Professional practice Flashcards
Name the four ethical principles
- Justice
- Autonomy
- Beneficence
- Non-malfeasance
How do you resolve an ethical issue
Identify the problem and relevant laws/principles
Consider the impact on stakeholders
Find potential course of action and choose
Assess the outcome and decide if more input is needed
What is PT scope of practice identified by
- Education and training
- Governing body (national standards)
- Institution (facility that you work at)
What is not in the PT scope of practice
Diagnosing medical conditions and diseases
Giving advice about medications
Medical treatments not in PT scope (can you predict and deal with potential complications of the tx and is there another profession more equipped to carry out this tx?)
What are the PT restricted activities and which can be delegated?
- Tracheal suctioning *
- spinal manipulation
- acupuncture or dry needling
- Treating a wound beneath the dermis *
- Ax or Tx of pelvic musculature
- Administering medication through inhalation *
When do you need to get consent and when are you exempt
Need: Prior to Ax, Tx, involving others in care, sharing health records
Exempt: in emergency (CPR) or if trumped by “duty to warn” and only if imminent
What is the minimum age for consent in Canada
No minimum age for consent
What is informed consent
the pt or SDM has received info about the tx, nature of the tx, benefits, risks, side-effects, consequences of not receiving the tx and alternative options.
Then the pt or SDM can make an informed decision and allows them to be involved in the decision making process.
Name the components of consent
- capacity
- voluntariness
- understanding
- disclosure
What are the consequences of not gaining consent?
Legal (assault and battery)
Professional misconduct (from complaint, board and college decides)
What are the 6 ways to effectively communicate
- Courtesy
- Clarity
- Listening
- Consider culture
- Get on same page
- Body language
How do you prevent poor communication?
-Clearly explain risks/benefits
-Using plain language
-Showing empathy
What can effective communication do?
-Support history taking, diagnoses, and clinical decisions
-Increase client’s adherence
-Help self-management
-Influence preventative health behaviours
-Improve client satisfaction and experience in care
What are alternative methods to communication?
Interpreters
Handwriting
Visual-gestural
Diagrams
Online platforms / technology
Educational materials
What does documentation about communication need to include?
Clear
Accurate
Professional
Timely
Explain what the 4 ethical principles mean
-Justice - everyone has fair and equal treatment
-Autonomy - Patient makes own informed decision
-Beneficence - Do good - act in patient’s best interested
-Non-maleficence - Do no harm
Which restricted acts cannot be delegated?
Acupuncture
Spinal manipulations
Communicating a diagnosis
Internal assessment or rehabilitation of pelvic musculature
What do you need to ensure before you delegate?
Written instructions of what to do if there is an adverse event
Person must understand circumstances
Person must be competent - with knowledge, skills, judgment
What do the components of consent mean?
-Capacity - able to understand and appreciate consequences, no age limit, determined by physio, situational based, given by substitute decision maker if not able
-Voluntariness - patient not coerced into making decision, PTs can give objective reasons and explain professional opinion in unbiased fashion but final decision is up to the patient
-Disclosure - disclose information in order to make informed decision, treatment, what it entails, risks and benefits, consequences if don’t do treatment and other alternative, can withdrawal consent at any time
-Understanding - making sure patient understand what you said, allow questions, check understanding
What must a SDM be?
Willing, available, capable, 16 years old or parent, act in wishes stated when patient was capable and PTs can take to consent and capacity board if think SDM not acting in patient’s wishes
What are the two privacy legislations?
-Federal - PIPEDA
-Provincial - HIC and HIC agents
What would you do if privacy breach occurred at your clinic?
- Contain the breach
- Notify patient - and tell them to report to the information and privacy commissioner
- Notify employerif agent of HIC
- HIC notifies regulatory college
- Notify information and privacy commissioner
What is the duty to warn?
