KMP Notes PDF

Guidelines for speech therapists and audiologists – Lecture 1 What is ethics:  The study of morality and values  Moral principles that govern a person’s behaviour  Ethics is knowing what is morally right and what is wrong  Ethics deals with human behaviour and decision making Values: On...

Guidelines for speech therapists and audiologists – Lecture 1 What is ethics:  The study of morality and values  Moral principles that govern a person’s behaviour  Ethics is knowing what is morally right and what is wrong  Ethics deals with human behaviour and decision making Values: One’s own standards and principles Morals: Conforming to owns accepted standards Guidelines according to which we live & can determine or constrain our ethics From morals to ethics: o Historical dilemmas o Nazi experiments o Tuskegee syphilis studies o Monster studies Who sets the standards:  Parents  Philosophers  Priest  Public  Profession  Parliament  Press From morals to ethics: Historical dilemmas – nazi experiment, Tuskegee syphilis studies, monster studies A great deal of decision making around ethics revolves around human rights What is ethics based on: o Stems for Hippocratic oath o Declaration of Helsinki o Bill of rights, SA constitution o National health act o Various other SA acts, child act and safety act o Rights of people with disabilities How ethical codes are set up:  To protect the individual or community  Morality of the group   To protect from exploitation  Services in the best interest of the client  Services - “evidence-based practice” Constitution of the Republic of South Africa, 1996: The HPCSA derives its constitutional mandate from Section 27 of the Constitution of the Republic of South Africa, 1996 (Act No 108 of 1996), which provides that: everyone has the right to have access to healthcare services, including reproductive healthcare. Ethics and the Health Care Professions:  A profession is that its members collectively agree to uphold a code of ethics  Being a good healthcare practitioner requires a life-long commitment to sound professional and ethical practice and an overriding dedication to the interests and wellbeing of one’s fellow human beings and society.  By registering with the HPCSA every year the members affirm their willingness to abide by our code of ethics Ethics and Laws for SLT & Audiologist Issues and dilemmas in the health professions are regulated by:  Laws which are promulgated (Government)  Professional guidelines (HPCSA & SASLHA) Ethics is different for individuals and varies in situations “The golden rule is that there is no golden rule” – depends on the view you take Being a professional and abide by ethical rules: To lead a good and honest life To be a good health professional To know what is right and do what we know is right What is justice What does it mean to do no harm Good or bad or saints or sinners What is professionalism and ethics: o It is about being an honest and virtuous person as well as developing your own “clinical touch” o Recommending concepts of right and wrong o Standards of behaviour Features of professionalism: o Commitment to serve the public well o Significant knowledge and training to practise o Setting standards and self-regulation o Registration or licensing to practise Professional ethics:  The study of standards of conduct and moral judgement  The system or code of a person, religion, group, profession or society  System of conduct painstakingly developed to guide the discipline Code of ethics: Non-maleficent Beneficence in the best interest Honesty Truth telling Justice Promise keeping Confidentiality Core ethical values and standards:  Respect for person  Beneficence – best interests  Non-maleficence – do no harm  Autonomy -freedom of self determination  Integrity – incorporate core ethical values as foundation for practise  Truthfulness – basis of trust  Confidentiality – privacy Core ethical values and standards: o Compassion: Sensitive and empathise o Tolerance: respect different beliefs o Justice: Fair and just treatment o Professional competence and self-improvement: Attain highest level of knowledge and skills o Community: Contribute to betterment of society Autonomy: Tell the truth and not deceive Respect for the privacy of others Protect confidential information Obtain consent for intervention Help make important decisions – maintain effective communication Autonomy looks at what the patient wants but should be helped by shared understanding so that patients are encouraged to develop autonomy and be involved in their own care. Encourage to look at health needs rather than wants. People should be treated fairly and equally based on the principles of respect and value of human beings above all considerations Ethics is more than performing but it is about good interpersonal relationships with whom we:  Interact  Promise keeping  Dedication  Commitment Levels of ethical practise Mandatory: merely in compliance with minimal standards. Aspirational: the highest standards of conduct. (Best practice) Aspirations of Audiologist and Speech-Language Therapist: Best practice in the profession is the most important goal, but also the greatest challenge. Best practice is efforts to integrate and synthesize emerging empirical data into everyday application. Provide services according to guidelines set out, yet function as a provider without fear of a lawsuit. Ethical predicaments: Distress – witnessing an incident when a client is