1999) and that for students to progress their own development they must have personal awareness of their own learning style (Nettleton and Reilly, 1998).
On practice placement 6 I had the opportunity to mentor a first year student for one session. Before conducting the session I contacted them and outlined my role as a mentor (see Appendix 7). With this I got my mentee to fill out a SWOT analysis (see appendix 7) which allowed me to gauge their prior knowledge. This was then followed by them completing the Honey and Mumford Learning style questionnaire (Honey and Mumford, ND), which categorised the student as a Reflector and Theorist. Following these evaluations, I adapted my teaching to follow the student's preferred learning style. As feedback to my mentoring session I encouraged my mentee to complete a reflection so I could evaluate my own skills as a mentor (see Appendix 8).On completing my mentoring session I used a reflective cycle to evaluate my own performance (see appendix 9). This experience has highlighted that although I possess skills in organisation, communication and interpersonal skills I demonstrate weakness in flexibility, risk taking and giving others control of situations. To further develop my skills in mentoring I intend to address my own learning style preferences to enable me to be able to be more flexible in my teaching, to allow for my mentee to learn from their own experiences.
LO4- Demonstrate Skills of career-long learning.
Continuing professional development (CPD) is defined as range of learning activities which enable health professionals to maintain and develop the competency to practise safely, legally and effectively (HCPC, 2012). Professional development occurs through day to day practice and by reflecting on learning needs and learning outcomes (CSP, 2005). The CSP (2013b) requires its members to actively engage and reflect on CPD to maintain and develop competence in practice. However, for reflection to be effective it must be open and involve genuine honesty (Clouder, 2000). By critically reviewing skills and knowledge, this enables us to remain up-to-date with challenges in current practice (French and Dowds, 2008). However, improving skills alone will not guarantee improved practice if the therapist cannot apply skills correctly (French and Dowd, 2008).
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Understanding learning needs and preferred learning style is an important part of professional development. Individuals have diverse and changing needs as they progress through their career (CSP, 2005). Therefore, by setting outcomes this enables learning to be focused on outlined gaps in knowledge. Critical reflection enables us to think in a mindful, considered and systematic way to help us with crucial decisions (Rolfe et al, 2011). However, although there appears to be many benefits in the practice of reflection there is still limited research to support its use for improved outcomes in practice (French and Dowds, 2008). Clouder (2000) agrees that if reflection stops at the individual there will be limited scope to promote change in practice actions.
On practice placement 6 I conducted a swot analysis (see Appendix 3), which allowed me to incorporate my weaknesses into objectives which needed to be addressed by the end of my placement (see Appendix 4). By assessing whether my learning outcomes had been achieved this allowed me to evidence that learning had taken place. At the end of placement, feedback from my educator (see Appendix 5), demonstrated I was proactive in seeking learning opportunities, however reflection of myself as a lifelong learner identified further developments that needed to be addressed (see Appendix 10).Currently my strengths lie in reflecting on action but I am limited by my ability to reflect in action. However, Cross (1998) highlights that novice practitioners are more likely to reflect on action than in action, therefore with increased experience I hope to develop this skill. As my least preferred learning style is as an activist I don't like taking risks, therefore I tend to lack flexibility during contact with patients however I am able to consider different views on reflection of the event. Appendix 10 demonstrates a reflective piece of lifelong learning which will enable me to continue to develop throughout my professional career. Following the termination of my placement it vital I seek learning opportunities to develop areas which are currently weak, by setting timed objectives this enables me to monitor my progress and to continue to develop as a life-long learner.
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