If danger imminent, going to cause serious bodily harm and danger to themselves or someone else then the duty of harm outweigh the duty of patient confidentiality
A young patient tells you not to tell their mom but they are going to try to harm themselves this evening. The patient begs you not to tell and states that they will lose trust in you if their mom finds out. What do you do?
Report to services that can help the child
A patient tell you not to tell their son that they have terminal cancer. Do you tell their son and what principle is this under?
-Lock - box
-No you cannot tell the son.
-You can record the information but not use it.
-Duty to warn precedes this
A patient doesn’t want the doctor to know that they have bloody poops. What to you do?
-Advise the patient that this is important information for the doctor to know and that there are health risks associated from withholding this information
-Ultimately it is the patient’s decision to tell this information or not
What are the requirements for all records?
- Organized- Dated, late must be post-dated, need name and job title
- Understandable - Legible, acronyms appropriate with document describing, english
- Accurate -Error - single line with date, reason and signature, permanent and reasonable time period
Who is allowed to access patient’s records?
- Patients or authorized personnel- can have a fee and accessed within reasonable time for retention period
- Health care professionals within the circle of care
- Authorized assessor or investigator from the College
- Police authority under the Missing Person’s Act
What are 3 ways to protect records?
-Physical
-Technological
-Administrative
How long should records be kept for?
- Keep records for 10 years after discharge or 10 years after turn 18 (most provinces), can keep longer for some circumstances (legal)
- Need to notify patient if records are being transferred to another HIC
- Documents need to be destroyed in an irreversible manner
What is a physiotherapy support personnel?
- PTA is not regulated - meaning that documentation does not have to be signed, and that the PT is responsible if something goes wrong
- PTA assists physio in safe and efficient manner
What are physiotherapist responsibilities and expectations with PTA?
- PTA cannot see patients without supervision transferred to other physio or discontinue care
- Need to have documentations up to college standards
- PTAs cannot assess or reassessed - needs to be consistently done by physio
- Needs to be explained to patients the role of the PTA vs. physio and obtain consent and assess type and level of supervision needed
- PTA needs to be competent and knows safety and infection control measures
- Can only assign to PTA if PT knows the intervention
What acts can PTA not do?
- Be delegated a controlled act from a physio to another physio and then to PTA
- Perform spinal manipulations, acupuncture, internal exams, communicating a diagnosis
- Assessment or reassessment of patient
- Change or create treatment plans
How do you know if PTA is competent?
- Review the PTAs roles/responsibilities
- Verify the PTAs understanding/knowledge
- Learn about PTAs educational background
- Watch the PTA to ensure know what they are doing
- Train the PTA as needed
What does written communication with PTA need to state?
- How to contact the PT or supervising PT
- Time/place meet to discuss with PTA
What can PT students do?
PT students are allowed to assess, change treatment plans, create treatment plans and do controlled acts (if supervisor knows them) - but must be competent (knowledge/skills), supervised appropriate and get consent from patient
What must supervisors do for PT students?
- Must get consent from patient, introduce name and title and roles/responsibilities - prior to treatment
- Must sign off on all notes
- Must determine the competency to determine the level of supervision
- Are responsible for patient’s care
What act is Mandatory reporting under?
Under the regulated health professionals act (RHPA)
What is self-reporting?
If guilty/charged of crime or finding or current investigation in professional crimes in any profession
Common types of Mandatory reporting ?
- Sexual Abuse
- Abuse of elderly in LTC or retirement homes
- Child abuse/neglect
- Disclosure to prevent harm
- Privacy breach
- Incompetence
- Incapacitated
- Termination of employment
- Holding out as a Physiotherapist
What are restricted titles?
- Cannot call self physiotherapist if not registered fully with the college - holding out
- Need to be reported if you see someone else doing this
- Cannot mislead someone and need to correct them if they think you are a physiotherapist
- Cannot do for other professions as well
What are the steps if there is a conflict of interest?
-Try to minimize conflicts, if not possible than have convo with the patient about conflicts, and document this and suggest alternatives
What are the steps you take if professional boundary breach?
