Professionalism & Ethics .docx

**Sue Behari-- Professionalism & Ethics:** +-----------------------+-----------------------+-----------------------+ | **REGULATED HEALTH | **Regulated Health | | | PROFESSIONS ACT | Professions Act Vs. | | | (RHPA):** | Standards of |...

**Sue Behari-- Professionalism & Ethics:** +-----------------------+-----------------------+-----------------------+ | **REGULATED HEALTH | **Regulated Health | | | PROFESSIONS ACT | Professions Act Vs. | | | (RHPA):** | Standards of | | | The Regulated Health | Practice:** | | | (RHPA) ensures that | | | | professionals provide | | | | ethical care to the | | Category< | | Components of the | | Descripti | | | | on | | 1. Regulation of | | Terminolo | | Health | | gy | | Professions: | Aspect | | | - Scope of | Regulated | | | Practice: Def | Health Professions A | | | ines | ct (RHPA) | of Professional Pract | | activities | Standards | ice | | and services | of Professional Prac | Defines the minim | | each | tice | um performance expect | | regulated | | ations for dietitians | | profession is | | to provide safe, eth | | authorized to | | ical, and competent c | | perform. | | lient-centered servic | | | What It I | es. | | - Controlled | s | Must, shall, requ | | Acts: Lists | | ire, expect | | specific | A law that set | | | medical | s rules for health pr | | | procedures or | ofessions to protect | Practice | | activities | the public. | Guidelines | | special | | Regulatory in nat | | authorization | Guidelines for | ure, offering volunta | | due to their | how health professio | ry behavior suggestio | | potential | nals should behave an | ns to assist practiti | | risks. | d do their jobs.< | oners in safe, compet | | | /li> | ent, and ethical prac | | 2. College | | tice. | | Responsibilities: | | Should, are encou | | | | raged | | - Each | Purpose | | | profession | | Position | | has its own | To ensure that | and/or Policy Stateme | | regulatory | only qualified profe | nts | | body, known | ssionals can provide | Describe the Coll | | as a College, | certain health care s | ege’s actions in spec | | which is | ervices. | ific circumstances or | | responsible | | provide guidance on | | for setting | | existing legal interp | | and enforcing | To ensure prof | retations. | | professional | essionals provide saf | | | standards, | e, ethical, and high- | | | including: | quality care. | Adviso | | - Developin | | ry Statements/ | | regulatio | | Practice A | | ns | Main Role | rticles< | | and | | /td> | | standards | | Provide notice to | |. | Defines what e | the profession about | | | ach health profession | requirements, such a | | - Licensing | is allowed to do.  | or Ministry of Health | | registrat | Creates regulatory bo | information. | | ion | dies to oversee profe | | | of | ssions. | | | practitio | | | | ners. | | | | | Provides speci | | | - Handling | fic rules and expecta | | | complaint | tions for daily pract | | | s | ice.  | | | and | Ensures consistent pr | | | disciplin | ofessional behavior.< | | | ary | /p> | | | actions. | | | | | | | | 3. Professional | | | | Standards and | Key Diffe | | | Conduct: | rence | | | | | | | - Establishes | Focuses on leg | | | requirements | al rules for all heal | | | for | th professions. | | | behavior and | | | | practice, | | | | including how | Focuses on spe | | | professionals | cific practices withi | | | should handle | n each profession. | | | interest, | | | | professional | | | | misconduct, | | | | record | Example | | | more. | | | | | The RHPA may s | | | 4. Public | ay that only doctors | | | Protection: | or nurses can give in | | | | jections. | | | - Ensures that | | | | health | | | | professionals | A nursing stan | | | meet defined | dard might require ke | | | standards to | eping patient informa | | | safeguard the | tion private. | | | unqualified | | | | or unethical | | | | practices. | | | | | Who | | | professionals | Enforces | | | their scope | It | | | and adhere to | | | | established | The government | | | standards. | , through laws and re | | | | gulations. | | | 5. Governance and | | | | Accountability: | | | | | Professional o | | | - Sets out the | rganizations like Col | | | framework for | leges or Associations | | | governance of |. | | | the Colleges, | | | | including | | | | their | | | | responsibilit | | | | ies, | | | | powers, and | Criteria used for | | | duties. | developing **Standard | | | | s | | | - Requires | of Professional | | | transparency | Practice** for | | | and | Registered Dietitians | | | accountabilit | (RDs): | | | y | | | | in the | 1. [Identifying the | | | regulation of | Need:]{.underline | | | health | } | | | professions. | | | | | - *High-Risk | | | 6. Controlled Acts | Areas:* The | | | Regulations: | College | | | | identifies | | | - Lists | areas that | | | specific acts | pose | | | (e.g., | significant | | | certain | risks | | | medical | (physical, | | | procedures) | emotional, | | | that only | financial, | | | qualified and | etc.) and may | | | authorized | need | | | professionals | standards to | | | can perform. | manage these | | | | risks. This | | | - Ensures that | involves | | | only those | analyzing | | | with the | risks and | | | appropriate | considering | | | training and | public | | | authorization | expectations | | | undertake | and how often | | | these acts. | these issues | | | | arise. | | | 7. Public and | | | | Professional | - *Member | | | Involvement: | Feedback:* | | | | Issues that | | | - Encourages | frequently | | | public | come up in | | | involvement | consultations | | | in the | or inquiries | | | regulation | from RDs may | | | process and | signal the | | | professional | need for new | | | development | standards. | | | through | | | | feedback and | 2. [Client | | | consultation. | Risk:]{.underline | | | | } | | | Purpose of the RHPA | | | | | - The issue | | | - Protection of the | must pose a | | | Public: Ensures | real (not | | | that all health | just | | | care | possible) | | | professionals | risk to | | | practice safely | clients, | | | and competently. | necessitating | | | | public | | | - Consistency in | protection. | | | Regulation: Provi | This could | | | des | involve risks | | | a standardized | to their | | | approach to the | physical | | | regulation of | health, | | | various health | emotional | | | professions. | well-being, | | | | financial | | | - Professional | security, | | | Accountability: H | etc. | | | olds | | | | health | 3. [Professional | | | professionals | Conduct | | | accountable for | Risk:]{.underline | | | their practice | } | | | and conduct. | | | | | - There must be | | | **STANDARDS OF | a reasonable | | | PROFESSIONAL | concern that | | | PRACTICE:** | RDs dealing | | | | with the | | | - Standards are | issue might | | | created by | engage in | | | colleges for the | unprofessiona | | | purpose of public | l | | | protection. The | or unethical | | | College's | behavior, | | | Standards of | which the | | | Professional | standard | | | Practice describe | would help | | | the required | prevent. | | | behaviors by | | | | which an RD's | 4. [Lack of Existing | | | performance can | Guidance:]{.under | | | be evaluated and | line} | | | serve as a basis | | | | for assessing | - If no | | | whether RDs | higher-level | | | fulfill their | document | | | professional | (like a law, | | | responsibilities | regulation, | | | to provide safe, | or competency | | | ethical and | guideline) | | | competent | already | | | client-centered | addresses the | | | services. | issue, a new | | | | standard may | | | - To fulfill | be needed to | | | the College's | clarify the | | | regulatory | College\'s | | | mandate of | expectations. | | | public | | | | protection. | 5. [Long-Term | | | | Relevance:]{.unde | | | - To inform the | rline} | | | public, | | | | employers, | - The standard | | | other health | should be | | | care | expected to | | | providers and | remain | | | College | relevant and | | | members about | applicable | | | the minimum | over an | | | expectations | extended | | | that RDs must | period, | | | meet in their | rather than | | | dietetic | being a | | | practice to | temporary | | | provide safe, | solution. | | | ethical | | | | | 6. [Behavioural | | | and competent | Expectations:]{.u | | | services. | nderline} | | | | | | | - To provide | - Clearly define | | | performance | the behavioral | | | assessment | expectations for | | | criteria for | Registered | | | the College's | Dietitians (RDs) | | | Quality | concerning their | | | Assurance | ethical and | | | Program. | professional | | | | responsibilities. | | | - To help guide | The goal is to: | | | the College's | | | | decision-maki | - *Provide | | | ng | Clarity:* The | | | in matters | standard aims | | | related to | to make it | | | professional | clear what is | | | conduct and | expected of | | | competence; | RDs in terms | | | and | of their | | | | conduct, | | | - To support | helping them | | | compliance | understand | | | with the | how to meet | | | required | their | | | behaviours | professional | | | and | and ethical | | | performance | obligations. | | | expectations | | | | of RDs | - *Enable | | | | Compliance:* | | | - practicing | By outlining | | | the dietetic | these | | | profession in | expectations, | | | Ontario. | the standard | | | Standards of | helps RDs | | | Professional | comply with | | | Practice are | the rules and | | | expressed | guidelines | | | using the | set by their | | | terms "must, | governing | | | shall, | body (the | | | require, | College). | | | expect." | | | | | - *Facilitate | | | | Enforcement:* | | | | Clear | | | | standards | | | | allow the | | | | College to | | | | effectively | | | | enforce the | | | | rules, | | | | ensuring that | | | | RDs who do | | | | not meet | | | | these | | | | expectations | | | | can be held | | | | accountable. | | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **[SECTION | **[SECTION | **Ethical | | I:] | IV:]** | Principles:** | | Controlled Act | **When interpreting & | | | Authorization for | communicating the | 1. [Respect for | | Registered Dietitians | results of capillary | Autonomy:]{.under | | (RDs):** | blood readings,** | line} | | | | | | **Under the Dietetics | **RDs must:** | - Recognizing and | | Act (1991):** | | respecting the | | | 1. Explain the | decision-making | | - RDs are | results, \* | rights of | | authorized to | clinical | individuals. | | perform the | significance | | | following | (optimal vs. | - Dietitians must | | controlled act: | suboptimal) and | ensure that | | | impact on the | clients have the | | *"3.1 In the course | nutrition care | information they | | of engaging in the | plan to clients. | need to make | | practice of | | informed | | dietetics, a member | 2. Provide | decisions about | | is authorized, | supporting | their care, and | | subject to the terms, | educational | they must honor | | conditions and | materials, as | those decisions, | | limitations imposed | appropriate. | including | | on his or her | | obtaining | | certificate of | 3. Refer clients to | informed consent. | | registration, to take | their primary | | | blood samples by skin | health care | 2. [Beneficence | | pricking for the | provider or refer | (Doing | | purpose of monitoring | clients who do | Good):]{.unde | | capillary blood | not have a | rline} | | readings"* | primary care | | | | provider to a | | | - The Dietetics | walk-in clinic or | | | Act (1991) | other local | - Acting in ways | | specifies that | alternative for | that promote the | | RDs have the | further testing. | well-being of | | authority in the | | individuals and | | course of | 4. Notify other | communities. | | practicing | health care | | | dietetics to | providers of the | - Dietitians should | | collect capillary | results, as | work to improve | | blood samples by | appropriate; and | population and | | skin pricks and | | public health, | | monitoring the | 5. Avoid | advocate for | | capillary blood | communicating a | equity, and be | | samples readings. | medical diagnosis | accountable for | | Currently, the | to clients. | their actions and | | most common | | their impact on | | application of | **\* Communicating | society. | | monitoring of | Capillary Skin Prick | | | capillary blood | Test Results:** | 3. [Non-malefice | | samples is for | | nce] | | the purposes of: | - RDs may | (Not | | | communicate the | Harming): | | a. Screening for | results of | | | optimal or | capillary skin | | | suboptimal | pricks to | | | blood glucose | clients, | - Avoiding actions | | levels, or | including | that cause harm | | | elevated, normal | | | b. Monitoring | or low values, | - This principle | | blood glucose | provided they are | emphasizes the | | levels in | not violating the | importance of | | clients with | controlled act of | harm reduction, | | diabetes. | communicating a | meaning | | | diagnosis as | dietitians should | | 1. It is | outlined in | strive to | | recognize | section 27(2) of | minimize any | | d | the Regulated | potential | | that in | Health | negative outcomes | | the | Professions Act | of their | | context | (1991): | interventions or | | of a | | advice. | | Registere | *"Communicating to | | | d | the individual or his | 4. [Respect for | | Dietitian | or her personal | Persons, | | -client | representative a | Justice, and | | relations | diagnosis* | Dignity:]{.un | | hip, | | derline} | | currently | *identifying a | | | , | disease or disorder | | | RDs may | as the cause of | | | be | symptoms of the | - Valuing every | | performin | individual in* | individual's | | g | | inherent worth | | capillary | *circumstances in | and ensuring fair | | skin | which it is | treatment. | | pricks | reasonably | | | and | foreseeable that the | - Dietitians must | | analyzing | individual or his or | advocate for the | | capillary | her* | just and | | blood | | equitable | | levels | *personal | distribution of | | under | representative will | resources and | | four main | rely on the | services, | | circumsta | diagnosis."* | ensuring that all | | nces: | | individuals | | | - If RDs have | receive fair and | | i. To teach blood | performed | respectful | | glucose | capillary skin | treatment, | | self-management | pricks and the | regardless of | | | results are | their background. | | ii. For random blood | indicative of an | | | glucose checks to | undiagnosed | **Ethical | | monitor progress | medical disease | Expectations:** | | | or disorder, RDs | | | iii. For compliance | cannot | Ethical expectations | | with diet/insulin | communicate the | in dietetics apply to | | or other blood | presence or label | four main areas: | | glucose lowering | of the specific | responsibility to the | | medications; and | medical disease | client, the public, | | | or disorder to | the individual | | iv. For confirming | the client. In | practitioner (self), | | hypo/hyperglycemi | this case, RDs | and the profession.  | | a. | must refer | | | | clients to their | a. **Responsibility | | 2. In conducting | primary health | to the client | | public | care provider | includes:** | | screening | (Physician or | | | clinics to | Nurse | | | identify | Practitioner, as | | | people at | appropriate) or | 1. [Client Autonomy | | risk for | "orphaned" | and Informed | | abnormal | clients to a | Consent:]{.underl | | glucose | walk-in clinic or | ine} | | levels and | hospital | | | recommend | emergency room | - Respect and | | appropriate | for further | uphold | | resources, | investigation and | clients\' | | follow-up | for communication | decisions and | | care and | of any medical | rights, | | referrals to | diagnosis. | particularly | | other primary | | regarding | | health care | **[SECTION | informed | | providers for | VI:] | consent, | | further | Documentation in | research | | diagnostic | Public Screening | participation | | testing. | Clinics** | , | | | | and personal | | **[SECTION | - Different | health | | II:]** | Documentation | information. | | **Prior to collecting | Requirements: | | | capillary blood | Registered | 2. [Professional | | samples, RDs must:** | Dietitians (RDs) | Competence and | | | performing | Client | | 1. Have the required | capillary skin | Welfare:]{.underl | | knowledge, skills | pricks and | ine} | | and judgment | analyzing results | | | specific to the | in public | - Use | | devices being | screening clinics | knowledge, | | used to safely | (e.g. community | skills, and | | and effectively | centres) have | judgment with | | perform the | different | a | | procedure. | documentation | professional | | | responsibilities | attitude to | | 2. Determine whether | compared to those | prioritize | | the test is | working