Week 2

Question 1

Therapeutic relationship

Answer 1

a relationship between a healthcare professional and a client by which the therapist and a client hope to engage with each other (giving your qualities/skills to a patient)

Question 2

Difference between personal vs professional relationship:

Answer 2

1) Length
 Prof: certain amount of sessions / Pers: days to years
2) Location
 Prof: treatment room / Pers: Anywhere
3) Purpose
 Provide care, treatment / Pers: have fun, feel listened
4) Structure
 Prof: Specific to pt / Pers: can be spontaneous
5) Interests
 Interest of the patient always comes first in a therapeutic relationship
 Example: a patient wants to use a 4-wheel walker instead of a 4-wheel walker however, they’re not ready yet
6) Balance of power
 OTA/PTA has the power meaning the pt is in a vulnerable state
 pt might not always feel comfortable voicing their concerns with treatment approach
7) Responsibility
 The healthcare provider establishes and maintains the professional relationship.

Question 3

What are the professional boundaries?

Answer 3

 The limit that allows for a safe interaction
 Clear distinction between your personal relationships and your professional relationships
 Defines your role as a health care provider from other roles that you have in life.

Question 4

What happens if professional boundaries are crossed? What are things to remember about this?

Answer 4

 Potential harm caused to the patient.
 Harm can be: Real, Potential, and Perceived.

Question 5

What falls under ‘harm’?

Answer 5

 Allowing your personal bias to shape your professional decisions
 Examples of personal bias

Question 6

How can you prevent ‘harm’ from your patient?

Answer 6

 Know your professional obligations
 Understand your responsibility
 Recognize your personal biases
 Understand your strengths and weaknesses
 Be prepared to justify your actions
 When in doubt, consult

Question 7

Patrick, a rehabilitation assistant at the hospital, often runs behind schedule. This often results in a shortened lunch hour for Patrick. To make up for this, Patrick often shortens treatment times that occur just before lunch so that he can get a full lunch hour.
What is the potential for harm here?
Do you have any suggestions for Patrick?

Answer 7

Potential harm:
 Negligence towards patients
 Not fair to other patients
Suggestions for Patrick:
 Find out why he is running behind schedule
 Have an assistant to help
NEVER shorten lunch break, legally not allowed to

Question 8

Joanne has a client on her caseload who is a financial advisor. She has saved a bit of money and is considering her options. She asks for her patient’s advice.
What is the potential for harm here?
Do you have suggestions for Joanne?

Answer 8

Potential harm:
–> Pressure/uncomfortable for patient to help making patient not want to come back
–> Receiving a service that is not compensated for
–> Not appropriate setting to discuss
–> Confusion of roles
Suggestions:
–> Ask for referrals

Question 9

A patient is struggling to decide between two medical treatment options. They ask John for his opinion and he gives it. The patient decides to go with that option.
What is the potential for harm here?
How could John have answered?

Answer 9

Potential harm:
–> Power dynamics, trusting John’s word even though it may not be right
–> Assistant does not have a say in diagnosis’s
How could he have answered:
–> Directing questions to PT/OT

Question 10

Sheila works with an elderly patient who is often confused following a total hip replacement. The patient will not get out of bed, so Sheila tells them that the Doctor wants them to get up and go for a walk. The patient consents.
Is there a potential for harm here?
Do you have suggestions for Sheila?

Answer 10

Potential harm:
–> Sheila is confused and may not be able to provide informed consent
Suggestions:
–> Ask PT what the approach is –> Try to help Sheila become less confused by explaining person, place, date

Question 11

Jane is providing a component of a physiotherapy treatment to a patient with low back pain. The patient states that she has not been able to go to the gym and is feeling down. Jane shares that she too is feeling low as she was recently dumped by her boyfriend. She says misery loves company and commiserating together is a good way to heal.
Is this behavior, okay? How did you decide?
What could Jane have said instead?

Answer 11

Okay behaviour?
–> Easily misinterpreted
Said instead:
–> Validated patients’ opinion without providing personal opinion
–> Inform PT

Question 12

John suffered a severe trauma in a car accident. Formerly very physically active, he now struggles to take a few steps. One day during treatment he begins to cry and you decide to give him a hug.
Is this behavior okay? What are a few considerations with personal touch?
What else could you have done instead?

Answer 12

Behaviour okay?
–> Can look misleading
–> Unfair treatment
Done instead?
–> Support patient with words
–> Hand on shoulder
–> Give tissues
–> Encourage them by telling them what progress they’ve made so far

Question 13

Alice has been treating a patient in his home for several weeks. The patient has offered Alice and her family the use of his apartment in Florida for a week as a thank you for all the great care he has received.
Is this behavior okay?
What are a few things Alice should consider?
What could Alice say to the patient?

