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A health care professional is a person who facilitates the identification , prevention and treatment of illnesses as well as disabilities (Crichton, 1997). This professional is qualified and therefore can give good health care in an organized and professional manner to the client in need of the particular health service. Health care professionals are normally governed by ethics dictated by their professional body or state. Health care professionals include : physicians , dentists , operating department practitioners , dietitians , physician assistants , nurse practitioners , nurses , pharmacists , therapists , chiropractors , optometrists , physical therapists , psychologists , phlebotomists , medical technologists (Crichton, 1997). These health care professionals are classified into the following main fields: Dentistry , medical , nursing and supportive health professional who include: dietitians , pharmacists ,occupational therapists , optometrists , psychologists , speech pathologists , radiographers , social workers and physical therapists (Crichton, 1997).
A dentist is a professional in the medicine branch known as stomatology which entails the evaluation , diagnosis , prevention and the treatment of diseases as well as disorders of the oral cavity , jaws , skull and face (Bond, 1994). A dietitian is a professional in foods and nutrition who advises people on eating habits in order to improve their health. A pharmacist is an expert in the field of pharmacy who takes part in the management of diseases through optimizing and monitoring drug therapy or collaborating with physicians in interpreting medical laboratory results (Bond, 1994). A pharmaconomist is a professional in pharmaceuticals while a physician assistant is an expert who has the license to practice medicine while being supervised by a licensed physician. A physical therapist is an expert who assesses and treats individuals so that they can develop , maintain and regain effective mobility in their entire life (Bond, 1994). A nurse practitioner is an highly educated expert who specializes in the diagnosis as well as the treatment of complicated as well as common medical disorders . A social worker is an expert who is dedicated to social change as well as social welfare. A physician who is also a medical doctor is a medical expert who works towards maintaining and improving human health. He studies, diagnoses and treats diseases or injuries.
An operating department practitioner is an expert working in surgical operating departments as well as other clinical areas such as intensive care units, accident & emergency and the ambulance service in the U.K. A psychologist is a health care professional who studies human or animal mental functions and behavior (Bond, 1994). A nurse is an expert who collaborates with other health care members to perform his/her functions. Nurses treat acutely or chronically sick people ensuring their safety as well as promoting and maintaining good family and community health. A medical laboratory scientist is an health care expert who does microscopic , chemical , immunologic , hematological and bacteriological diagnostic analysis on body fluids which include urine , stool , blood , sputum , cerebral spinal fluid , pericardial fluid , peritoneal fluid , synovial fluid and other specimens. A phlebotomist is an expert who specializes in drawing blood for various medical purposes. A psychotherapist is an expert trained to offer counseling services to individuals with various social problems (Bond, 1994).
For the well being of the client , the health care professional should : be friendly and helpful to the client , willing to return client calls , have office hours that are convenient to the client , be easily accessible to the client , have a friendly communication style , refer frequently to other specialists , have a warm relationship with the client and treat clients with respect (Bond, 1994).
Therapeutic relationship is a term given to the relationship between a health care expert and the patient aimed at effecting a change in a patient. Theoretically, it consists of transference, working alliance and real relationships (Bond, 1994). The therapist should cultivate a strong therapeutic relationship with the client in order for the client to open up and this makes it easier for the therapist to comprehend the patient’s condition. The therapist should use a patient centered approach to ensure an effective therapy (Bond, 1994). For the patient to open up , the therapist should first win his/her trust. This facilitates the sharing of knowledge between the patient and the therapist and gives the patient a sense of control of the therapeutic relationship. To develop therapeutic relationship with the patient , the health professional should develop the following skills: unconditional acceptance-the therapist should not discriminate patients on the basis of their background , ethnicity , social status or the presenting illness. The acceptance should not have conditions on the side of the patient. Conversely , the therapist should not expect anything in return for the unconditional acceptance. This unconditional acceptance makes the patient free to interact with the therapist and open up to him/her (Bond, 1994).
Empathy – this is a tactic whereby the therapist assumes the feelings of the patient in order to understand the patient’s condition better. Empathy enables the patient comprehend his/her situation and then come up with the answers and changes required to overcome their problems (Bond, 1994). The therapist helps the patient get these answers and changes. The therapist relies on the fact that one can be a patient and an healer at the same time. The therapist then communicates his/her potential of being a patient to the patient who in turn activates his/her intrinsic potential of being a healer thereby contributing to their own self-healing. The practitioner can also inspire the patient through sharing knowledge of his own personal experience and the way he overcame a certain medical condition which relates to what the patient is going through at that moment. This in turn can challenge the patient and inspire him/her to take action which can help them out of their current situation (Bond, 1994) . The fact that the therapist went through a similar experience helps him/her understand the patient’s condition better. The therapist should not at any given time come out as more interested in gaining knowledge on the patient’s condition as opposed to treating the patient (Bond, 1994).
