JCPSLP Vol 17 Supplement 1 2015_lores

Interprofessional education Interprofessional education (IPE) is also seen as one area which may offer a potential avenue for improved collaboration and patient care (Reeves et al., 2008). IPE facilitates an opportunity for different health professionals to engage in shared learning in order to improve collaborative practice and the health care of patients. It therefore has greater potential for improving IPC than multidisciplinary (where there are shared learning experiences but no interaction) or uniprofessional education (where professionals learn independently from one another) (Reeves et al., 2009). Further detailed information in relation to interprofessional health education can be found in the comprehensive literature review completed by the Learning and Teaching for Interprofessional Practice (LTIP) Australia project team (2011). It is noted that application of an interprofessional approach is growing in student education by higher education providers (LTIP, 2011). A work culture that facilitates this practice is thus important so that students do not disengage when they enter the workforce. Expanded scope of practice Currently in Australia, there is much discussion about expanded scope of practice roles particularly for nursing and allied health practitioners; for example, see work undertaken by Health Workforce Australia (2013). These changes in understandings of professional boundaries may lend themselves to conflict and concerns both intra- and interprofessionally (Shulman et al., 2009). For instance, the concept of speech pathologists being credentialed to independently perform FEES or suction through a tracheostomy has led to much controversy in some work places in relation to competency and to issues of potential quality and safety impacts. Implications for speech pathologists As members of the health care team, speech pathologists play an important role in the successful application of interprofessional clinical and team-based care in practice. However, as we have endeavoured to demonstrate, interprofessional ways of working may result in speech pathologists facing a range of complex ethical challenges. In updating and revising the 2002 SPA Ethics Education Package, the SPA Ethics Board has taken the approach of encouraging speech pathologists to integrate ethical decision-making into every day practice, including the way in which ethical dilemmas are viewed and the approaches taken to resolve them. To assist this process, the existing Ethics Education Package is being updated and revised to include additional protocols and tools designed to help clinicians to explore, better understand and resolve ethical issues. These tools provide an excellent resource to assist speech pathologists grappling with issues in relation to interprofessional collaboration. Clinicians are encouraged to reflect on these issues as relevant to their own context and to explore ways to improve interprofessional practice in the interests of enhanced patient care. Conclusion As stated in the profession’s Code of Ethics, speech pathologists observe the highest standards of integrity and ethical practice as a fundamental professional responsibility (SPA, 2010). In undertaking this work, speech pathologists are obliged to consider our clients in a broad context and in

views of the patient/client and their carers, and the strength, experience and limitations of individual disciplines. Teamwork efficiency is promoted by clear team and organisational processes which support teams in their efforts to be effective and efficient (Clark et al., 2007). In reviewing teamwork within an ethical framework, the principles of beneficence, non-maleficence, truth, integrity, respect for autonomy and justice must be considered by the interprofessional team and should be reflected in how clinical decisions are made (Clark et al., 2007; SPA 2010). For example, an effective family meeting may involve a treating team “pre-meeting” to explore treatment options and ensure a shared understanding of the current clinical picture before presenting the realistic achievable options to patients and their families. It could also include discussion in relation to how team members can demonstrate mutual respect for each contribution to the patient’s goals. Clark et al. (2007) propose a conceptual framework to assist health care teams to understand the ethical parameters of interprofessional teamwork. This comprises three elements which function at individual, team and organisational levels: • Principles – general guidelines for behaviour based on ethical concepts. For example, accepted practice standards of the professions in a team. • Structures – formal and informal processes which include forms of knowledge and patterns of behaviour for individuals and collectively related to teamwork within an organisation. For example, shared awareness of the practice of other professionals on a team. • Processes – procedural factors of interprofessional practice. For example, the development of open communication and dialogue. The use of such a framework can assist speech pathologists and their teams to further the “discourse on interprofessional ethics” (p. 601) in order to better understand these issues and develop solutions to address them (Clark et al., 2007). Furthermore, collaboration should be understood as a human process as much as a professional one, encompassing both what we know and who we are (D’Amour et al., 2005). An interprofessional ethic of care therefore may better facilitate patient-centred decisions, particularly if considered within a reflective framework such as the one described. IPC practice-based interventions IPC practice-based interventions are strategies put into place in health care settings to improve work interactions and processes between two or more types of health care professionals (Zwarenstein et al., 2009). In their review of the literature, Zwarenstein and colleagues (2009) describe a small number of promising activities which were shown, to varying degrees of robustness, to have positive effects on IPC. These included interprofessional rounds, interprofessional meetings and externally facilitated interprofessional audit processes. Speech pathologists may have the opportunity to participate in these forms of interventions in their workplace and, where interprofessional skills are not practised, consider advocating for their adoption. For instance, they could reflect on how ward rounds and meetings may be adapted so that perceived power imbalances could be addressed allowing for more opportunities for shared goals and planning. In considering resource allocation, organisations may also need to empower health professionals with the necessary time to participate in IPC.

38

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

Journal of Clinical Practice in Speech-Language Pathology