Professional Practice Flashcards
What are the four ethical principles?
Justice, autonomy, beneficence, non-malfeasance
Define justice, and how it relates to PT practice
equality, fairness of treatment or fair distribution of resources. PTs must maximize fairness to every patient regardless of a patients age, gender, race, or any other factors.
Define autonomy, and how it relates to PT practice
the right of a patient to be self-governing or to function independently. PTs must ensure they are giving the patient enough information to make an informed decision.
Define beneficence, and how it relates to PT practice
the duty to do good. A PT’s course of actions should always be in the interest of the patient
Define non-malfeasance and how it relates to PT practice
refers to the principle of do no harm, prevent harm or remove harm. Course of action affecting the patient should not cause harm whether it is by omission (what we don’t do) or commission (what we do).
How to resolve an ethical issue (6 steps)
1) IDENTIFY an ethical problem
2) IDENTIFY the facts, laws, and ethical principles
3) CONSIDER the impact on stakeholders and patients
4) FIND potential course of action
5) CHOOSE a course of action
6) ASSESS the outcome of the action and decide whether further action is needed.
Scope of practice can be identified by the following (3)
1) education and training
2) governing body
3) institution
For physiotherapy, the 3 essential competency profiles are
Physiotherapy diagnosis, physiotherapy assessment, physiotherapy interventions
What are the 9 physiotherapy interventions? (MECCA FEST)
consultation, education, therapeutic exercise, manual therapy/SFT techniques, electro-physical agents, mechanical modalities, functional and activity training, cardio-respiratory techniques, prescribing aids and devices.
What is NOT in the physiotherapy scope of practice
1) Diagnosing medical conditions and diseases
2) Prescribing or discussing the use of medication
3) other medical interventions not in the PT scope.
What is a controlled act or restricted activity?
a healthcare activity that by law should be performed by individuals authorized to perform them or by individuals who have been delegated the activity by an individual who is authorized to perform them.
How do you manage adverse outcomes with controlled acts/ restricted activities?
must know what to do in adverse outcomes occur while perfoming the act/activity. Additionally must have written instructions that describe how to manage any reasonable foreseeable adverse outcomes.
What are some restricted activities for physiotherapy?
tracheal suctioning, spinal manipulation, acupunture (including DN), treating wound below the dermis, assessing or rehabilitating pelvic musculature, administering a substance by inhalation.
What do you have to ensure for the individual being delegated the restricted activity ?
1) has the knowledge, skills, and judgement to do so competently
2) understands the circumstances in which they can perform the activity, with whom, and any other limitations.
3) how to manage adverse outcomes and has written instructions that describe how to manage any reasonably foreseeable adverse outcomes.
What are the restricted activities that CANNOT be delegated?
acupuncture, communication a diagnosis, spinal manipulation, internal assessment or rehabilitation of pelvic musculature.
Consent is required prior to?
assessing a patient, treating a patient, sharing health records or personal information regarding a patient to a third party
what is the only exception to obtaining consent?
emergency
How can consent be given?
implied or expressed
is there a minimum age for consent?
no
who obtains consent for a delegated task?
the physio as they are responsible for the treatment
Can consent be given for a multi-faceted course of treatment?
yes
when a patient is present with a plan involving multiple heathcare providers, how is consent obtained
it can be obtained through one of the healthcare providers that will be on behalf of the rest of the healthcare providers in the plan.
What is the patients right regarding consent?
to consent or refuse treatment
Can consent be withrawn
yes at any time (if it is safe to do so)
Does consent need to be documented?
Yes
What is informed consent?
The patient, or decision maker in the situation, is given all information by the therapist with regards to the treatment, the nature of the treatment, benefits, risks and side effects, consequences of not relieving the proposed treatment and the alternative options.
why is informed consent important?
it gives patients or decision makers the opportunity to make any substitutes, and creates meaningful participation by patient in the process.
What are the 4 components of consent?
capacity, voluntariness, disclosure, and understanding.
What is capacity? Regarding consent?
the patient must have the ability to understand the interaction and appreciate consequences of their decisions. if patient is unable to demonstrate capacity, it is passed to a substitute decision maker
What are the responsibilities of a physio regarding capacity to consent?
the physio is responsible for determining capacity when gaining consent. no age determinant and is decision specific.
What are possible indicators that a patient may be incapable of providing consent?
confused or delusional thinking
cognitive disability
inability to retain info (memory problem)
impaired by drugs (legal or illegal) or alcohol
irrational thinking as a result of severe pain, acute fear, anxiety or depression.
What is a substitute Decision Maker?
An individual who is authorized to provide or refuse consent to a treatment on behalf of a person who is incapable of making decisions.
Hierarchy of substitute decision makers (under the Health Care Consent Act).
Legal guardian, attorney for personal care, representative from the consent and capacity, board, spouse/partner, paren or adult child, parent with right of access, brother or sister, any other relative, public gaurdian and trustee.
What is voluntariness? Regarding consent?
Details that patient must never be coerced/ manipulated in making a decision.
What are some of the caveats of voluntariness? (ie. persuasion? bias? professional opinion?)
