What place for ethics?An overview of ethics teaching in occupational therapy and physiotherapy programs in Canada

Professional values and perception of knowledge regarding professional ethics in physical therapy students: A STROBE compliant cross-sectional study

Undergraduate students start the acquisition of a professional identity, and begin to achieve professional values and consciousness of an ethical behavior as future health professionals. The aim of this study was describe professional values and perception of knowledge regarding professional ethics of physical therapy students. A cross-sectional study was performed. A total of 351 students participated in the study. Professional values and perception of knowledge regarding professional ethics were assessed. Ethical approval was obtained from the University Ethics Review Board. The most important value was equity, while the least one was abnegation. The second educational year showed higher scores in importance of scientific quality (P = .010 vs first year), the third year in respect for life (P = .041 vs first year, respectively), and the fourth year in respect to patient's autonomy (P = .033 vs first year). First-year students showed lower scores in perception of knowledge regarding professional ethics (P < .001 vs second, third, and fourth year), while second-year students had higher scores (P < .001 vs first and third; P = .006 vs fourth year) and no differences between third- and fourth-year students were found. Those professional values highly considered by the students were mainly shared professional values, with equity ranked highest and abnegation lowest. Furthermore, second-year students had a well-established perception of knowledge regarding professional ethics, showing significant higher scores when compared to the rest of the educational years. This is the first cross-sectional study that describes these variables among physical therapy students and it is a starting point for future. Physical therapy educators might want to take into account these findings when teaching and guiding students in developing awareness for their professional values and perception of knowledge regarding professional ethics.

Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning

INTRODUCTION

Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes.

MATERIALS AND METHODS

A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge.

RESULTS

Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women.

CONCLUSION

Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Physiotherapy Students' Experiences about Ethical Situations Encountered in Clinical Practices

(1) Background: It is important to explore the ethical situations that physiotherapy students encountered in their clinical practices. (2) Methods: Qualitative, explorative, descriptive study. The participants included third-year physiotherapy students. They had to write five narratives about ethical situations encountered in their clinical practices. Krippendorff’s method for qualitative content analysis was used to cluster units within the data to identify emergent themes. The study protocol was approved by the authors’ University Ethic Committee of Human Research (H1515588244257). (3) Result: 280 narratives were reported by 64 students (23.34 ± 4.20 years, 59% women). Eight categories were identified from the qualitative analysis of the data: (a) professional responsibility, (b) professional competence, (c), beneficence, (d) equality and justice, (e) autonomy, (f) confidentiality, (g) respect for privacy, and (h) sincerity. All participants were informed and provided written informed consent. (4) Conclusions: Ethical principles were frequently violated in physiotherapy. Experiences of physiotherapy students must be examined to tailor educational interventions prior to their initiation into practice. Ethics education is needed in workplaces and should be increased in basic education. Facilitating the ethical awareness of future physiotherapists is a challenge for university teachers who provide ethical competence training.

Attitudes towards learning professional ethics in undergraduate physiotherapy students: A STROBE compliant cross-sectional study

BACKGROUND

Ethics is a key competence to be acquired by physiotherapy students to ensure quality care. However, students may not be aware of the importance of ethics for the development of their clinical practice, in the same way that their attitudes towards Professional Ethics are unknown within their curriculum.

OBJECTIVES

The aim of this study was to identify the attitudes towards learning Professional Ethics among undergraduate students of Physiotherapy Degree and compare the attitude between the educational years.

DESIGN

A cross-sectional study was carried out.

SETTINGS

Physiotherapy Degree at the University of Valencia, Spain.

PARTICIPANTS

In the study 340 physiotherapy students participated.

METHODS

This was a quantitative study with a cross-sectional observational design. The students of the different years of the Physiotherapy Degree had to complete the Attitudes Questionnaire towards Professional Ethics in Physiotherapy in order to analyse the study objective.