treated without compassion Dilemma – beneficence being compromised Locus of authority – who needs to take control Before coming to a decision on a clinical problem affecting one or more people, the healthcare professional should take account of: Ethical principles behind health care Ethical behaviour - duties of a doctor/healthcare professional Ethical consequences - general nature of the outcome to be achieved Real life constraints - pertinent practice features Don’t promise things you cannot keep and when making statements be truthful. Help when you can and minimise harm. Balance the decisions about the individual needs of patients versus the requirements of others. E.g. relatives, community or society in general. Recognise your own personal motivations and values and be aware how any decision can be influenced by your level of knowledge, the resources available to you and the roles of medical practice and the law of the land Seedhouse ethical grid Steps to take: 1. Identify to dilemma/ get the story straight 2. Establish the necessary information 3. Analyse the information 4. Formulate possible solutions  5. Implement the policies or acts (outcome is largely determined by who you are) Strategies to reduce moral stress: Areas of concern/hot topics: Areas of concerns/hot topics:  Over servicing  Over charging  Mobile practise  Hearing aid and fraud  Service as a whole  Employing inexperienced practitioners  CAPD management/scope of practise  “When strings are attached”  Research Media and technology: o Facebook advertising vs marketing o Radio and television interviews o Newspaper articles and statements o Electronic information Loose lips and disclosure: o Respecting privacy and confidentiality o Informed consent to give a report or client to participate o Professional/client privilege o Tea party / corridor conversations Insurance: Indemnity is important– find a good broker Third party insurance to cover for any accidents in your practice Whistle blowers:  Courage and perseverance  Do not allow abuse (to self and others)  You have rights  You are protected (protected disclosure act) Know yourself: Be sure you know who you are and what you do There are rules and regulations that govern professions Make sure you know them If you are employed understand the contract You cannot plead ignorance The Three R’s of ethics: Respect – our attitude which should be applied Responsibility – towards our client’s colleagues and our profession Results – the means of manner in which we achieve these Ethical conflicts: Ethical conflicts in the health care professions are ever-increasing due to: The growing use of technology Expanding scope of practice Business practices becoming a greater part of the profile of the professions Main focus areas: Human relations Research and publication Public statements General ethical issues Services Human relations include: Discrimination Informed consent Conflict of interest Unprofessional conduct Harassment Research and publications: Misinterpretation – reporting information – reports General ethical issues: Prohibits violations Report violations Cooperation with HPSCA Monitoring: the aim is to Supervise the profession Protect the public Professional must be given the opportunity to lodge complaints Action needs to be taken and punishment meted out How to lodge a complaint: o The complaint must be succinct o Full Name, address, practice and registration number o Detail of the complaint and any proof or documents o Signature of the complainant or the legal advisor Unethical behaviour can include: o Discrimination o Improper conduct o Rude behaviour towards patients o Patients not aware of procedures o Information disclosed without prior permission from the patient After a hearing the HPSCA can: o Reprimand a professional o Fine of maximum R10,000.00 o Strike off the role Practicing in the health professions – Lecture 2 It is vital that we practise our health professions in the most ethical way as possible If any practitioners (students & independent practitioners) are found to be acting unethically, you will:  Be assessed  Need to work under supervision  Have regular follow ups  May even be struck off from the register Becoming a practitioner: Immediate follow completion of their studies, graduates from the health profession go into community service This is a statutory requirement for subsequent ‘independent’ practice, whether in the public or private sectors Community service: Community service placement used to be a paper-based system but changed to an electronic service in 2018. The ICSP (Internship and Community Service Programme) is a subsection of the Department Of Health that is responsible for the placements First steps: o On graduating you register with the HPCSA on the community service register (signed by the Dean) o This is your license to practice and without it you cannot be employed o Without it you are engaging in illegal practice and can be prosecuted o Lapsing of registration Current status on opportunities: In SA at present there is a shortage of posts in the public sector and therefore many practitioners choose to go into private practice once they have an independent category of registration This scenario may be described as ‘the good, the bad and the ugly’ depending on how you enter it and how you proceed in your career path Considerations for practise: Become a taxpayer (SARS) Register with professional bodies Professional organizations/ bodies