Although coercion is unacceptable, persuasion is.
information should not be framed with a bias
physio may provide professional opinion however must present the options objectively.
What is disclosure? Regarding consent?
Must disclose all information for the individual to make a decision
What does disclosure involve?
Nature of treatment
benefits
possible risks and side effect
alternative options
consequences of not receiving treatment
What is understanding? Regarding consent?
Its the responsiblitly of the physiotherapist to ensure the patient has not minterpreted the information (always proved opprotunities for questions)
What are some ways to ensure understanding?
encourage questions to help patient’s understanding.
ask the patient if they understand
ask the patient to paraphrase
What are the 2 concequences of not gaining consent?
legal
professional misconduct
What are the two privacy legislations?
PIPEDA and Provincial health information privacy acts
What is the Personal information protection and electronic documents act (PIPEDA)?
federal statute that governs the collection, use, and disclosure of personal information.
What is the Provincial Health Information Privacy Acts?
The name differs in each province but the rules and regulations are overall consistent
it regulates collection, use, and disclosure of personal health information by Health Information Custodians (HICs).
What are HICs?
Health Information Custodians.
They are healthcare practitioners, hospitals, and pharmacies.
Agents of HICs (eg employees of a physio clinic) hold the same duties and responsibilities as HICs.
What are the necessary steps of a data breach?
1) notify the affect person at the first reasonable opportunity (mention that a complaint may be made to the Information & Privacy Commissioner)
2) Agents of HICs must let their employer know at the first reasoanl opprotuinity and ensure the breach is contained.
3) HIC must report to the appropriate regulatory college when they take any disciplinary action against a member of health regulatory college due to a privacy breach of personal information
4) notify the Information & Privacy Commissioner if there is reasonable grounds to believe a breach has occurred.
What is “Duty to Warn”?
A providion in the privacy law allowing a regulated health care professional to break confidentiality if the healthcare professional determine that based on their best judjement, maintaining confidentiality poses a imminent risk of harm or danger to the patient, themselves, or another party (ie. disclosure to prevent harm)
- essentially if there is a imminent risk of harm or danger, the duty to warm overrules the duty to maintain confidentiality.
What are some possible situs where Duty to Warn overrules?
- there is a clear risk to a person or group of people
- there is risk of serious bodily harm or death
- the danger is imminent
What happens if danger or harm is NOT imminent?
consent must be obtained by the patient to disclose any personal or health information
What is meant by “lock box”?
a concept that describes a patients right to withhold, or withdraw consent to the collection, use, or disclosure of their personal health information
patients chose what is locked and who the lock applies to
What are two caveats of the “lockbox”
1) A patient cannot stop a regulated healthcare professional form recording information that is required by Law or by College standards. BUT if the patient decides to “lock” the information, it cannot be used or disclosed with the patient’s expressed consent or in the cases where the law allows you to disclose information (ie. in an emergency)
2) In cases where disclosure of information may prevent or reduce imminient harm or danger, the duty to warm takes priority over maintaining confidentiality of “locked” information.
What is the purpose of record keeping?
- track the patients course
-determine future care needs
give evidience of and rationale for the care provided - communication regarding patient’s past and current status
- facilitae safe, quality care, and improve efficency, consistenct, and coordination
- records tell the patient’s story and a record of each encounter
–> what was done, by whom, where, why, the outcome, and the recommendations for follow-up
General requirements for all records (3)
Well organised
understandable
Accurate
Requirements for clinical records
Refer to page 18 of the book. Too many, dunno how to approach.
Financial record requirements (7)
- date of service provided or sale of product
- client’s unique identification
- patients naes
- physiotherapist’s name and any other individuals who provided care under the physiotherapist’s supervision (ex PTA, student physiotherapist)
- description of the care, service or product provided.
- fee amount (including any interest charges and discounts)
- any payment received and balance owing
requirements for equipment records
routinely inspected
maintained
calibrated on a regular basis according to applicable legislation and/or manufacturer’s recommendations
Who has the right to access patient’s health records? (4)
Patients or their authorized representative
care provders within the “circle of care”
authorzed assessor or investigator from a college
police officers under the missing persons act
Ways to protect patient records(3)
-physical (locked cabinets, -restricted office access, alarm systems)
-technological (passwords encryption, firewalls)
administrative- security clearances and restricted access, confidentiality agreements
How long must records be kept for?
minimum of 10 years after discharge OR 10 years after patient would have turned 18
BC is 16 years
NS is 6 years
How are documents destroyed?
in an irreversible manner
What happens when a clinician retires?
ensure records are stored in a safe place that is secure and should have a plan in place for the record. Records may be transferred to a new clinic location.
Infection Control Responsibilities
- identify and minimise risks
- use current and generally-accepted infection prevention and control measures
- ensure there are appropriate written protocols for infection prevention and control measures for their practice setting
Equipment Maintenance responsibilities (4)
- Identify and minimize risks caused by the equipment
- ensure the equipment used to provide patient care is safe and properly maintained
- ensure equipment is inspected and maintained by product manufacturer
- Ensure appropriate written processes for routinely reviews.