Attending & listening:- this is the most crucial skill that the practitioner must adopt. This is a very important skill since the therapist cannot understand and build a relationship with the patient without listening (Bond, 1994). The therapist should focus on not only what the patient says but also the paralinguistic and non verbal aspects of the discussion. Paralinguistic is the aspect of speech such as volume , fluency and length while the non verbal aspects are the patient’s gestures and facial expressions in the process of the conversation. These aspects are dependent on each other and they also help the therapist understand problems that the patient does not speak out. The practitioner should take the necessary precautions before jumping into conclusions on the meaning of certain aspects. They should actually guide him in knowing which line of questioning to pursue (Bond, 1994).
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Open – Ended Questioning – the therapist should not ask too many questions or even talk a lot to the patient (Bond, 1994). He should instead employ use of open ended questions so that the patient can talk openly and even explain their condition further. This will make the therapist understand the patient better . The therapist can also consider using reflection as a way of encouraging the patient to expand their points(Bond, 1994) . In reflection , the practitioner sparks more debate through picking up on the last few words which the patient has spoken. Although open ended questions are preferred , its sometimes crucial to use closed questions especially when investigating certain manifestations of a particular illness (Bond, 1994).
Silence - although a conversation is a key tool in a therapeutic relationship , silence is also important because it allows the patient figure out what they want to say as well as how to express themselves. Silence also allows the therapist to think deeper and meditate on what the patient has been saying. However , the silence shouldn’t be long-lasting since this can render the patient uncomfortable and start doubting the practitioners competence (Bond, 1994). Concreteness – the therapist should be clear when dealing with the patient and should also help the patient express himself better (Bond, 1994). Heres, the therapist makes use of closed questions to eliminate vagueness in statements . This relationship is further enhanced by the therapist’s ability to explain the way he sees the patient’s condition , the steps he is to take as well as the steps the patient should take (Bond, 1994). Precautions must be taken to avoid use of technical language in explaining his views to the patient. The therapist should use layman’s language that the patient can understand as opposed to the use of medical terms (Bond, 1994).
Professionalism – the fact that the therapist uses simple language in order to reach the patient does not mean that he looses professionalism (Bond, 1994). The therapist should still remain in his professional position of helping the patient. The therapist should be very keen to avoid letting emotions affect his position (Bond, 1994). The therapist should not be too proud to the extend of pretending to have the capacity to handle cases which are above his ability. He should instead refer the patient to a more qualified professional if the condition is beyond his ability to handle. This allows the patient to get a better solution to his condition and also helps the practitioner improve his skills from the experience. As part of professionalism , the practitioner should not go beyond his ability scope as this may lead to handling too many patients. This in turn may reduce his effectiveness to individual patients (Bond, 1994).
Physical and behavioral techniques – the therapist should urge on and show the patient that he is following what the patient is saying by either nodding his head or using any word to this effect (Bond, 1994). This should however not be overused as it can make the therapist come out as simply automated. The therapist should also show interest in what the patient is saying by using different behavioral tactics (Bond, 1994). The sitting arrangement should also not have the effect of scaring the patient. For instance , sitting directly opposite the patient can make the therapist appear authoritative and scare the patient. Letting the patient sit on the same desk as the therapist can reduce this tension. The therapist though should ensure whichever sitting arrangement adopted would facilitate interaction as well as maximum observance of feedback from the patient (Bond, 1994).
Warmth and genuineness – these are personality skills of the practitioner and are hardly learnt. They are crucial if a therapeutic relationship between the two parties is going to be successful (Bond, 1994). Warmth refers to the patient’s view of how approachable he/she sees the practitioner. To achieve this , the practitioner must have the following aspects ; non discrimination policy , lack of blame and closeness (Crichton, 1997).This calls for a friendly and welcoming practitioner .Genuineness on the other hand is the practitioners personal desire to assist without being motivated by money or other incentives which can act as a barrier in the therapeutic relationship (Crichton, 1997).
Counseling can be employed to give patients an improved care. Counseling simply refers to the process whereby a therapist helps the patient comprehend the causes of his/her problems and advises the patient on how to resolve them (Etherington, 2002). Through counseling , the therapist should make the patient realize the cause of their condition while following professional ethics. The therapist should tailor the counseling session to suit the patient’s unique situation , needs , culture as well as values (Etherington, 2002). Counseling should only target resolving the problems afflicting the patient without changing the patient’s religious and cultural values. The counselor should help the patient identify his/her problems and then design together a positive change (Etherington, 2002). Patient counseling should also involve providing medical information to the patient or their family verbally or through writing (Corney, 1993). This information advises the patient on how to use the drugs , their side effects , precautions , storage , diet as well as life style modification. For instance , a patient who smokes should be advised on how to quit the habit if it aggravates their condition (Corney, 1993).
During counseling , the therapist should help the patient recognize the positive role the medicine will play in their life. Through counseling , the patient is advised on the medicine’s generic and brand , how long it takes to work , the feeling to expect on taking the drug , when and how to take the medicine (with water or fruit juice) and foods & drinks to avoid while taking the drug, The counseling should help the patient know how to handle the possible side effects of the medicine as well as help the patient gain strategies on self care management (Etherington, 2002). Counseling would ensure safe and proper use of medication in order to enhance therapeutic results.