within | client | | appropriate for | established | welfare. | | the specific | RD-client | Dietitians | | client | relationships. | should | | | | provide | | 3. Obtain informed | - RD | client-center | | client consent, | Responsibilities: | ed | | as appropriate: | | care with | | | - *Follow | empathy, | | i. Explain to | Organizationa | compassion, | | clients the | l/Program | and dignity, | | rationale and | Requirements: | fostering | | clinical | * | respectful | | significance | RDs must | relationships | | of performing | document |. | | the capillary | their | | | skin prick; | activities | 3. [Cultural Respect | | | according to | and | | ii. Indicate the | the specific | Non-Discriminatio | | nature of the | requirements | n:] | | test (e.g., a | of the | | | sample of | organization | - Honor each | | capillary | or program | client\'s | | blood will be | they are | inherent | | taken); | working with. | worth and | | | | cultural | | iii. Outline the | - *Required | beliefs | | possible | Documentation | without | | risks and | Includes:* | discriminatio | | contraindicat | | n. | | ions | - [Statisti | Respect | | for | cs:] | diverse ways | | performing | Number of | of knowing | | the capillary | tests | and avoid | | skin prick. | performed | prejudice | | |. | based on | | 4. Consider the | | attributes | | client's specific | - [Educatio | like race, | | circumstances | nal | gender | | when assessing | Resources | identity, | | the risks, | :] | sexual | | precautions, | Details | orientation, | | appropriateness | of any | body size, | | and sensitivities | education | age, | | associated with | al | religion, or | | performing skin | materials | socioeconomic | | pricks; | provided. | status. | | | | | | 5. Ensure processes | - [Other | 4. [Equitable and | | are in place to | Relevant | Individualized | | manage suboptimal | Details:] | Care:]{.underline | | tests results and | | } | | for minimizing | Any | | | client risk when | additiona | - Provide | | presented with a | l | equitable | | critical blood | informati | care to all | | glucose test | on | clients, | | result | pertinent | treating each | | | to the | interaction | | 6. Verify that there | screening | uniquely. | | are mechanisms in | activitie | Avoid | | place to ensure | s. | assumptions | | safe functioning | | and seek | | of both the | **[SECTION | clarification | | equipment and | VII:]** | to understand | | supplies used to | Dietetic Interns: | clients\' | | perform and | | backgrounds | | analyze capillary | - The Regulated | and beliefs, | | blood samples | Health | ensuring a | | | Professions | safe and | | 7. Consider the | Act (1991) | supportive | | cost-effectivenes | outlines the | environment. | | s, | exceptions under | | | reliability and | which a | 5. [Evidence-Informe | | alternatives to | controlled act | d | | capillary skin | may be performed. | Practice:]{.under | | pricks and make | This includes: | line} | | an effort to | | | | avoid unnecessary | *"Fulfilling the | - Use | | duplication; and | requirements to | evidence-info | | | become a member of a | rmed | | 8. Refrain from | health profession | approaches to | | delegating the | and* | meet | | authority to | | clients\' | | perform capillary | *the act is within | needs while | | skin pricks to | the scope of practice | considering | | other health care | of the profession and | their | | providers. | is done under the* | preferences | | | | and | | There are | *supervision or | traditions. | | interdependent laws | direction of a member | Recognize the | | and regulations that | of the profession."