Throughout the years of clinical experience, I have noted how many clinical dilemmas physiotherapy students have undergone. Personally there are multiple dilemmas I could refer to. Amongst the incidents that occurred, my stature was a factor.
During my clinical rotation, I was placed at a hospital setting. The patient was a lady in her fifties, who has undergone a laparotomy and was a day post operation. On arrival she was chatty and friendly with the current nursing sister. I introduced myself, explained what physiotherapy entailed and gained her consent. Throughout the subjective the patient was friendly, chatty explaining stories about herself. Under my impression we formulated a patient- physiotherapy relationship.
According to the Health Professions Council of South Africa (2008) effective communication enable the patient to make informed decisions by explaining their condition and the treatment thereof, which in turn leads to clarity of objectives and provides them with an understanding. This will provide a framework for the patient to co-operate with agreement to their management.
We started the objective assessment and it went fairly well, however we moved onto mobilization, she sat on the edge of the bed, she was reluctant as she mentioned that I was too “small” to help her up and walk with her as she mobilizes, I gathered the walking frame. She was comfortable using the frame. The second session she refused to do the physiotherapy session, she said the nurse and I should apply lotion onto her legs. I explained the role of physiotherapy again and attempted to motivate her yet she still refused, I respected her and accepted that this could cause an altercation with my clinician. I respected the right of the patient to refuse treatment.
My clinician went to see her as I reported what had occurred prior that day in our feedback session. The patient co-operated well, she mobilized without the walking frame and minimal assistance, the patient expressed to the clinician she did not appreciate the tone I used when approaching her. I was approached by my clinician and I apologized to the patient as I have respect for my elders. Upon the fourth session, I would treat the patient with chest exercises and motivate her, she would mention my stature when we had to mobilize and enquire for the frame again. In each session somewhere my stature would be mentioned.
The concept of moral distress has a changing definition as there is a lack of consensus. However Webster & Baylis (2000) suggested that moral distress is setting aside or violation of deeply held beliefs, values and principles; that results in unresolved moral distress. Moral distress results moral residue which is defined the recollection of practical situations that the clinicians carry with themselves in powerful concentrated thoughts.
Carpenter (2010) defined moral distress as the individual practitioner’s experiences of loss of personal and professional integrity when their desire to maintain professional standards achieves the best outcomes for clients With regards to my experience the patient was not comfortable with my small stature when mobilising, when mentioned each session it lead to the idea that my capability to be effective was farfetched. As each session occurred I could feel my motivation and confidence was affecting the session therefore I was not giving the 100% I would give within the first three sessions. The thought crossed my mind that due to this my session was not effective as she did not trust my stature instead of my ability as a student physiotherapist. I respected her rights throughout the period she was my patient. Was it against the patients’ rights to treat her, despite her being somewhat uncomfortable with my stature?
It made me question my integrity within my profession.
References
GUIDELINES FOR GOOD PRACTICE IN THE HEALTH CARE PROFESSIONS SEEKING PATIENTS’ INFORMED CONSENT: THE ETHICAL CONSIDERATIONS. Booklet 9. May 2008
GUIDELINES FOR GOOD PRACTICE IN THE HEALTH CARE PROFESSIONS ; NATIONAL PATIENTS’ RIGHTS CHARTER. BOOKLET 3. May 2008.
Carpenter . C. Moral distress in physical therapy practice. 2010.
5 thoughts on “The moral distress of petite vs patient”
Hi there Aly,
Thank you for sharing your writing piece on moral distress. I am going to follow the rubric guidelines for feedback.
Context: Your topic falls within the topics we have discussed in our ethic lectures. Consider adding a picture for the reader as it may help to trigger thoughts about the writing piece and intrigue them to read it. I suggest a picture with the quote: “Dynamite comes in small packages”? This will further link to your topic that although a person may be petite of stature, it does not change the ability or the capacity to manage a patient effectively. I feel I can relate to your topic as I am too somewhat of petite of stature. Many people have asked me in the past, “Are you sure you are strong enough to be a Physiotherapist”, and although at times discouraging, it is important to know and be certain that YOU are enough and to be confident in your abilities.
Argument: You proposed a good arguments with good statements. However, I feel that you can further be justified more strongly by adding more referenced statements or the use of stronger words. For example, consider finding literature that deals with what peoples’ thoughts are when receiving physiotherapy treatment from a petite physiotherapist and in return, how this impacts then the work of the petite physiotherapist? Although you state in the writing piece how it impacts the physiotherapist, I feel by adding references it will strengthen and validate your arguments. For your conclusion, I feel that perhaps you need to link it more to your arguments which you made earlier in the writing piece.
References: You used good references; however, just check your referencing style. Consider using lowercase letters for the first two references. Also, you included Webster & Baylis (2000) as an intext citation, however it is not included in your reference list below.
Writing: To aid in the flow of your thoughts, consider linking words such as: therefore, nonetheless, moreover or in addition as these words will help with linking your arguments. In terms of grammar errors, consider using commas after using linking words. Maybe consider joining paragraph 2 and 3 as it still deals with the same aspect? Perhaps consider joining paragraph 5 and 6, for example:
The concept of moral distress has a changing definition, as there is a lack of consensus. However, Webster & Baylis (2000) suggested that moral distress is setting aside or violation of deeply held beliefs, values and principles; that results in unresolved moral distress. Moral distress results moral residue, which is, the recollection of practical situations that the clinicians carry with themselves in powerful concentrated thoughts. Furthermore, Carpenter (2010) defined moral distress as the individual practitioner’s experiences of loss of personal and professional integrity when their desire to maintain professional standards achieves the best outcomes for clients. Concerning my experience, the patient was not comfortable with my small stature when attempting to mobilise her. When mentioned in each session it lead to the idea that my capability to be effective was farfetched. As each session occurred I could feel my slight lack motivation and confidence was affecting the session, therefore I was not giving the 100% I would give within the first three sessions. The thought crossed my mind that due to this my session was not effective, as she did not trust my stature instead of my ability as a student physiotherapist. I respected her rights throughout the period, as she was my patient. Was it against the patients’ rights to treat her, despite her being somewhat uncomfortable with my stature?
From here on, I suggest adding a paragraph based on the literature you found that deals with what peoples’ thoughts are when receiving physiotherapy treatment from a petite physiotherapist and in return, how this influences then the work of the petite physiotherapist? I think this will strengthen your argument and help you to link your thoughts together for a conclusive ending.
I enjoyed reading this, it triggered me to think about my thoughts on the topic.
Well done Aly!
– Jana x
Hi Alyssha, Thanks for sharing this piece with us. I will refer to the marking rubric to explain where and what you can improve on, I hope that this is fine.
Content: I thought your topic of Moral distress was relevant to what was discussed in class. However, have you thought about introducing the topic and its definition earlier in the piece, as I found myself wondering what your topic was about, until you introduced the topic. Perhaps the addition of a link to a video can help to give the reader an idea of what you intend discussing. For example you could add a motivational video on how size does not matter. This topic made me think about my own experiences in which “larger” patients tend to prefer to be seen by male physiotherapists, as they feel safer. The addition of more literature will help to strengthen your content as well.
Argument: I think that you bring up relevant issues within your piece. However you can strengthen this argument by finding literature that discusses how the performance of an individual may be hindered by the beliefs of others. You can also find literature that discusses the beliefs of patients on the size of physiotherapists. After relating your experience and what moral distress is, you should then perhaps speak about why size matters in one paragraph and in the next you can speak about why it does not, and then back up these statements with literature.
References: Including more references that are from journal articles will strengthen your argument. You did however in-text reference well. I know that we must reference in APA, and the references should be in lower casing, which is not the case for your first two references, also Consider using lowercase letters for the first two references. Also, you included an in-text from Webster & Baylis (2000), which is not in your bibliography.
Writing: I will do this in a separate comment.
Writing : Here I will add your piece and edit it so that you can see my suggested changes.
Throughout the years of clinical experience (Are you referring to your years of clinical experience ?), I have noted the many clinical dilemmas physiotherapy students face . One of the clinical dilemmas that I personally faced, was related to my stature. – You could perhaps add in what Moral distress is, and then state that you have experienced it personally, then explain what caused it : ie the incident.
During my clinical rotation, I was placed at a hospital setting. The patient was in her fifties, she had undergone a laparotomy one day ago. When I arrived she was chatty and friendly with the nursing sister. I then introduced myself and explained what physiotherapy entailed. Throughout the subjective the patient was friendly and chatty. I was under the impression that we had formulated a good relationship.
