Physiotherapists as Advocates for Individuals Living With Dementia

Welcome to <a href="Current and Emerging Roles in Physiotherapy Practice">Current and Emerging Roles in Physiotherapy Practice</a>. This page is being developed by participants of a project to populate the Spinal Cord Injury section of Physiopedia. 

• Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!  
• If you would like to get involved in this project and earn accreditation for your contributions, <a href="mailto:[email protected]">please get in touch</a>!

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - <img class="FCK__MWTemplate" src="http://www.physio-pedia.com/extensions/FCKeditor/fckeditor/editor/images/spacer.gif" _fckfakelement="true" _fckrealelement="1" _fck_mw_template="true">  

Introduction

Dementia is a global health priority, affecting populations worldwide (WHO 2015). Health care issues, including dementia, are taking center stage in both political and media discussions, and health professionals, including physiotherapists, must be ready to participate in these discussions with confidence and influence. The Scottish Government’s Proposal for Scotland’s National Dementia Strategy 2016-19, states the need for continued support to improve all areas of dementia care, at all stages of the condition. It is crucial that individuals with dementia receive the care and services they require and are not disempowered or discriminated against due to their condition. The Proposal for Scotland’s National Dementia Strategy 2016-19 also prioritizes “enhancing a multi-disciplinary approach to care at home, including the promotion of the therapeutic and enabling role of AHPs for people with dementia” (pg. 7). By taking on the role of advocate and tackling key issues related to dementia and dementia care, physiotherapists can ensure the rights of every individual are being upheld, that each person is receiving the best possible care, and that no individual living with dementia is victimized or discriminated against.
In Scotland there are almost no courses on developing the skills needed for advocacy, with the few available being continuing education diplomas and certificates in Independent and Mental Capacity Advocacy (City and Guilds). Advocacy is not directly included in professional qualification courses and there are few books available on the subject, further indicating the need for this wiki.

Target Audience

This is a learning resource for practicing physiotherapists and physiotherapy students to give them the tools necessary to act as advocates for individuals living with dementia.

Learning Outcomes

By the end of this wiki, you should:

1. Critically identify the need for advocacy on behalf of people living with dementia.
   
2. Critically discuss the potential attitudes and perceptions of health-care professionals and the general population towards individuals living with dementia.
   
3. Be able to critically evaluate the role of physiotherapist as advocate for individuals living with dementia.
   
4. Be able to reflect on personal experiences of providing physiotherapy to vulnerable populations and identify opportunities for advocacy.
   

Advocacy

What is Advocacy?

Advocacy involves speaking out on behalf of another individual or group of individuals in a way that represents their best interests. The New Penguin English Dictionary defines advocacy as “active support or pleading”. From this definition it can be implied that advocacy entails supporting someone by actively acquiring resources for them or on their behalf. There are many different forms advocacy can take, such as self-advocacy, legal advocacy and independent advocacy, and anyone who possesses the necessary skills can act as an advocate. In health care, advocates act according to the patient’s values and wishes and advocacy can be seen as part of the therapeutic relationship between the patient and health care professional (Campagna, 2013). It involves informing the patient of their rights, ensuring they have the required information to make informed decisions, supporting the patient in their decision, and protecting their interests and rights (Bateman, 2000). Advocacy is also about influencing decision-making, and health care professionals use this skill everyday. Whether it is persuading a patient to stop smoking, convincing colleagues to improve patient care or ensuring a patient has access to the services they require, advocacy is taking place.

Why is Advocacy Important & Who Requires One?

Advocacy arises as a result of working with people who are disadvantaged in some way. Individuals working with groups who are marginalized in society, such as the elderly, ethnic minorities, or individuals with disabilities, must be prepared to act as advocates on their behalf. Since advocacy involves aiding and supporting individuals or groups, it fits into the range of fundamental activities performed by health-care professionals. Advocacy can provide an element of informed and compassionate health care planning and delivery that is available from no other source (Bateman, 2000). Every individual has equal rights to access the services they require, but particular populations or individuals may be unable to protect their own rights or access services. It is vital that individuals who are disempowered in some way are not subject to inadvertent discrimination or decreased access to services because of their circumstances. Advocacy is a mechanism through which individuals’ rights are enabled and protected.