RESULTS

The four educational years' scored 3.80 or more in the questionnaire. Second-year students scored the highest (4.25 ± 0.35) and had significantly more favourable attitudes towards learning ethics in relation to the rest of the years (p = 0.007 vs. first; p < 0.001 vs. third and fourth). First-year students (4.09 ± 0.37) obtained a significantly higher score than third (3.86 ± 0.35) and fourth years (3.80 ± 0.33) with p < 0.001 vs. both third and fourth. Finally, in relation to the 3 categories of the items' questionnaire the mean scores showed significant differences between the second year and the rest of the years.

CONCLUSIONS

The attitudes towards learning Professional Ethics among students of the Physiotherapy Degree at the university is favourable, although it varies depending on the academic year, with the students in the academic year in which Ethics is taught (i.e. second year students) being the ones with better attitudes.

Addressing the Ethical Issues Associated with Fieldwork Education in Occupational Therapy: Results of an Empirical Study Conducted in Quebec

Occupational therapists who contribute to fieldwork education are exposed to ethical issues when supervising trainees. Both the ethical issues and the solutions to address these ethical issues are undocumented in the literature. A qualitative study was conducted to document these issues and their solutions. Twenty-three occupational therapists with supervising experience participated in this study. All the participants reported experiencing ethical issues while supervising trainees. This article aims to present the solutions proposed by the participants in order to address the ethical issues of fieldwork education. Intrinsic solutions are linked to supervisors’ ethical, pedagogical or occupational therapy competences. The extrinsic solutions deal with the appropriate measures which can and should be implemented so as to better support the supervisors’ work and better recognize the important contribution of occupational therapists who train the next generation of occupational therapists in clinical settings. This study is likely to have implications on clinical practice, teaching, research and governance.

Ethical considerations about informed consent in physiotherapy in Romania

Background and aim

Physiotherapy has a distinct feature in terms of patient relationship, regarding the level of communication, especially how physical therapy sessions take place throughout the rehabilitation process. One of the particularities encountered in Romanian physiotherapy practice is related to obtaining informed consent (IC), considering that the initial contact of the patient is with a rehabilitation doctor when general consent is obtained. The aim of this study was to investigate Romanian physiotherapists aspects related to the frequency and use of IC at physiotherapy onset.

Method

A cross-sectional study was conducted among Romanian physiotherapists using a survey with 2 open and 37 closed items, including nine demographics items, developed after a systematic literature review. The closed items were Likert type scales, measuring frequency or agreement on scale from 1 to 5. The questionnaire was distributed online from November 2017 until May 2018 and data was gathered from 148 physiotherapists. The statistical analysis targeted descriptive analysis and multiple regression.

Results

The results suggested that only 40.82 % of physiotherapists are always seeking to obtain IC at physiotherapy onset, while 16.3 % never apply this legal demand in their professional activity, confidence intervals were set to 95% with 3.34 lower bound and 3.82 upper bound. Through multiple regression, we have identified factors which correlates with an increased frequency of IC obtaining at physiotherapy onset. Professional skills, ethical knowledge and ethical reasoning are factors with a positive influence towards obtaining IC with an increased frequency.

Conclusions

Ethical knowledge, moral reasoning and consideration for patient are elements which have a positive influence regarding the awareness of IC. The process of demanding and obtaining IC within Romanian physiotherapists must be improved despite the particularities of medical practice. Further research is needed to identify the methods by which Romanian physiotherapists awareness toward IC can be increased.

Continuing competency in ethical decision making: An interpretive description of occupational therapists' perspectives

BACKGROUND.

Competency in ethical decision making is a criterion for ethical practice, and it is expected to advance with ongoing professional development. However, research exploring continuing competency needs of occupational therapists regarding ethical decision making is limited.

PURPOSE.

The purpose of this study was to explore potential gaps and directions for development related to continuing competency in ethical decision making from the perspective of practicing occupational therapists.

METHOD.

Interpretive description informed secondary data analysis of professional narratives from a grounded theory study regarding ethical decision making. In-depth interviews were conducted with a purposive sample of 18 occupational therapists. Data analyses focused on identifying gaps and future directions regarding continuing competency.

FINDINGS.