According to the Health Professions Council of South Africa (2008) effective communication enables the patient to make informed decisions by explaining their condition and the treatment thereof, which in turn leads to clarity of objectives and provides them with an understanding. (This shows that you would expect the patient to now cooperate with you however, consider if this reference is needed to strengthen your argument) This will provide a framework for the patient to co-operate with agreement to their management.
We started the objective assessment and it went well, however when we moved onto mobilization, she sat on the edge of the bed and was reluctant. She then mentioned that I was too “small” to assist her in standing and walking. I then brought the walking frame and she was comfortable using it. (This makes me ponder if you should have not have brought the walking frame initially, as at certain facilities this is the criteria with any patient post surgery. As well as for safety reasons) In the second session she refused to cooperate, she then stated that the nurse and I should apply lotion onto her legs. I explained the benefits of physiotherapy again and attempted to motivate her however, she still refused. I respected her wishes and accepted that this could cause an altercation with my clinician .
My clinician then went to see her as I reported what had occurred prior that day in our feedback session. The patient co-operated well with the clinician. She mobilized without the walking frame and minimal assistance, the patient expressed to the clinician she did not appreciate the tone I used when approaching her (I feel that this experience must have been emotion provoking however, have you considered how this sentence adds to or weakens your argument) I was approached by my clinician and I apologized to the patient. During the fourth session, I treated the patient with chest exercises and motivated her. She continued to mention my stature when we had to mobilize and inquire for the frame again. In each session somewhere my stature would be mentioned. (Have you considered that this might have been due to the fact that the patient was feeling unsafe, or generally might have had a bad experience previously)
The concept of moral distress has a changing definition as there is a lack of consensus (I feel that this should be introduced in the first paragraph) . However Webster & Baylis (2000) suggested that moral distress is setting aside or violation of deeply held beliefs, values and principles; that results in unresolved moral distress. Moral distress results moral residue which is defined the recollection of practical situations that the clinicians carry with themselves in powerful concentrated thoughts. (I feel that you need to relate this to how your beliefs or values were put aside, try to make it flow with the scenario)
Carpenter (2010) defined moral distress as the individual practitioner’s experiences of loss of personal and professional integrity when their desire to maintain professional standards achieves the best outcomes for clients (This is a great definition, which relates to this circumstance, perhaps introduce it earlier and how it made your performance change) With regards to my experience the patient was not comfortable with my small stature when mobilizing, when mentioned each session it lead to doubt in my own abilities (This is very relevant). I could feel my motivation and confidence was affecting my performance . I found myself pondering if I was not effective as she did not trust my stature. Instead of trusting my ability as a student physiotherapist. I respected her rights throughout the period she was my patient. Was it against the patients’ rights to treat her, despite her being somewhat uncomfortable with my stature? This is a good question, based on michaels comments in class, I dont think that you should try to end the piece with a conclusion of how you will fix issues, perhaps also look into human rights! As I feel that this piece will be ideal as a human rights issue, instead of moral distress, OR you could do both, you can look at issues like the rights of patients to refuse treatment.
It made me question my integrity within my profession. (I think that we all have moments in which we question this, however I feel that this was a really good clinical experience that provoked my thoughts)
Well done, I have no doubt that you will do well with this topic. Feel free to ask me any questions if you have any, my apologies if my comments were in anyway offensive!
Size really does not matter! Kind regards
Hi Alyssha, Thanks for sharing this piece with us. I will refer to the marking rubric to explain where and what you can improve on, I hope that this is fine.
Content: I thought your topic of Moral distress was relevant to what was discussed in class. However, have you thought about introducing the topic and its definition earlier in the piece, as I found myself wondering what your topic was about, until you introduced the topic. Perhaps the addition of a link to a video can help to give the reader an idea of what you intend discussing. For example you could add a motivational video on how size does not matter. This topic made me think about my own experiences in which “larger” patients tend to prefer to be seen by male physiotherapists, as they feel safer. The addition of more literature will help to strengthen your content as well.
Argument: I think that you bring up relevant issues within your piece. However you can strengthen this argument by finding literature that discusses how the performance of an individual may be hindered by the beliefs of others. You can also find literature that discusses the beliefs of patients on the size of physiotherapists. After relating your experience and what moral distress is, you should then perhaps speak about why size matters in one paragraph and in the next you can speak about why it does not, and then back up these statements with literature.
