Patterns of ethical issues and decision-making challenges in clinical practice among Ghanaian physiotherapists

Abstract

Objectives: To determine the patterns of ethical issues and decision-making challenges encountered by practicing physiotherapists in Ghana.Design: This is a cross-sectional study in which the stratified sampling technique was adopted to sample the participants.Setting: The study involved physiotherapists at the private healthcare setting and from different levels of public healthcare facilities.Participants: Eighty-two duly registered physiotherapists who were practising in Ghana participated in the study.Interventions: Participants completed a 30-item questionnaire related to ethical issues and challenges encountered in making ethical decisions. Data analysis was premised on the frequency of occurrence of ethical tensions and difficulty in decision making which were dichotomized as 'high' and 'low' issues, and 'extreme' and 'low' difficult decisions, respectively.Results: The age range of the participants was 21-49 years (mean 31.5 ± 1.4years). 18 (22%), 31 (37.8%) and 33 (40.2%) physiotherapists practice in the primary, secondary and tertiary healthcare settings respectively. 56 (68.3%) and 43 (52.4%) of the participants affirmed that 'establishing priorities for patient's treatment amidst limited time resources' was the most frequently encountered and the most extremely difficult ethical issue to make a decision on respectively. Whereas, limiting physical therapy services for personal or organizational gains sub-theme was the least occurred issue which was also the least difficult to make a decision on as indicated by the respective 16 (19.5%) and 18 (22.0%) physiotherapists.Conclusion: A wide range of primary and secondary ethical issues were reported by the sampled physiotherapists, which tend to pose difficulty during the decision-making process in practice.Keywords: Ethical issues; code of ethics; decision making; physiotherapy practice, ethical judgementFunding: The research work was self-funded by the authors.

Views of physiotherapists on factors that play a role in ethical decision-making: an international online survey study

“…Social, cultural and/or religious values and behaviours that influence decisions within health care settings can differ greatly between World Physiotherapy regions [ 31 – 34 ]. There is also great variability in the understanding of the body, health, illness and healing [ 35 , 36 ] and work conditions [ 6 , 27 , 37 ] around the world. Moral, professional, religious or political theories held by individual clinicians can conflict with particular ethical principles [ 38 ], as well as the values and goals of physiotherapists with those of other professionals [ 29 ], their work systems [ 1 ] and their patients [ 39 ].…”

Scarcity of resources and inequity in access are frequently reported ethical issues for physiotherapists internationally: an observational study

“…There is evidence that physiotherapists in a wide variety of practice contexts face ethical issues, based on published research from mostly Western societies [1][2][3][4][5][6][7][8][9]. A small number of studies are being reported from culturally different areas of the world [10][11][12][13][14], but no previous study has determined the scope and nature of ethical issues in the physiotherapy profession worldwide. What we do know from existing research is that ethical issues are part of everyday physiotherapy practice across fields of the physiotherapy profession, causing moral distress for practitioners and affecting quality and outcomes of care [1,2,4,9].…”

“…Recent publications provide initial insights into the ethical experience of physiotherapists in non-Western societies [10][11][12]14]. An African perspective in studies from Ghana and Zambia report physiotherapists frequently experience issues with gift-giving and professional boundaries in the patient-therapist relationship [11,14].…”

“…Recent publications provide initial insights into the ethical experience of physiotherapists in non-Western societies [10][11][12]14]. An African perspective in studies from Ghana and Zambia report physiotherapists frequently experience issues with gift-giving and professional boundaries in the patient-therapist relationship [11,14]. Physiotherapists in Zambia also identified conflicts between culture and the treatment process, issues of patient safety with home exercise programs, interprofessional conflict and competency of informed consent [11].…”

“…Physiotherapists in Zambia also identified conflicts between culture and the treatment process, issues of patient safety with home exercise programs, interprofessional conflict and competency of informed consent [11]. In Ghana, providing physiotherapy care when resources are limited was the most frequent ethical issue, followed by managing patient and family expectations [14]. Physiotherapists providing end of life care in another African country, Nigeria, identified ethical issues of conflict between cultural beliefs and patient autonomy when disclosing information about dying.…”