From ‘Thinking’ to ‘Doing’: Influences that Determine the Ethical Actions of Physiotherapists

To examine how individual physiotherapists' differing priorities and interpretations of contextual factors determine their ethical actions.

Qualitative methods informed by interpretivism and phenomenology were employed. Data regarding how the different contextual influences affected physiotherapists’ ethical decisions and eventual actions were collected through in-depth interviews with 42 physiotherapists practising in four different healthcare settings in Singapore. Inductive content analysis was used to analyse the interview transcript data, revealing how these influences directed their ethical actions. 

The findings indicated that physiotherapists’ ethical actions were influenced by their social contextual factors and also by what they as individuals ‘bring’ to the setting, including their emotional or behavioral tendencies, individual characteristics, physical needs, and motivations. Pivotal influences were termed as factors that had the most significant effect on determining whether physiotherapists acted in accordance with their ethical reasoning. Based on four distinct types of pivotal influences that were identified, participants were grouped as: 1. Followers relied heavily on validation from senior colleagues, often compromising their ethical beliefs to align with organisational expectations. 2.Self-Believers demonstrated independence in their ethical actions, guided by personal values rather than external pressures. 3.Mediators balanced adherence to professional guidelines with organisational protocols, often navigating conflicts between personal ethics and institutional demands. 4.Collectivists prioritised societal implications in their decision-making, reflecting a broader perspective on patient care that included healthcare policies and cultural norms.

The study concluded that the dynamic interaction between individual characteristics and situational contexts significantly affected physiotherapists’ ethical actions. Different individual characteristics impacted physiotherapists’ responses to different contextual factors. The findings suggest that tailored interventions and support systems are needed to address the specific pivotal influences affecting the individual physiotherapists. Future work should focus on developing strategies to enhance ethical decision-making, considering the diverse contextual influences identified in this study. 

Understanding the pivotal influences on individual physiotherapist’s ethical decision-making can improve professional training and organisational policies in physiotherapy. Tailored ethics education that factor in individual characteristics, mentorship programs, and supportive environments are vital for fostering ethical actions, particularly for novice practitioners. Encouraging a balance between personal values and professional duties, along with addressing organisational and societal pressures, can enhance ethical practices in physiotherapy.