Summary

This document provides an introduction to ethical principles in healthcare, encompassing morals, ethics, and the Canadian Health Act. It touches on issues of patient autonomy, care delivery, and legal frameworks governing healthcare.

Full Transcript

- Explain pain supercharge book - Regulation means there is a college body that protects the public from practitioner malpractice - Canadian health act (CHA) provides a framework for provinces to regulate health care providers - In BC - health care providers are autonomous and s...

- Explain pain supercharge book - Regulation means there is a college body that protects the public from practitioner malpractice - Canadian health act (CHA) provides a framework for provinces to regulate health care providers - In BC - health care providers are autonomous and self regulate to protect the public - The practitioner makes their own decisions, does not require doctors referral - Corporations like objective measurements - Including smart goals Study soap Ethics in Health Care Morals vs Ethics Morals are individual compass - Ethics are a rules of conduct that are based on morality - Morales guide ethical behaviour Ethics - Ethics is the study of morals and moral judgements - When moral norms can be compared, observed and weighed it is known as ethics - Ethical Principals** 1) Respect for autonomy a) The right of adults with capacity to make informed decision about their medical care b) Informed consent: patients must be provided with all relevant information to make an informed decision about their care c) Confidentiality: protecting patient privacy is paramount 2) Beneficence a) Acting in the best interest: healthcare providers must aim to benefit the patient 3) Non-maleficence a) Do no harm: avoiding actions that may harm the patient 4) Justice a) Fair distribution of resources: ensuring equitable access to healthcare services b) Non-discrimination: treating patients impartially, regardless of their background \ Autonomy No autonomy | Patient has an opinion what happens | Most autonomy - Must provide the truth about their condition, inform risks and benefits of treatment, permitted to refuse interventions Justice - Refers to basic fairness - Intent of justice is to maximise fairness for all patients and potential patients - Distributive justice: looks at how health care resources are distributed amongst the whole of society - Comparative justice: looks at the distribution of health care services at the level of the individual Legal and ethical frameworks - Canadian Charter of Rights and Freedoms - Guarantees fundamental rights and freedoms, including those related to healthcare - Canada health act (1984) - Principles: public administration, comprehensiveness, universality, portability, accessibility - Objective: ensure all eligible residents have reasonable access to medically necessary services without direct charges. - The act is Canada’s federal legislation for publicly funded health care insurance. The act sets out primary objective of canadian health care policy “ to protect, promote and restore the physical and mental wellbeing of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” Ethical Bodies and Guidelines - BC health authorities Act - Structure: establishes regional health authorities responsible for delivering healthcare services - Function: provides governance and accountability mechanisms for the management and delivery of healthcare services - Health professions act - Regulation: regulates various health professions to ensure practitioners meet specific standards of practice - Oversight: includes colleges for each profession that oversee licensing, professional conduct, and continuing education BC kinesiology associations - non regulated, but does have an ethical framework to guide practice Ethical issues in Canadian healthcare - End of life care: - Medical assistance in dying (MAID): legal in canada since 2016, with strict guidelines and criteria - Palliative care: focuses on providing relief from the symptoms and stress of a serious illness - Resource allocation: - Wait times: ethical concerns around fair access to timely healthcare - Rural vs. Urban Disparities: addressing the unequal distribution of healthcare resources - Indigenous health: - Cultural Competency: ensuring healthcare services respect and incorporate indigenous perspectives and needs - Addressing Historical Injustices: recognizing and rectifying past and ongoing healthcare inequities faced by indigenous peoples - Privacy and Data Security: - Electronics health records: ensuring the confidentiality and security of patient information in the digital age Consent and Documentation Health care consent is the process by which a patient voluntarily agrees to a proposed medical treatment after being fully informed of its benefits, risks, and alternatives Process is crucial for ensuring respect for patient autonomy and ethical medical pracctice The Health Care Consent and Care Facility Admission Act (HCCCFAA) - Sets out rules for which a capable adult can give or refuse consent for health care Consent - An adult can: 1) Give or refuse consent on any ground, including moral or religious, even if doing so results in death 2) Select a particular form of health care based on any grounds 3) Revoke consent at any point 4) Expect respect for their decision 5) Expect to be involved in all case planning and decision making Informed consent - Disclosure: providing the patient with comprehensive information about the proposed treatment, including its purpose, benefits, risks, and potential alternatives - Understanding: ensuring that the patient fully understands the information provided, and uses language that the patient can understand. The patient must have the oppportunity to ask any questions - Voluntariness: confirming that the patient’s decision is made voluntarily, without coercion or undue influence - Competence: assessing that the patient has the capacity to make the decision Basics for obtaining consent Clear communication: use plain language refrain from using medical jargon. Consider using visual aids if necessary Assess understanding: ask the patient to explain back the information to ensure comprehension Document everything: keep thorough records of the consent