PROFESSIONAL AUTONOMY AND ACCOUNTABILITY IN RADIOGRAPHY
INTRODUCTION:
Professional accountability and autonomy are integral within the role of health professionals in the NHS today. Professional accountability requires the individual practitioner to take responsibility for their actions and the outcomes. In the UK, professional accountability is part of the PCT (Primary Care Trust) clinical governance framework, which aims to provide quality, cost-effective and evidence based care (Tilley and Watson 2004). In a society where litigation is on the increase, it becomes imperative that ethical and legal implications of accountability are understood by health professionals as well as the implications for everyday practice (White and McKay 2002).
Autonomy is the ability of a professional to make independent decisions by utilising their professional judgement (MacDonald 2002) and acting in a self-directing role. This implies that a radiographer has the freedom to make a decision based on their professional knowledge and expertise, without being under pressure (Schutzenhofer and Musse, 1994; Ballou, 1998; Jochemsen and Have 2000).
Lewis et al. (2008), state that the term “professional autonomy” can also be used for occupational groups, such as radiographers, allowing such groups to develop services, provide independent governance for their profession and legislate competence via nationally recognised registration and licensing boards. In the UK such governance and guidance is provided to radiographers by the Health Professional Council (HPC), which regulates a number of other health related professions and aims to protect the public. Therefore any individual wishing to practice a profession covered by the HPC such as radiographers, are legally bound to register with the council. As such the HPC has the authority to govern the professional practice with the power to prevent the individual from practicing if they do not meet the standards set by the council.
RADIOGRAPHER TRAINING
The Standard of Proficiency for Radiographers (HPC 2007) includes details regarding Professional autonomy and accountability. Such an authority as the HPC subsequently has an impact on the CPD of the health professional. For example after qualification a radiographer may specialise in a certain specified field of radiography such as paediatric radiography, by additional training and qualification, which must satisfy the HPC. Additionally should this individual also wish to return to practice in the wider field of radiography, they must satisfy the HPC by demonstrating that adequate training and qualifications have been undertaken to diversify their role. Karagozoglu (2008) has shown that the educational curriculum of a radiographers training program is not adequately able to improve students’ thinking nor does it allow them the ability to act like independent professionals. Therefore in light of this information it is increasingly necessary for post qualification CPD and lifelong learning, to allow radiographers to be in a stronger position to make autonomous decisions. Radiography departments are now placing a high level of importance on CPD now and each radiographer should have a set time period each week to update their CPD portfolio.
In a profession which has experienced reduced staffing levels, Chapman (1997) and Forsyth and Robertson (2007) show that role expansion in radiography is already taking place, not only to fill the staff shortage in radiography but also in radiology. This implies that radiographers are now enhancing their CPD and are required to make those decisions which were once made by the radiologist and thereby the radiographer is driven to make autonomous decisions. However this level of autonomy further impacts the requirement of accountability on the profession of radiography, and may lead to legal implications. White and McKay (2002) show that radiographers have been actively developing their roles over the past decade and are participating in arenas which were mainly for radiologists e.g. red dot schemes. (White and McKay 2002; Karagozoglu 2008). Technological advancements, such as Doppler sonography; videoscopic surgical techniques, interventional techniques and PACS have also impacted on the enhancement of the radiographers role thus enhancing their powers of autonomy (White and McKay 2002; Craven 2003).
However this has also caused concern in recent years as there is no clearly established mode of accountability and responsibility highlighted for these roles (White and McKay 2002). Radiographers are uncertain of their legal position with their enhanced ability for autonomy and accountability mainly due to a lack of case law precedent. It stands to reason that clear legal guidance is required in this arena, and until this is in place, it is the responsibility of employers such as the PCT to assess the risks and benefits not only to their patients but also the professionals involved. However Brady (1995) argues that by not including accountability in considering the role of a radiographer, the future autonomy of the profession may be threatened. Therefore when considering the medico-legal implications, it is important to ensure that the radiographer’s professional autonomy is not removed.
NEWLY QUALIFIED RADIOGRAPHERS
Radiographers are required to demonstrate an array of skills within their professional portfolio in relation to both their professional autonomy and accountability. Some of these skills such as the technical areas require continual updating in order to keep pace with the technical demands of the role as suggested by Jackson (2007). Therefore one of the main challenges to a newly qualified radiographer is to adapt and respond to technological changes.
