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THE ROLE ETHICS AND PROFESSIONALISM PLAY ON RELATIONSHIPS WITH HEALTH PROFESSIONALS
First of all it is important to emphasise on the fact that being employed in the healthcare establishment is a responsible and stressful work and that is why, a set of factors should be taken in account in the process of making a decision of being the doctor or physician.
Walther N. et all consider that the selective approach towards the personal features of the future healthcare professionals should be applied in the beginning of their career - in the process of their entry to the educational establishments due to the fact that there are some personal features, which cannot match with the professional activity of the physician. Among such personal features, authors outline the following issues: dysfunctional tendencies (dysfunctional personality characteristics); high levels of anxiety; negative approach towards examination process; inclination for inadequate behavior in stressful situations; lack of self-confidence and self motivation; deficits of the social skills; constant fear of failure; communicative problems etc. (Knights & Kennedy 2007).
In addition, authors consider that there is a probability of negative impact of the following dysfunctional tendencies as inclination for sexual harassment, suicide, substance abuse etc.
I would like to pay additional attention to the substantial abuse due to the fact that this is the problem of our current society. The other name of substance abuse is drug abuse. Scientists consider the substance abuse as the maladaptive pattern of use of some remedies, which do not cause dependence if they are applied according to the manual. There are different definitions of the drug abuse and this term is widely applied both in medical and in non-medical practice. For example, there are such contexts of substance abuse using as psychoactive drug or performance enhancing drug. Generally it is possible to consider the drug abuse as the negative effect of drug using (in comparison with the positive aspects of its medical applying - responsible drug use) (Walther, 2010)
Another wide applying of the substance abuse term is associated with tobacco, alcohol, cocaine, opioids, benzodiazepines and barbiturates. In all above listed cases the negative impact on the health condition, causing the criminal responsibility and suffering from the social and psychological harm –that all are unfavourable aspects of the substance abuse. Currently, in accordance with UN statistical data, more that 50 million people worldwide are regular users of heroin, cocaine and synthetic drugs. This problem is very urgent for the nowadays youth and it is obvious that the future doctors are also under the risk of being substance abused that us why the selective approach towards their employment and even entering to the educational establishments should be applied.
That is why authors have developed the model for these features evaluation in the process of interview in the entry to the educational establishment, this model is developed in the form of mini-interview protocol, which consists of a set of short OSCE-style stations. The key task of such approach is evaluation and correction of the deviations, which do not feet the basic requirements of the health care professionals’ activity.
Other scholars consider that it is almost not possible to correct the personal features of the individual, which have been formed in the beginning of the life by parents, social environment and other factors.
Patrick Duff considers the humanity to be the core value and the professional attribute of the physicians. That, in turn, means that such issues as inappropriate sense of entitlement and arrogance should be eliminated from their personal features even in the case of professional success, development and occupation of the high positions in the educational establishments’ hierarchy.
Patrick Duff considers that the worst feature in communication with the patients for the doctor is the hubris even if this negative feature is combined with the excellent competence in the area of activity and with the clinical skills. That is why it is possible to draw a conclusion that the doctor is required to have the high rate of morality, competence, empathy and respectful attitude towards the problems of their clients- patients.
The next important feature is the fair treatment due to the fact that in some cases the physicians integrate their professional activity with the business and are tending to make money from the vital problems of their patients- they recommend them the high const treatment, which is not the best solution for their disease treatment etc. That is why the honesty in the light of intellectual and personal features is the second attribute of the physicians’ professionalism.
Patrick Duff defined the honesty as the initial bedrock of creating the set of professional features of the doctors. This feature provides the doctor with the creditability and creates ones’ reputation.
The next features, required for the professional activity of the medical staff imply the responsible attitude towards all the actions and decisions, made by the doctor, ones’ reliability, and accountability.
Additional attention of the doctor should be paid to ones’ own spiritual and physical health in order to be able to make fast and correct decisions, to be adequate and objective towards the circumstances and to keep the balance between the own-family life and the daily responsibilities at the hospital. For this approach it is rationally to apply the maxim- “Physician, heal thyself”.
Such personal features as respectfulness, tactfulness, sensitivity, compassion, altruism and loyalty are the attributes of professionalism for the healthcare workers.