Advocacy may include supporting an individual to: (Centacare!!!)

• The right to confidentiality and privacy
  
• The right to dignity and respect
  
• The right to quality services
  
• The right to choice and control
  
• The right to information to inform decision making
  
• The right to non-discriminatory service
  
• The right to make complaints
  
• The right to protection of legal and human rights, and freedom from abuse and neglect
  

Individuals require advocates for various reasons. As discussed above, advocacy comes from working with people who are disadvantaged in some way. These disadvantaged populations are vulnerable and often marginalized in society. They may be momentarily vulnerable, weakened by illness or injury; or distressed by a loved one’s suffering, disability, or death. Often these populations may have difficulty self-advocating and may struggle to protect their own rights. They may include ethnic minorities, people with disabilities, the elderly, and individuals living with dementia.

What Skills or Attributes are Required to be an Advocate in Health Care?

There are no uniformly accepted educational requirements to be an advocate in health care (Campagna, 2013), but Kelland and colleagues (2014) interviewed 17 self proclaimed leading advocates in the field of physiotherapy and have proposed eight attributes a physiotherapist must display competence in, in order to be successful in the role of advocate. Others have noted similar characteristics required for a health professional to be successful advocates (Bateman; Campagna). The attributes are listed below:

Collaboration

• Physiotherapists must collaborate with multiple people in various ways. It is important to understand the roles of other health professionals in order to collaborate and best meet the needs of the patient. Physiotherapists must also collaborate with their patients and their families to ensure effective patient-centred care.

Communication

It is important to know one’s audience and to adapt one’s communication style accordingly. Physiotherapists must be good listeners and be able to speak out when necessary. Listening is critical to understanding the needs of others and is a valuable first step to empowering patients to advocate for themselves.

Scholarly practice

In order to be a successful advocate, one must understand whom they are advocating for, their mission, and what their needs are. By researching and demonstrating that there is a need for advocacy in a particular area, more will be achieved. It is important to have sufficient and accurate data and research before speaking out.

Management

To be a successful advocate, physiotherapists must understand aspects of management and how these factors might affect one’s ability to advocate for patients. For example, it is important to understand financial, funding, and service delivery model factors that impact a physiotherapist’s ability to advocate for patients.

Professionalism

It is important to engage in professionalism and take on roles beyond those of a clinician. This includes showing a commitment to improving the overall health care patients receive, not necessarily only to physiotherapy.

Passion

When one is passionate about the issue at hand, advocacy will be easier. However, it is important to balance and keep emotions in control; there is a place for passion, not for anger.

Perseverance

Advocacy is often a long-term venture and thus perseverance is an important quality to possess.

Humility

Physiotherapists must be able to reflect on whose agenda they are advocating and commit to advocating for that agenda, even if it is not their own. It is essential to understand the needs and priorities of other people.

Five of these attributes, collaboration, communication, scholarly practice, management and professionalism, overlap with current standards for practice for physiotherapy defined by the Health and Care Professions Council and the Chartered Society for Physiotherapists (CSP), and represent acquired skills. The other three, passion, perseverance, and humility are additional and individual to the role of advocate. Therefore, this indicates that all physiotherapists within the UK currently possess over half of the attributes for successful advocacy and thus are well equipped to take on this role. For physiotherapists to be successful as advocates, they must have to ability to integrate and adapt the above 8 attributes in practice. The CSP’s Physiotherapy Framework lists “advocacy” as an expected value of all CSP members, while the HCPC Standard of conduct, performance and ethics state that health care professionals must “promote and protect the interests of service users and carers”. While this does not specifically include advocacy as a role, the words protect the interests of fall into the earlier mentioned definition of advocacy. By understanding the role of advocate and what attributes are needed for successful advocacy, physiotherapists of all levels of experience can be advocates and ensure patients have their rights protected and are receiving the best care. Therefore, this makes physiotherapists suitable and capable advocates for individuals living with dementia.

Recent Related Research (from <a href="http://www.ncbi.nlm.nih.gov/pubmed/">Pubmed</a>)

Feed goes here!!|charset=UTF-8|short|max=10

References

References will automatically be added here, see <a href="Adding References">adding references tutorial</a>.

<span class="fck_mw_references" _fck_mw_customtag="true" _fck_mw_tagname="references" />