A newly qualified radiographer will be expected to perform general radiographic duties and all practical aspects of radiography, under supervision to ensure they reach the required standard (NHScareers.com), some of which can be seen in table 1 below
Table 1.This highlights the typical training of a newly qualified radiographer. Table created in MS paint from information obtained form NHScareers.com)
In line with Standard of Proficiency for Radiographers, they will also be required to use highly technical and very expensive x-ray equipment, in a manner safe to themselves and others. Additionally as part of their care giving and the principles of Standards of Conduct, Performance and Ethics, they will be required to give patients instructions and assistance if necessary. Radiographers are also required to communicate with patients on a regular basis regarding appointments, time delays and queries, and liaise with professional staff as necessary
Newly qualified radiographers may work in any number of locations in hospital or community settings (Mackay et al. 2008), with elderly patients and those with mobility problems. A newly qualified radiographer may spend much of their time working in the accident and emergency department (Mackay et al. 2008; Jackson 2007; Chan 2007) dealing with injured patients, parents or relatives and liaising with other clinical professionals. Table 2 shows the key areas a diagnostic radiographer may work in post qualification and any additional training or CPD required for this area.
Table 2. Diagnostic Radiography Table created in MS Paint from information obtained from NHScareers.com
As health care professionals, radiographers have a duty of care towards the patients they examine (Hardy and Boynes 2003) especially for those working with children, and these radiographers must undertake additional training and development to understand not only adequate technical training for successful diagnostic examination of paediatrics (van As et al.2006), but also psychosocial development, knowledge of paediatric anatomy and pathology as well. Although radiographic examination of children requires special technical considerations, it is often the psychological aspect of gaining a child’s confidence and cooperation that can prove most challenging to clinical radiographers especially newly qualified radiographers. Success in this area can prevent additional distress to the child by reducing the need for immobilisation and restraint to ensure that a diagnostic examination is achieved (Robinson and Collier 1999)
Issues surrounding child consent for medical examination are closely linked to children’s Rights. However, the legal and ethical interpretations of children’s Rights with respect to medical consent are inconsistent both nationally and internationally (United Nations Convention on the Rights of the Child 1989; the Human Rights Act 1998), in particular to relating to child consent for imaging examinations (Hardy and Armitage 2006).
Recent studies by Davis and Reeves (2004) have also shown that radiographer’s can play a role in child protection, in relation to their legal, ethical and professional responsibilities. Under UK legislation, Radiographers are not designated officers for child protection (DoH The Children Act 1989) as they are in Ireland. However, they do work under Area Child Protection Committee (ACPC) guidelines which outline local procedures to follow in cases of suspected NAI/child abuse (North East Lincolnshire, A.C.P.C).
Davis and Reeves (2006) have shown that few radiographers have little or no training in the area of Child Protection and are not aware of Child Care legislation or its implications for their working practices. It has been suggested by Davis and Reeves (2006) that there should be an awareness of specific courses and that it would be useful for one person in every paediatric unit to attend. However, paediatric patients may be seen in any number of locations such as District General Hospital with A&E facilities as well as in specialist paediatric hospitals. Therefore if only one member of the department attends a course on Child Protection then this would exclude a large population of radiographers who may be X-raying children. It is also important to note that, a parent/carer who has deliberately caused a child’s injuries may not take the child to the local paediatric hospital, and may choose a more distant general hospital to try and avoid a child protection referral.
To expand on this, research by van As et al. (2006) has shown that training in this area should focus on signs of abuse, fracture types and behaviour patterns.
CONCLUSION:
The Standard of Proficiency for Radiographers(HPC 2007) includes expectations regarding Professional autonomy and accountability. Broadly, these standards state that radiographers must be able to practice within the legal and ethical boundaries of their profession and use good personal judgement in different situations such as Child Abuse cases, understand consent and confidentiality. Another important aspect of Professional autonomy and accountability covered by the HPC includes CPD. These Standards apply to all radiographers and are crucial to autonomy and accountability on a daily basis in the radiography profession and are therefore constantly referred to.
Newly qualified radiographers do not have the specialist training for their chosen department or the experience of their superiors. As such they will be unsure of procedures and practices, as well as much of the medico-legal implications of their work. They will feel some fear and vulnerability in making autonomous decisions due to their lack of experience and may not always be in the vicinity of their supervisor when asked to make decisions or even talk to patients. As suggested by some of the research done recently, the training of radiographers needs to be improved to give them a wider knowledge of their roles and accountabilities. Until national guidelines are published for accountabilities, it remains the domain of local agencies and employers to oversee the professional accountability of radiographers. However this will leave discrepancies in some areas and the possibility of inconsistent behaviour.
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