In order to achieve the level when the majority of doctors have such features, the special training programs and workshops with the case studies should be implemented into the practice along with the initial evaluation of the personal features of the future physicians. The respectful attitude, based on the core principles of the ethical behavior should be inherent to the personnel of the healthcare establishments in all spheres of their professional activity- whether it is the communication with the colleagues, patients or with the students. The last aspect (communication with the students) is very important because the pattern of the future doctors behavior in the healthcare establishment is forming in the process of their education though the direct observation of their supervisors; behavior, attitude, communicative skills and personal features and approach towards their professional activity. Such behavior should be formed on the sublime level- only in such case it is possible to reach the level of the high professionalism combined with the personal features and respectful attitude towards all the people (Duff, 2011).
In addition, I would like to support this point of view with the evident examples of the violation of the basic rules of morality, ethics and responsibility on the working place. First of all, the beginning of such violation lies in the irresponsible attitude towards the educational process. Secondly, arrogance and disrespectfulness occur due to the fact that the student or the resident gets the inappropriate sense of entitlement. Among other negative features of the doctor, it is possible to consider the prerequisites to the discrimination, whether it is based on sexual, gender or racial issues and is directed to the patients or to the colleagues.
In some cases the physicians’ over evaluated sense of self-importance leads to the abrasive interactions with the colleagues or with the patients. As a result of such behavior, the lack of responsibility for own decisions and actions may occur and that is not acceptable in the practice of the physical due to the fact that it puts the health and life of the patient under the risk.
As an economical example of an inappropriate behavior of the doctor, it is possible to consider the fiscal irresponsibility of one’s actions, such issue may imply the high cost laboratory tests, which are not required by the current situation, integrating the selfish expansionist ends with the healthcare activity and getting the extra incomes from such activity etc.
In some cases, the doctors are not tending to update their knowledge with the latest trends and effective achievements of the medical science and that in turn, may be considered as the lack of the commitment to self-learning. It is obvious that the medicine requires lifelong learning due to the fact of the constant scientific developments and inventions in all its areas. Finally, it is possible to consider the personal excesses the negative example of the physicians’ conduct.
That is why it is possible to make a conclusion that it is hard to overestimate the role of the ethical and responsible behavior for the doctors and for the future doctors’ professional activity due to the fact that it is the basics for their professional success- it disciplines, it develops the new approach towards the professional activity and the life quality in whole, it develops the positive features of the character- such as responsibility, honesty and reliability and finally, it makes the contributions to the image of the nowadays doctor, who is competent, highly appreciates the moral values of the society and may be considered as the pattern of behavior for the future generations of the professionals in the area of healthcare.
In the end of this section, I would like to consider the case study. First of all, it is possible to consider such behavior as inappropriate for the faculty member- the sexual/romantic relations with the students (subordinates). In the case if there is possibility of solving this problem without involving the third parties- rejecting the proposal of the faculty member, supporting it with an availability of beloved person or husband and if such rejection does not have the negative outcomes for the future career of the resident, such approach should be applies, in the case if there is a sexual harassment, but nit the romantic feelings the second approach should be applied - this concern should be addressed to the direct supervisor of the faculty member- to the head of a chair or to the dean.
At the same time, this issue should not be made public by the resident, because it may have the negative outcome for her further career- this is the task of the faculty members’ supervisor (in the case if the eye-to-eye conversation does not bring the positive outcome and if the problem won’t be solved).
Generally, faculty-resident interaction is not acceptable due to the key rules of subordination. To my opinion, the first stage of conversation with the faculty member should be eye-to-eye conversation with the supervisor and in the case if it is the first violation of such type, the severe reprimand and warning should be applied. In the case of repeated commission, the retirement should take its place and it should be based on the fact of service discrepancy and the public discussion of this fact should also take its place in order to prevent further violation of the basic rules by other doctors .
DESCRIBE HOW THE CONCEPT OF SELF-REGULATORY STRENGTH APPLIES TO PATIENT CARE AND RELATIONSHIPS WITH HEALTH PROFESSIONALS
In order to develop this theme in the light of the medical workers’ professional activity, it is important to rely to the background of the self regulation notion. Scholars consider the self regulation as the ability of the individual to alter and manage own behavior. Usually, the main reasons for the changes in behavior are the stressful situation, changeable circumstances, new ideas and goals and finally, the social standards of life.
In majority of cases, the quality of the actions, carried out by the individual depends on ones’ own motivation and beliefs. Finally, some scholars consider that the everyday self regulation is mainly influenced by the life standards, its objectives and ideals of the individual.
Laura B. Luchies et all in their article “The Effects of Self-Regulatory Strength, Content, and Strategies on Close Relationships” outline the following conceptions, concerning the self regulatory strength: its effects on the activity of individuals, its content and strategies (Luchies et all, 2004).
