RESPONSIBILITIES OF BEING A PROFESSIONAL
Since its inception in 1894, physiotherapy practice has been
governed by a set of legal, regulatory and ethical frameworks and these are
explored here. As described earlier, physiotherapists, as part of a profession,
have certain rights or privileges together with a responsibility to themselves,
the patient, the profession and the organization within which they undertake
their professional role. These responsibilities sit within legal, organizational
and regulatory frameworks
Characteristics of a
profession
There are various theories on how to describe a profession in
the literature. One way reflects work undertaken during the 1950s and 1960s
which explored professions by identifying common traits and considering the
qualities that distinguished a profession from an occupational group (Koehn
1994; Richardson 1999). A profession is described as:
• licensed by the state;
• a professional organisation which has developed and maintains
a code of conduct or standards of practice based on acknowledged ethical
principles;
• able to discipline members who contravene the code/standards;
• having exclusive knowledge and a technical base which is
protected by the law;
• autonomous in its members’ work;
• having members undertaking professional activity which
requires them to have responsibilities or duties to those who need assistance;
• having responsibilities which are not incumbent on others.
By creating evidence of these traits, professions have been able to justify
their ability to exercise power within society. Professionalism defines what is
expected of a professional. Becoming an autonomous professional requires an acceptance,
often implied, of certain responsibilities, in return for certain privileges.
These responsibilities require behaviours and attitudes of individuals in whom
professional trust is placed. Professionalism is widely understood to require
these attributes (Medical Professionalism Project 2005 (cited in CSP 2005b); CSP
2011a):
• a motivation to deliver a service to others;
• adherence to a moral and ethical code of practice;
• striving for excellence;
• maintaining an awareness of limitations and scope of
practice, and a commitment to empowering others (rather than seeking to protect
professional knowledge and skills). However, defining and providing evidence of
professionalism is often more complex. A recent research report by the HCPC
(2011) considered the concept of professionalism as many fitness to practise
cases referred to regulators include professionalism. The report summarised
that:
… professionalism has a basis in individual characteristics
and values, but is also largely defined by context. Its definition varies with a
number of factors, including organizational support, the workplace, the
expectations of others, and the specifics of each service user/patient
encounter. Regulations provide basic guidance and signposting on what is
appropriate and what is unacceptable, but act as a baseline for behaviour, more
than a specification… A profession that fulfils these expectations
establishes and maintains credibility with the public and demonstrates
its capacity to carry the privileges of professional practice –
autonomy and self-regulation. In turn, fulfilment of these expectations
demonstrates a profession’s ability to fulfil the parallel
responsibilities of professional practice – accountability, transparency
and openness. A key element of physiotherapy students’ preparation for
practice on qualification is their being supported in developing their
understanding of, and engagement with, the responsibilities and
privileges that professionalism encapsulates. The concept of
professionalism also relates strongly to the role of physiotherapy
support workers. Possessing knowledge and skills not shared by
others Any profession possesses a range of specific knowledge and skills
that are either unique or more significantly developed than in other
professions. For physiotherapy, the roots of the profession can be found
in massage. Physiotherapists continue to use massage therapeutically, as
well as employing a wide range of other manual techniques, such
as manipulation and reflex therapy. Therapeutic handling underpins many
aspects of rehabilitation, requiring the touching of patients to
facilitate movement, and the significance of therapeutic touching of
patients still sets physiotherapy aside from other professions.
The World Congress for Physical Therapy (WCPT) states that:
Physical therapy provides services to individuals and
populations to develop, maintain and restore maximum movement and functional ability
throughout the lifespan. This includes providing services in circumstances
where movement and function are threatened by ageing, injury, diseases,
disorders, conditions or environmental factors. Functional movement is central
to what it means to be healthy… (WCPT 2011)
Cott et al. (1995) proposed an overarching framework
for the profession:
the movement
continuum theory of physical therapy, arguing that the way in which
physiotherapists conceptualise movement is what differentiates the profession
from others. They suggest that physiotherapists conceive movement on a
continuum from a micro- (molecular, cellular) to a macro- (the person in their environment
or in society) level. The authors argue that the theory is a unique approach to
movement rehabilitation because it incorporates knowledge of pathology with a
holistic view of movement, which includes the influence of physical, social and
psychological factors into an assessment of a person’s maximum achievable
movement potential. They argue that the role of physiotherapy is to minimise
the difference between a person’s current movement capability and his/her
preferred movement capability.
In the UK, one approach to conceptualising physiotherapy is
to consider physiotherapy, as defined by the Royal Charter, as the four pillars
of practice of:
• massage;
• exercise and movement;
• electrotherapy;
• kindred methods of treatment
A recent definition of the Physiotherapy Framework
states that:
Physiotherapy is a healthcare profession that works with
people to identify and maximize their ability to move and function. Functional movement
is a key part of what it means to be healthy. This means that physiotherapy
plays a key role in enabling people to improve their health, wellbeing and
quality of life.
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