to register with: SASLHA/SAAA – which represents your interests as a practitioner and has an important role to play with regard to negotiating fees with the Department of Health A Trade Union if you are an employee – this is to look after your interests as they may relate to the Department of Labour, salary particularly The Board of Health Care Funders (BHF) – you are required to register with this body if you are in practice to obtain a practice number (enables you to claim payment from Medical Aids) Going into private practice: Once an independent practitioner (after completing your community service year) it is assumed you might be employed in a private practice The format is determined by the regulations set out in the Health Professions Act No 56 of 1974, amended in 2008 There are different formats of private practice, and you can select a format that suits you and it could be one of the following:  Solus practice – single owner  Partnership – two or more partners  In association – two or more persons who have independent practices but share some of the expenses (e.g. secretary, premises, equipment)  Group practice  Incorporated practice – (Section 54A company) – directors who own shares in proportions agreed upon, equal to an amount of cash into the practice and who then share the end of year profits proportionately. Insurance:  Find a good broker who will get you on the insurance you need  Professional liability id important  If you enter a partnership, take out a policy against your partners life (to cover costs if they die)  Take out insurance on the premises if you own them  Take out a professional provident society policy as soon as you graduate (covers medical costs, times without income, dread diseases etc.)  Medical aid if the PPS does not cover it  Third party insurance for an accident in your office As an employee in a practise:  Most new graduates are approached by established practitioners who want to extend their practices (and in doing so, their incomes)   Many new graduates are ‘employed’ to provide a service to schools (there are no posts for speech therapists at schools unless the governing body creates one  Often this is at the expense of the new graduate who is not well informed about the issues mentioned already  Forewarned is forearmed  Know your rights:  A contract is vital, and this contract should set out clearly:  The job description  Your duties and responsibilities  The salary you will be paid, how and when, whether it will be adjusted annually and what criteria will be applied, incentives for productivity and how this will be determined (key performance indicators)  The probation period and how you will be evaluated at the end of it (i.e. the performance indicators that will be used), any conditions that pertain regarding an adjustment to the salary  A travel allowance for off-site duties  A professional development allowance  Leave arrangements (sick, compassionate, annual, maternity)  Code of conduct and disciplinary procedures  Grievance procedures  Research and studies  Management of poor performance  Restraint of trade should you leave the practice  Additional sources of income (e.g. clinical tutoring)  Notice (both parties)  General paragraph regarding compliance to practice policy The employer:  By law you are entitled to a contract  Many speech therapists are running practices without doing so – this is illegal and unethical as well as exploiting the inexperienced new graduate  Many speech therapists offer a ‘deal’ to new graduates to provide them with the experience they need in exchange for sharing/splitting fees unfairly or on a minimal commission basis only The Employee: o Insist on a contract and read it before you sign it o You are within your constitutional rights to delete and alter a contract until you and the other party are happy with it  o If you are not happy with the contract, either forget it and look elsewhere for work, or on your own head be the consequences o Your employer should provide you with a practice policy and procedures manual/explanation o This sets out the general procedures for record keeping o General “practice rules” and expectations and billing o Records must be kept for a number of years and produced on demand if requested by the HPCSA or a lawyer – therefore keep good records o A contract may also include the clinical procedures that the practice will follow o If you produce anything original for the practice, claim it in writing as your intellectual property so you can take it with you when you leave o Remember that the patients belong to the practice, not to you – if you leave the practice you may not take the patients with you Always consider: What are my values? How would I like to be treated by my employer? How would I like to be treated if I was a patient of the practice? What would provide me with complete job satisfaction? How will I respond if I find that I don’t like what I am doing? Guidelines for SLT’s and audiologists working in private practice: Who you are Business objectives Key personnel Premises Equipment, materials, machinery Products and/or services Fees and billing Customers Competition Promotion/marketing Qualifications and registration Roles and responsibilities Marketing and business cards, stationary etc. Guidelines for SLT’s and Audiologists working in public health sector: Guidelines for service provision: health promotion, early hearing detection, ECI, high risk neonates, family intervention (SASLHA Document) Management of client waiting lists Referrals Collaboration Areas of expertise Guidelines for infection control:  NB familiarize yourself with universal precautions  Differs from context to context  Cannot refuse to assess or treat  Confidentiality  Disinfection and cleaning  Use sterile and clean instruments  Hand washing  Clean booths and therapy rooms/ventilate  Use barriers (gloves, masks)  How to handle spills Harassment: A form of discrimination, demeaning, bullying violates human rights Contexts of occurrence: Public or private sector Between colleague, client, parent, line manager How to deal with it: Maintain professional boundaries Inform clients of the facilities’ policy Avoid physical contact where possible Work with the door open Do not give your phone number Code of conduct: Importer, distributor, manufacturer of materials, toys, equipment, accessories: Conflict of interest Perverse incentives Gifts / bartering Community based: Familiarize yourself with the WHO guidelines Aim to offer highest quality service based on evidence Multilingual population: “Knowledge and/or use of two or more languages” Need to have a good knowledge how to manage multilingual clients Report writing and professional notes – lecture 3 What is a patient record: A patient health record is the longitudinal collection of an individual’s personal and health information, recorded by a healthcare practitioner or at the directive of the healthcare practitioner, regardless of the form or medium used to make such a record Record keeping has a professional, ethical and legal purpose:  Reminder of what has been found, decided and done  To ensure continuity of care  Promote evidence of standard of care  Consider any notes legal documents  Competence can be compromised  Case notes usually informal (session planning)  Other always professional and scientific style The audiologist / speech-language therapist is often judged by his/her reports Other use for records:  To conduct clinical audits  To promote teaching and research  Administrative purposes  Evidence for occupational disease and injury compensation  As evidence during litigation There are multiple different forms of record keeping When deciding what form to use, you need to ask yourself - to whom or for what purpose? Examples of forms of record keeping: o Assessment / diagnostic o Referrals o Management plan o Therapy programme / chart logs o Progress report / termination report o SOAP notes Other forms of record keeping include:  Audio visual materials  Clinical research and data  Reports for litigation (medico-legal)   Why is record keeping so important:  Summary and interpretation of information regarding a clients functioning/performance  Provide a record of findings  Facilitates communication between professionals Requirements for record keeping: Contemporaneous: Made at time of interaction Have integrity: Accurate, complete, comprehensive, unambiguous, not tampered with, not derogatory Attributable: Name of practitioner, dated and timed, signed Accessible: Readily available and easily accessible Securely stored: Control measures in place to prevent unauthorised access Content should be: o Complete but concise o Professional o Clear/factual o Consistent o Accurate o Objective Other considerations: Follow guidelines for making alterations A standardized format should be used Billing records should be kept separate from patient records Attached documents should be labelled individually Electronic documentation should be able to:  Edit  Store securely  Retrieve  Ongoing record keeping (SOAP notes)  Feedback and counselling session Telepractise: Main issues – confidentiality and ethics Other – reimbursement, malpractice and keeping notes Technical resources: o Electronic mail o Fax machines/faxes o Telephones o Hard copies o Informed consent What will we report on: On tests scores, descriptively Performance data Provide explanation Relate to client’s overall communication profile and needs Accurate reporting:  Provides clinician accountability  Provides justification for judgments and decisions  Ethical considerations  Prognosis: Not misleading and unrealistic  Often the only contact between SLT /A and other professionals  Can compromise or establish your credibility Content of health records: o Personal particulars of patient o Time, date and place of consulations o Full history of patient o Who is making the notes o Written proof of informed consent o Full clinical examination (assessments and findings) o Differential diagnosis o Proposed management o Patient’s response to treatment o Information and advice given to patient o Clinical decisions made o Additional testing/assessments required o Referrals made o Results and reports from other assessments Tests and materials: o Authentic/original o Appropriate (sensitive to cultural background)  o Qualitative and descriptive o General considerations re external influences o Can be checklists o Practice to gain experience in using them Tests: Which tests (reference) What was tested / evaluated Results Deduction – what does this mean APA 7 Referencing e.g.: Test of Childhood Stuttering (TOCS, Gilliam R. et al, 2009) Clinical examination results: Summary and recommendations Provide a summary of the findings and explanations of significant contributing factors List recommendations and justify these Format of contents for letter: Practitioner details, time and date How evaluated (the test