What is the primary role of a physiotherapist support personnel?
assist the physiotherapist in delivery of physiotherapy services in a safe, effective and efficient manner
Physiotherapist responsibilities for PTAs
-ensure skills are up to standard and safety standard
-only assign things you can do
-consent from patient that they are being treated by the support person
- ensure task has no assessment component
- make sure we as physios do reassessments
- assess type of supervision is required
- ensure a plan is in place for a planned or unplanned absence. another physio is ready to be in charge
- ensure record keeping is up to college standard
Support personnel cannot do? (5)
- assess or reassess patients
- change the treatment plan proposed by the supervising physiotherapist
- create treatment plans
- perform any controlled acts that have been delegated to the physiotherapist
- perform any part restricted activities (ie. acupuncture, communicating a diagnosis, spinal manipulation , or internal assessment or internal rehabilitation of pelvic musculature
How can physios ensure support personnel is adeuqate in delovery appropriate care
- Review- the roles and responsibilities
- verify- support personnel’s knowledge
- learn- about support personnel’s training and experience to ensure is adequate. They don’t need any formal education in Canada/
- watch- support personnel perform the task or the assigned care
- train- and educate the support personnel as needed
( if already verified by another PT then no need to reverify)
Regarding support personnel, physios must have written protocols stating
- How and when physio and support discuss patient care
- how the suport personnel can contact the physiotherapist. (physios can be supervised remotley. and must be working while they are working or available)
- how the support personnel can contact the alternative supervisor if the physiotherapist cannot be reached
What can PT students do that PTA cant do?
- assess or reassess patients
- change the treatment plan proposed by the supervising physiotherapist
- create treatment plans
- perform any controlled acts that have been delegated to the physiotherapist
- perform any part restricted activities (ie. acupuncture, communicating a diagnosis, spinal manipulation , or internal assessment or internal rehabilitation of pelvic musculature). HOWEVER this should be safe and gain consent from patient.
What is required of the PT su[ervisor with the PT student
- tell patients the name and title
- inform the patient the students role and responsibilities
- get consent from the patient
Are supervisors responsible for the care provided by PT students?
yes. except for BC.
Rules of co-signing for PT students
physios must co-sign
What is manditory reporting?
we have to report certain circumstances
what are examples of mandatory reporting
self reports to college if you are criminally charged in any offence, any finding of misconduct (this counts in any jurisdiction in place or job)
common types of mandatory report
-sexual abuse
-incompetence
- incapacity
- holding out as a physiotherapist
- child abuse or neglect
- abuse or neglect in a LTC or Retirement homes for a RESIDENT (no legal obligation in they are elderly and live at home, ethically you should though)
- privacy breaches
- disclosure to prevent harm
- termination of employment
Restricted titles
must not use any term that is not a physiotherapist.
- must not use “physiotherapist” if not a physiotherapist.
- use other restricted titles
conflict of interest examples
- recommendation of products or services that are not indicated.
- benefits for referrals
professional boundaries
boundaries set a clear distinction between personal and professional relationships.
examples of professional breaches
- personal disclosure by the physio
- giving or receiving gifts
- engaging in business or leisure activities with a patient
- doing a special favor
- comments, words or gestures
- entering into a personal/social relationship with the patient
Restrictions for maintaining profession boundaries
- treat their relatives or close people
- date their patient
- date a former patient (unless i year after discharge, no longer imbalance of power, no longer dependent on the physiotherapist)
- date a patients relative
what is classified as sexual abuse
- physical
- touching in a sexual manner
- remarks sexually
Boundary reflective test: the witness test
would you do or say the same if someone was watching?
Boundary reflective test: the documentation test
would you document what you did or say?
Boundary reflective test: the explanation test
can you explain what you did and why?
Boundary reflective test: the justification test
do you know your professional obligations and does what you did follow it?
providing or refusing care
- not refuse based on discrimination
What is Memorandum of Understanding? (MOU) When is it used?
links 10 provinces for cross border care.
- used when physio is performed in one jurisdiction and continued in another
- when the patient cant continue appropriate physiotherapy in their juridiction so needs alternative elsewhere
What are circumstances where MOU does not work?
- care is available for the patient in their jurisdiction
- there is no need to do so as inperson is appropriate
What kind of things are important to obtain consent about with telerehabilitation?
- recieving virtual vs inperson
- recording of any kind
- transmission of information via telerehabilitation technologies
- participation of other healthcare providers or the patients’s family in the provision of care
what are the 6 effective commnication keys?
1- coutesy
2- clarity
3- listening
4- consider culture
5- get on the same page
6- body language
how can poor communication be avoided?
clearly explaining risks and benefits
using plain language
showing empathy
Alternative methods of communication?
- interpreters
- handwriting
- visual-gestural communication
- technology
- diagrams
- printed education materials
Documentation of communication must be:
-clear
- accurate
- professional
- timely
physios should discontinue concurrent care and document if?
- unneccessary duplication of treatment
- inefficent use of resources
- the risks of providibg treatment outweigh the benefits to the client
