Weeks 1 and 3: professionalism and scope of practice Flashcards
What is a ‘competency’?
The observable ability of a person, integrating knowledge, skills, values and beliefs in their performance of tasks; durable, trainable and measurable
Activity
An area of work that encompasses groups of related tasks; time-limited, trainable and measurable
Components of competencies
- Associated and relevant to all rehabilitation workers
- Durable
- Expressed as behaviours
Components of activities
- Associated w a role, its requirements and the scope of practice of the rehabilitation worker
- Begin and end
- Encompass tasks
- Relevant to some rehabilitation workers and not others
Example of competencies
Communicating effectively with family/caregiver, adopting rigorous approach to problem solving etc.
Example of activities
Gaining informed consent, documenting info, assessments/tools
Kinesiologist core competency profile entry to practice competencies: six domains
- Foundational knowledge
- Professional profile: assessment
- Professional practice: intervention
- Professional and ethical conduct
- Communication and collaboration
- Ongoing and professional development
Allied health
Umbrella term used to describe individuals who are trained to work individually or with others to support individuals to achieve optimal health
Association of schools advancing health professions (ASAHP) definition of allied health
Encompasses a broad group of health professionals who use specific scientific principles and evidence based practice for diagnosis, evaluation and treatment of acute and chronic diseases; promote disease prevention and wellness for optimum health and apply administration and management skills to support health care systems in a variety of settings
Is there an official definition of allied health in Canadian law?
No, but there is in U.S. federal law
Who are allied health professionals?
Non-nurse, non physician health care providers such as PTs, OTs, RTs, diagnostic medical personnel, imaging specialists, nutritionists and dieticians etc.
What do allied health professionals do?
Assessment, health promotion, provision of treatments and rehabilitation services
Help patients manage/overcome barriers related to disability
Who do allied health professionals work with?
Individually or as part of a multi-disciplinary team alongside physicians and nurses to provide access and effective care for patients
What are allied health professionals a core component of?
Patient centered care
Where do allied health professionals work?
Hospital, private practice, community care etc.
Three themes of professionalism
- Patient and patient-therapist relationship
- Knowledge, skills and practice
- Altruistic values
Theme 1: The patient and patient-therapist relationship
- Understanding and treating the individual patient.
- Placing the patient in the centre.
- Having patient trust.
Theme 2: Knowledge, skills and practice
- Recognizing and addressing limitations.
- Having, mastering and updating skills and knowledge.
- Being part of a health care team.
- Being a good communicator.
- Practicing safely.
- Getting the job done.
- Having an evidence base;
- Being educators.
- Being professional.
- Respecting professional boundaries (i.e., boundaries between professions).
- Maintaining boundaries with patients.
- Having leadership.
Theme 3: Altruistic values
- Honesty
- Making a difference
- Respecting patient’s cultures, backgrounds, values, rights, experiences, personal journeys and personal space.
- “going the extra mile”
What is a therapeutic alliance?
The working relationship between the patient and therapist
What is the therapeutic alliance established by?
Established by collaboration, communication, therapist empathy and mutual respect
Benefits of a strong therapeutic alliance?
Positively influences treatment outcomes such as improvements in symptoms, health status and patient satisfaction with care
What can effective clinician-patient communication do?
- support better history-taking, diagnoses and clinical decisions
- increase a patient’s adherence to recommendations and follow ups
- help patients self-manage a chronic condition
- influence patients to adopt a preventive health behaviours
- improve patient satisfaction and experience of care
Advantages to e-Professionalism
- treating patients from a distance via telehealth/telerehab
- social media helps like minded people communicate and share ideas
Disadvantages to e-Professionalism
- professional boundaries and patient confidentiality
- privacy, consent
- changing health behaviours from googling symptoms, misinfo online
Role of regulatory colleges
- protect public interest and enforce standards of practice
- creates standards of practice to ensure safe, ethical and competent services to the public
- ensures core principles, standards and relevant legislation are applied to practice
What is regulation?
Framework under which health professions are regulated
- supported by laws that give or limit rights and assign responsibilities
- sets out roles, rights and responsibilities of the government and regulatory agencies (colleges)
What makes a profession unregulated?
- profession is not listed in RHPA
- does not have college that protects public
- individual does not have to be a member of a regulatory college to call themselves a member of that profession
Examples of unregulated professions
- personal support workers
- physician assistants
- physiotherapy assistants
- athletic therapists
- nutritionist
Regulated health professions act (RHPA)
Legislative framework for regulating the scope of practice of health care professions in Ontario
What does the RHPA framework intend to do?
