Ian Cooper, Dep HOD Physiotherapy, Sir Charles Gairdner Hospital, Perth WA A/Prof Sue Jenkins, School of Physiotherapy, Curtin University, Sir

Transcription

1 Do student physiotherapists think differently about professional boundaries after a targeted education session? Ian Cooper, Dep HOD Physiotherapy, Sir Charles Gairdner Hospital, Perth WA A/Prof Sue Jenkins, School of Physiotherapy, Curtin University, Sir Charles GairdnerHospital,Perth, WA Dr Clare Delany, Senior Lecturer, School of Physiotherapy, University of Melbourne, Victoria Dr Genevieve Dwyer, Lecturer, School of Physiotherapy, University of Sydney, NSW Dr VenerinaJohnston, School of Health and Rehabilitation Sciences, University of Queensland, Queensland Dr Rosemary Godbold*, Senior Lecturer, Health Care Ethics, Faculty of Health and Applied Sciences, AUT University, Auckland, New Zealand rosemary.godbold@aut.ac.nzold@aut.ac.nz

2 Session overview Background Method Findings and discussion Conclusion

3 The nature of the therapeutic relationship: vulnerable to boundary violations Background power imbalances personal information physical closeness lead to boundary negatively impact on trust and respect. HPDT: 3 out of 5 physiotherapy cases concern professional boundary issues.

4 Student Physiotherapists and the sexual professional boundary Attracted to patients 10% M 4% F Dated a patient 0% M 0% F Dated an ex-patient 0% M 0% F Experienced Inappropriate Patient Sexual Behaviour (IPSB) 68% M 81% F Anget al 2010

5 Qualified Physiotherapists and the sexual professional boundary Attracted to patients 74% M 41% F (p< 0.001) Dated a patient 7% M 3.5% F (p=0.18) Dated an ex-patient 21% M 16% F (p = 0.24) Experienced IPSB 41% M 51% F (p = 0.17) Cooper and Jenkins, 2008

6 Incidence may be higher? Knowledge of others dating Qualified staff 33% current patient 60% ex-patient Cooper and Jenkins 2008 Students 4% current patient 9% ex-patient Ang et al 2010 Other regional Physio data NZ Study 7.5% of PT s had engaged in a sexual relationship with a patient Cullen et al 1997 Other Health Workers (excl. physio) Sexual relationship 3 12% (M > F) Gabbard 1999

7 IPSB in physiotherapy Inappropriate patient sexual behaviour Australian Studies 78% students Ang et al % qualified physios Cooper and Jenkins 2008 North American Studies De Mayo et al % American PTA members reported patient sexual behaviour 63% reported specific sexual harassment Canadian Study 81% Canadian PT s and u/g s reported patient sexual behaviour McComas et al 1993

8 Gender and Location Male health professionals more likely to be involved in boundary violations Female patients exclusively victims Rural practitioners more likely to blur boundaries than their metro colleagues Celenza 2007 Private more likely to blur boundaries than public Cullen at al 1997, Cooper and Jenkins 2008, Cooper et al 2010

9 New Zealand & Australian Standards of Ethical Conduct 2.9 not exploit any patient/client whether physically,sexually, emotionally, or financially. Sexual contact of any kind with patients/clients is unacceptable establish and maintain appropriate professional boundaries with patients/clients and their whanau and families (c) sexual relationships with people who have previously been a practitioner s patients or clients are ofteninappropriate, depending on the extent of the professional relationship and the vulnerability of a previous patient or client

10 Method Does targeted education to entry level physiotherapy students on professional and sexual boundaries change their opinions and intentions to act on a series of vignettes? 238 entry level physiotherapy students: University of Queensland (Queensland), Sydney University (New South Wales), Curtin University (Western Australia) and Auckland University of Technology (New Zealand). Students responded to 7 vignettes, once before a standardised lecture and workshop on ethics and professional boundaries, and again afterwards. Ethics approval

11 Findings Professional Boundary vignette 1 Pre mean Post mean A female physiotherapist is invited by her brother to be the physiotherapist for his sports team. She agrees and a few weeks later accepts an invitation to go on a date with one of the team member = This is OK and I might do it if the circumstances were right, 2 = I wouldn t do this, but I wouldn t criticise anybody who did, 3 = I don t know if this is right or wrong, 4 = This behaviour is wrong, 5 = This behaviour is so wrong that the physiotherapist involved should be barred from practice.

12 Findings professional boundary vignette 2 A male physiotherapist working in a small rural town commences a sexual relationship with a person not currently a patient but who has been a patient in the past on a number of occasions Pre mean 2.4 Post mean = This is OK and I might do it if the circumstances were right, 2 = I wouldn t do this, but I wouldn t criticise anybody who did, 3 = I don t know if this is right or wrong, 4 = This behaviour is wrong, 5 = This behaviour is so wrong that the physiotherapist involved should be barred from practice.

13 Findings Professional Boundary vignette 3 A physiotherapist meets the son/daughter of a patient they are currently treating at a party. Soon after this meeting the son/daughter invites the physiotherapist to be a friend on Facebook. The physiotherapist sees no harm in this and is soon corresponding regularly Pre mean Post mean = This is OK and I might do it if the circumstances were right, 2 = I wouldn t do this, but I wouldn t criticise anybody who did, 3 = I don t know if this is right or wrong, 4 = This behaviour is wrong, 5 = This behaviour is so wrong that the physiotherapist involved should be barred from practice.

