JCPSLP Vol 17 Supplement 1 2015_lores

Emerging trends in contemporary ethical issues

Responsible and ethical clinical practice A framework for knowledge translation Belinda Kenny and Susan Block

In this paper Belinda Kenny and Susan Block, members of the Speech Pathology Australia Ethics Board, reflect upon the challenges and opportunities facing speech pathologists as they make decisions about client interactions and intervention. Such challenges can be particularly stressful when clinicians attempt to evaluate, interpret and maintain best practice and emerging evidence, and balance the demands of everyday clinical practice. Professional perspectives Many speech pathologists work in an environment where specialisation is neither possible nor appropriate. As a consequence, most of our colleagues work with a diverse caseload, with people of different ages, backgrounds, diagnoses, needs and demands. This means that clinicians have a wide scope of practice within which they need to continuously develop knowledge (SPA, 2003). Furthermore, pressures imposed by expanding waiting lists and managers who are often not speech pathologists, may create tensions between optimal treatment and service delivery policies (Kenny & Lincoln, 2012). Speech pathologists may then perceive a need to reduce the amount of treatment a client receives (McAllister, 2006). When such tension exists, it becomes imperative that the best possible treatment is delivered to maximise client outcomes. This goal requires us to carefully consider our knowledge base and how we translate evidence into our everyday practice. Indeed, the revised Code of Ethics (SPA, 2010) espouses speech pathologists’ responsibility for knowledge and application of evidence as a fundamental professional value and requires that: “We maintain our currency of professional knowledge and practice and acknowledge the limits of these” (p. 1). Nonetheless, the process of developing, accessing and translating knowledge may be a difficult and confronting task for many of us (Cartwright, 2012). Theoretical perspectives One of the main methods of acquiring knowledge is through access to the publication of research findings. Dissemination of research findings aims to present new information that constructively impact upon the status quo. The nature of such impacts may involve changes to current

treatment approaches, changes in treatment focus or timing and, changes in outcome measurement. New knowledge can be disseminated through publications, case presentations, conferences, professional development seminars or a range of discussions and meetings. Whatever the means, translation of knowledge is the significant process that underpins the flow of research knowledge to practice. In recognition of the importance of these events and their impacts upon professional development and client care, Speech Pathology Australia (SPA) has incorporated a range of such learning opportunities into the calculation of Professional Self Regulation (PSR) points for members (SPA, 2013). The link between ethics and research has been clearly established, with human research ethics committees adopting a major gatekeeping role in monitoring benefits and risks of new research programs (Emanuel, Wendler & Grady, 2000). However, ethical considerations extend beyond the research studies themselves. Knowledge translation (KT) may be defined as: the exchange, synthesis and ethically sound application of knowledge – within a complex system of interactions among researchers and users for the purposes of accelerating and capturing benefits of research through better health outcomes, more effective health services and resources, and a strengthened health care system. (Canadian Institutes of Health Research, 2009, emphasis added by authors) This definition is consistent with applying an ethics lens through which key KT decisions should be considered by researchers and clinicians. Some of the ethical challenges of KT The goals of KT, to create and implement new health care knowledge, may provide significant benefits for our clients, the profession and employers. However, ethically sound application of such knowledge requires critical reflection of both the research processes and their outcomes. Trevor- Deutsch, Allen and Ravitsky (2009) posed five questions to support such a reflective process: 1. What are the key ethical principles and values that should guide KT? 2. What are the responsibilities of different stakeholders in the KT process (e.g., researchers, research funders,

KEYWORDS ETHICAL PRACTICE

KNOWLEDGE TRANSLATION

Belinda Kenny (top) and Susan Block

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

Journal of Clinical Practice in Speech-Language Pathology