Answer 13

Behaviour ok?
–> Overstepping relationship
Say instead?
–> Send something to whole department/team instead of Alice himself

Question 14

It has been a year since Tom was discharged from the rehab unit. He has returned to work and has resumed all of his pre-injury activities. He runs into Joanne, the PTA that worked with him, at the grocery store and asks her out for coffee. Joanne is interested in going but is ensure what to do.
Is this behavior okay? How did you decide?

Answer 14

 College of PT says after a YEAR, you CAN date someone who was a patient

Question 15

Susan has been working with Jacob for two weeks. During this time, Jacob has expressed concerns about how much of a recovery he will make and what this will mean for him in the future. Susan provides Jacob with support and encouragement by discussing his progress with him and reminding him of his achievements since treatment was initiated. During their treatment today, Jacob tells Susan that he is developing feeling for her.

Answer 15

–> Talk to PT and suggest another PTA takes over
–> Susan reflects to see if their was anything misleading she was doing

Question 16

Cultural Competence

Answer 16

The ability to interact effectively with people of different cultures and backgrounds.

Question 17

Guide to culturally competent care

Answer 17

 Promote a caring attitude
 Awareness of culture
 Obtain background information
 Preserve, accommodate
 Don’t be defensive
 Reflect

Question 18

Yasmin is an new OTA PTA who accepted a position in Northern Ontario. Yasmin grew up in a large city, attended a private school and finished her college program as an OTA PTA at a large urban college. What steps should Yasmin take to prepare for her new position?

Answer 18

–> Travel to where she’s working before she starts work to get an impression of the community and get to know people in small community
–> Integrate into the community for a smoother transition
–> Northern Ontario: large Indigenous population - do your research on how to best prepare for this population of patients

Question 19

Consent that done for the greater good of the patient is called:

Implied consent

Expressed consent

Imputed consent

Informed consent

Answer 19

Imputed consent

Question 20

A patient must always provide consent in writing.
True

False

Answer 20

False

Question 21

The term privacy can be defined as keeping a patient’s information between you and the patient and not telling others.

True

False

Answer 21

False

Question 22

Once a patient provides consent for treatment, it is assumed that all future treatments under the same profession have been consented to.
True

False

Answer 22

False

Question 23

Mr. Jones has been referred to your facility for treatment of a chronic back disorder. The referral source is a good friend of Mr. Jones and a long term patient at your facility. Mr. Jones’s friend asks how his buddy is making out with treatment. How do you respond?

You verify Mr. Jones has signed a consent to release information form and let his friend know how he is doing.

You politely explain to the friend that all patient information is confidential and you cannot share any aspects of his care or even if he is coming to the clinic.

You tell the friend Mr. Jones is doing awesome and show him Mr. Jones’ exercise log so he can see how quickly Mr. Jones is progressing.

You deny ever meeting Mr. Jones and tell his friend to mind his own business.

Answer 23

You politely explain to the friend that all patient information is confidential and you cannot share any aspects of his care or even if he is coming to the clinic.

Question 24

Allison, a marathon runner with a knee injury, has been attending physiotherapy sessions. Her physiotherapist has asked you to administer Allison’s modalities and supervise her current exercise program. When you speak with Allison, she reports she is having some low back pain and wonders if you can provide her with some exercises for her back as well. What do you do?

Check Allison’s range of motion for the back, see if she is able to recruit her core stabilizers, obtain her consent, and show her the appropriate exercises.

Tell Allison too bad. You cannot change the treatment and the physio is busy.

Administer the treatment as per the care plan as well as providing Allison with basic stretches for her back. She has requested this which implies consent.

Explain to Allison that you will need to first check with the physiotherapist and inform the physio about Allison’s back pain. It will be the clinician’s role to explain and obtain consent for any assessment or treatment required.

Answer 24

Explain to Allison that you will need to first check with the physiotherapist and inform the physio about Allison’s back pain. It will be the clinician’s role to explain and obtain consent for any assessment or treatment required.

Question 25

Treatment should not begin prior to reviewing the plan with the patient, even if consent was previously obtained.

True
 	False

Answer 25

True

Question 26

After 2 sessions of ultrasound a patient decides she does not want to continue the treatment. When obtaining her original informed consent, the physiotherapist explained that she might require 6-10 sessions to see positive results. The patient understood and agreed to this treatment. Can consent be withdrawn now that the treatment plan is being carried out?

True
 	False

Answer 26

True

Question 27

Which of the following acts ensures that healthcare practitioners have no authority to make treatment decisions on behalf of patients.

Personal Informaiton Protection and Electronic Document Act (PIPEDA)

Personal Health Information Protection Act (PHIPA)

Health Care Consent Act (HCCA)

Common Law Act

Answer 27

Health Care Consent Act (HCCA)

Question 28

Consent that is assumed based on a patient’s actions is called:

Imputed consent

Implied consent

Informed consent

Expressed consent

Answer 28

Implied consent