Wellbeing and Professionalism

Keywords::

• Professionalism
• Wellbeing
• Stress

Experiencing stress is a normal part of life; however, prolonged or high rates of negative stress can have wide-ranging consequences including impacts on demonstrating professionalism at work. A thematic analysis of member and public contacts with the Speech Pathology Australia (SPA) Ethics Team at National Office showed that issues related to professionalism have been the most frequently discussed topics since 2015. This includes the various aspects of professionalism including professional integrity, competence, responsibilities, communication, and conduct. Similarly, professionalism, and in particular professional communication, is one of the most commonly occurring themes in formal complaints made to SPA.

Professionalism is a core value within SPA’s Code of Ethics (2020a) and professionalism and integrity are defined as follows: “We uphold the reputation of our profession in all our activities and communications. We act in an objective manner and are transparent, accountable and keep our commitments”.

The Ethics Team at National Office sought to understand the drivers for SPA members and members of the public who sought support for issues relating to professionalism. The team identified that the speech pathology workforce has been under increasing stress in recent years. Factors contributing to this stress included needing to modify services and responding swiftly to government health orders during the COVID-19 pandemic, consumer and staff illness, increasing wait lists for services, navigating natural disasters, and workforce challenges including recruitment and retention of staff. In addition, many members have been working in increasingly complex contexts, including the provision of services in response to a broad range of individual needs and a variety of family situations. This can be even more complex if individuals have been unable to access support services for many years prior to the rollout of the National Disability Insurance Scheme. These stressors have been observed to impact some SPA members in ways that challenge their ability to maintain professionalism, in particular, professional communication with individuals with communication or swallowing needs, their families, or our colleagues.

This paper explores the impacts of stress on a speech pathologist’s professionalism and communication with others and considers and presents some actions that can mitigate the impacts of stress on professional conduct. It is hoped that this paper will add to resources available to SPA members to support reflection on their own professionalism and professional communication and to help them to uphold professional standards and professional values, especially in the context of the interaction between challenging external and personal factors.

Review of current research of stress and the impacts on professionalism

Research trends

Research evaluating the rates of stress in allied health professionals has found reports of higher rates of job-related stress when compared to the general population (Muller et al., 2020), which tends to be under recognised (Cabarkapa et al., 2020). Since the COVID-19 pandemic started impacting daily work, in 2020, the rates of stress, burnout, and clinical levels of anxiety and depression have increased in allied health workers in Australia and other countries (Dobson et al., 2020). In a systematic review, Muller et al. (2021) found that overwhelmingly, research studies indicated allied health professionals reported higher levels of anxiety, depression, and difficulties maintaining healthy sleep habits. In a study of Australian healthcare workers, Dobson et al. (2021) found they more often reported experiences of stress, anxiety, and depression. Additionally, 20% to 80% of participants reported experiencing symptoms of burnout, which can include exhaustion and personal detachment. Similarly, 73% of allied health staff in a hospital setting reported experiencing burnout in the past month, and 69% reported difficulties managing emotional problems (Rubin et al., 2021). While reporting similar results, Søvold et al. (2021) noted that these trends have manifested due to high or increased workloads since the start of the pandemic, work that is of a faster pace with adaptations and reduced social supports. It has been recognised that higher levels of stress in allied health professionals can have a negative impact on factors related to professionalism (Rubin et al., 2021; Søvold et al., 2021).

Impacts of stress on allied health professionals

Higher levels of stress and mental health impacts on allied health professionals have wide-ranging consequences, particularly on professionalism. These can include reduced quality of care for individuals, families, and communities, higher numbers of professional errors, and lower rates of satisfaction with service (Rubin et al., 2021; Søvold et al., 2021). Stress has been shown to have a significant impact on the cognitive abilities related to positive professional practices. Higher levels of stress have been found to decrease our attentional capacity so that professionals are less able to manage when attention needs to be allocated to multiple pieces of information, or information needs to be held front of mind. Decision-making quality decreases with higher levels of stress and leads to difficulty identifying and screening out unimportant information (LeBlanc, 2009).

