Ethical Issue

Question 1

OT think DC home without equipment is appropriate, I dun think so

Answer 1

Issue
- OT and I have a disagreement about how to provide care for the Pt. I do not agree with the decision to DC the Pt home without equipment
- My duty to work with the other team member to reach a conclusion that is in the best interest of the Pt

Alternative
- Work together in a respectful exchange of views to provide both parties with each other’s viewpoints to learn more about the situation

Agree on an action and document
If unable to reach an understanding
- Reach out to a colleague who is not invovled in the Pt’s care for unbaised advice
- Seek out advice from your facilities ethics committee
- Contact your professional association/college to ask for help

Question 2

Pt of sound mind refuse Rx even risk of decline

Answer 2

• Responsibility to respect my Pt’s autonomy and give them the opportunity to consent/decline Rx

Pt status now
- Of sound mind+capable of making decisions about his own care

Educate Pt
- Importance of secretion removal
- Risk of not receiving Rx
- Alternative Rx options

If Pt refuse after that
- respect that decision and not treat
- document the interaction in the Pt’s records and bring this to the attention of the team during next team meeting/rounds

Question 3

How would you assess your knowledge to ensure you are safe to perform this task?

Answer 3

Evaluate my training, knowledge and skill level
- Where: from an experienced colleague (determine whether he is a credible source)
My own skills & knowledge:
- practice the skills under the supervision of my colleague (feedback & direction)
- Indication & CI
- Risk of the technique (educate Pt to gain consent)
- Adverse reaction and how to manage it
- Research the techique: evidence-informed practice in the use of the skills
- Self-evaluate whether can enhance my practice

Do my due diligence and investigate if there are any legislative/regulatory requirements
Manip in extremity is ok, no need rostering

If new Rx/around for years
If new and emerging treatment technique: procceed with caution and look for the latest study/research about the technique

Question 4

Minor Pt aggressive/disoriented/yelling, legal gaurdian request continue treatment

Answer 4

Safety issue
- Pt is unsafe to be treat at this moment, mobilization the Pt could harm both the Pt and myself

Respond and communicate
- Communicate with the mother openly and let her know it would not be safe for the Pt or myself to mobilise them now
- I would be happy to come back as soon as the Pt was ready. I would notify nursing tema of the situation so they could see if any interventions were needed

Document the safety issue
- An attempt was made to mboilize the Pt buy it was unsafe as the Pt now was aggressivem disorientaed, and yelling uncontrollably

Question 5

Nurse ask you to perform tracheal suction but I am not rostered

Answer 5

Must practice in a safe, competent, accountable, and responsible manner within my individual SOP
- I do no have experience with tracheal suction I would not perform the task
- Tracheal suction is a controlled act and I am not rostered to perform it
- I should be open and honest with the nurse and decline to perfrom the task
- I would ask my supervisor to help me learn this task so I could eventually add this to my skill set

Question 6

Assess child without their parents being present?

Answer 6

• Must respect the Pt/SDM’s right to be informed about the proposed Rx
• Ethical dilemma: child is a minor–>unknown if they can provide consent for Rx/involve a legal guardian
• A child may consent to/refuse medical Rx on their own if the healthcare provider is sure that the Rx is in the child’s best interest and the child understand the details of the Rx and the risk/benefit involved=mature minor
• Up to me to determine if the child is a mature minor and consent to their own treatment

Things to consider when making this decision
- Is the child paying attention?
- Are they asking appropriate questions?
- Do they understand what you are telling them?

If mature minor–>assess & treat, Document: interaction and include that I have deemed the Pt a mature minor

If not mature minor–>not proceed–>call a parent and ask if they could come to the appointment to provide consent for assessment and treatment

Question 7

Pt’s sister ask for Coma Pt current condition

Answer 7

• I would not share the Pt PHI if I had not been given permission by either the Pt or their SDM
• Now the Pt is in a coma so it would be necessary to get consent from their SDM first

I would advise the family member that I cannot discuss my Pt’s personal information without permission and advise them to talk directly to the SDM

Question 8

Pt showing lumbar red flags

Answer 8

• This Pt is present with S/S of cauda equina (bil. LL numbness/weakness, loss of bladder control, saddle paresthesia) which is a medical emergency
• Given the presenting symptoms, it would be in the Pt’s best interest to get immediate medical attention
• I would inform the Pt that based on their symptoms, I believed urgent medical care was necassary
• I would refer them to emergency

I would not diagnose this Pt as this is beyond my scope of practice

• I would document my findings and the actions taken in the Pt’s chart

Question 9

Whose responsibility to ensure Pt are safe when entering the rehabiliation department

Answer 9

My responsibility
- as well was rest of the staff and management of inpatient departmnet to ensure that Pts are safe

• Report these concerns to my acting supervisor and follow up promptly to ensure they are addressed