Module 7 Flashcards
Define occupation
routinized work, lack of autonomy, structured conditions and patterns.
Define profession
autonomous decision making in ambiguous circumstances…application of judgment… knowledge and skills
When is an occupation a profession?
A continuum rather than a dichotomy
Occupation deemed a profession if it possesses a number of traits.
No consensus on which traits
Many are generally agreed upon
Traits are categorized as either structural or attitudinal
Structural Traits
Specialized knowledge and skills
Performing a service important to society
Autonomy for the service provider
Self-regulation, formal organizations and codes of ethics
A system for training others in the knowledge, skills and values of the profession
Shared ethical values
Practice based on theoretical knowledge
Professional culture passed on to new entrants
Professional authority that includes power and privilege sanctioned by the community
Attitudinal Traits
A belief in service to the public
A sense of a calling, or dedication to the profession
Commitment to self-improvement
Service orientation to patients and to the profession
Creativity and innovation
Trustworthiness
Accountability
Integrity, duty, and honour
Leadership
Define Attitudes and Behaviours
Attitudes - learned predisposition
Behaviour - actions in response
A professional attitude can be defined as a predisposition, feeling, emotion, or thought that upholds the ideals of a profession and serves as the basis of professional behaviour.
Key traits of a profession
Special knowledge based on a theoretical framework
Ability to use that knowledge with experience and good judgment
Payment for services
Professions also differ from non-professional occupations in that the relationship between provider and recipient is not merely nor primarily commercial.
Professions are expected to charge a fee (in some cases substantial) for the services provided; however…
The primary goal of the exchange is to maximize the benefit received by the patient rather than the provider of the service.
Patient and Profession (relation to payment)
It is a relationship built on the ability of the patient to trust the professional will be working in the patient’s best interests
The nature of the relationship implies both a covenantal and a fiduciary relationship
Seen as essential between a member of a profession and the person being served.
Why has pharmacy not been considered a profession in the past?
- Lack of control over work. deference to physicians
- Semi-professional based on over-reliance on technical skills
- Quasi-professional due to lack of autonomy or equivalency of members (heirachy - unclear roles)
How can pharmacy become a profession?
Consistently demonstrate the structural and attitudinal traits of a health profession.
Must possess clinical knowledge and skills, and the ability to control how these are used to provide patient care through self-regulation and professional autonomy.
Must possess and convey the attitudes, values and habits that are at the core of a profession.
Attributes such as altruism, accountability; excellence; duty; honour and integrity; and respect for others.
Define standards of practice
Standards of Practice are grounded in those services and abilities expected of pharmacists as health care professionals.
They are not “laws” but, along with a Code of Ethics, describe the behaviours expected of a practising professional
Pharmacy model of practice
- Providing care
- Knowledge and Expertise
- Communication and Collaboration
- Leadership and Stewardship
- Professionalism
(PKCLP)
Pirates Kill Civilians Love Pirates
Define professionalism
many definitions
attitudes and behaviours that serve to maintain patient interest above self-interest”
Hammer’s Bicycle Wheel Metaphor
The central hub (Values/Attitudes)
Altruism, caring, honor/integrity, duty
Respect, empathy, compassion
The spokes (Behaviours)
Takes responsibility, maintains confidences
The tire (the surface of professionalism)
Professional dress, courtesy, punctuality
Recent version of Hammer’s Bicycle Wheel Model
Hub: fiducial or covenantal relationship between pharmacist and patient (individual or collectively)
Spokes: behaviours expected to arise from a commitment to patients.
Rim: interaction between the performance of various pharmacy activities and the pharmacist’s expressed professional values and behaviours. (how you interact with the pt)
Patient-Centred Professionalism
- Primacy of the Pt
- Provider needs to respect and support the right of the patient to make decisions about what care will be sought and accepted
THE PROVIDER FACILITATES THE PROCESS BASED ON NEEDS AND PREFERENCES OF THE PT
Professionalism Vs. Professional Identity
- professional identity is foundational to the development of professionalism within the individual.
Boundaries between the two are difficult to define, and the effect on one another is continuous and non-linear.
Why professional identity matters?
- Focus still primarily on dispensing
- Lack of a professional identity is seen as an important rate-limiting factor when addressing change to barriers
Apothecary
Highly regarded makers of medicines who combined art and science to care for the people of their communities.
Dispenser
A person of science and moral character. Dispensing new effectivesmedicines created by science with some compounding.
Merchandiser
Corporatized and undesirable. Seen as responsible for a decline in professional standing. Reduced individual autonomy. Conflict between professional and business goals
Expert Advisor
Pharmacist as consultant or expert advisor to the physician. Drug Information and clinical service centred; but role is clearly subordinate to physicians.
Health Care Provider
Pharmaceutical care and patient-centred. Accountable and responsible for drug-related patient care outcomes. De-emphasizes the dispensing and merchandising roles.
Discursive Pile Up
- Older elements are retained that are incompatible with newer identity being constructed
Why is a strong professional identity needed?
maintain or advance professional status in times of changing scopes of practice;
support the self-regulation needed to ensure high standards; and
create the confidence needed to practice effectively.