In my early days in the profession, I handled a case involving a cancer patient. This client had sought guidance from different professionals since the ailment had affected her for a long time so she opted to come to my newly opened clinic. I had a lot of confidence and the will to help her, less did I know that I was bound to make the similar mistakes to the ones her former therapists were making. Firstly, instead of empathizing with the patient, I sympathized with her. Instead of assuming the feelings of the patient, I pitient the patient to an extend that she began to hate herself because of her condition. This prevented the patient from understanding her condition in order to come up with answers and changes to overcome it. I was also more interested in gaining more knowledge regarding the patient’s condition instead of focusing on helping the patient overcome her situation. This made me come out as selfish. I also made the mistake of asking the patient too many questions most of which were closed ended. This restricted the patient from giving adequate information regarding her condition.
I almost lost my professionalism through being too simple to her to the extend that she almost lost trust in me. I could also not refer her to a more experienced therapist since to me this meant that I lacked the requisite skills to handle her condition.
If I was to handle the same patient today, I would empathize with her instead of sympathizing with her because this would enable the patient understand her condition and take part in the treatment process. In addition, I would ask her a limited number of open ended questions except in cases investigating certain manifestations of a particular illness. This would make the patient give unlimited information regarding her condition. I would also be keen not to lose my professionalism in order to sustain the patient’s trust in me. I would also refer her to a more qualified therapist if I cannot handle the case since this does not mean am not competent.
Ethical issues may include dissemination of the health care details far beyond the office thereby interfering with the patient’s privacy. This patient’s information could be used in marketing pharmaceuticals or for creating a database for treatment as well as research and this increases access to it (Visscher, 1972). Patients have a right to confidentiality of their medical information and records which should be respected unless waived by the patient. Placing a patients medical data in the public domain may evoke discrimination especially if the patient is suffering a terminal illness such as AIDS and cancer. Mental illness victims also suffer discrimination thus privacy is of paramount importance to avoid this (Visscher, 1972).
Autonomy of the patient happens to be another ethical issue. Autonomy dictates that the patient be given an opportunity to decide whether to accept or reject treatment. This is based on the fact that the society appreciates the individuals ability to make sound decision about personal issues (Visscher, 1972). Autonomy is a very paramount indicator/sign of the well-being of both the patient and the health profession. The biggest ethical question here is whether the health care should focus to do good and benefit from it or to do good to the patient and have the patient and the society in general benefit from it (Visscher, 1972). The health care professional violates this especially when the patient involved has a psychiatric condition such as clinical depression. The health care professional should allow patients who have the mental ability to make end of life decisions choose an early death by refusing to be treated. This raises serious ethical concerns since the health care professional could be seen as aiding death (Visscher, 1972).
Beneficence – this is a core value of health care ethics. This is the practice of doing things which improve the well being of others. The health care professional should make decisions that are to the best interest of the patients (Visscher, 1972). The biggest problem here is the identification of the things. Many scholars argue that practices such as cosmetic surgery , euthanasia and contraception are not consistent with this principle. This is seen to contradict the autonomy principle since such practices could have been chosen by the patient. The health care professional in this case has to choose between doing what the patient wants or doing what will heal the patient (Visscher, 1972).
Non – maleficence – this requires that the health care professional chooses to do no harm to the patient than to do good to them. Many health care professionals carry out procedures on patients believing that they would do good without testing them adequately to ensure that they can cause no harm. Patients end up being harmed by such procedures. Many health care professionals carry out risky treatments on patients especially when the situation is likely to be very dangerous without treatment and this violates this ethical principle (Visscher, 1972).
Double effect – this refers to a situation whereby the health care professional carries out a procedure that has a good out come but unwillingly harms the patient. The professional can undertake a certain procedure with a good intention to save the life of the patient but the patient dies in the process. Also , a physician can administer morphine to dying patient to ease the pain but this accelerates the demise of the patient by damaging the respiratory system (Visscher, 1972).
Informed consent – this ethical principle requires that the patient should be made aware of the benefits and risks of their treatment choice. If the patient is not well informed , he/she can make decisions that are not consistent with his/her values and wishes. If the patient is incapacitated , the informed decision regarding the treatment of the patient should be made by a person appointed by the patient or by their next of keen (Visscher, 1972) .
Culture – the patient could be subscribing to a culture that has funny magical theories regarding the origins of diseases. The health care professional in this case would have a very difficult task of harmonizing such believes with medical values (Visscher, 1972). Truth – revealing the outcome of the diagnosis can be difficult especially where a terminal illness is involved (Visscher, 1972).
Futility – the physician is faced with a great dilemma when it is apparent that the patient will not survive but the patient’s family insists on advanced care. Though the physician is sure of the zero survival chances of the patient , there is again the religious belief of the sanctity of human life and the need to preserve it (Visscher, 1972). Sexual relationships – there is a possibility of this between the patients and doctors and this can create serious ethical conflicts (Visscher, 1972).
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