JCPSLP Vol 17 Supplement 1 2015_lores

b) cultural barriers • profession-specific world views, where there may be differences in language, vocabulary, approaches to clinical care and different understanding of values and issues (Hall, 2005) • intellectual and qualitative differences (Irvine et al., 2002) • issues of professional identity (Braithwaite et al., 2013; Irvine et al., 2002) • lack of understanding of others’ roles (Reeves et al., 2008). Thus, there is a need to develop and to clearly articulate a shared understanding of the role of the speech pathologist with respect to the interprofessional team in order to minimise the impact of interprofessional barriers. Such interprofessional discussions could include perspectives on moral reasoning and ethics (Wright & Bratjman, 2011). Indeed, professional ethics is one force which can drive the reform of interprofessional relationships in order to ensure greater team effectiveness (Irvine et al., 2002) and ultimately better health outcomes. While there are a range of approaches to ethical critiques, understanding interprofessional care requires an appreciation of the diversity of subject viewpoints, including those between and within health care professions (Irvine et al., 2002). This, Irvine et al. (2002) suggest, necessitates an openness to concepts of practice ideology, such as understanding and accepting both the social and medical aspects to client care. In practice, this may take numerous forms, for example, how a clinical team incorporates the opinion of the speech pathologist when planning to discharge a patient from the ward. Attitudes towards interprofessional collaboration One factor in determining whether IPC is successful lies in the extent to which the attitudes of health professionals are aligned in support of IPC in practice (Braithwaite et al., 2013). In their recent longitudinal Australian study, Braithwaite et al. (2013) concluded that personnel from the major health professions (including speech pathology) generally value IPC, with allied health having the most favourable attitude towards interprofessional practice and doctors the least. More specifically, allied health professionals had more favourable ratings in relation to the quality of interprofessional care, teamwork and collaboration (Braithwaite et al., 2013). In a practical sense, differences in attitudes may have ethical implications for speech pathologists working in interprofessional teams. Different views of IPC can lead to dilemmas in terms of the delivery of services to clients, for example in areas of confidentiality and privacy, and service provision where there may be differing views of how these are best approached. These differences may need to be explored, discussed and resolved locally in order to “provide clients with access to services consistent with their need” (SPA, 2010, p. 10). For example, negotiating which team members should attend a clinical outreach flight to a remote area community when only three of five members of a paediatric assessment team can be accommodated on the flight. Ethical reflection in an interprofessional context Reflective practice is a self-regulatory process that facilitates an enhanced understanding of both the self and the situation with the intention that future actions can be informed by this understanding (Sandars, 2009). Reflection

promotes self-awareness, self-monitoring, self-regulation and mindfulness (Mann, Gordon & MacLeod, 2009). Stone, Groesbeck and Parham (2007) note that critical reflection is one of several principles that should underpin the work of community health workers, stating “it is ethically very important to examine practices, structures, and concepts that may maintain inequitable power imbalances” (p. 360). This notion could be extrapolated to speech pathologists working in health care and other team settings. Feedback from professional development activities, student teaching and research in speech pathology settings indicate that critical reflection is used as a tool more often by more experienced clinicians in order to identify and articulate ethical dilemmas. It becomes a part of daily professional practice. Reflective questions might include: • What specific knowledge or skills do I bring to the team? • How could the functioning of the team be improved to benefit the needs of clients? • Do I hold attitudes which may be restricting optimal teamwork? Interprofessional practice and ethics as a moral issue Ethics involves exercising our moral obligation and duty (Clark et al., 2007). In noting that a sole disciplinary perspective is inadequate to account for the diversity of a person’s health care needs (biological, psychological, social and spiritual), Wright and Bratjman (2011) suggest that the impetus for health professions to work collaboratively is a moral one. As Zwarenstein et al. (2009) assert, how well different health care professionals work together can influence the quality of the health care provided. Thus, they suggest, if there are difficulties with how health care professionals communicate and interact with each other, problems in patient care can occur (Zwarenstein et al., 2009). Interdisciplinary moral deliberations are required for reflective and balanced clinical decisions to be achieved in complex clinical scenarios. As health ethics may be viewed differently across disciplines (for example, medical ethics versus social work ethics), a patient-centred approach focused on how patients might be best treated should be taken (Wright & Bratjman, 2011). Wright and Bratjman (2011) also caution that, despite this intent, individual professions may have specific ideas in relation to their contributions in relation to what entails optimal care and how that care is delivered. Such an issue highlights the importance of giving patients and carers a voice in defining “good” health care outcomes. Ethics and interprofessional practice – addressing the issues Health care systems are complex entities characterised by competing demands, ongoing workplace reform and changing work environments (Firestone, 2010; McAlearney, 2008; Miller & Gallicchio, 2007). The complex dynamics of individual professionals and their health care team must function within this messy environment (Clark et al., 2007). Addressing the ethical issues which arise from interprofessional practice can similarly be challenging. An interprofessional ethics framework As described above, the effectiveness of an interprofessional team is influenced by a range of factors, including shared understanding of team roles and function,

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

www.speechpathologyaustralia.org.au