- Identify
- Correct
- Document
What are the steps you take if professional boundary breach?
- Identify
- Correct
- Document
What harm can occur from a professional boundary breach?
- Short cuts
- Treat patient like object
- Manipulation
- Purposeful manipulation
- Deceiving or cheating your patient
- Bias
What are the restrictions to maintain boundaries?
- Cannot date patients, unless been 1 year since discharge, no longer power imbalance and no longer reliant on physiotherapist
- Cannot date patient’s family members or supporters
- Cannot treat family members or close friends unless emergency or no other option
What are the reasons to discontinue care?
- Abuse
- Patient is noncompliant with treatment
- Failed to pay
- Patient requests
- Alternative services provided
- Not enough resources
- Professional boundary has been breached
What needs to happen when collaborating with the client?
-Working WITH client to meet needs/goals
-Help client understand role
-Help client make informed decisions - through treatment options, scope and roles, person responsible for coordinating care, funding mechanism for care (including implications for concurrent care), role of SDM, family and caregivers
-Respect client’s decision (what care and who provides it)
What is collaborative practice?
Collaborate with clients, health care team members and other stakeholders (family members, caregivers) that
-addresses goals and needs
-communicates effectively to coordinate care
-treats with dignity and respect
When should you participate in collaborative care?
-Complementary
-Benefits client
-Appropriate use of human/ financial resources
How do you know if your care is compatible with other service providers?
Inquiring from client or others
Provide info about physio
Share about the roles/responsibilities of physios in client centered care
Understanding treatments others will perform
A patient is seeing two different physios. One is treated low back, and one is treating ankle. Is this alright?
Yes - no duplication
When is a referral required?
Required in hospital/government funded, not outside of this
When and how should you refer?
Based on need, provide alternatives
No conflict of interest (kickbacks)
What are the steps to concurrent care?
Identify
Communicate
Manage risks
Document
When should you discontinue concurrent care?
Unnecessary duplication
Inefficient use of resources
Risks outweigh benefits
*should communicate this and provide rationale. Document it.
What are the steps taken when there is a problem/conflict?
Discuss problem with client or service provider
Work together to identify cause
Agree on how to resolve problem and desired outcome
Identify the consequences if not resolved
Document the situation and steps taken to resolve
Take appropriate action if problem recurs
Why use telerehabilitation?
Access to care - e.g., rural, travel difficulties
Continuity of care -e.g., PT moves or patient moves
Global crisis - e.g. covid-19
Access unique specialty / skills
What factors of professional judgement are needed to see if telerehabilitation is appropriate?
Is there similar care online
Can do without a physical exam
Is this the most appropriate delivery of service
Is there patient factors that may impact ability to deliver appropriate care (cognitive, sensory, physical)
What does MOU standing for?
Memorandum of Understanding
When may and may not you use a MOU?
May use
-No access to appropriate care for patient and would not be able to obtain it
-Follow-up care - continuity of care
May not use
-Conflict of interest - in physios best interest but patient would benefit equally or more from local
-No patient need - as appropriate and suitable care available
When do you need to get informed consent to telerehab?
Prior to receiving services through telerehab
Prior to videotaping, recording, or storing information from session
Prior to transmitting information
Prior to involving others
What do you need to do when communicating through email?
-ensure copy if treatment information or advice
-security and privacy measures in place with addition technological, physical and administrative safegaurding
-must be appropriate, relevant and private
What do you need to do when communicating through email?
-ensure copy if treatment information or advice
-security and privacy measures in place with addition technological, physical and administrative safegaurding
-must be appropriate, relevant and private
Safety expectations for telerehabilitation
Ensure technological support if failure, test before and have alternative phone numbers for patient and physio if fails
If emergency
-Have contact number of local emergency department
-Have contact number of family / someone nearby - and consent to contact
-Have policies and procedures of what to do when waiting for assistance, or not requiring assistance
