The Domain of values is defined in the CSP framework as ' a set of ideals that motivates and informs an individual's behaviors and actions'. Altruism, advocacy, compassion and caring, honesty and integrity, fulfillment of duty of care & social responsibility and commitment to excellence make up the values defined by the CSP framework. The criteria to meet this domain does not change based on an individual's experience level. The importance of values to a physiotherapist is also echoed in the HCPC standards, NHS values and CSP standards of practice. 

Altruism is the act of caring for others by doing something that will benefit them (2). I have demonstrated this through handover letters sent to a patient's carers following discharge from stroke community service, which is evidenced as 'Handover of exercises to Carers'. As the patient had completed their pathway and were deemed fit for discharge this was not a necessity. The concern for the patient's wellbeing, the need to work together for patients and the need to improve lives drove me to handover exercises for the carers to assist the patient with. This also demonstrated a fulfilment of duty of care & social responsibility; the patient had an outstanding goal of returning to his upstairs bedroom but the patient's family were unwilling to complete any rehab exercises with the patient to help reach this goal. As the patient had bidaily care, I decided to hand over to them, so that the patient did not lose any function while his referral for standard community physiotherapy was being processed.  While I would have described myself as caring prior to starting this MSc, it has been during my experiences on placement where I have been able to witness examples of altruism. I have been able to reflect on occasions that my educators have made phone calls to patients next of kin, contacted carers and referred patients for befriending services. By discussing what these small gestures can mean to the patient with seniors and by attempting to bring similar gestures into my own practice, it has allowed me to grow my own scope of practice. I now always try to think of ways of implementing altruism with all my patients, but still often discuss methods I'm not familiar of with seniors. Completing handovers, has not always been something I have found easy - particularly in letter form. Initially I struggled with the language and information required in the letter. I overcame this by reading previous letters sent on Systmone and getting feedback from my educator.

Advocacy involves promoting the wellbeing of certain patients or communities (2). For me this means being able to speak up for the benefit of those who may not be heard. Prior to attending any practice placements, various online trainings were conducted. This included completing safeguarding training to ensure I have the basic knowledge to manage the wellbeing of vulnerable children and adults. This has been included as evidence as 'Safeguarding Certificates'. This was probably my first taste of the concept of advocacy. Although many topics are discussed in classrooms, it is not until going on placements that many concepts make sense. For me personally, my scope of practice grew throughout the course of my placements in relation to advocacy by witnessing my seniors advocate for different patient groups. However, the biggest impact on advocacy for me was the development of a business proposal for a second-year assignment. This is included as evidence as 'Business Case Summary'. I identified a vulnerable patient group (mental health), who I felt were not fully having their needs met through current services. It was advocating for this mental health population to receive physiotherapy services that my scope of practice truly improved. Having completed this business proposal, allowed me to have confidence moving forward that I can identify vulnerable patient groups and communicate their needs, when they cannot. There were many areas of this project that require improvements. These include making sure my idea is truly innovative and does not already exist and getting more feedback on preferences from patients. I feel as I gain more experience as a qualified physiotherapist and complete rotations, my knowledge of different patient groups will grow as will my confidence in speaking up for them (3). The biggest point I have taken from this is the need to speak up for others, even when it is not easy to do so.

A physiotherapist must act with honesty and integrity to their employer and the patient to maintain high standards (4). I have attempted to achieve this through being honest in my evaluation of my own strengths and weaknesses while on placement, and throughout the course of my study.  This is presented here as 'strengths, weaknesses, action plan' and 'reflection'. This allowed my educators and tutors to grade what sort of scenarios they were comfortable with me dealing with. This process has involved me being honest about my practice and demonstrating integrity in discussing negative experiences and weaknesses I had encountered in the past. This is similar to the process of reflecting that I have become familiar with during my time studying. At the beginning of the course - being honest about my own practice was not something I was very familiar with and I sometimes struggled to not only identify areas in my practice for development, but areas of strengths. By routinely completing SWOT analysis (strengths, weaknesses, opportunities, threats) with the guidance of practice educators I have become more confident in identifying weakness but also identifying strengths. Sometimes, an area I still find challenging is planning how to address areas for development. I am able to identify the area but forming a solution often requires some guidance from seniors. My scope of practice has improved that I am now much more comfortable analysing my strengths and weakness and through discussions and reflections with seniors I aim improve my ability to address weaknesses using development plans more frequently. I have included a SWOT and 'PDP' as evidence of my attempts to better myself in this regard.

My fulfilment of duty of care is evident from placement feedback from educators. This demonstrates how they felt I was conducting my role, but also my commitment to quality of care from improvements I made. This is presented here as ' feedback from educators'. This value is also evident in my completion of action plans - demonstrating I aim to improve my abilities to fulfil my duties. For me this value means fulfilling my role to the best of my ability. As their are still many gaps in my knowledge, I will seek out guidance moving into qualified practice for anything I am unsure about. This will allow me to reflect on the process and in turn enhance my practice.

Finally, my commitment to excellence is demonstrated through the formation of a business proposal that I could bring to a commissioning group to provide an innovative service to a specific patient group. This is presented here as 'Business Case Summary'. While this project was far from perfect, it highlights my ability to advocate for an overlooked patient group (mental health) and attempt to identify solutions that may reduce numbers of hospital admissions in this population. By researching for gaps in current services, identifying relevant policies , and proposing a solution which was for the benefit of a  population, I am committed to quality of care. While the execution of the business plan has much room for improvement, I believe that being involved in committees for service improvements and proposals once qualified, will allow me to get the much-needed experience. 

These mentioned values should be evident at every level of healthcare . I believe  there is no categorisation of different levels of these values, as they are the basic principles we all require to fulfil our roles as physiotherapists. However, these values have been somewhat threatened individually and profession wide through the emergence of the COVID-19 pandemic. For me personally I have found it challenging to enhance some areas of my own scope of practice. For example, demonstrating compassion and caring for patients has been challenged for me personally. Two reasons for these new challenges were the removal of many face to face services in April 2020 and the emergence of Personal protective equipment (PPE). For me, I found it difficult to engage with patients over the phone and struggled to build a rapport. There was similar challenges in visiting patients in the ward while wearing full  PPE. I found patients had their guards up much more. Greater time was required in these encounters, to ensure patients were confident in my values.