Professional/organisational responses

There is greater interest in preventative and responsive interventions to support allied health professionals to manage the increasing experience of stress in their work. They can be grouped generally into personal, professional, and organisational supports. On a personal level, psychological resilience and effective coping strategies have been reported to be higher in people who are able to maintain good sleep routines, access social supports, and engage in health-related behaviours such as healthy diets and regular exercise (Dobson et al., 2021, Søvold et al., 2021). Additionally, the impacts of stress on cognitive capacity can be mediated by the way a person interprets the demands of a stressful situation, their sense of control over the outcomes, and personal coping style (LeBlanc, 2009). Professionals have noted the positive impacts of interventions such as mindfulness training, individual and group-based supports (Rubin et al., 2021), and the use of self-care plans that increase self-awareness through individuals frequently checking in on their own stress levels and encouraging self-compassion (Søvold et al., 2021). At an organisational or management level, it is thought that encouraged and judgement-free options to take personal leave when experiencing symptoms of burnout have a positive impact on the response to high levels of stress (Cabarkapa et al., 2020). Professionals in management positions can reduce stigma by leading conversations about stress and mental health at work, modelling behaviours such as good time management, planning and taking breaks including annual leave, and seeking professional support. Managers and employers may also consider screening for early signs of burnout in staff (Søvold et al., 2021). Rubin et al. (2021) suggested reviewing workloads and schedules and focusing on improved communication between professionals at work to create positive and mutually supportive team environments.

Speech Pathology Australia supports for wellbeing and professionalism

The role of the Ethics Team

The Ethics Team at National Office comprises ethics advisors and the Manager, Ethics and Professional Issues. Included in the team responsibilities are provision of support, information, and resources to assist members in their ethical decision-making. Members can call or email the ethics advisors or use other communication channels, such as the SPA Member Hub, to seek information and advice regarding ethical issues that occur in professional practice. A query may relate to a specific situation a member is facing, an issue raised by a person they are working with, or an area of practice they are undertaking or intending to commence. The discussions focus on proactive ethical decision-making, identifying and considering ethical issues, then exploring the appropriate choices or courses of action, where possible, before a situation becomes problematic. In this way, discussions with advisors may serve to alleviate some of the stress regarding a specific situation. The role of the team is to provide guidance, support, and information rather than a direct “answer” as a number of contextual impacts may influence any situation, and it would be inappropriate to assume that all of these can be communicated in a single email or phone call.

Identification of impacts of stress

Many members contact the SPA Ethics Team for a proactive discussion; however, there are also many contacts from members who are reacting to circumstances that have become stressful, as well as contacts from the public relating to an interaction with a speech pathologist. The SPA Ethics Team have identified that, over the last 3 years, discussions have increasingly focused on professionalism and professional communication and the ways this intersects with the stress and wellbeing of the SPA member. The level of stress reported by members was impacting their ability to consider the other person’s narrative within a challenging discussion. A pattern was observed that as a member’s stress increased, so too did the effort involved in taking the time to empathically consider the situation from the perspectives of others. Many members reported that they had benefited from the opportunity, during discussions with the ethics advisors, to acknowledge the impacts reported above, of exhaustion and personal detachment, including information overload, decision fatigue, and reduced responsiveness. Awareness of how stress impacts each of us has individually helped members recognise that professionalism and professional communication can become more effortful to maintain as stress increases. Being aware of this, identifying the causes of stress, and developing strategies to manage stress has supported members to undertake actions in line with the SPA’s Code of Ethics (2020a), especially the section on professionalism.

Professional support for wellbeing

Professional support is an important mechanism through which clinicians can explore strategies to manage the causes of, and their responses to, workplace stress. Indeed, SPA views professional support, including supervision and mentoring, as a critical component of speech pathology practice underpinning reflective practice, lifelong learning, and ethical, evidence based and culturally responsive practice (SPA, 2022). In 2022, a new certification program came into effect to reflect this commitment to engaging in lifelong learning and self-reflection by mandating a minimum of 2 hours per year of engagement with professional support and 2 hours of cultural learning when members join or renew their annual SPA membership. This also supports SPA’s newly updated Professional Standards (2020b) that require all members to demonstrate self-awareness (Standard 2.1), use critical reflection to inform professional development and practice (Standard 2.2), and engage in learning with colleagues, students, and the community (Standard 2.6). Engaging in professional support can be a tool to help support speech pathologists to reflect on their own personal stressors or biases and identify when these might be impacting their professional communication and/or decision-making. Professional support can also provide an opportunity to have important, objective conversations in a safe and supported environment.