- better protect and serve the public interest
- be an accountable system of self governance
- provide modern framework for work of health professionals
- provide consumers w freedom of choice
- provide mechanisms to improve quality of care
What practical rules for colleges does the health professions procedural code (HPPC) set out?
- registering members
- handling complaints
- conducting investigations
- funding for sexual abuse of members
Profession specific acts
- establish each health profession’s college and its governing council
- defines scope of practice
- lists controlled acts
- has health professions procedural code deemed to be part of them
What does each profession have under the RHPA?
Its own act, ie. Kinesiology act 2007
What is the scope of practice of a kinesiologist?
The practice of kinesiology is the assessment of human movement and performance and its rehabilitation and management to maintain, rehabilitate or enhance movement and performance
Kinesiology act 2007- define the restricted titles
No person other than a member shall use the title “kinesiologist”, a variation or abbreviation or an equivalent in another language
Kinesiology act 2007- controlled acts
Procedures or activities which may pose a risk to the public if not performed by a qualified professional
How many controlled acts can a registered kinesiologist perform?
0
But they can be delegated
Kinesiology act 2007- representations of qualification
No person other than a member shall hold themself out as a person who is qualified to practice in Ontario as a kinesiologist or in a specialty of kinesiology
Health professions regulatory advisory council
An independent body to the Minister of Health and Long-Term Care with a mandate to advise the Minster of a number of items related to the regulation of health professions
Health Professions Appeal and Review Boards
Independent third party with a mandate to review registration and complaints of the health regulatory College
What is the concept of scope of practice?
What members of a profession are competent at doing and legally permitted to do in a given jurisdiction
What is a personal scope of practice?
What that member is actually registered to do and feels competent to perform; can be narrow relative to the whole profession’s scope
What may a personal scope of practice include?
Acts outside of usual legal scope for the profession ie. delegating acts
Example of delegation outside of scope of practice for a PT
Screening MRI/CT scans for low back pain in chronic pain patients in a hospital
**must be a specific pop. in a specific location
Registered kinesiologist modalities and services
- electrical therapy techniques
- general nutrition counselling
- fitness and health eval and exercise prescription
- athletic training, therapy and interventions
- ergonomics
- biomechanics
- exercise phys
- completion of insurance assessment forms
- manual osteopathic techniques
Purpose of a scope of practice
Protects public to ensure that care provided by practitioner is not beyond their skills and knowledge
What does a scope of practice NOT do?
Prevent others from performing the same actvities
Scope of practice of a physiotherapist
Assessment of neuromuscular, musculoskeletal and cardiorespiratory systems, the diagnosis of disease or disorders associated with physical dysfunction, injury or pain to develop, maintain, rehabilitate or augment function and promote mobility
Overlapping scopes of practice
Almost all healthcare professions have overlapping scopes of practice with regard to communicating w patients in distress, respecting their autonomy and gaining their consent for any assessment or treatment process
Controlled acts
Procedures or activities which may pose a risk to the public if not performed by a qualified practitioner
How many controlled acts are there?
14
Controlled act #1
Communicating a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual will rely on the diagnosis
Controlled act #2
Performing a procedure on tissue:
- below the dermis
- below the surface of a mucous membrane
- below the surface of the cornea
- below the surfaces of the teeth, including the scaling of teeth
Controlled act #3
Setting or casting a fracture of a bone or a dislocation of a joint
Controlled act #4
Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust
Controlled act #5
Administering a substance by injection or inhalation
Controlled act #6
Putting an instrument, hand or finger,
i. beyond the external ear canal,
ii. beyond the point in the nasal passages where they normally narrow,
iii. beyond the larynx,
iv. beyond the opening of the urethra,
v. beyond the labia majora,
vi. beyond the anal verge, or
vii. into an artificial opening into the body
Controlled act #7
Applying or ordering the application of a form of energy prescribed by the regulations under this Act
Controlled act #8
Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept
Controlled act #9
Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses other than simple magnifiers.
Controlled act #10
Prescribing a hearing aid for a hearing impaired person
Controlled act #11
Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning
Controlled act #12
Managing labour or conducting the delivery of a baby
Controlled act #13
Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response
Controlled act #14
Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement,
insight, behaviour, communication or social functioning
Delegating controlled acts
The act of transferring authority from one practitioner to another to perform a controlled act
What is the goal of delegation of controlled acts?
