Final Flashcards
What are the 4 aspects of consent that are needed in dietetic practice?
- building trust
- collecting personal info
- sharing info with practitioners
- developing the nutrition care plan
What is the difference of express and implied consent?
express consent = given orally or written
implied consent = is implied
What are the 7 elements of informed consent?
- did you disclose the nature of the treatment?
- did you disclose who will be providing the treatment?
- did you explain the reason for intervention?
- did you explain the material effects, risks, and side effects of the intervention
- did you provide alternatives to intervention?
- did you explain the consequences of declining intervention?
- did you provide an opportunity to ask questions?
“Treatment” is defined as anything that is done in a:
1.
2.
3.
4.
5
health-related purpose
“Treatment” is defined as anything that is done in a:
1. therapeutic
2. preventative
3. palliative
4. diagnostic
5. cosmetic
health-related purpose
It includes:
A) a course of treatment
B) plan of treatment
C) community treatment plan
_____ is defined as anything that is done in a:
1. therapeutic
2. preventative
3. palliative
4. diagnostic
5. cosmetic
health-related purpose
treatment
______ outline the minimum level of performances expected from dietitians for obtaining informed consent
standards of consent
what are the 9 minimum standards of consent?
- consent for nutrition treatment
- consent to use personal health info
- must assume clients can provide consent unless there is reason to believe otherwise
- must use appropriate substitute decision maker
- must keep incapable clients as involved as possible
- must apply culturally approach to obtain consent
- must respect client’s right to refuse treatment
- must provide treatment without consent in emergency
- must document express consent
What are the general guidelines for capacity to consent?
- kids < 7 yrs can’t consent to treatment
- kids 7-12 yrs can rarely consent to treatment
- kids 12+ should be carefully assessed on case by case basis
capacity can vary - may be able to consent to simple treatment, but not to complex treatment
what are the 4 criteria to being a substitute decision maker?
- 16+ yrs
- capable
- able and willing to make decisions
- act in accordance with last capable wishes of the client
What is the hierarchy of substitute decision makers?
- guardian appointed by court
- attorney for personal care conferred by a written form when client is capable
- consent and capacity board appointed representative
- spouse
- child or custodial parent
- access parent
- brother or sister
- other relative
- public guardian or trustee
what is the lock box provision?
under the lock-box provision, a client can refuse to share personal health info with other health care providers (withhold or withdraw consent or may prohibit or place conditions on this disclosure)
They are expressly withholding or withdrawing their consent
what are examples of what a client may choose to withhold?
abortions, incarceration, psychotherapy notes, medication history
Why do we document things/record keep?
- accountability
- protect yourself in the future
- its the law
what are 3 types of records?
- health records (part of every dietitian’s practice)
- financial records
- equipment service records
what are the 5 record keeping standards?
- RDs must ensure their documentation is ACCURATE, OBJECTIVE, REFLECTIVE of dietetic services provided
- RDs must document in a systematic and timely manner
- Ensure comprehensive client health record is maintained when nutrition assessment and intervention are provided
- RD must maintain financial records whenever billing occurs
- Ensure reasonable measures are in place to maintain the security of client health records
In which 8 scenarios do you have to report to the CDO within 30 days?
- self-reporting
- sexual abuse of a client by a dietitian
- professional misconduct, incompetence, or incapacity of a dietitian
- unsafe practice or unethical conduct by dietitians
- revoking priveleges on employment, suspending or imposing restrictions on a dietitian’s practice for professional misconduct, incompetence or incapacity
- terminating employment of a dietitian for professional misconduct, incapacity, or incompetence
- intended to terminate or revoke a dietitian and they left the profession first
- dissolving a partnership, association, or group practice for professional misconduct, incompetence, or incapacity of a dietitian
In which scenarios do you have to report to other authorities?
- sexual abuse of a client by another regulated health professional (not a dietitian) - to an appropriate college
- professional misconduct, incompetence or incapacity of another regulated health professional - to the appropriate college
- suspect that a child is being abused or neglected - Children’s aid society
- suspect that an elderly resident in a long term care home suffers from unlawful conduct, improper or incompetent treatment or care - director of the long-term care home
- suspect that an elderly resident in a retirement residence suffers from unlawful conduct, improper or incompetent treatment or care - director of the long-term care home
- privacy breach
REPORTING OBLIGATIONS TO THE REGISTRATION AND QUALITY ASSURANCE PROGRAMS
Mandatory liability insurance coverage
practicing less than 500 hours in the past 3 years
change of contact or employment information
Why are professions regulated?
for the sole purpose of public protection
what is the difference between a professional association and a regulatory body?
professional association = does advocacy work for the profession
regulatory body = to protect the public
if a regulatory body were to advocate for workers, would that be a conflict of interest?
yes! because regulatory bodies are supposed to protect the public
what does RHPA stand for? what does it do?
the regulated health professions act (1991)
the RHPA sets out the framework for the regulation of the entire health profession sector
the dietetic act of 1991 sits under
the RHPA
the CDO gets its authority from
the RHPA
controlled acts fall under:
the RHPA
______ governs all healthcare professionals and colleges in Ontario
the RHPA
What is the mission of the CDO?
to assist people with how to access safe competent healthcare
what are the 3 main functions of the CDO?