References: Including more references that are from journal articles will strengthen your argument. You did however in-text reference well. I know that we must reference in APA, and the references should be in lower casing, which is not the case for your first two references, also Consider using lowercase letters for the first two references. Also, you included an in-text from Webster & Baylis (2000), which is not in your bibliography.
Writing: I will do this in a separate comment
*THIS IS NOT A DUPLICATE COMMENT*
Writing : Here I will add your piece and edit it so that you can see my suggested changes.
Throughout the years of clinical experience (Are you referring to your years of clinical experience ?), I have noted the many clinical dilemmas physiotherapy students face . One of the clinical dilemmas that I personally faced, was related to my stature. – You could perhaps add in what Moral distress is, and then state that you have experienced it personally, then explain what caused it : ie the incident.
During my clinical rotation, I was placed at a hospital setting. The patient was in her fifties, she had undergone a laparotomy one day ago. When I arrived she was chatty and friendly with the nursing sister. I then introduced myself and explained what physiotherapy entailed. Throughout the subjective the patient was friendly and chatty. I was under the impression that we had formulated a good relationship.
According to the Health Professions Council of South Africa (2008) effective communication enables the patient to make informed decisions by explaining their condition and the treatment thereof, which in turn leads to clarity of objectives and provides them with an understanding. (This shows that you would expect the patient to now cooperate with you however, consider if this reference is needed to strengthen your argument) This will provide a framework for the patient to co-operate with agreement to their management.
We started the objective assessment and it went well, however when we moved onto mobilization, she sat on the edge of the bed and was reluctant. She then mentioned that I was too “small” to assist her in standing and walking. I then brought the walking frame and she was comfortable using it. (This makes me ponder if you should have not have brought the walking frame initially, as at certain facilities this is the criteria with any patient post surgery. As well as for safety reasons) In the second session she refused to cooperate, she then stated that the nurse and I should apply lotion onto her legs. I explained the benefits of physiotherapy again and attempted to motivate her however, she still refused. I respected her wishes and accepted that this could cause an altercation with my clinician .
My clinician then went to see her as I reported what had occurred prior that day in our feedback session. The patient co-operated well with the clinician. She mobilized without the walking frame and minimal assistance, the patient expressed to the clinician she did not appreciate the tone I used when approaching her (I feel that this experience must have been emotion provoking however, have you considered how this sentence adds to or weakens your argument) I was approached by my clinician and I apologized to the patient. During the fourth session, I treated the patient with chest exercises and motivated her. She continued to mention my stature when we had to mobilize and inquire for the frame again. In each session somewhere my stature would be mentioned. (Have you considered that this might have been due to the fact that the patient was feeling unsafe, or generally might have had a bad experience previously)
The concept of moral distress has a changing definition as there is a lack of consensus (I feel that this should be introduced in the first paragraph) . However Webster & Baylis (2000) suggested that moral distress is setting aside or violation of deeply held beliefs, values and principles; that results in unresolved moral distress. Moral distress results moral residue which is defined the recollection of practical situations that the clinicians carry with themselves in powerful concentrated thoughts. (I feel that you need to relate this to how your beliefs or values were put aside, try to make it flow with the scenario)
Carpenter (2010) defined moral distress as the individual practitioner’s experiences of loss of personal and professional integrity when their desire to maintain professional standards achieves the best outcomes for clients (This is a great definition, which relates to this circumstance, perhaps introduce it earlier and how it made your performance change) With regards to my experience the patient was not comfortable with my small stature when mobilizing, when mentioned each session it lead to doubt in my own abilities (This is very relevant). I could feel my motivation and confidence was affecting my performance . I found myself pondering if I was not effective as she did not trust my stature. Instead of trusting my ability as a student physiotherapist. I respected her rights throughout the period she was my patient. Was it against the patients’ rights to treat her, despite her being somewhat uncomfortable with my stature? This is a good question, based on michaels comments in class, I dont think that you should try to end the piece with a conclusion of how you will fix issues, perhaps also look into human rights! As I feel that this piece will be ideal as a human rights issue, instead of moral distress, OR you could do both, you can look at issues like the rights of patients to refuse treatment.
It made me question my integrity within my profession. (I think that we all have moments in which we question this, however I feel that this was a really good clinical experience that provoked my thoughts)
Well done, I have no doubt that you will do well with this topic. Feel free to ask me any questions if you have any, my apologies if my comments were in anyway offensive!
Size really does not matter! Kind regards