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sexual harassment in the workplace

Definition of Sexual Harassment

Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when either:

• The conduct is made as a term or condition of an individual’s employment, education, living environment or participation in a University community.
• The acceptance or refusal of such conduct is used as the basis in decisions affecting an individual’s employment, education, living environment, or participation in a University community.
• The conduct impacts an individual’s employment or academic performance unreasonably or creates an intimidating, hostile or offensive environment for that individual’s employment, education, living environment, or participation in a University community (Arbor, 2018).

Clinical experience description:

At a recent block I had a patient who had a skin disease which lead to sores over his entire body. He was referred to physiotherapy for mobilization. During the second session with him he made a few comments that I brushed off at the time comments such as “I need to take you on a date, not a date date but just a coffee” “you’re such a great physiotherapist” “be careful I’m completely naked under the gown”.  Besides the comments during sessions he would constantly glare at me like a deer in the headlights, speaking to me in a flirtatious tone.

In the third session we proceeded to walk and I was trying to not only make sure he does not fall, but also holding his gown closed at the back, as we were walking his comment to me was “I’m so glad I’m not your boyfriend, you are really torturing me” to which I responded that he needs to receive physiotherapy to improve.

The comment that got me the most was when we were walking and he stopped walking and started smirking with a giggle and he said “You are a naughty one aren’t you? You want my naked body to show”. I was taken off guard and being in a professional setting I kept quiet. He was discharged from physiotherapy after this session.

For the next week each time I walked past his ward he would call my name repeatedly screaming and screaming my name over and over day by day on a never ending cycle, which I ultimately ignored. Then on the one day, as I walked by the ward he was in, my entire body feeling uncomfortable as I approach the ward, I passed it and nothing. Silence. Not even 5 seconds later I hear my name being called and turn around and see him standing there in the passage way.

What is the effect that Sexual Harassment has on physiotherapists?

According to a study by Cooper, Jones & Jenkins, 2010 sexual harassment in healthcare settings is reported to occur at a high rate in the form of inappropriate patient sexual behavior (IPSB) towards healthcare professionals. Inappropriate patient sexual behavior has been defined as “a verbal or physical act of an explicit or perceived sexual nature which is unacceptable within the social context in which it is carried out” (Johnson et al 2006). These acts can vary from forced physical advances to innuendos and sexist remarks and when specifically related to the physiotherapy profession, the close physical proximity, partial disrobing of patients and interpersonal relationships established over a course of treatment therefore places physiotherapists at risk of experiencing IPSB (Cooper, Jones & Jenkins, 2010). Inappropriate patient sexual behavior can lead to the development of significant physical and psychological symptoms and these consequences can negatively impact on a physiotherapist’s work in the form of absenteeism, reduced productivity, lack of confidence and poor concentration (Cooper, Jones & Jenkins, 2010). For students the effects of IPSB have the potential to reduce the quality of the learning experience (Cooper, Jones & Jenkins, 2010).

Neurological impairments leading to inappropriate sexual behavior

Inappropriate sexual behavior (ISB) as a result of neurological impairment is often overlooked in comparison to other challenging behaviors such as agitation and aggression, yet the impact on patients and carers can be equally significant. In a study by Knight et al., 2008 patients with a neurological impairment were evaluated  the study found 924 incidents of challenging behavior captured over a 10-week period for 36 patients; 16.34% of incidents were sexual behavior. Statistical properties of the scale were obtained using written descriptions and video enactments of ISB generated by clinicians. Results indicate strong construct and content validity, and good inter-rater and test-retest reliability. (Knight et al., 2008).

Examples of Sexual Harassment
Unwanted sexual statements: Sexual or dirty jokes, comments on physical attributes, or rating others as to sexual activity or performance, talking about one’s sexual activity in front of others and displaying or distributing sexually explicit drawings, pictures or written material. These unwanted sexual statements can be made in person, in writing or electronically (Arbor, 2018).

Unwanted personal attention: Letters, telephone calls, visits, pressure for sexual favors, pressure for unnecessary personal interaction and pressure for dates where a sexual intent appears evident but remains unwanted (Arbor, 2018).

In a study by Cooper & Jenkins, 2008 when the respondents in the study were presented with a vignette describing alleged sexual misconduct, 83% of respondents stated they would advise the patient to make a written complaint to the appropriate disciplinary body. Less than 20% stated that they would personally report their colleague to the Physiotherapists’ Registration Board or the Australian Physiotherapy Association National Professional Standards Panel. In conclusion the variation in responses to the vignettes, the reported incidence of sexual attraction and dating of patients, and apparent confusion with regard to the complaints process identifies the need for education of the physiotherapy profession in Australia (Cooper & Jenkins, 2008).

