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JCPSLP Volume 15, Number 3 2013 149
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,
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