- registration
- quality assurance
- complaint and discipline
one of the main functions of the CDO is registration. what is the registration program responsible for?
- establishing stands for entry to practice
- assessing qualifications of applications for entry to practice
- issuing certificates of registration to qualify applicants
- annual registration renewals (collecting payments)
- ensuring that the register of dietitians is accurate and publicly available online
It establishes the standards of qualifications for persons to be issues a certificate of registration
the use of the RD title is protected under:
the registration regulation of the CDO
are temporary members of the CDO required to use the professional totle RD?
yes
either registered dietitian, RD, dietetist professionalle, or Dt.p
why do RDs need to use their designated title?
- to protect the public
- to inform the public to let them know they are receiving services from the regulated people
who is allowed to use the title dietitian?
- a person who received either permanent or temporary designation
- person who has met requirements from CDO
STUDENTS CANT USE THE TITLE “RD TO BE”
what is the final step to becoming an RD?
the Canadian dietetic registration exam (CDRE)
what is the purpose of the CDRE exam?
to distinguish between competent for entry to practice, and non-competent practitioners
how does one become eligible to write the CDRE exam?
if they were deemed by provincial regulatory body to have met academic and practical training requirements
when someone writes the CDRE exam, they have the MINIMUM competence for safe practice
how often does quality assurance, one of the 3 functions of the CDO, occur?
annually with renewal in first year of practice, and every 5 years after that
what are the 4 programs within the QA program?
- self-directed learning tool
- jurisprudence knowledge and assessment tool (JKAP)
- per and practice assessment
- practicing fewer than 500 hours in any 3 year period
why is quality assurance important?
it helps members improve their competence
what is the self-directed learning tool (one of the 4 QA programs)?
all members must fill it out every year
it helps guide dietitians and requires them to develop plan for professional improvement
what is the jurisprudence knowledge assessment tool (one of the 4 QA programs)?
you have to do it in your first year (you have 3 tries and 3 months to do it). have to do it every 5 years after that
what is the peer and practice assessment (one of the 4 QA programs)?
it is a 2 step process
Step 1:
- dietitians are randomly selected to undergo this assessment.
- have to identify colleagues to complete survey about their performance
Step 2:
- behaviour based interview
what is the minimum amount of hours you have to practice, according to quality assurance?
500 hours within 3 year period
what does the complaint and discipline function of the CDO do?
it addresses concerns about the conduct, competence, and capacity of dietitans, and is one of the ways the CDO works to protect the public
what are the 3 committees under the complaint and discipline function, that work to investigate and address concerns about members?
- inquiries, complaints, and reports committee
- discipline committee
- fitness to practice committee
what are the 3 main organization structures of the CDO?
- committees
- council
- staff directory
what are the 6 statutory committees of the CDO (statutory committees are required by law)
- executive committee
- registration committee
- QA committee
- inquiries, complaints and reports committee
- patients relations comitee
- fitness to practice and disciplines committee
the committees of the CDO are made up of 4 main types of people:
- elected council RDs
- public members
- appointed RDs
- CDO staff
which group is responsible for establishing policies and standards that regulate dietetics?
Council
the council of the CDO is made up of:
8 elected RDs
7 public appointees
the staff directory is made up of:
14 staff members
they do the operations of the college
ALL CDO members must have liability insurance, according to by law #5
How does one get dietetic insurance?
- employer’s insurnace
- dietitians of canada OR independent insurance broker
how many members of the CDO will randomly be selected to submit proof of insurnace?
10%
____ supports compliance of standards, provides advice on practice use, and provides info they can use to practice safly and ethically
the practice advisory program
what are some examples of resources that the practice advisory has?
- educational resources
- presentations
- annual workshops
- individualized profesional practice supports
who does the college’s practice advisory service provide professional practice guidance to?
RDs, the public, other health professionals, employers, and students
what is jurisprudence?
all the decisions made by the court of canada
can a perceived conflict of interest be just as damaging as a real conflict of interest?
yes
what is the difference between conflict of interest and boundary crossing?
conflict of interest = usually financial
boundary crossing = similar to CI, except the competing interest is a personal feeling not tangible incentive
what are the 3 aspects of the foundations for professional practice?
- trust = in someone we rely on
- integrity = being truthful and honest
- ethics = principles for how we conduct ourselves
what are the 4 components of conflict of interest?
- personal interest
- can be ANY benefit
- can be to family, friends etc - professional judgment
- includes a. knowledge b. client input c. professional obligations d. experience - improper influencing
- ie. paying for someones attendance at a conference (getting a pen at a conference isnt the same) - reasonable person test
- how would someone outside the situation deem the situation?
what are the 4 aspects of professional judgment (which is a component of COI)?