In a study by Lowe & Gabard, 2014 the specific aims of this research were to; gather insight on students’ ability to identify, address, and report ethical and legal violations encountered in the clinic; gain insight into barriers that prevent students from reporting these violations; and collect student suggestions for the curriculum and clinical supervision that might assist them in identifying and reporting ethical and legal violations. A survey was developed, to assess 6 potential areas for ethical and legal violations: resource utilization, supervision, sexual harassment, truth telling, respect, and blatant wrongdoing. In many cases students did recognize legal and ethical wrongdoing in the clinical environment and responded appropriately. Among those who recognized the problems but did not report, the most common barrier was “low position of hierarchy.” The second most common barrier reported was “did not recognize as an issue.” Results from the discussion groups indicated that the survey reflected topics covered in didactic coursework; however, students felt they would have benefited from having courses covering these violations earlier in their curriculum and incorporating ethical and legal issues into the more clinically based coursework (Lowe & Gabard, 2014).

Harassment of patients

This is not allowed as the patient already vulnerable. It violates the trust of colleagues in the profession. However if the feelings are genuine and voluntarily returned the relationship should only be pursued once the patient-health professional relationship no longer exists.

Harassment by patients

This appears to be a more common problem in physiotherapy where therapists come into close physical contact with patients. Several studies have established that up to more than 90% of physiotherapists and physiotherapy students have experienced some form of sexual harassment. When it is mild, most will ignore it or not respond, in severe cases appropriate disclosure and a note in the patient’s folder should result and reassignment of the patient to another therapist.

The following steps are suggested by Gabard and Martin (quoting Scot, who is both an attorney and a physical therapist):

1. Investigate the victim’s complaint

2. Counsel the offender to stop

3. Transfer the patient to another therapist

4. Consult other professionals, as appropriately

5. If the patient persists in sexual harassment, remove him/her from service

What I’ve learned and how this will influence my future practice;

• From my research I have learned that inappropriate patient sexual behavior can lead to the development of significant physical and psychological symptoms and these consequences can negatively impact on a physiotherapist’s work in the form of absenteeism, reduced productivity, lack of confidence and poor concentration. For students the effects of IPSB have the potential to reduce the quality of the learning experience.
• Inappropriate sexual behavior (ISB) as a result of neurological impairment is often overlooked in comparison to other challenging behaviors such as agitation and aggression, yet the impact on patients and carers can be equally significant. This was important to me as I have a better understanding of when it is not the patient’s fault that they act inappropriately
• I also learned that a study concluded that students felt they would have benefited from having courses covering violations earlier in their curriculum and incorporating ethical and legal issues into the more clinically based coursework.
• Furthermore I now understand that I could have made a note of the patients behavior in the clinical notes, I also could have told someone about what happened which could have led to the patient being removed from my patient load and given to someone else.

References;

Cooper, I., Jones, A., & Jenkins, S. (2010). Professional sexual boundaries—Asian and Western perception: An observational study. Hong Kong Physiotherapy Journal, 28(1), 2-10. doi: 10.1016/j.hkpj.2010.11.003

Cooper, I., & Jenkins, S. (2008). Sexual boundaries between physiotherapists and patients are not perceived clearly: an observational study. Australian Journal Of Physiotherapy, 54(4), 275-279. doi: 10.1016/s0004-9514(08)70007-2

Arbor, A. (2018). What is Sexual Harassment? | Sexual Assault Prevention and Awareness Center. Retrieved from https://sapac.umich.edu/article/63

Knight, C., Alderman, N., Johnson, C., Green, S., Birkett-Swan, L., & Yorstan, G. (2008). The St Andrew’s Sexual Behaviour Assessment (SASBA): Development of a standardised recording instrument for the measurement and assessment of challenging sexual behaviour in people with progressive and acquired neurological impairment. Neuropsychological Rehabilitation, 18(2), 129-159. doi: 10.1080/09602010701822381

Lowe, D., & Gabard, D. (2014). Physical Therapist Student Experiences With Ethical and Legal Violations During Clinical Rotations: Reporting and Barriers to Reporting. Journal Of Physical Therapy Education, 28(3), 98-111. doi: 10.1097/00001416-201407000-00011