and what tested) What are the results What are your deductions/interpretations Justify your recommendations Do not forget to explain terminology Storing of records: Clinicians in private practise – record belongings to clinician Clinicians responsibility to keep confidentiality of client information Store in a safe place and locked Backup of copied need to be stored If on computer – have a password Store for a period of years as legally stipulated How long should they be stored: Ideally indefinitely particularly if using electronic format If not practical – minimum of six years since record has become dormant (last treated) Exceptions: Under 18 – kept at least until 21st birthday Mentally incapacitated – lifetime of patient Who owns the health records: Health records are owned by health practitioner In state institutions – property of institution A patient is entitled to have access to information contained in record Copies must be made available to patients on request Who may receive a report: Clients older than 12 years may have direct access to their records Clients under 16 years: parent or legal guardian may request access to client records, with authorization from patient Written authorization needed if you want to share records with a third party Reporting and statements:  Provide accurate and relevant information  No misinterpretations: credentials, competence, education, training, experience or scholarly contributions  HPCSA registration number  Practise number What if you disagree: Consider the moral ethical principles:  Descriptive reporting  Only observed behaviour  Justify your observation Some tips and rules: o Positive statements o Be specific and avoid ambiguous terms o Complete and clearly understood words o Specific and accurate o Language that conveys a sincere professional attitude o Complete verb forms (not “doesn’t”) o Careful regarding personal pronouns o Avoid exaggeration o Beware of emotional terminology – good, outstanding or clever etc. o Active verbs: avoid passive – based on this examination it was found o Check spelling and punctuation o Avoid colloquial phrasing, e.g. bored to death General tips: o Proofread o Read aloud o Use grammar and spell check o Check if you have justified statements o No long rambling sentences o When in doubt – ask a buddy Beware of fabrication and falsification:  Research  Legal matters  Defrauding  Reimbursement Ensure that: Use every resource to ensure high quality service Clients need to be fully informed of what will be tested and the final results Can not guarantee results or outcomes Inform of possible negative effect Provide no service via correspondence What is discussed will be reported on What to disclose: Need to reveal outcomes Video or audio recordings Research data (misuse – no consent) Medical aid schemes (be informed of who pays) What is the best for the client Social media ethics – lecture 4 Social media In previous years, social media was not a problem for clinicians The ethical use of social media has now been a hot topic. There is a need to maintain high professional and ethical standards in using social media. Need to be aware of potential risks involved in sharing information, even if consequences are unintended What is social media: Social media describes the online tools and electronic platforms that people use to share content. Social media includes: o Social networks (e.g. Facebook, Twitter, WhatsApp and LinkedIn) o Content-sharing platforms (e.g. YouTube and Instagram), o Personal and professional blogs (including email, SMS, electronic journals as well as those published anonymously), o Internet discussion forums, o And the comment sections of websites Content in relation to HPCSA: The key objective of the HPCSA and it professional boards is to guide the profession and protect the public Social media Benefit Challenges  Expertise sharing and education  Lack of direct control  Professional branding  Sharing of confidential information  Identify professionals and people  Privacy not guaranteed with common interests  Requests for direct professional  Build support networks advice  Identify challenges faced by  Blurred line between professional society and private life  Advocacy  Recruitment Obligation in relation to social media: “Just as with all aspects of professional behaviour, health practitioners should be aware of their obligations under the HPCSA Ethical and Professional Rules, the Professional Board’s scope of practice and other relevant legislation, such as the Promotion of Access to Justice Act 3 of 2000, the Protection of Personal Information Act 4 of 2013, and the common law.” Patient confidentiality: o All patients are entitled to privacy and confidentiality o Disclosure of a patient’s information may only be in accordance with a court order, patients consent and in terms of the law. o Health practitioners can share confidential information with other members of the health care team involved in the patient’s care and with individuals who have the patient’s consent o Obtain written consent of patient before publishing information on social media, whether or not a healthcare practitioner believes the patient can be identified or not. o Patient under 12 years - written consent from parent or guardian and assent of minor. o Health practitioners sharing information for the sake of education and training through social media must ensure that the recipient of the information is not able to identify