ch 16-18 Flashcards
Introduction to Balancing Client Rights and Practitioner Values
Balancing client-centered care with personal beliefs and ensuring practitioner safety.
Understanding Moral Injury
Definition:
- A situation where actions violate deeply held personal beliefs.
- May result in symptoms similar to depression or PTSD.
Impact:
- Moral injury can disrupt practitioners’ mental health and professional abilities.
Ethical Obligation:
-Practitioners are not required to endanger themselves physically or morally
Ethical Responses to Safety Concerns
Practitioners can remove themselves from situations posing physical danger
Steps to Address Safety Risks
Move to a safe location.
Attempt collaboration with clients or others to resolve risks.
Follow organizational guidelines for relationship termination, if necessary
Addressing Implicit Bias
Discuss biases with mentors.
Review professional standards.
Participate in cultural humility and inclusion training.
Reflection and Cultural Humility
Identify and acknowledge implicit biases.
Practice cultural humility during stress or conflict
Moral Distress vs. Moral Injury
Moral Distress:
Temporary discomfort during ethical uncertainty.
Requires intensive self-reflection.
Moral Injury:
Long-term mental health harm.
Includes symptoms like depression, anxiety, and burnout.
Key Goal: Avoid moral injury while managing moral distress
Navigating Ethical Limitations
Moral objection to identity, roles, or routines is not a valid reason to terminate
therapeutic relationships.
Steps for Transition:
-Reflect on limitations.
- Prioritize client, student, or colleague well-being.
- Follow organizational guidelines for transition.
Tips for Ethical Practice
Proactive Self-Reflection:
Organizational Guidelines:
Collaboration:
Introduction to Productivity in
Occupational Therapy
Definition of Productivity:
- Measurement of workload and service delivery in occupational therapy.
Contemporary Practice:
-Focus on functional outcomes and units of service for reimbursement.
Challenge:
- Balancing quality care with productivity expectations
Patient-Driven Payment Model (PDPM)
Introduced in 2019.
Emphasis on medical diagnosis rather than billable therapy units
Impacts PDPM
Reduced therapy staff numbers.
Increased workload for remaining practitioners
Challenges in Productivity Standards
Key Challenges:
-Managing higher caseloads.
- Balancing direct and indirect client care.
- Ensuring quality amidst tight schedules.
Ethical Concerns:
- Balancing organizational directives with client best interests
Common Ethical Challenges
Charging for unprovided services.
Coercing participation against client objections.
Documenting off-clock to meet standards.
Overrating impairments or providing unnecessary services.
Reporting colleagues or employers for suspected violations
Professional Duty
Follow legal and ethical standards.
Use independent clinical judgment for client care
Consequences of Non-Compliance
Legal penalties, loss of license, and professional reputation damage.
Strategies for Practitioners
Work within organizational structures.
Report fraud or unethical practices.
Seek whistle-blower protections if necessary.
Whistleblowing
Protected under the False Claims Act (2015).
Provides legal recourse and potential financial rewards
Resources for Practitioners
AOTA Practice Essentials
Office of Inspector General (OIG): Reporting fraud and violations.
Medicare and Medicaid Services: Guidance on compliance and reimbursement policies.
State Licensure Resources Regulations governing OT practice.
Tips for Ethical Practice
Be Informed
Proactive Communication
Moral Courage
Seek Guidance
Introduction to Ethical Challenges in
Occupational Therapy
Key Challenges:
Organizational trends and societal inequities.
Business orientation and resource allocation.
Cultural diversity and social determinants of health.
Focus of Discussion:
Primarily health care organizations such as hospitals, clinics, skilled nursing
facilities, and home health agencies
Evolution of Organizational Ethics
Gained momentum in the 1990s with the Joint Commission mandate.
Focus on hospital codes of conduct addressing admissions, billing, staff relations, and more
focus and purpose
Shift from individual ethics to group and organizational behavior.
Align decisions with organizational values transparently and fairly.
Common Ethical Problems
Productivity and billing pressures.
Compromised care due to cost containment.
Moral distress in therapeutic relationships.