process, including any questions asked and answers provided Respect patient autonomy: always respect the patient's right to make their own decisions regarding their health care Cultural sensitivity: be aware of cultural differences that may affect the consent process and accommodation the patients needs accordingly Types of consent - Explicit (written) consent: a signed document indicating the patient's agreement to the proposed treatment - Verbal consent: spoken agreement from the patient, typically documented in the medical record - Implied consent: inferred from the patients actions, such as presenting for treatment or complying with the treatment plan in non emergency situations - Emergency consent: assumed in situations where immediate treatment is necessary to prevent serious harm or death, and the patient is unable to provide consent Legal and ethical considerations 1) Consent must be obtained before any treatment is administered, except in emergencies 2) Consent can be withdrawn at any time 3) Special considerations may be needed for minors, individuals with cognitive impairments, and patients who speak a different language Consent for vulnerable populations Include: - Minors - Consent for a minor, if you believe the minor is competent to understand the risks, benefits, and alternatives for the proposed treatment. You are allowed to take them. Otherwise a guardian is needed. - Elderly - Cognitive impairment - Significant physical impairment HCCFAA in long term care - Zero tolerance for abuse or neglect of residence in long term care facilities - A kinesiologist must report any of the following to the ministry of health - Improper treatment or care - Abuse of a resident - Neglect of a resident resulting in harm - Unlawful conduct resulting in harm - Misuse of a residence money - Misuse of funding provided to long term care facility Consent for the incapable adult (dont need to remember) If a kin deems that a client is incapable and there is no substitute decision maker agreement in place then the following is the order for obtaining consent 1) Spouse 2) Child 3) Parent 4) Sibling 5) Grandparent 6) Grandchild 7) Anyone else related by birth or adoption Consent for the incapable child 1) parent/legal guardian 2) Parent without custody 3) Sibling 4) Grandparent 5) Anyone else related by birth or adoption A kinesiologist must Obtain and document informed consent prior to application of a kinesiology procedure Respect the client's right to refuse or decline service Share in decision making with the client or family Actively involve the client and family in developing treatment goals Report any abuse of consent When consent can be broken - Mental health act - If a person reports that they are planning to harm themselves, have a plan and intend to follow through on the plan. Kin MUST ensure the patient gets direct access and accompaniment to the closest hospital - When they don't have a plan use best judgement, and document it - If they do have a plan, do not let them out of your sight - Child Protection act - If a kin suspects any child needs protection, they must report to the ministry of child and family development - This duty overrides all PIPA regulations - Failure to do so can result in a fine up to $10,000, six months in jail or both - Report must be made if: - Risk or previous risk of harm, sexual abuse or sexual exploitation - Risk of deprivation of necessary health care or failure to provide consent for necessary health care Documentation - Accurate documentation of patient assessments, treatments, and progress - Effective charting helps track patient progress, communicating with other healthcare providers, and maintaining legal and professional standards SOAP note - Subjective - Objective - Assessment - Plan - Records must contain identifying information (*on each page of the documentation) - Legal name* - Date of birth - Contact info - Helpful to add in - Occupation - Exercise habits currently - under intervention you will also provide patient information (information provided to the client about their injury) A Kinesiologist Must - Maintain complete and legible client records - Including referrals and any correspondence (such as email or text) with client name on each page - Document about delegated tasks, interventions used, client response to treatment including errors or adverse reactions - Ensure all kinesiologist entries are identifiable against other team member notes - Sign or initial all entries and maintain in chronological order - corrections/changes must be stuck through and initialled - Whiting out or deleting information is falsifying the documentation - Document in either english or french Best practice for documentation - Clarity - document must be legible, whether hand written or in digital form - Timeliness: chart as soon as possible after the session to ensure accuracy - Accuracy and detail: provide comprehensive and precise details to create a clear record - Confidentiality: ensure all patient records are kept confidential and secure - Professional language: use clear, professional language and avoid jargon that may not be universally understood - Compliance: follow regulators Retaining Records Storage can be completed via paper or electronically on a computer hard drive, cloud storage or external drive PIPA-BC requires records be kepts for 1 year minimum and up to 15 years BCAK recommendation is clinical records be kept for a minimum of 16 years ○ Time frame for minors is 16 years after they turn 19 This retention also applies to a kinesiologist clinical retirement Transferring records When leaving a clinical practice, the original records should be retained by the practicing kinesiologist or the information custodian If transferring records from paper to digital, the the digital copy becomes the original and the paper copy can be destroyed Destroying Records - When the time comes to destroy a record, it must be done in a secure way that prevents anyone from accessing the files - Shredding - Complete electronic destruction - Incineration - Good practice to record the name, date and means (ie. shredding) of destruction Report writing Vital component to a kinesiologists role, supporting efficient patient care, professional collaboration, legal protection, and