Ethical Principles in Healthcare

honourable Principles in wellnesscareIntroductionThe Department of Health (DoH) (2003) highlighted the importance for each professions shortly regulated by the Health Professions Council to demonstrate competence through continuing professional using (CPD). CPD is a systematic, ongoing, structured process that encourages the maturation and maintenance of knowledge, skills and competency that assists us in becoming better practitioners (Chartered federation of physiotherapy (CSP), 2003). As a result of the Health Act (1999) and for registration with the Health Professions Council (HPC), CPD is a wellnessy requirement (HPC Standards of Proficiency, 2007) that must be completed in accordance with the (HPC) Standards of chronic sea captain Development (HPC, 2006). This attempt allows for demonstration of life-long development using assure from clinical use and critical evaluation to contribute to my CPD. erudition gist 5 will be demonstrate throughout this essay. Throughout this essay the reader is order 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 (cecal appendage 1). butt against professional behaviour with an understanding of the first harmonic, legal and ethical boundaries of professional practice.Beauchamp and Childress (2001) identify quaternity ethical principles Autonomy, Beneficence, Non-maleficence and Justice. These ethical principles potful be use to morally reason whether an action or end is right or wrong when used in conjunction with a set of guidelines (Kohlberg et al, 1983). overlord codes of draw are developed within moral, ethical and legal frameworks to uphold 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 handle the importance of consent and duty of car e for both legal and ethical reasons with regards to fount 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 sensible consent from a forbearing for any tradement you may perform or else you could face tribulationnel for assault, battery or negligence under civil or criminal law (Hendrick, 2002). It is a fundamental ethical priniciple that every person has a right to exercise autonomy (Article 9 human race 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 charitable dignity (Sim, 1986). However, inability for Patient X to conform to the Mental Capacity Act (2005) meant he was set 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.Assumi ng the health check heed 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 non treated Patient X on the basis he had swine flu, this would pay been failing to do justice to him, acting outside of the Disability disagreement Act (2005) which states everyone should have equitable access to and utilisation of at carrys regardless of disability and also Article 14 of the Human Rights Act (1998) in that no one should be discriminated against based on their health 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 non been kept and therefore negligence can be assumed. Although not legally binding, the CSP rules of professional conduct in effect have the same status as law and failure to comply with them means they may not provided be used in disciplinary hearings but also in legal legal proceeding 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 rescind unwanted litigation, but they should not undermine the ethical implications. Appendix 3 demonstrates how I have learnt from this experience. tax the needs of a range of overhaul users and, with reference to current professional knowledge and relevant research, apply, valuate 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 m anagement of two patients treated whilst on PP6 with differing severities of chronic hindering pulmonary affection (COPD) exacerbations (Appendix 4) will be discussed.The National 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 rhythm method of ventilation proficiency (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 identify by Finer et al (1979), atelectasis is a common problem observed in mechanically freshen patients for which MHI has been found to be beneficial in reducing it in a well controlled clinical exam by Stiller et al (1996), scoring a PEDro rating of 6/10.Absence of a cough reflexive 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 compliance with ACBT replaced the need for MHI and suctioning.Patient A developed bilaterally symmetric shoulder subluxations due to his lengthy intubation for which subluxation cuffs were applied, as suggest by Zorowitz et al (1995) with positive effect. patronage this select 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-am bulatory. A high quality, randomised control trial 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 drain positions and positioning into the cardiac chair setting on the bed were used (BTS, 2008).The range of problems service users reconcile with means practitioners need to be adaptable, drawing on current evidence, professional knowledge from disparate palm 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 talk skillsCaseload management typically refers to the number of cases handled in a certain ageframe by an single(a) for which they have a duty of ca re towards (Scottish Executive, 2006). It is the management of time effectively through appropriate 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 based 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 pendant on a variety of factors for example, the trust where PP6 was completed, enforced protected meal times which did not run alongside staff meal times. Therefore, to prevent there being a void in the day, patients were soothe prioritised 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 essential 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 ensure task completion and objectives are being met (Curtis, 2002).Inter-professional collaborationism 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, 199 7). Liaison with members of the multi-disciplinary team (MDT) is encouraged by Shortell and vocalist (2008) as practitioners are less likely to work off their own autonomy, ensuring patient safety, as demonstrated during handover in (Appendix 5).The acquire 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 kick upstairs 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 free learner (Coles, 1996) in which the relationships developed 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 outline (Appendix 7) was completed to assist recognition of my personal learning 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 supported in a recent check into 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 mente e and myself were both musing learners, therefore 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 revie wing 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 allied 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 Unpublised 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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