Two main themes regarding gaps were identified: "I didn't have the knowledge" and "I don't have anybody." Education, tool development, and ethics mentorship were identified directions for development.

IMPLICATIONS.

Findings advance understanding of continuing competency needs of occupational therapists regarding ethical decision making.

Teaching professionalism: some features in Canadian physiotherapy programs

The role of "professionalism" is core to many health professions including Physical Therapy (PT), and the development of competence in professionalism is a key requirement of entry-to-practice PT programs. However, the actual curriculum, teaching methodologies, and evaluation methods currently used to develop professional competence during PT training programs in Canada are unclear. This study explored current teaching practices, evaluation and curricular content related to professionalism in Canadian entry-to-practice PT programs. Results showed that teaching practices related to professionalism were not necessarily congruent with methods promulgated by educational theory and relied heavily on lecture, while more appropriate strategies such as simulation and role play were under-utilized. The numbers of different teaching methods utilized for specific aspects of professionalism were variable. Emphasis on different curricular areas related to professionalism also varied: communication was given the most emphasis while change management was under-represented. It is posited that teaching methods related to professionalism could be improved and curricular content and emphasis should also be reconsidered.

Ethics and sexual health: Exploration of the ethical code of conduct for physiotherapists concerning sexual health in clinical practice

Physiotherapists have an important role in sexual health, but there are specific ethical considerations regarding sexuality and the practice of physiotherapy which require serious consideration. This article aims to illustrate how the professional ethical code of physiotherapy can serve as a tool for ethical clinical reasoning regarding sexual health in clinical physiotherapy practice. We analyse the ethical codes for physical therapy, in relation to a definition of sexual health and the declaration of sexual rights. The analysis outlines several ethical considerations crucial in dealing with sexual health, while also acknowledging the critical role of cultural context in any ethical analysis. We conclude that physiotherapists need to practise ethical reasoning and that the ethical code of physiotherapy can act as a point of departure for reflection on thought-provoking ethical dilemmas to improve the practice of physiotherapy and support clients' overall health.

Doing what's right: A grounded theory of ethical decision-making in occupational therapy

Background: Ethical decision-making is an important aspect of reasoning in occupational therapy practice. However, the process of ethical decision-making within the broader context of reasoning is yet to be clearly explicated.Objective: The purpose of this study was to advance a theoretical understanding of the process by which occupational therapists make ethical decisions in day-to-day practice.Method: A constructivist grounded theory approach was adopted, incorporating in-depth semi-structured interviews with 18 occupational therapists from a range of practice settings and years of experience. Initially, participants nominated as key informants who were able to reflect on their decision-making processes were recruited. Theoretical sampling informed subsequent stages of data collection. Participants were asked to describe their process of ethical decision-making using scenarios from clinical practice. Interview transcripts were analyzed using a systematic process of initial then focused coding, and theoretical categorization to construct a theory regarding the process of ethical decision-making.Findings: An ethical decision-making prism was developed to capture three main processes: Considering the Fundamental Checklist, Consulting Others, and Doing What's Right. Ethical decision-making appeared to be an inductive and dialectical process with the occupational therapist at its core.Conclusion: Study findings advance our understanding of ethical decision-making in day-to-day clinical practice.

Exploration des dilemmes éthiques entourant le traitement de la dysphagie à l’enfance et leurs solutions : perceptions d’intervenants