the ongoing development of the field. Ensures that kinesiologists provide high quality, accountable, and evidence-based services to their patients Purpose of Report Writing (finish writing) - Documentation of patient care - Communication with other health care professionals - Aptient - Documentation of patient care - Record keeping - Legal protection - Communication with healthcare professionals - Interdisciplinary collaboration - Referral processes - Patient progress tracking - Monitoring progress - Adjusting treatment plans - Evidence based practice - Data collection - Quality improvement - Patient education and engagement - Communication with patients - Setting expectations - Professional accountability and development - Self reflection - Standardisation of care - Insurance and reimbursement - Justification for services - Compliance with regulations Forms for reporting - ICBC - Job Demand analysis - worksafe - WSBC independent provincial agency that aids in: - Compensation (lost wages) - Prevention - Insuring employers - Provides benefits, medical care and rehabilitation after a workplace injury - In the event of injury WSBC is mandated to provide a return to work rehabilitation, compensation and health care to injured workers Privacy Law in professional kinesiology 1) acts/statues - most commonly thought of form of law (BC legislature) 2) Regulations - developed by the government or regulatory college to establish the working of a regulatory college 3) By-Laws - made by the regulated college to manage internal operations 4) Case Law - court decisions used as a guide by lawyers and judges when similar situations arise 5) Guiding documents - practice standards, policy statements published by college to guide clinical practice Provincial and federal privacy organization - Office of the information and privacy commissioner of BC enforce the privacy information - Freedom of information and protection of privacy act (FOIPPA-BC) - Public sector hospitals - PErsonal information Protection ACt (PIPA-BC) - Private sector cant be displayed or given without consent of the individual - Government of CAnada Protection Act - Personal information protection and electronic document act (PIPEDA) FOIPPA-BC - Protection act used in public care settings - Guarantees the right of the Public to gain access to their information and request corrections - Does not apply to information gathered by private sectors PIPA-BC - Applies to kinesiologists working in private settings - BC based businesses must comply with this act - Personal information cannot be collected, used or disclosed without prior informed consent PIPEDA - Government of canada enforcement of information privacy - Law giving individuals the right to access and request corrections about their personal information Personal information - Can share any information regarding a client without consent from the client Confidentiality - Maintaining confidentiality is fundamental to any kinesiologist and is central to the client therapist relationship - Protecting information through appropriate consent and security means - Disclosing only what you have been authorized - Destroying information that is no longer required or has reached its retention limit Protection Secure Files - Encrypt sensitive data: all patient data stored digitally should be encrypted both at rest (stored data) and in transit (data being transmitted) to prevent unauthorised access - Jane or other medical EMR - Fax - Use encrypted communication channels: utilize secure, encrypted email services or patient portals for communicating sensitive information - Microsoft teams - Not standard gmail Secure files User authentication: implement multi-factor authorization, strong passwords Role-based access: Session management: Secure systems - Electronic health records systems (EHR): use certified and secure EHR systems that comply with relevant legal standards - Paper medical records must be kept in a locked file, at rest or in travel - Secure devices: ensure all devices used to access patient information have up to date antivirus software, firewalls, and are configured with security settings PRivacy principles 10 privacy principles Kinesiologists are responsible for the personal information of both the clientele and employees Privacy officer must be appointer to work in compliance with PIPA-BC Privacy officer contact info needs to be accessible to the public Sole proprietor/self employed kinesiologists all need their own privacy policy document (add to assignment) Privacy officer responsibilities: - Help clients understand what happens to their information - Develop and implement organizations policies and procedures - Train employees about privacy policies and confidentiality - Respond to inquiries and complaints - Oversee privacy practices - Ensure compliance with government legislation An organization or kin should be able to identify why they are collecting information and what benefit it has to be collected if no reason can be identified then it should no longer be collected Consent to collect use and disclose - Kins a re required to obtain consent to collect, obtain, and disclose personal information - Consent should be expressed verbally or in writing - Implied consent should only be sued in the absence of ability to give expressed consent Limiting collection - kins/organizations only permitted to collect the min amount of information necessary to fulfill the requirements for optimal care for the clientele - If you do not need information, do not collect it Limiting use, disclosure and retention - Kins can only collect personal information for the purpose communicated to the client - If collection purposes change, this must be communicated to the client and new consent obtained - A release information form is recommended whenever a client's personal information is being requested Information obtained and maintained must be kept up to date Openness - Must divulge what info is being held and how it is used - Has to be known how an individual can access their information Individual access - Clients are entitled to access their personal information to ensure accuracy and completeness - Organization can charge a minimal fee Challenging compliance - Members of the public are able to challenge a