Make delivery of health care more efficient and effective for patients/clients
Standards for delegation of controlled acts
- must be in best interests of patient
- must be safe and effective
-responsibility always remains with the person delegating the act however you should always familiarize yourself with standards of practitioners you work with
Which controlled acts are considered unsuitable for delegation under the College of Kinesiologists of Ontario (CKO)
2, 4, 6, 8, 9, 10, 11, 12, 13
What components of controlled act 2 can kinesiologists be delegated?
Performing a procedure on tissue below the dermis or below mucosal membranes
Can registered kinesiologists be delegated to perform acupuncture?
NO
Does the delegator need to be present during the performance of the controlled act ?
NO
Purpose of a regulatory body
To protect the public
Membership of a regulatory body
Mandatory, requires passing an exam and proof of competency
Roles of a regulatory body
- sets requirements
- develops standards of practice
- investigate complaints and disciplines
- maintains a register of individuals eligible to practice
Governance of a regulatory body
By peers and members of the public appointed by the government
Purpose of an association
To advocate on behalf of members
Membership of an association
Voluntary, based on professional designation
**proof of competency not required
Roles of an association
- advocates
- promotes the profession
Governance of an association
Board of directors who are elected members
Examples of a profession with an association
PTA
Purpose of the College of Kinesiologists of Ontario (CKO)
Created by ON government to regulate profession of kinesiology in public interest
Governance of CKO
By a council that is accountable to the ON government
Membership of the CKO
Mandatory for individuals wishing to work as a kinesiologist in ON
Roles of the CKO
- sets requirements for entry-level practice
- maintains list of qualified individuals
- develops rules and guidelines
- investigates complaints
- requires kinesiologists to participate in a program that helps ensure knowledge and skills are up to date and monitors that participation
Purpose of Ontario Kinesiology assoication (OKA)
To advocate for and advance the interest of their members and the profession of kinesiology
Governance of the OKA
By a board of directors elected by members that is accountable to members of the association
Membership of the OKA
Voluntary
Roles of the OKA
- advocates w policy makers in the interest of members
- markets and promotes the profession of kin
- provides continuing professional development opportunities to members
- represents members interests by monitoring developments that may impact scope of practice, employment opportunities and enhancing relationships w related professions
What is the scope of practice of an occupational therapist?
Assessment of function and adaptive behaviour and the treatment and prevention of disorders which affect function or adaptive behaviour to develop, maintain, rehabilitate or augment function or adaptive behaviour in the areas of self-care, productivity and leisure
What is the scope of practice of a speech-language pathologist?
Assessment of auditory function and the treatment and prevention of auditory dysfunction to develop, maintain, rehabilitate or augment auditory and communicative functions
What is the scope of practice of a respiratory therapist?
Providing of oxygen therapy, cardio-respiratory equipment monitoring and the assessment and treatment of respiratory and associated disorders to maintain and restore ventilation
What are three ways that an OT can perform controlled acts?
- They could be direct granted authority- only psychotherapy
- They could perform the controlled act under an exception in the legislation ie. acupuncture
- They could be transferred the authority via delegation
Which controlled acts do physiotherapists have direct authority to perform?
(1) Communication of a diagnosis
(2) Acupuncture and treating wounds below the dermis
(4) Spinal manipulation
Tracheal suctioning
(5) administering a substance by inhalation
(6) Inserting a hand, finger, or instrument beyond the labia majora or anal verge to assess pelvic muscles
Which controlled acts can a PT delegate?
- tracheal suctioning
- wound care
- administering a substance by inhalation
Which controlled acts can a PT NOT delegate?
- acupuncture
- communicating a diagnosis
- spinal manipulation
- internal assessment of pelvic muscles
Overlapping scopes of practice of PT, chiro and physicians example
Diagnosing low back pain
Overlapping scopes of practice of PT and OT example
Selecting an appropriate wheelchair for a patient and contributing to a team process for designing custom seating systems
Overlapping scopes of practice of PT and speech-language pathologist example
Assessing and treating patients w swallowing disorders
Overlapping scopes of practice of PT, nurses and RT example
Managing patients in intensive care unit who need ventilator support
Overlapping scopes of practice of PT, RKIN, chiro, massage therapists, physicians, nurses and OT example
Preventing disorders which affect function
Healthcare professionals who are authorized to perform acupuncture in Ontario
- chiro
- dentists
- medical doctors
- naturopathic doctors
- nurses
- optometrists
- PT
- traditional Chinese medicine practitioners