Proactive management of stress

Recognising stress and the ways it impacts behaviour can help clinicians recognise these changes at an early stage. This can be useful for taking preventative actions such as having some time off, seeking professional support, delegating work to others, and speaking with management about changes to caseloads. Additionally, reflection and identification can be helpful in preparing, by consciously prioritising those actions that become difficult as soon as stress levels rise (e.g., taking the perspectives of others, taking the time to embed kindness in our actions, and listening through the lens of responsive, respectful care). It can be difficult to both acknowledge and act on early signs of stress; however, it is an action in line with SPA’s Code of Ethics (2020a). Taking time to rest and heal is an act of responsiveness and helps to ensure a professional service that is embedded in quality and safety.

It can be enticing to prioritise quick, easy solutions when feeling stressed. However, it is important at this time to revisit both personal values and the professional values outlined in SPA’s Code of Ethics to help reflect upon the situation, consider what conduct is appropriate within a professional context, and plan how to act in line with those values, professionally and personally. Building and engaging with personal and professional strategies and networks during times of low, or lower, stress will enable space to proactively plan for managing and responding to stressful or challenging situations as they arise.

For both managers and clinicians, it is important that time for case and ethical discussions is valued as a way to ensure client safety. This can also be an action that supports clinician mental health and acts as a measure to reduce the risk of professional and personal burnout. Taking the time to reflect and consider situations from the perspectives of others helps to uphold the values of respect, responsiveness, and professionalism, as outlined in SPA’s Code of Ethics. Caring for ourselves supports us to do our jobs to the best of our ability in that moment. Caring for our physical and mental health is an act grounded in kindness and self-compassion and is, at its core, an ethical act.

Tools to support professional decisionmaking

SPA has developed several tools that members can access from its website to support decision-making, which can reduce the stress experienced in a situation and the impact of stress on professional decision-making, conduct, and communication in a professional context. These include specific resources that can be downloaded, such as use of one of four different ethical decision-making frameworks, support for deciding whether to use a therapy approach, ways to identify our own personal scope of competency, or how to identify quality professional learning opportunities. Other supports include a range of podcasts, recorded collaborations exploring a series of ethical issues, Speak Out magazine articles addressing common queries in practice, and FAQs on key topics. In addition, the revised ethics education package (“Code of Ethics: Support for Everyday Practice”) was launched in 2022 to provide meaningful opportunities to reflect on and apply the four ethical reasoning approaches to scenarios that are common in daily practice. In response to increasing member need in this area, SPA has also developed a 3-hour, online, on-demand learning package called Riding the Wave of Stress: Recognising and Managing Stress to support members to identify and manage workplace stress, which is free to SPA members. Members may identify other strategies that can be accessed within their workplace such as support from colleagues, development of a culture of support and openness within a practice, or access to Employee Assist programs.

Conclusion

The increase in stress experienced by allied health professionals including SPA members in the last few years has highlighted that the impacts of stress on our professional wellbeing and professionalism can be significant. By considering the impacts of stress on capacity to demonstrate professionalism and conduct in professional contexts, this discussion has shown that identifying and managing stress in the workplace is an ethical issue. Speech pathologists’ working contexts can by their very nature be stressful due to the provision of services and supports for people living with communication and swallowing needs, families, and communities. Undertaking reflection to identify stressors, as well as strategies and actions to mitigate the impact of that stress, supports the quality and safety of the services we provide, which is the ultimate goal of ethical practice.

Relevant links for this article

Riding the wave of stress: Recognising and managing stress	https://bit.ly/SPAethicslink4
Ethics collaborative: Why your mental health is an ethical issue.	https://bit.ly/SPAethicslink5
Ethics collaborative: Professional communication: Developing a safe space.	https://bit.ly/SPAethicslink6
Ethics collaborative: Using ethical values and principles in everyday life.	https://bit.ly/SPAethicslink7
Ethics Education. Code of Ethics: Support for Everyday Practice.	https://bit.ly/SPAethicslink8
Position statement: Professional support, supervision and mentoring (2022).	https://bit.ly/SPAethicslink9
2020 Code of Ethics.	https://bit.ly/SPAethicslink10

Additional information

Notes on contributors

Trish Johnson

Trish Johnson is a speech pathologist and Manager of Ethics and Professional Issues at Speech Pathology Australia.

Kelly Williams

Kelly Williams is a speech pathologist and Ethics Advisor at Speech Pathology Australia.

Nadia Marussinszky

Nadia Marussinszky is a speech pathologist and Ethics Advisor at Speech Pathology Australia.

Alex Felix-Faure

Alex Felix-Faure is a psychologist and team leader at a not-for-profit allied health children and family services organisation in Melbourne.