kin/organization compliance with the privacy of information by contacting the Chief privacy officer - Clients can also report to the office of the information and privacy commissioner of British Columbia (OIPC) - Kins reply to the OIPC must be completed with 30 days Privacy officer Complaints Motivational interviewing - Form of patient communication that helps elicit change Ambivalence - The state of having mixed feelings to contradictory ideas about something - Ambivalence is normal; needs to be explored, not challenged - Resolving ambivalence can be the key to change Stages of change - Pre-contemplation - intention on changing behaviour - Not yet considering change, may be unaware of the need for change or are resistant to it - Characteristics: denial, lack of awareness, and defensiveness - Interventions: raise awareness, provide information, and discuss risks and benefits - Motivation interviewing will not be helpful or is very difficult - Contemplation - aware a problem exists but with no commitment to action - Acknowledges the problem and start to think about the possibility of change, weighing pros and cons - Characteristics: ambivalence, consideration, and self-reflection - Interventions: explore ambivalence, discuss pros and cons, and enhance motivation - Motivation interviewing can be helpful - Preparation - intent on taking action to address the problem - Intend to take action soon and may begin to take small steps toward change - Characteristics: planning, commitment, and gathering resources - Intervention: assist with planning, set realistic goals, and provide support and encouragement - Action - active modification of behaviour - Actively take steps to change their behaviour - Characteristics: implementation of new behaviours, effort, and visible change - Interventions: provide support, monitor progress, and help overcome obstacles - Dont need motivational interviewing because they already have - Maintenance - sustained change; new behaviour replaces old - Work to sustain new behavviour and prevent relapse - Characteristic: long-term behaviour change, consolidation, and resilience - Interventions: reinforce positive behaviours, develop coping strategies, and maintain support systems - Can be useful to use MI if there are obstacles that present - Relapse - fall back into old patterns of behaviour - Characteristics: setback, frustration Stages of change in motivational interviewing Tailoring interventions: MI practitioners use the stages of change model to tailor their interventions based on the clients current stage, providing appropriate support and strategies Enhancing motivation: by understanding where a client is in the change process, practitioners can better address their specific needs, reduce ambivalence, and enhance motivation Promoting self efficacy: the model helps clients recognize their progress and strengths, building confidence in their ability to change Integrating the models Assessment: determine the client’s stage of change through open-ended questions and reflective listening Intervention: apply MI techniques that align with the clients stage, such as raising awareness in precontemplation or planning in preparation Support: continuously support the client through each stage, acknowledging their efforts and helping them navigate challenges Motivational interviewing: is a client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence - Developed by William R MIller in the early 1980’s - Spirit of motivation interviewing - Mi is characterisced by a collaborative respectful and compassionate approach. The practitioners role is to guide rather than direct, creating partnership with the client where they feel heard and supported - Partnership - Acceptance - Compassion - Evocation Evocation - In MI interviewing, is used to draw out a person’s own motivations, desires, and reasons for change rather than imposing ideas or solutions from the outside - the goal of evocation is to help individuals explore and articulate their intrinsic motivations for making positive changes in their lives. This approach is especially powerful because it empowers individuals to recognize and act upon their own values and goals - Eliciting change talk: encouraging the individual to talk about their own reasons for wanting to change. Change talk includes statements that express desire, ability, reasons, or need for change - Example: “what would be different for you if you were to quit smoking?” - Asking a question then being silent after for 3-5 seconds to give time for the client to think before speaking - Exploring values and goals: asking questions that help the individual reflect on their values, long-term goals, and how their current behaviour aligns or conflicts with those - Example: “how does your current lifestyle fit with the person you want to be in the future” - Connecting actions to outcomes: helping the individual see the connection between their current behaviours and the outcomes they want to achieve, thereby evoking a sense of responsibility and empowerment - Example: “what positive changes might you notice if you start incorporating more physical activity into your daily routine?” - Empathic listening: actively listen to the person’s responses and reflecting their thoughts back to them, which helps to clarify and reinforce their own motivations - Example: “sounds like you really value spending quality time with your family, and you’re concerned that you current stress levels are affecting that” - Avoiding the righting reflex: resisting the urge to correct or provide solutions, and instead focusing on drawing out the person’s own insights and motivations - Instead of saying “you should really start exercising more” you might ask “what do you think would be the benefits of being more active?” Principles of motivational interviewing Key principles: 1) Express empathy 2) Develop discrepancy 3) Roll with resistance 4) Support self-efficacy - No judgement - stay curious Express empathy Use reflective listening Develop discrepancy Help clients recognize the gap between their current behaviours and their broader goals or values. - Cognitive dissonance: holding conflicting beliefs/behaviours Roll with resistance Avoid arguing instead work with client’s resistance to change, using