PIF Pyramid
KKSDI Kim K Show Dont Interrupt
The formation of a professional identity
Bottom
Knows (Knowledge) - behavioural norms of a pharmacist
Knows When - individual behaviours are appropriate (competence)
Shows how (performance)- able to demonstrate the behaviours expected of a pharmacist under supervision
Does (Action) - Consciously demonstrates the behaviours expected of a pharmacist
Is (Identity) - Demonstrates the attitudes, values and behaviours expected of one
Top
Define Ethical Dilemna
a situation in which a difficult choice has to be made between two courses of action, either of which entails transgressing a moral principle
Autonomy
Ability to accept or refuse care (level of understanding)
Confidentiality
Not to divulge patient information (maintain trust
Telling the truth
Cannot mislead or misinform the patient (nor permit others to mislead or misinform)
Do no harm
Seek to improve patient’s condition while minimizing pain and discomfort (well-being – mental, physical, spiritual)
Justice
Equitable distribution of resources and personal responsibility for one’s health
Guiding Principles in Bioethics
Autonomy
Confidentiality
Telling the truth
Do No Harm
Justice
Bioethics vs. Professional Ethics
Bioethics
The focus is on rights and principles.
The application of bioethical theory to difficult and challenging ethical dilemmas arising from patient care.
Professional Ethics
Centres on the integrity of the individual clinician in complying with a professional code of behaviour.
Codes, or norms, that are reflective of, yet sometimes in conflict with, bioethics
Duty-to-self
As individuals we have a right to our own beliefs and opinions, and should be free to live our lives in the manner we judge best for ourselves.
But, one does not impede others from exercising the same rights, as individuals we should be allowed to live our lives in a manner that is consistent with our own beliefs and values.
Duty to Care
While each of us is a moral agent, the freedom to act according to one’s own conscience is further curtailed when we choose to become a health care professional.
When we assume the privileges of our profession, we must be prepared to put aside some aspects of conscience (duty-to-self) to serve the societal obligations (duty-to-care) of our chosen profession.
What should a pharmacist do when they have a moral objection?
- Do not tell pt why you object
- help them seek out other pharmacies or care providers that provide the service
- help the pt receive the care
Primacy of PT
As a health care professional, one must be prepared to accept the fact that a situation may arise that requires the practitioner to act in the interests of their patients, even when these actions are contrary to the personal beliefs and preferences of the practitioner.
What are some actions that defame pharmacy?
Drive through Pharmacies –> Services must be individualized for the pt
Discount Terminology –> The term “discount” places pharmacists in the merchandiser world
Inducements/Incentives –> should obtain pt’s trust and respect through earning it
Internet Pharmacy –> Distinguish online drug marketing and procurement should be seperate to pharmacy. Many of these drugs are unapproved and potentially dangerous/ineffective
Counselling in Public Areas –> Broadened scope of practice, broadened service –> respect pt’s privacy –> using counselling rooms for PWI’s for methadone
Allowing other professions to define our practice –> Shared authority is vital; however, pharmacists need to take on more responsibility
Physicians Identity in Comparison to Pharmacists
- Physicians do not simply do medical work, they are physicians
- This ideology does not exist in community pharmacists
- Community pharmacists rarely volunteered their occupation, nor did they overtly question care plans or treatment
Why do Pharmacy Professionals lack an Identity
Pirates to Land Run
a) Personal identity was more important than professional identity
b) Trust in other health professionals competence is integral to personal identity
c) Lack of self confidence around potential value of self-disclosure as a pharmacist
d) Reliance upon personal identity for advocating for care rather than professional knowledge and skill –> “being polite and nice as a way for decision-making”
Professional Identity Formation Pathway
- Not linear, it evolves and adapts over time depending upon circumstances
Three professional identities
Identity Splinting –> Previous occupational or personal identities remain dominant and result in weak professional identity (abortion is immoral, will not prescribe abortificants)
Identity Patching –> One’s professional identity is incomplete in some areas, patched together with occupational or personal identities (9-5 pharmacist, leave that at work and no responsibility to represent a professional identity)
Identity Enrichment –> One’s underlying personal/occupational identity is amplified by professional identity (cue jumping- entitled to certain privileges)
Findings of Ontario Study of Pharmacy Technicians
a) Identity Splitting most common professional idnetity
b) Social Validation is crucial to developing a professional identity
c) Professional identity formation is restricted by by lack of roles, role models and environmental oppurtunities to act as semiautonoumous professionals
–> Education to becoming “registered is unclear” –. Some post-secondary to regulation, some un-regulated to regulated through online learning
–> Technical skills rather than judgment and decision making
Emergency Hormonal Contraception
- SOme pharmacies hold conscientious objection to OTC supply of EHC and refuse to supply it
- Some see this as a right to pharmacists autonomy and integrity while others vie wit as a contradiction to the professional obligations of pharmacists
- Can morally object; but must not prevent that person from seeking care and should help that person seek care
Why should conscientous objection be allowed? Is it enough to justify the conscientous clause?
Moral Anguish –> would be harmful to force someone into moral distress
- Conscientous clause should not be used to avoid service the pharmacist finds unpleasent
- NO
Integrity
- A set of virtues, namely a commitment to acting morally which includes critical assessment and self-reflection of ones own view and genuine consideration of other points of view
- Connection to cultural safety
Conscietous Clause Faults
- An individuals personal values to some extent were given preference over the professions values
When can a pharmacist object to a service?
- performing the action would be against a personally held value and such act would not go against the core values of the profession
Model of Compromise
- The profesisonal informs the pt about the relevant service or tx
- The profesisonal refers the pt to someone who can provide the service or tx
- The referral does not cause unreasonable burden on a pt
Incompatibility Thesis
To refuse to supply a tx or service promised by the professional body is is to fail to meet one’s professional obligations
- By referring elsewhere, the provider has not prevented the profession from fufilling its obligations