Une recension des écrits révèle qu’il existe peu de connaissances sur les dilemmes éthiques (et leurs solutions) entourant le traitement de la dysphagie à l’enfance. Le but de cette étude était d’explorer, voire de décrire les dilemmes éthiques rencontrés par des intervenants lors du traitement des problèmes d’alimentation chez des enfants souffrant de dysphagie et les façons dont ceux-ci procèdent pour les résoudre. Des entrevues semi-dirigées ont été réalisées auprès de huit intervenantes travaillant dans un Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Québec. Toutes les intervenantes mentionnent avoir rencontré des dilemmes éthiques, et ce, en moyenne deux fois par année et ceux-ci leur ont fait vivre une certaine détresse. Ces dilemmes ont trois causes principales, soit les refus de traitement de certains parents, les suivis partiels des recommandations professionnelles et les divergences d’opinions avec des partenaires externes. Pour résoudre ces dilemmes, les intervenantes affirment recourir à des discussions en équipe et à de l’aide de supérieurs, de partenaires externes ou de parents. La majorité des intervenantes mentionnent avoir besoin de moyens supplémentaires pour résoudre ces dilemmes et proposent certaines avenues en ce sens. Les résultats de la recherche rejoignent en général ceux documentés dans les écrits. Plus d’attention devrait être portée à ces dilemmes étant donné le peu de ressources éthiques, actuellement disponibles, adaptées à ces situations pour les résoudre et la détresse que ceux-ci occasionnent.

How physiotherapists perceive, interpret, and respond to the ethical dimensions of practice: A qualitative study

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for "in the moment" ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.

Supporting ethics educators in Canadian occupational therapy and physical therapy programs: A national interprofessional knowledge exchange project

Ethics education is the cornerstone of professional practice, fostering knowledge and respect for core ethical values among healthcare professionals. Ethics is also a subject well-suited for interprofessional education and collaboration. However, there are few initiatives to gather experiences and share resources among ethics educators in rehabilitation. We thus undertook a knowledge exchange project to: 1) share knowledge about ethics training across Canadian occupational and physical therapy programs, and 2) build a community of educators dedicated to improving ethics education. The objectives of this paper are to describe this interprofessional knowledge exchange project involving ethics educators (with a diversity of professional and disciplinary backgrounds) from Canadian occupational and physical therapy programs as well as analyze its outcomes based on participants' experiences/perceptions. Two knowledge exchange strategies were employed: an interactive one-day workshop and a wiki platform. An immediate post-workshop questionnaire evaluated the degree to which participants' expectations were met. Structured telephone interviews 9-10 months after the workshop collected participants' perceptions on whether (and if so, how) the project influenced their teaching or led to further interprofessional collaborations. Open-ended questions from the post-workshop questionnaires and individual interviews were analyzed using qualitative methods. Of 40 ethics educators contacted, 23 participated in the workshop and 17 in the follow-up interview. Only 6 participants logged into the wiki from its launch to the end of data collection. Five themes emerged from the qualitative analysis: 1) belonging and networking; 2) sharing and collaborating; 3) changing (or not) ways of teaching ethics; 4) sustaining the network; and 5) envisioning the future of ethics education. The project attained many of its goals, despite encountering some challenges. While the wiki platform proved to be of limited benefit in advancing the project goals, the interactive format and collaborative nature of the one-day workshop were described as rewarding and effective in bringing together occupational therapy and physical therapy educators to meet, network, and share knowledge.

Low Back Pain: Investigation of Biases in Outpatient Canadian Physical Therapy

BACKGROUND

Previous research suggested that physical therapy services can be influenced by patient characteristics (age, sex, socioeconomic status) or insurance status rather than their clinical need.

OBJECTIVE

The aim of this study was to determine whether patient-related factors (age, sex, SES) and the source of reimbursement for physical therapy services (insurance status) influence wait time for, frequency of, and duration of physical therapy for low back pain.

DESIGN

This study was an empirical cross-sectional online survey of Canadian physical therapy professionals (defined as including physical therapists and physical rehabilitation specialists).

METHODS

A total of 846 physical therapy professionals received 1 of 24 different (and randomly selected) clinical vignettes (ie, patient case scenarios) and completed a 40-item questionnaire about how they would treat the fictional patient in the vignette as well as their professional clinical practice. Each vignette described a patient with low back pain but with variations in patient characteristics (age, sex, socioeconomic status) and insurance status (no insurance, private insurance, Workers' Compensation Board insurance).

RESULTS

The age, sex, and socioeconomic status of the fictional vignette patients did not affect how participants would provide service. However, vignette patients with Workers' Compensation Board insurance would be seen more frequently than those with private insurance or no insurance. When asked explicitly, study participants stated that insurance status, age, and chronicity of the condition were not factors associated with wait time for, frequency of, or duration of treatment.