it as an opportunity to further explore their motivations Reframing Involves offering a different perspective on what the client has said, which can help them see their situation in a new light. This can gently challenge the client’s resistance without being confrontational Support self efficacy Encourage clients to believe in their ability to change and highlight past success as evidence of their capability Core skills of motivational interviewing OARS - Open ended questions: encourage clients to talk about their thoughts and feelings in detail - Affirmations: recognize and acknowledge the clients strength and efforts - Reflective listening: mirror what the client says to show understanding and prompt further discussion - Summarising - Unlike reflective listening this is done as a recap of what has been discussed to ensure clarity and reinforce what the client has said Rulers of motivational interviewing Conviction: percieving the benefits of behaviour change Confidence - feeling capable of changing behaviour Measuring the rulers Measuring confidence and conviction can be done on a 10 point likert scale ○ 0-3/10 LOW Patient receives no benefit or advantage Doubt words such as maybe or possibly ○ 4-6/10 MODERATE Aware of the theoretical advantages of change ○ 7-10/10 High Likely to make the change Rulers Game Plan Skeptical - increase conviction to 4-6/10 by improving perception of cognitive advantages then improve personal advantages to increase conviction to 7/10 Frustrated: increase confidence by detecting obstacles and create solutions Cynical: increase conviction so the patient feel motivated to change; then tackle barriers Pass to action: set the action plan Brief action plan - Is a concise and focused strategy designed to help individuals achieve specific goals by breaking them down into manageable steps. It is often used in healthcare, counselling, and coaching to support behaviour change and goal achievement Define the goal Specific: Measurable Achievable Relevant Time Bound - Break down the larger goal, into smaller more attainable steps Plan the details What - walking, core exercise Where - around neighbourhood, living room Time (days of the week, time of day) Distance/time (1km, 10 mins etc) Challenges (weather, kids etc) Assess the confidence Review the commitment - Have patient review goal and say it out loud in a sentence Professional Titles and Practice Standards - Lorimer Moseley - pain stuffs Professional Titles - Are restricted within the health professionals act. - You can’t call yourself a physio without being a registered physio - Otherwise you will be held accountable by law - Only for regulated fields Scope of Practice - Standard of practice is a skills that is respected by a health care professional and is governed by a respective college - Kinesiologist, are not yet a governed health profession but they do have standards of practice as they move towards becoming regulated - Protects the public - Conform to the standards of the HPA (health professions act) - Clearly identifies where a kin overlaps with other health care professionsals - Any asssessments, treatments and interventions must fall within the scope of practice Objective Scope Simply, if an assessment, treatment or intervention falls within the scope of practice Subjective Scope Whether You have the education, skills or experience to deliver and provide the assessment, intervention or treatment safely - If there is a gap of using a skill or being educated this can be out of scope Permitted Treatments for kinesiologists in BC 1) Fitness and health evaluations 2) Exercise prescription 3) Postural assessment and education 4) Exercise therapy and intervention 5) Therapeutic application of heat and cold 6) General nutrition counselling 7) Ergonomics 8) Completion of insurance assessment forms With additional training 1) Manual therapy 2) Use of modalities like (IFC, Ultrasound, TENS Restricted Activities What cant we do - Making a diagnosis of any form - Managing the labour and delivery of a baby - Applying or ordering imaging - Prescribe medication including NSAIDS - Nutrition advise for nutrition administered through enteral or parenteral means - Vision hearing or dental advice - Allergy testing - Cardiac stress testing - Performing physically invasive procedures including: - Anything below the dermis - Setting or casting a fracture - Reducing a dislocated joint - Movement of the spinal joint beyond the voluntary limits - Administering a substance by any means - Putting an instrument, hand or finger: - Into the ear canal - Byond nasal passage - Beyond the pharynx - Beyond the urethra - Byond the labia majora - Beyond the anal verge - Into an artificial opening - Basically any opening Insurance coverage Since it is not regulated yet, it is grey area. Kins must hold liability insurance and said insurance only covers you for acts defined with in the BCAK scope of practice document Essential Competencies Majority of the competencies rely on the basis of ethical practice, organization, policies) Professional Boundaries - Must maintain professionalism at all times and not act as a friend to clients - Keep at arm's reach - Not engage in sexual behaviour - Do not accept gifts - Remain a HCP - client relationship and limit personal details shared with the client Self Disclosure Gifts - Accepting gifts of small values (~$50) from a client as a thank you at the end of the session or from a vacation or a box of holiday chocolates can be accepted - Kins must be culturally aware, not accepting gifts can be insulting - Gifts of larger value should not be accepted as this can indicate that the client is developing a personal relationship with the kin and could potentially result in changing the professional relationship Friendship - Being friends with a client is a form of dual relationship and can offer a lot of confusion and result in impartial care - If a situation is being to friendly it might be required for the kin to stop the clinical situation and refer to another kin for continuation of care Touching a Client - Touching is almost inevitable in a health care setting - When touching a client, whether in an encouraging way (pat on the back) or friendly way (a hug) can be interpreted as sexual misconduct - Immense care