14 IPSB vignettes 4a Findings Pre mean Post mean You are a male physiotherapy student on a musculoskeletal placement in a rural hospital outpatient department and on every occasion a male patient tells you a joke that involves sexual humour = Ignore the situation and do nothing, 2 = Ask the patient to cease the activity but continue to treat them, 3 = Inform the patient that you will be talking to your supervisor about what has occurred at the cessation of the treatment, 4 = Cease the treatment immediately and advise the patient that they will be treated by another therapist at their next appointment, 5 = Cease the treatment immediately and instruct the patient that they are discharged and not to return to the clinic.

15 IPSB vignettes 4b Findings Pre mean Post mean You are a female physiotherapy student on a musculoskeletal placement in a rural hospital outpatient department and on every occasion a male patient tells you a joke that involves sexual humour = Ignore the situation and do nothing, 2 = Ask the patient to cease the activity but continue to treat them, 3 = Inform the patient that you will be talking to your supervisor about what has occurred at the cessation of the treatment, 4 = Cease the treatment immediately and advise the patient that they will be treated by another therapist at their next appointment, 5 = Cease the treatment immediately and instruct the patient that they are discharged and not to return to the clinic.

16 IPSB vignette 5 Findings Pre mean Post mean You are on a neurological placement in the Head Injury Unit of a large rehabilitation hospital. One of your patients tries to touch your genital area during the treatment session = Ignore the situation and do nothing, 2 = Ask the patient to cease the activity but continue to treat them, 3 = Inform the patient that you will be talking to your supervisor about what has occurred at the cessation of the treatment, 4 = Cease the treatment immediately and advise the patient that they will be treated by another therapist at their next appointment, 5 = Cease the treatment immediately and instruct the patient that they are discharged and not to return to the clinic.

17 IPSB vignettes Vignette 6 Findings Pre mean Post mean Your patient insists on calling your first name and asks you questions of a personal nature eg do you have a boyfriend/girlfriend, social interests etc = Ignore the situation and do nothing, 2 = Ask the patient to cease the activity but continue to treat them, 3 = Inform the patient that you will be talking to your supervisor about what has occurred at the cessation of the treatment, 4 = Cease the treatment immediately and advise the patient that they will be treated by another therapist at their next appointment, 5 = Cease the treatment immediately and instruct the patient that they are discharged and not to return to the clinic.

18 Discussion Targeted Education did not alter students intentions to act against a series of vignettes No significant difference between Programs Trend in responses (in line with other studies) Males < less conservative than females Grad Entry Masters < less conservative than BSc Overseas students < less conservative than Oz/NZ born students Rural student responses = Metro students Preliminary analysis of the comments as opposed to the scores students gave does show changes. i.e. 50% changed their mind

19 Conclusion Implications for Educators Implications for Registration Boards Ethics may be the only subject they study where they have preconceived/set ideas prior to commencing uni Non examinable subject so?no need to take on board Acknowledge that single lecture/workshop is not the optimal approach to this?ethics to be integrated to every clinical subject taught Despite findings for physios have every confidence that findings would be similar for other health professions

20 References Ang, A, Cooper, I and Jenkins S New Zealand Journal of Physiotherapy2010: 38: 3; Baca M, Sexual boundaries: Are they common sense? The Journal for Nurse Practitioners2009; 5 (7) Celenza A. Sexual Boundary Violations: therapeutic, supervisory and academic contexts New York Jason Aronson. p , Cooper, I. and S. Jenkins, Sexual boundaries between physiotherapists and patients are not perceived clearly: an observational study.australian Journal of Physiotherapy, 2008: 54: 4: Cullen R, Davidson M, Guthrie B. Physiotherapists who have had sexual contact with patients: the 1996 NZSP survey. New Zealand Journal of Physiotherapy 1997; 25: 7-9. de Mayo R Patient sexual behaviours and sexual harassment: a national survey of physical therapists. Physical Therapy 1997: 77: Farber N, Novack D, Silverstein J, Davis E, Weiner J and Boyer E. Physicians experiences with patients who transgress boundaries. Journal of General Internal Medicine 2000:15: Gabbard G (1999) Boundary Violations. In Boch S, Chodoff, P and Green SA (Eds) Psychiatric Ethics (3rd edn). Oxford: Oxford University Press, pp Gabbard G and Nadelson C, Professional boundaries in the Physician patient relationship. Journal of the American Medical Association 1995;273 (18): Galletly CA. Crossing professional boundaries in medicine: the slippery slope to patient sexual exploitation. The Medical Journal of Australia 2004: 181: Johnson C, Knight C, Alderman N. Challenges associated with the definition and assessment of inappropriate sexual behaviour amongst individuals with an acquired neurological impairment. Brain Injury 2006: 20: 7: McComas J, Herbert C, Giacomin C, Kaplan D, Dulberg C. Experiences of Student and Practicing Physical Therapists with Inappropriate Patient Sexual Behavior. Physical Therapy 1993: 73: Nadelson C and Notman M, Boundaries in the doctor-patient relationship. Theoretical Medicine 2002: 23: Ontario College of Physiotherapists