the patient from the data disclosed. o Health practitioners must ensure that the recipient of patient information via social media understands that such information is given to them in confidence, which they must respect. o The obligation to keep patient information confidential remains even after the patient dies The practitioner-patient relationship: o Interaction between health practitioners and their patients on social media can blur the boundaries of the professional practitioner-patient relationship. o Health practitioners are advised not to interact with patients via social media platforms o Health practitioners may choose to share personal information about themselves with their patients during face-to-face consultations, but social media does not offer a similar level of control over the extent and type of content shared. o Should the health practitioner receive an inappropriate message from a patient via social media, they should politely re-establish professional boundaries and explain their reasons for doing so. o If a patient is seeking health care advice over social media, politely request them to set up an appointment in-person. o If a patient persists in contacting the health practitioner, the practitioner should keep a log of all contacts and seek advice from the HPCSA. o Education shared online should be EBP and generic – encourage to set up appointment with a professional  o Health practitioners should separate their professional and personal social media accounts to help maintain the appropriate professional boundaries. o The health profession’s image: o The health care practitioner use social media in their personal o Content posted on social media may harm the health practitioner’s employability and recruitment, limiting professional development and advancement Social media activities health practitioners should avoid: Taking photographs during care or treatment Making unsubstantiated negative comments about individuals or organisations Making informal and derogatory comments about patients Making comments that can be perceived as racist, sexist, homophobic or otherwise prejudiced, even if meant in jest or as satire. Health practitioners may engage fully in debates on health matters, however they must be aware that the laws regarding defamation, hate speech and copyright also extend to content shared via social media Health practitioners must not post their opinions on the probity, skill or professional reputation of their colleagues on social media If a colleague makes derogatory or inappropriate comments on social media, health practitioners are advised to bring it to their attention discreetly, and not to engage or respond publicly on the social media platform. Health practitioners are advised to include disclaimers in their social media profiles, indicating that the views expressed therein are their own and not those of the health profession or the health establishment they represent. Advertising using social media:  Social media is also a popular tool for the advertisement and promotion of goods and services, with the growing online market being one of the most emphasised in business practice.  When using social media health care practitioners must comply with the HPCSA rules on advertising practice, and must make sure that they are declaring their financial interests in hospitals  Touting involves drawing attention to one’s professional goods or services by offering guarantees or benefits that fall outside one’s scope of practice.  Canvassing involves the promotion of one’s professional goods and services by drawing attention to one’s personal qualities, superior knowledge, quality of service, professional guarantees, or best practice.   Health practitioners may not advertise, endorse or encourage the use of any hospital, medicine or health related product on social media in a manner that unfairly promotes the practice of a particular health practitioner or establishment for the purposes of financial gain or other valuable consideration.  A failure to follow these guidelines when using social media will undermine public trust in the health profession How to be cautions with social media:  Health practitioners must be aware that, even with a pseudonym, anonymity on social media platforms is never guaranteed.  If health practitioners use social media in their personal capacity, they are advised to adjust their privacy settings to restrict public access.  Once content is shared online, it is difficult to remove, and health practitioners must use social media on the understanding that the information they post will remain on the internet permanently  Even if a health practitioner deletes a post on a social media site, this does not necessarily mean the content has been removed.  Health practitioners should avoid using social media when stressed, tired, upset or under the influence of alcohol. Clinicians sharing photos of them and their clients: Picture provided by community service speech therapist, Leandri Wolmarans. Consent was received from her as well as the parents of the child Take home message: o Always put the patient at the centre o Put yourself in patient’s shoes o Protect your professional boundaries o Before posting, ask “What if this post went viral?” o Share generic medical information for awareness and educational purposes o Privacy settings do not necessarily guarantee privacy o We have no control on how fast and far information spreads on social media