must be taken with very clear consent prior to touching a client Personal Relationship - Kins are to not engage in a personal/sexual relationship with a client during or post treatment for a minimum of 5 years Conflicts of Interest - conflict of interest arise when a kin does not take reasonable steps to separate personal interest from that of the client - Examples - Splitting fees from a referring person -Receiving benefits from suppliers -Selling a product to a client without disclosing markup -Referring a client to a business in which there is a personal financial interest/benefit Primary, Secondary, and tertiary levels of care Preventative levels of Care - People who are insufficiently active present a 20% to 30% increased risk of early death compared to people who are - WHO found healthy lifestyle can reduce the prevalence of developing preventable lifestyle based disease - Hypertension - Type 2 diabetes - Dyslipidemia - COPD - Chronic liver disease - Various forms of cancer Preventative Care - Kins are in a prime position to improve the health, wellness and longevity of our community - Preventative care is salient to promote longevity and this is where kinesiologist can shine Prevention - Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability, or if none of these are feasible, slowing the progress of disease and disability Levels of Prevention Primordial prevention - prevention measures taken to prevent the development of risk factors for disease before they even occur Primary prevention - strategies and interventions designed to prevent the onset of disease or injury by targeting specific risk factors that are already present Example: child has family history of diabetes so you educate them on nutritioning before symptoms show Secondary Prevention- preventive measures that lead to early diagnosis and prompt treatment of disease, illness, or injury to prevent more severe problems developing. These measures available to individuals and communities for the early detection and prompt intervention to control disease and minimise disability Example: mammogram, blood sugar levels are rising outside of normal, Tertiary prevention- preventive measures aimed at rehabilitation following significant illness. At this level health services workers can work to retain, re-educate, and rehabilitate people who have already developed an impairment or disability. Measures are aimed at softening the impact of long-term disease and disability by eliminating or reducing impairment, disability, and handicap; by minimising suffering; and by maximising potential years of useful life Delivery *do not need to study* - Medical settings - Usually by secondary or tertiary care professionals (doctors, pharmacist, lab techs) - Focus on managing symptoms and delaying the onset of further symptoms - Mixed Healthcare settings - Almost any health care setting (private or public) with access to screening and intervention strategies - Non medical settings - Any clinical prevention strategies delivered in community settings Immune system - Protects body from harmful substances, germs and cell changes that could make you ill - Main jobs - Fighting disease-causing germs (pathogens) like bacteria, viruses, parasites or fungi, and to remove them from the body - Recognize and neutralising harmful substances (antigen) from the environment - Fighting disease-causing changes in the body, such as cancer cells - Innate immunity is the body’s first line of defense. It is non specific, meaning it responds to pathogens in a general way rather than targeting specific invaders. This type of immunity is present from birth and provides an immediate response to infections - Key features - Immediate response - acts quickly often within minutes or hours of encountering a pathogen - Non-specific - it recognizes and responds to common features of pathogens (such as bacterial cell walls) rather than specific ones - No memory - does not remember pathogens after infection, so it responds the same everytime - Components of innate immunity 1) Physical barriers a) Skin b) Mucous membrane 2) Chemical barriers a) Stomach acid b) Lysozyme 3) Cellular Defenses a) Phagocytes b) Natural killer cells c) Dendritic cells 4) Inflammatory response 5) Complement system Adaptive immunity is the body’s second line of defense, kicking in when the innate immune response is not sufficient to clear an infection. Unlike innate immunity, adaptive immunity is specific to particular pathogens and has a memory component allowing for a faster and stronger response upon subsequent exposure to the same pathogen Key features: 1) Specificity: targets specific antigens found in pathogens 2) Memory 3) Delayed response Components - B Cells: produce antibodies that bind to specific antigens on pathogens, marking them for destruction - T Cells: - Helper T Cells: activate other immune cells - Cytotoxic T Cells: directly kill infected cells Antibodies: proteins produced by B cells that specifically bind to antigens on pathogens. This can neutralize the pathogen or mark it for destruction by other immune cells Memory cells: after initial infection memory B and T cells remain in the body, providing long lasting immunity. If the same pathogen is encountered again, these cells respond more rapidly and effectively Vaccines: work by exposing the immune system to a harmless form of a pathogen, stimulating the production of memory cells without causing disease. This prepares the adaptive immune system to fight the real pathogen if it is encountered later Mode of transport - Direct transmission - Contact - Airborne - Droplet - Indirect - Vectors (mosquitos, ticks, lice) - Fomites (contaminated equipment) - Food or water Infection control - Infection prevention and control (IPC): is a practical evidence based approach preventing patients and health workers from being harmed by avoiding infections Can use hand sanitizer as long as it is above 60% alcohol PPE Donning - putting on Doffing - taking off Cleaning - This is the physical removal of dirt, organiz matter, and some microorganisms from surfaces - Cleaning invlovles using water, detergent or soap to remove visible contaminants, but it does not necessarily kill germs Disinfection - This process involves using chemical agents to kill or