"ethic of care" in physical therapy practice and education: Challenges and opportunities, The

Journal of Physical Therapy Education, Winter 2000 by Romanello, Mary

The Importance of Listening and "Paying Attention"

Manifesting the ethic of care requires a certain set of skills. An ethic of care in physical therapy marries medical and moral knowledge with skills typically associated with empathy: looking, listening, and hearing. The skill and art of listening begins with the physical therapist-- patient introduction and continues through the conclusion of each therapy session. Truly listening involves what Robert Bellah called "paying attention,"24(p28) giving something one's full consciousness. Listening engages the physical therapist to sense the patient's reality by gaining an understanding of the patients experiences and functional limitations caused by disease or injury. This notion is extremely important in the practice of caring; it follows, therefore, that the art and skill of listening should be a staple of physical therapy practice throughout treatment.

It begins with the physical therapist listening to the initial history of the patient to understand the mechanism of injury, the location of the pain, the date of injury, and the goals of the patient. Desiring a clearer picture of the patient's situation, the therapist seeks responses to questions about the home situation, the psychological stresses the patient experiences, and the fears the patient possesses regarding his or her condition. The physical therapist must be concerned about how these factors influence the patient's rehabilitation process. Such factors play a critical role, for example, when a patient who is undergoing treatment for his or her own functional limitations is also caring for a friend or relative. Consideration of the patient's daily physical and emotional condition, as well as time restraints, becomes an essential component of the treatment modifications. The physical therapist may need to adjust exercises so they can easily be incorporated into the patient's daily routine. Emphasis on body mechanics may be necessary to protect the patient from further injury. Such changes can only be included in the patient's plan of treatment if the physical therapist works relationally with the patient, being aware of the patients pathology and life experiences simultaneously. "Paying attention" also involves understanding the patient's spoken words and gaining a sense for the need to question what is unspoken. Practicing physical therapy with an ethic of care entails attentiveness and engrossment that allows the physical therapist to receive the feelings of the patient, thereby understanding the concerns, wants, needs, and fears of the patient and their influences throughout the course of the patient's treatment.

Risks and Conflicts Associated With Caring

While the ethic of care is vital to physical therapy practice, it brings about risks and conflicts for the practitioner. Caring demands time and energy on the part of both the physical therapist and the patient. Wuthnow explained the significant energy required of those in a caring relationship: