Midterm Flashcards
Six elements of Vision 2020
Autonomous practice, direct access, DPT, Evidence Based Practice, Practitioner of Choice, Professionalism
Five Roles of a PT
Clinical Practitioner, Consultant, Administrator/manager, researcher, educator
Core Values of Professionalism in PT
Accountability, altruism, compassion/caring, excellence, integrity, professional duty, social responsibility
Altruism
place patient’s needs before your own
Accountability
Acceptance of responsibility for diverse roles, obligations, and actions
Excellence
Evidence based practice
Integrity
adherence to ethical principles or professional standards
How do PTs know what they can do?
Scope of Practice, Standards of Practice, Laws/Regulatory Authorities, Code of Ethics
Scope of Practice
Examining
Alleviating impairment thru intervention
Prevention/wellness
Consultation/education/research
Standards of Practice
Criteria, performance standards an assessments for the practice of PT Ethical/legal considerations Revised Code of Ethics effective 7/1/10 Administration of PT service Patient/Client management model Education Research Commitment to society
Patient Client Management Model
Patient management sequence- how we systematically approach patient care
Structure of documentation of initial episode/interaction with patient/clients
Terminology must be understood within the context of PCMM
PCMM Cycle
Examination Evaluation Diagnosis Prognosis Intervention
Examination
Beginning to understand what is going on with your patient
History, systems review, test&measurement
Comprehensive screening and testing process
Purpose: to establish the nature and status of condition
Evaluation
PT makes clinical judgments using data collected during examination
Purpose: to interpret the findings
Diagnosis
Label assigned based on the information collected and clinical experience
Prognosis
(Plan of Care)- Guide to PT practice is used to help determine these
What are we trying to achieve- GOALS (short term/long term)
Predict the level of improvement- OUTCOMES
How long will it take- FREQ & DURATION
Intervention
Treatments/Coordination of care
Administered and modified based on response
Medical Model
Medical doctors (MDs, Dos) Treat the ailment/disease (we don't do this)
Disablement Model
DPT’s
Addresses the functional impairments that result from a medical condition
Looks how health changes and progresses towards disability
ICF- International Classification of Functioning, Health, and Disability
This links nicely with our coding system here in the U.S.
Addresses activity and participation
Nagi’s Framework
Healthy -> Disease -> physiological impairment -> Functional Limitations -> Disability
Disease (Nagi)
Signs and symptoms (joint swelling)
Physiological impairment (Nagi)
MS, NM, CP, Integumentary (decreased AROM)
Functional Limitations (Nagi)
physical, psychological, social (difficulty walking)
Disability (Nagi)
Environmental Role (can’t work)
Qualities of a Profession
Autonomy, Ethical Standards, Accountability
Hierarchy of criteria of a profession
Autonomy of judgement
Service to patient/clients
Specialized education- CAPTE, arm of APTA
Representative organization- APTA, develops standards, educational opportunities
Life Time commitment
Autonomous Practice
direct and unrestricted access: entry point to health care system
ability to refer to other healthcare providers
ability to refer to other professionals
ability to refer for diagnostic tests
Collaborative, independent, self determined thoughts and actions
Ethical Standards
Standards of Practice for Physical Therapy Code of Ethics (PT) Guide for Professional Conduct (PT) Standards of ethical conduct for the PTA Guide for conduct of the PTA Professionalism in PT: core values
Levels of Care
Primary, Secondary, Tertiary
Primary Care
entry into health care system
no referral required
Secondary Care
care provided after receiving care at a primary level
referral is frequently required
Tertiary Care
care provided by a specialist
Team Approach
Intradisciplinary and Interdisciplinary
Intradisciplinary
within your departments/practices
Interdisciplinary
across departments
across disciplines
across professional levels- physicians and PT techs
Screenings
determine if an underlying condition might be present
to determine if further services might be needed
Health Promotion
prevention or minimize risk of injury
Coordination of Care
communication
documentation of episode of ‘care’
Discharging Patient/client
goals/outcomes met
Discontinuation of Services
patient/client terminates services
PT/client unable to continue due to medical/psychosocial or financial reasons
PT judgement is intervention will not improve the status of the individua
Utilization of the PTA
no-examination, evaluation, diagnosis, prognosis or plan of care- PT only
Yes- Assessments- measurement or assigned value but not “assess”
Yes- Interventions, some of them
Yes-modify a plan of care only due to a patient’s status or response to an episode of care
Can a PTA progress a patient?
If it’s in the plan of care yes. The plan of care may say, progression resistant exercises for 2 weeks, the PTA can increase the resistance.
