Ethics Question Framework

Question 1

Assigning a Task to PTA

Answer 1

1. Educate the Pt about the difference between a PT & PTA
   →PT assess & creates a program that is reviewed with the PTA
   →PTA carries out the program as designed by the PT
   →PTA cannot change/alter the program in anyway and must report to PT if any Pt qestions, concerns, or issues arise
   →Educate the Pt about the benefits of using a PTA in their care
   →Ensure my patient has the opportunity to ask question
2. Obtain informed consent from the Pt/SDM for the invovlement of a PTA in the delivery of their PT Rx
3. Educate the PTA that Pt consent can be revoked at any time
4. Teach the assigned task to the PTA
   → Demonstrate the task exactly as you want it performed
   → Enusre good body mechanics
   → Provide FITT/dosage
5. Ensure PTA is competent to carry out the assigned task
   →Watch the PTA complete the task
   • Ensure good body mechanics
   • Provide FITT/dosage
     - I would correct and provide feedback as necessary

Question 2

Assigning a Task to PTA (Cont)

Answer 2

6. Teach the PTA to recognize any adverse Rx reactions (redness, swelling, increased pain) and how to proceed
   →Cease treatment
   →Immediately report to the PT
   →Document situation in Pt’s chart
7. Document assigned task
   →Identity of the PTA who performed the assigned task
   →Detail of the assigned task
   →Consent has been received from Pt to work with PTA
   →Include a written supierivison plan
   
   • Method of communication: phone, email, or directly for consultation as needed
   • Frequency of supervision/Pt reassessment
   • Arrange for transfer of supervision to another PT in the event of planned or unplanned absence
     →Any changes made/progression of the assigned task
8. Reassess Pt and assigned task at timely interval
9. Adjust Rx plan based on reassessment

Question 3

Managing a Discrepancy with a Superior

Answer 3

1. State the issue

→Use your knowledge of your professional standards to help identify the issue

2. Discuss alternatives and agree on a plan

→Your alternatives should be in alignment with your professional standards

3. State what you would do if the disagreement continued

→It is often appropriate to remove yourself from the situation (e,g, move to a different unit within the hospital, resign from a private practice)
→If possible→consider speaking to an alternate supervisor/higher authority

Question 4

Recognize the Conflict Framework

Answer 4

1. What is the connection betweeen the persons involved?
2. Is there potential for financial benefit?
3. Is there a conflict of interest?
4. Can action be justified
   →Can quality care still be provided?
   →Can the therapist be fair and transparent?

Question 5

Conflict Resolution Principles Framework

Answer 5

1. Understand the issue
   →Use Recognize the Conflict Framework
2. Discuss alternatives
   →Make decisions with the Pt’s best interest in mind
   →Help the Pt make an informed choice by offering alternatives and allowing them to ask questions
3. State that their decision will not affect future care
4. Agree on an action and document
   →Document the decision-making process and the decision

Question 6

Professional Boundaries Framework

Answer 6

I Think, I Feel, I Want Framework
- Use when responding to a Pt crossing a boundary
- I think, I feel, I want to address the issue
→I think you didn’t mean to touch me that way
→I feel very uncomfortable when you touch me
→I want you to stop doing that
- If the Pt does not understand/crosses another boundary→Get someone else to treat the Pt

Question 7

Informed Consent Framework

Answer 7

1. Ensure my Pt is seated and in a comfortable position
2. Obtain my Pt’s undivided attention

• Can’t gain informed consent if the Pt is distracted←I cannot be sure they heard and understood the proposed treatment
• If distracted by something: politely redirect them→explain why it is important that I have their undivided attention

3. Educate my Pt about the proposed treatment by including…

• Their condition/injury
  Explain the injury/condition that the Pt has and what PT can do to help
• The nature of the proposed treatment
  Explain what the Rx will consist of in layman’s terms and the mechanism behind its actions (e.g. explanation of how a modality works)
• Risks & benefits of the proposed treatment
  Start with stating risks and end with stating benefits (e.g. increase healing time)
• Alternative courses of treatment
  Provide them with 2 alternative options
• Allow the Pt to ask any questions
  Inform them that they have the right to revoke consent at anytime

4. Ask my Pt: “Do I have you consent?”
5. Verbalize the final decision
   Will you/will you not proceed with treatment?
   (See ‘Consent to treat chart’)

Question 8

Risk Management Framework

Answer 8

1. Identify the safety issue
2. Respond to the safety issue
   - Take the necessary steps
   →Address the factors contributing to the safety issue
   - Be transparent
   →Communicate effectively with the Pt, other healthcare members, family members
3. Document the safety issue(s).

Question 9

Risks in PT practice

Answer 9

Human
- Pt: communication ability, cognitive, balance, complexity of condition, stress, anxiety, pain
- PT: knowledge, skills, judgement, experience, communication ability, ability to monitor/observe/etc.
- Team: culture, communication, competence, trust, willingness to collaborate

Equipement
- Hardware: acupuncture needles, electrotherapy modalities
- Usage: proper maintenance & sterilization, adherence to established protocals, suitability for particular Pt etc.

Environment
- Inside of Pt care area: surface, lighting, waste disposal/sharp Mx, pace of change, workload demand, availability of resources & info
- Outside of Pt care area: walkways, steps, railings, waiting rooms, elevator, washrooms

Clinical Technique
- Nature of technique: Manipulation, tracheal suctioning, resistance training, amublation
- Applying technique: level of evidence, PT experience, suitability for the Pt, adherence to established protocols

Question 10

Communication Strategies Framework

Answer 10

1. Is there an issue that limits communication?
2. Who will you be communicating with?
   * Regardless of their communication limitation (state the limitation if appropriate), I would never exclude the Pt from the conversation
3. What strategies will I use to establish therapeutic communication?
   * State scenario or pathology specific strategies

Question 11

Communicating with a Challenging Pts/Family member Framework

Answer 11

1. Identify the issue
   * Is therer a safety issue?
2. Create, communicate, and document a plan of action
3. Monitor the situation

Question 12

Communicating with a Challenging Pts Framework-
Pt last minute cancel for mutliple times without reason

Answer 12

1. Identify the issue
   - Pt is not attending their scheduled appointment and is not giving enough notice to fill the gap in the PT’s schedule
2. Create, communicate, and document a plan of action
   - Talk with the Pt about the importance of attending PT
   - Review your policy around cancellation
   - Identify if there is anything you can do to help
   –> Childcare issue? Could they bring their child to the appointment?
   –> Scheduling issue? Could you schedule their appointment after work?
   - Docement your discussion iwth your Pt and how you plan to resolve the situtation?
3. Monitor the situation
   - Is this something that continually occurs
   - Were you able to reolve the situation
4. If unable to establish a solution and feel it is best to DC the Pt from your treatment
   Responsible for transferring the Pt to another PT. Failure to do so could result in professional misconduct

• Pt should be provided with information as to where they might be able to obtain further services
• Pt should have a reasonable period of notice before you plan to DC them, unless in the vent of immediate DC (e.g. abuse/safety issue)
• Document the reason for DC & the plan of action