inactivate microorganisms on surfaces after cleaning Principles of disinfecting 1) Surface compatibility 2) Contact time 3) Concentration 4) Full coverage 5) Clean then disinfectant 6) Appropriate disinfectant 7) Regularity Supplies needed for a gym setting - Liquid or foam soap - Disposable paper towl - Alcohol based hand sanitizer - Disinfectants - Gloves - masks Delegation and interdisciplinary care Benefits of interd care\ - Holistic approach: by working together, healthcare professionals can address the physical, emotional, and social aspects of a patients health - Improved outcomes: collaborations leads to more comprehensive care, which can result in better health outcomes and higher patient satisfaction - Efficient care deliver: sharing expertise allows for more effective and efficient care, reducing the risk of overlapping or conflicting treatments Concurrent treatment - BCAK - non regulated; members are expected to coordinate care with other health care professionals, specifically if they are working on similar goals or areas of concern - Refer to other health care provider if their needs are better addressed (refer to dietician for nutrition advice) - Kin needs to clearly explain funding implications for concurrent treatment (i.e. paying twice for the same service) - Identifies, documents and communicates the risks of concurrent treatment - Declines service when there is an ineffective use of resources or the risks outweigh the benefits - I.e. manual therapy to the same area by both PT and Kin Delegation Health professions act - BC act that permits health care professionals to preform restricted acts and can in turn delegate the performance of the task subject to appropriate supervision Delegation - College of health and care professionals (specifically physiotherapists) commonly delegate exercise therapy - Commonly for ICBC, WorkSafe and MCFD Delegation responsibility - It is the responsibility of the delegating professional to follow the regulations from their respective college - Supervision (direct or indirect depending on sensitivity of the intervention) must be adhered to - Record keeping must be completed by the delegating professional - The delegating professional can request supplemental chart notes from the delegated activities as well - Insurance must be aware of who is providing the service (BlueCross, Sunlife etc.) - This can effect billing Kinesiologists as the delegator - Yes - Kins can supervise rehabilitation assistants - Different needs for insurance - $25 rider on insurance for BCAK membership - Basically things that fall under personal trainer scope - Kins CANNOT delegate medically supervised exercise prescription What does the delegating kin need to do - Assess the competency of the delegate - Be satisfied with the quality of the performed acts - DIRECTLY supervise the delegate as the acts are being delivered - Chart for all client sessions following all charting regulations - Client consent for delegation of acts - Record name of delegate and statement attesting their competency - Record the interventions being used, and the outcomes - Sign off on any supplemental charting completed by delegate Billing - Fees need to be transparent and the client needs to be aware of the cost PRIOR to the service being provided - Clearly posted in the service reception area and online - It is up to the kin to inform the client prior of the total fee for service - Any marketing must be clear and show the entire cost upfront - Service offerings cannot be tied to the purchase of another service - Ie. you cannot refuse service, unless the client also purchases another service - Clients need to be aware they can buy any recommended products elsewhere and are not required to purchase them from the clinical space - Billing transparency also needs to include any fees for penalties for late/missed appointments Invoicing Itemised Billing - What needs to be on an invoice - Describe the service provided - Who provided the service - Date of service - Cost of service - Form of payment (and if payment was completed) - Ie. is it a bill or receipt Billing - Kinesiologists cannot offer a discount of bills paid immediately - However - a kin can charge interest on an overdue account Telehealth - Virtual healthcare refers to the delivery of health services and information via digital platforms, such as video conferencing, mobile apps, and online portals Role of kinesiology in virtual healthcare - Kinesiologist have a large focus on human movement, exercise, and rehabilitation with limited hands on services (typically) - Kinesiologists are in a prime position to use virtual platforms to deliver exercise prescriptions, monitor patient progress, and provide educational resources - What skills ar pertinent in ensuring safe care - Benefits of virtual healthcare in kinesiology - Accessibility: increased access to care for patients in remote or underserved areas - Convenience: flexibility in scheduling and reduced need for travel, making it easier for patients to adhere to treatment plans - Continuity of care: ensures continuous support, even during times when in-person visits may not be possible - Data tracking: use of wearable technology and apps to monitor patient progress in real-time. Tracking of Home Exercise Programs (HEP) using accessible software systems - Disease mitigation: prevent infection or transmission of communicable disease between themselves, and the healthcare practitioners, other client(s) or people in their community Telehealth service delivery can be appropriate provided the kinesiologists operates within their scope of practice, competency, and abides by the BCAK’s code of ethics, professional practice standards, and other guiding documents Tools and technologies EMR, HEP and video conferencing: platforms like zoom, microsoft teams, embodia, Janeapp for virtual consultations and sessions designed for remote patient engagement and management Wearable devices: integration of devices like fitness trackers and smartwatches for monitoring physical activity, heart rate, and other vital signs Mobile apps: Use of apps for exercise tracking, instructional videos, and patient education (e.g., embodial, physiotools) Implementation Strategies Setting up a virtual practice: ○ Technical requirements: hardware (computers, cameras), software, and a stable internet connection ○ Legal and ethical considerations: understanding licensing requirements, privacy laws (e.g., PIPA compliance), and informed consent Patient Onboarding: ○ There is an increasing number of patients that are comfortable with virtual care, however, many still need in depth instruction Virtual treatment approachs Exercise prescription: design and deliver individualized exercise programs remotely, including the use of video demonstrations and progress tracking Rehabilitation Programs: managing post-surgery or injury rehabilitation through virtual sessions, ensuring proper techniqu and adherence to the program Health Education: providing resources and education on topics such as posture, ergonomics, and injury prevention via webinars, videos, or online materials. Limitations and considerations Technical barriers: issues such as poor internet connectivity, lack of access to necessary technology, and patient tech literacy Engagement and adherence: strategies to keep patients motivated and engaged in their treatment plans without the physical presence of a clinician Increased risk: virtual services result in a significant increase in risk of injury to a client due to the lack of in-person supervision to provide assistance, such as preventing a fall, or providing emergency assistance when necessary Privacy: virtual service delivery results in an increased risk of a personal privacy breach, including exposure of personal health information, which requires access to a private space to communicate and access to secure electronic means of communication Limitations: acknowledging the limitations of virtual care, such as the inability to perform hands-on assessments or interventions If virtual care will result in known increased risk of injury or a significant reduction in treatment effectiveness, virtual care should be avoided and in-person care should be utilized Prior to offering Systems complaint with PIPA-BC (not all platforms are safe and secure for sharing personal medical information) Established safety protocol for EMS services should an emergency take place (emergency contact) Ensure informed consent is obtained with benefits and risks cleared Privacy policy should be shared with the client receiving telehealth care You can only offer it AFTER completing an appropriate assessment of risks and the treatment requirements Ensure alternate communication options are set up in case internet options fail Evidence based Practice (EBP) - Conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions Principles of Evidence Based Practice Evidence based practice incorporates: clinical expertise, patient factors, best available research evidence Five Steps 1) Ask a question 2) Find best evidence 3) Evaluate evidence 4) Apply information in combination with clinical experience and patient values 5) Evaluate outcomes EBP: Principles Integration of best research evidence ○ Definition: use the msot current, relevant, and scientifically sound evidence available. Includes staying updates with the altest research findings, clinical guidelines, and systematic reviews ○ Application: clinicians should be proficient in searching for, appraising, and applying research evidence in their practice Clinical expertise ○ Definition: refers to the clinician’s accumulated experience, education, and clinical skills ○ Application: while research evidence is crucial, clinicians must use their expertise to determine how best to apply this evidence to individual patient care Patient Values and Preferences ○ Definition: consideration of the patient’s personal values, cultural beliefs, preferences, and expectations ○ Application: engage patients in their care by discussing treatment options and respecting their choices, ensuring that care is patient-centered Decision making process ○ Definition: process of combining research evidence, clinical expertise, and patient preferences to make informed decisions about patient care ○ Application: this involves shared decision-making, where clinicians and patients collaborate to choose the best course of action Outcome evaluation ○ Definition: continuously monitoring and evaluating the outcomes of decisions made based on evidence to ensure they lead to the desired health outcomes ○ Application: implementing changes when outcomes do not meet expectations and continuously improving care through this iterative process Lifelong learning ○ Definition: commitment to continually updating one’s knowledge and skills through ongoing education and self-reflection ○ Application: clinicians should stay engaged with new research, seek feedback, and adapt their practice based on enw evidence and insights Interdisciplinary collaboration ○ Definition: working with other healthcare professionals to integrate different perspectives and areas of expertise in the application of evidence-based practice ○ Application: collaborative practice ensures a holistic approach to patient care, pooling knowledge from various disciplines Why have an evidenced based practice Improved patient outcomes Enhanced quality of care Increased patient safety Patient centred care Cost effective care Better informed decisions Improved professional development Enhanced collaboration and communication Greater accountability Adaptability to new evidence Formulating a clinical question PICO(T) - In order to seek out the appropriate evidence, you need a clear question that you need answered - PICO is an acronym to ask clinical questions and guide your search for evidence P - Patient or problem I - intervention C - Comparison O - Outcome (T) - Time - Do not make it wordy Midterm 60 marks 29 m/c 13 t/f 5-6 short answers 3hrs Majority of intense questions are from the start of the semester. Levels of evidence Assessing the Evidence Validity - asses the study’s methodology and whether the results are trustworthy Reliability - Determine if the evidence is directly applicable to your clinical context and patient population Impact - evaluate the potential benefits or harms that this could be applying to your clinical situation Accessibility - do you have the required materials or space required to complete the intervention

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