Delegation of clinical roles to PTA
Education- additional training Experience & skill level Current responsibilities Predictability of outcomes Acuteness of patient’s status, stability complexity and criticality Federal and State statutes Liability and Risk Management issues Mission of the practice setting Needed frequency of reexamination
Supervision of PTAs in FL- general
Delegation of duties without PT present- yes PTAs can work on pt. w/out PT present
same rules apply-delegation criteria
PT must be available by telecommunication access (2-way) at ALL times during the delivery of care in same geographical location
Supervision of PTAs in FL when employed by physicians
GENERAL supervisions by a PT Board certified physician orthopedic chiropractor physiatrist ONSITE supervision of a PT all other or non board certified as outlined in practice act
Ethical Compass
A set of internal ideas, concepts, values, and duties that keep us heading in the right direction as professionals.
Guidance when there are alternative pathways or behaviors
A tool that we can fall back on when we feel lost or unsure
Resources Available for Ethical Decision Making
Code of ethics
Standards for ethical conduct
These documents may not provide definitive answers to difficult ethical decisions
Ethics
A rational reflection
Particularly important when there are competing realms or 2/more possible courses of action
The reflection or analysis needed when confronted with conflicted ideas/values
Values
Standards for what is right and wrong, good or bad,etc
Derived by individuals from personal, professional, organizational, societal, and cultural sources
Different from ethics, but foundational to ethical decision making
Laws
May be local, state, or national
Include rules, admin codes, and regulations created by admin agencies to interpret, delineate or implement legislation
Justice
Determined by- Fairness, need, and/or entitlement
Types of Justice
Distributive, Criminal, Compensatory, Procedural
Distributive Justice
how benefits, burdens, rights, and responsibilities are distributed
Criminal Justice
a system of punishment through law
Compensatory Justice
compensation for wrongs
Procedural Justice
fair processes or due process
Informed Consent
The duty of informed consent requires the PT to respect the right of the patient to make a decision about his/her health care, based on understanding the necessary info (benefits, risks,etc). This includes the right to agree to or refuse the course of action
3 conditions of informed consent
Competence of the patient
Information
Voluntariness
Confidentiality
Duty to maintain privacy of info concerning patients by not divulging it to unauthorized persons
Paternalism
Generally considered the opposite of autonomy
2 types: Weak and Strong
Strong Paternalism
a more active intervention to promote good
Weak Paternalism
intervention solely to protect a patient from harm
Fidelity
Put the patient first to meet REASONABLE expectations
Professional Boundaries
The idea of not becoming inappropriately involved, emotionally or behaviorally, with patients and others involved in one’s work.
It does not mean emotional uninvolvement and indifference.
Conflict of interest
Exists when a professional has competing interests or obligations that prevent fulfillment or primary professional obligations
Multiple obligations do not of themselves create a conflict of interest
Concepts of RIPS
Environmental Context (realm)
Individual process involved (ethical sensitivity, judgment, or courage)
Situation (ethical issue, dilemma, distress)
RIPS process (4 steps)
Recognize and define
Reflect
Decide
Implement, reassess, and evaluate
Realms of RIPS
Societal, institutional/organizational, individual
Societal realm
the primary concern at this level is the common good
Ex- national and state systems, including legal, financial, cultural, and religious establishments.
Issues at this level tend to have more complexity and higher importance than those in other realms
Institutional/organizational realm
The primary concern is the good of the organization
Ex- mediating structures, such as professional organizations, families, agencies, and corporations
The focus of this realm is on structures and systems that facilitate organizational/institutional goals
Individual realm
The primary concern is the good of the patient
Ex- PT working directly with the patient
The focus of this realm is on rights, duties, relationships, and behaviors between individuals.
There is lower complexity of problems as compared to other realms
Individual Processes
Ethical sensitivity
Ethical judgment
Ethical courage/character
Ethical Sensitivity
recognizing and interpreting ethical situations
Ethical Judgement
judging which action is right or wrong
Ethical courage/character
prioritizing ethical values over other ones, demonstrating courage, persisting , implementing, developing and negotiating a plan of action
Types of Ethical Situations
Issue/Problem Dilemma Distress Temptation Silence
Issue/Problem
important values are present or may be challenged
Dilemma
2 alternative courses of action; each fulfills an important duty and it is not possible to fulfill both obligations
Distress
you know the right course of action but are not authorized to perform it
Temptation
involves a choice between right and wrong and in which you may stand to benefit from doing the wrong thing
Silence
ethical values are challenged, but no one is speaking about this challenge to values
5 Tests of Right vs Wrong
Legal test: is something illegal
Stench test: does it feel wrong
Front-page test: how would you like your actions on the front page for everyone to see
Parent test: if I were my mother would I do this
Professional ethics test: what do the documents say
3 ways to make an ethical decision
Rule based- rules, duties, or over-arching principles
Ends based- focuses on consequences of the decision
Care based- emphasizes concern for others and relationships (golden rule approach)
Types of Communication
verbal/nonverbal, reading, writing, listening (all equally important)