LIMITATIONS

This study used a standardized vignette patient and may not accurately represent physical therapy professionals' actual clinical practice.

CONCLUSIONS

There appears to be an implicit professional bias in relation to patients' insurance status; the resulting inequity in service provision highlights the need for further research as a basis for national guidelines to promote equity in access to and provision of quality physical therapy services.

Job and career satisfaction among Indian physiotherapists: A preliminary survey

Background/Aims:

Job and career satisfaction is an integral part of an individual's professional life. It affects job performance, consequently influencing growth of the profession. Physiotherapy in India is maturing making such data indispensable. This study aims to assess the level of job and career satisfaction among Indian physiotherapists.

Methods:

A cross-sectional pilot survey was done with a self-administered e-questionnaire and the 265 surveys collected were subjected to descriptive statistical analysis.

Results:

Overall job satisfaction is 63.68% (3.35±1.32) and career satisfaction is 56.39% (2.84±1.39).

Conclusions:

The majority of physiotherapists were moderately satisfied with their jobs and careers. It is essential to incorporate favourable factors in the workplace that promote professional satisfaction and there is a need to enhance opportunities for continued medical education. This study provides a global outlook of a developing country.

Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators

PURPOSE

Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods.

METHOD

Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation.

RESULTS

Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important.

CONCLUSION

The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.

Ethical issues raised by private practice physiotherapy are more diverse than first meets the eye: recommendations from a literature review

PURPOSE

Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues.

METHOD

After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed.

RESULTS

A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized.

CONCLUSIONS

The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported-through education, research, and good governance-in providing the best possible care for their patients.

The contribution of conceptual frameworks to knowledge translation interventions in physical therapy

There is growing recognition of the importance of knowledge translation activities in physical therapy to ensure that research findings are integrated into clinical practice, and increasing numbers of knowledge translation interventions are being conducted. Although various frameworks have been developed to guide and facilitate the process of translating knowledge into practice, these tools have been infrequently used in physical therapy knowledge translation studies to date. Knowledge translation in physical therapy implicates multiple stakeholders and environments and involves numerous steps. In light of this complexity, the use of explicit conceptual frameworks by clinicians and researchers conducting knowledge translation interventions is associated with a range of potential benefits. This perspective article argues that such frameworks are important resources to promote the uptake of new evidence in physical therapist practice settings. Four key benefits associated with the use of conceptual frameworks in designing and implementing knowledge translation interventions are identified, and limits related to their use are considered. A sample of 5 conceptual frameworks is evaluated, and how they address common barriers to knowledge translation in physical therapy is assessed. The goal of this analysis is to provide guidance to physical therapists seeking to identify a framework to support the design and implementation of a knowledge translation intervention. Finally, the use of a conceptual framework is illustrated through a case example. Increased use of conceptual frameworks can have a positive impact on the field of knowledge translation in physical therapy and support the development and implementation of robust and effective knowledge translation interventions that help span the research-practice gap.

Theoretical frameworks used to discuss ethical issues in private physiotherapy practice and proposal of a new ethical tool

In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.

Values and ethics in practice-based decision making

BACKGROUND

Values are evident in health ethics literature; however, it is seldom clear how they are visible in practice.

PURPOSE

The aim of this study was to illuminate how values inform occupational therapists' decision making in practice.

METHOD

Fifteen New Zealand community occupational therapists completed this embedded experimental mixed-methods study. A pre-deliberation questionnaire was completed prior to deliberation of a case study using web-based values transparency software, the Values Exchange, followed by a post-deliberation questionnaire. Categorical data were analyzed using non-parametric statistics. Written responses to open questions were thematically analyzed.

FINDINGS

Most participants disagreed with the proposed action for the case. Degrees of divergence, concern for dignity and risk, and values-based reasoning were found, revealing how ethical deliberation was values based. IMPLICATIONSs. Recognition and transparency of the values inherent in practice-based decision making is possible and desirable in promoting sound ethical reasoning.