In the light of the healthcare establishments’ employees’ professional activity and relationships with the colleagues and patients, the self regulation has a great impact. From one hand, the self-regulatory ability of the individual is mainly influenced by the ones’ ability for the self regulation. This personal feature of the physician may be considered as one of the most important due to the fact that the professional activity of the medic is considered to be the stressful work, which requires quick decision making process under the changeable and in some cases, unpredictable circumstances. Another aspect of the self regulation ability implies the self-regulatory strength - the total amount of the self-regulatory ability, which may be applied into the practice while managing the difficulties in the given goal achievement. In the light of the employment in the healthcare establishments this means managing own stress and fear of failure, personal life problems etc while making a decision concerning the patient treatment care, and support. In addition, such ability may be useful in the psychological support of the patient with the terminal disease.
It is obvious that there is a deep interpretation between the self-regulatory strength (which involves the temporary fluctuations and chronic individual differences) and the quality of the relationships of people in the team working process. In addition, in the case if the individual (physician) has got the strong dispositional self-control, the probability of being successful in this area of the professional activity increases.
In the scopes of the influence of the self regulation for the professional activity of medics, I would like to consider this question in the light of the three following directions: individual differences in self-regulatory strength; situational fluctuations in self-regulatory strength and interpersonal goal content.
While taking in consideration the individual differences in self-regulatory strength, it is important to pay additional attention to the fact that people vary in their ability to regulate themselves successfully and that is why it is important to take this aspect in account in the beginning of the professional career of physician (Walther et all, 2010).
In other words, as it has been stated in the previous section, the selective approach should be applied in the process of the students’ entering to the educational establishment and those individuals, who have the lowest rate of the self regulation ability should not be provided with a possibility of working in the stressful situations in the hospitals (for example, they should not be employed as the surgeons or as the resuscitation specialists, but at the same time, there is a probability that their cognitive thinking may be applied for the scientific work or for being employed as the nurses). All these aspects should be taken in account at the initial stage of the professional career development in order to provide the individual with the possibility of complete self realization and the life goals achievement again, as it has been stated above the psychological tests should be applied for this purpose and these tests should involve the case studies and even visiting of mortuary, observation of postmortem examination etc in order to evaluate whether this individual is temperamentally suitable for work in the health care establishments or not at the initial stage.
In some educational establishments, such practice is widely applied and it is not possible to consider it as the violation of the human rights- freedom of choice in particular, because in majority of cases those individuals, who cannot match their personal character features and mentality with the work with blood, pain and negative emotions of the medical workers’ professional activity, make the decision by themselves that this is not what they want form the life and chose another profession. For the process of such evaluation purpose the strength model of self regulationshould be also applied. Its main advantage is drawing the full picture of the individuals’ self-regulatory strength
While taking into account the role of the situational fluctuations in self-regulatory strength for the physicians, it is important to rely to the fact that in some cases the depletion of the self-regulatory strength may have its place due to some circumstances- stress, physical emaciation, personal problems etc. It is obvious that such mental and health condition has a negative impact on the relationships with the patients with the colleagues and on the total work efficiency and adequacy of the made decisions.
In addition, the negative outcome of the fluctuations in self-regulatory strength may be reflected in the lowered efficiency of the self-presentation of the physician. It may be represented in the form of the excess information disclosure about other patients, about own personal life etc, which is not acceptable for the professional activity of the employee of the healthcare establishment.
The last aspect of the self-regulatory strength in the professional activity of the health professionals to be discussed in the scopes of this research paper is the interpersonal goal content. While talking in account the fact that the work in the health care establishments mainly is organized in eh form of the teamwork. It is important t pay additional attention to the fact that in such case the key success factor is the balance of the multiple sets of the interpersonal goal. That means that the promotion of the positive relationships between the healthcare professionals and of the careful supervision and respectful subordination in the team.
It is obvious that the quality of the relationships in the team depends on the interpersonal goals of its members. At the same time, there are two opposite aspects of this question- from one hand, the individuals, who are involved into the close professional relationships are tending to standardize their goals onto the common and integrated one and from the other hand, every member of the team is tending to promote and to defend the individual approach, position and the point of view, concerning some particular issue.
That is why in order to keep the balance in the team working in the healthcare establishment, to be the successful and professional in the particular area and to have the positive relations with patients and colleagues, the high level of responsibility, self regulation and the respectful attitude towards work and people are required. Such characteristics of the individual are both inherent to the individuality form the beginning of the life and may be considered as the result of good education and also, they may be achieved as a result of the constant self development and improvement (Walther et all, 2010).