- knowledge
- client input
- professional obligations
- experience
what are the 3 ways of approaching conflict of interest?
- recognize it. THEN
- a) avoid it
- b) manage it
when approaching a conflict of interest, what are the 3 situations you want to avoid no matter what?
- RD, related person, or corporation, cant directly or indirectly accept gifts, rebate, credit or other benefit due to the RD referring a client to someone
- […] cant offer gifts etc because someone referred client to you
- […] cant enter arrangement respecting a lease or use of premises or recruitment whereby RDs receive benefit for volume of client purchases made (ex. RD rents space from pharmacy. refer clients to purchase suppments which leads to recution in RDs rent)
- pressuring clients to participate in research that directly benefits the RD
- selecting a foodservice supplier on the basis that that supplier offered a gift or other personal benefit
what other COI circumstances should be avoided?
accepting large benefits/gifts
asking for a donation for a research project for a loan for your business
conflicts involving patietns who cant protect themselves
conflicts relating to client assessments or that involve treatment
what is the DORM principle for managing COI?
- Can we DISCLOSE? identify nature of conflict
- can we provide OPTIONS? provide alt options
- can we REASSURE? reassure clients that choosing something else wont affect quality of service provided
- can we MODIFY it? remove conflict. ie if selling supplements to clients, sell them at cost
what is the definition of boundary crossing?
there is no generally accepted definition of boundary crossing. but the focus is on behaviour
boundary crossing can be:
one off
accidental
unexpected
third part initiated
purposeful
RD initiated
low, medium, or high intensity
what is a checklist we can use to see if boundaty crossing is occurring?
- is this in my client’s best interest
- whose needs are being served
- could this actin affect my services to the client?
- could i tell a colleague about this?
- could i tell my spouse/partner about this?
- am i treating the client differently?
- is this client becoming special to me?
what are 6 types of boundary crossing?
- self disclosure - dont tell too many details about personal life
- giving or receiving gifts
- dual relationships (hiring client or selling products)
- ignoring established conventions (rescue fantasies, romantic relationships)
- sexual abuse / touching
- rescue fantasies
are sexual relationships with clients ever permitted under the RHPA?
no - even if the client consents, its not allowed
what are the 3 aspects of the definition of sexual abuse?
- sexual comments
- touching of a sexual nature
- sex or other forms of sexual relations
how long does a client remain a client for?
for 1 year after the therapeutic ends
what is the consequence of someone being found guilty of sexual activity?
they will have their registration revoked for at least 5 years
what are the rules are reporting sex abuse?
- reporting sex abuse is mandatory
- report goes to practitioners health regulatory collect
- client name cant be disclosed without consent
what is the purpose of the professional RD-client therapeutic relationship?
to provide safe dietetic services to people who need them
boundary crossing is the point from where the RD-client relationship goes from professional tp personal
what are 4 consequences of boundary crossing?
- damage trust between RD and client
- interfere with the RD’s professional judgements to the detriment of the client
- hinder a client’s ability to question treatment suggestions
- compromise client’s ability to provide voluntary consent
rescue fantasies are examples of
boundary crossing
what are the early signs of boundary crossing?
- inappropriate emotions
- daydreaming about a client
- flirting
- exchanging personal gifts
- meeting a client at a coffee shop
what are examples of dual relationships?
- treating friends and relatives
- becoming friends with a client
- personal relations with a client’s family
- treating your romantic partner or spouse
- treating your boss, colleague, or employee
are RDs prohibited from treating relatives and friends?
NO
except they are not allowed to treat romantic partners and spouses
what happened in may 2018?
new section of protecting patients act of 2017 under the RHPA
they expanded the definition of a patient SPECIFICALLY within the context of a sexual abuse
says that patient is client for a whole year after relationship ends
what is the fine for people who fail to report abuse?
$50,000 for individuals
$200,000 for corporations
what are the 5 standards for prfoessional practice that relate to conflict of interest?
- avoid COI that are not manageable by safeguards
- identify situations that are, or may lead to, COI
- manage situations to help alleviate a real or perceived COI
- maintain professioanal RD-Client relationship when avoiding or managing a real or perceived COI
- document any potential, real, or perceived COI and how it was managed
what is the personal interest test?
ask youself - am i receiving any personal benefit? (gifts, advantages, discounts etc)
what is the professional judgment test?
will this action compromise my objectivity?
the improper influence test
am i changing my actions so that i can have the benefit
reasonable person test
what would a reasonable person think?
what is the purpose of the RD-client therapeutic relationship?
to provide safe dietetic services to people who need them
what are the 2 main rules around sex under RHPA
- RDs cant have sex with a client
- RDs cant treat a sexual partner
An RD found guilty of sexual activity which involves frank sex will have their registeration revoked for
5 years
if a client becomes a friend or an employee, that is an example of
boundary crossing
when dietitians borrow money from a client, that is an example of
boundary crossing
does boundary crossing apply to non-therapeutic clients like organizations, companies, and municpalities?
no
if an RD accepts a free gym membership for referring a client, that is
COI
