Exploring ethical sensitivity in the South African context : developing and implementing a measure in the therapeutic sciences

Abstract

An understanding of the client, his/her needs, emotions and circumstances is fundamental to an effective therapeutic relationship. This holistic focus of the relationship and service excellence are, together with ethical sensitivity, important pillars for effective and competent practice. Since there are currently no measures available to evaluate ethical sensitivity in the therapeutic sciences, this study aimed at developing, implementing and evaluating a multidisciplinary measure of ethical sensitivity for healthcare professionals in the therapeutic sciences. The focus was specifically on four professions – audiology, occupational therapy, physiotherapy and speech-language therapy – within the South African context. The study followed a two-phase, sequential mixed-methods research approach. Phase 1, the qualitative exploration of ethical sensitivity, focused on developing a measuring instrument by means of a systematic review of the following: ethical codes of conduct; focus group discussions; individual in-depth interviews; an expert panel review; and public complaints websites. Phase 2, the quantitative stage, focused on implementing and evaluating the measuring instrument. One hundred participants – i.e. final-year students who represented the four professions included in this study – completed the measuring instrument. Participants’ overall scores on the Measuring Instrument for Ethical Sensitivity in the Therapeutic sciences (MIEST) were comparable for all four professions, which confirmed the multidisciplinary usability of the instrument. All participants tended to make decisions based on the principle of Beneficence. Participants were particularly sensitive about the impact of the therapist’s actions on the individual client (individualistic culture), and sometimes overlooked their duty to the community (collectivistic culture). Overall, participants selected an alternative response for the target principle of Non-Maleficence. The MIEST can be used to assess the ethical sensitivity of student therapists (and possibly qualified therapists as defined in this study) and describe the stage of their ethical sensitivity development throughout the course of their professional development. The constructed vignettes make the MIEST appropriate for use in problem-based learning programmes. Further research could focus on testing and refining the vignettes and items included in the MIEST to enhance reliability and validity.