* | limitations | | have been put in | | of | | place for RDs to have | During the training | evidence-base | | the authority to | of Dietetic Interns, | d | | perform capillary | RD preceptors may | practices, | | skin pricks and | provide instruction | acknowledging | | analyze the blood | and direction for | that research | | samples. These | | often | | include amendments to | students to acquire | reflects | | laws and | the competence to | Western | | corresponding | perform this | methodologies | | regulations under | controlled act. RDs |. | | the: | need to recognize | Consider all | | | that it is | relevant | | 1. Dietetics Act; | | contexts, | | and | professional | including | | | misconduct to be: | cultural, | | 2. Laboratory and | | social, and | | Specimen | *"Assigning members, | environmental | | Collection Centre | dietetic interns, | factors. | | Licensing Act | food service | | | | supervisors, dietetic | 6. [Collaboration:]{ | | As a result, RDs may | technicians or other |.underline} | | not delegate the | health care providers | | | authority for | to perform dietetic | - Work | | performing capillary | functions for which | respectfully | | skin pricks & | they are not | with | | | adequately trained or | colleagues, | | analyzing results to | that they are not | clients, | | other health care | competent to | caregivers, | | providers. Exception: | perform."* | and other | | See "SECTION VII: | | relevant | | Dietetic | RDs need to ensure | partners | | | the competence | (like | | Interns." | (knowledge, skill, | spiritual | | | and judgement) of | leaders) to | | **[SECTION | Dietetic Interns to | provide care | | III:] | collect capillary | that meets | | When performing skin | blood sample through | specific | | pricks, RDs must:** | skin pricks prior to | client needs. | | | performing the | | | 1. Use | controlled act | 7. [Accurate Billing | | evidence-based | directly on clients. | and Financial | | infection | Once performance | Integrity:]{.unde | | prevention and | readiness is | rline} | | control practices | established, Dietetic | | | as outlined in | Interns may perform | - Bill clients | | organizational | skin pricks to | accurately | | policies and | collect Capillary | for the | | CDO's Guidelines | blood samples and | services | | for the Disposal | monitor the blood | delivered and | | of Biomedical | readings under direct | maintain | | Waste Associated | or indirect RD | transparent | | with Skin | supervision, as | financial | | Pricking | appropriate. In | records. | | | either circumstance, | | | 2. Take the | RD preceptors should | 8. [Professional | | necessary steps | be available as a | Boundaries:]{.und | | to ensure an | resource and ensure | erline} | | appropriate | that Dietetic Interns | | | environment in | are following the | - Maintain | | which capillary | Professional Practice | clear | | skin pricks would | Standard: Collecting | professional | | be performed to | Capillary Blood | boundaries, | | protect client | Samples through Skin | avoiding | | privacy. | Pricking & Monitoring | personal | | | the Blood Readings | relationships | | | (Point of Care | with clients, | | | Testing) when | particularly | | | performing this | sexual | | | authority. | relationships | | | | or conduct | | | **Code of Ethics:** | that could be | | | framework that | perceived as | | | outlines the values, | sexual. | | | principles, and | | | | expectations for | 9. [Trauma-Informed | | | dietitians, dietetic | Care:]{.underline | | | practicum students, | } | | | and applicants to the | | | | profession. | - Recognize and | | | | address the | | | | impact of | | | | trauma on a | | | | client\'s | | | | well-being. | | | | Collaborate | | | | to create a | | | | healing | | | | environment | | | | that respects | | | | individual | | | | experiences | | | | and avoids | | | | re-traumatiza | | | | tion. | | | | | | | | 10. [Privacy and Data | | | | Protection:]{.und | | | | erline} | | | | | | | | - Implement | | | | measures to | | | | protect personal | | | | health | | | | information, | | | | especially when | | | | using | | | | technologies like | | | | artificial | | | | intelligence | | | | (AI), social | | | | media, and | | | | virtual care | | | | tools. | | | | | | | | 11. [Ethical Use of | | | | AI:] | | | | | | | | - When using AI | | | | tools, apply | | | | professional | | | | judgment to | | | | review and ensure | | | | that the output | | | | aligns with | | | | principles of | | | | equity, | | | | diversity, and | | | | inclusion. | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | b. **Responsibility | c. **Responsibility | **Jurisprudence & | | to the public:** | to self and the | Professional Practice | | | profession:** | Resources:** | | | | | | | 1. [Accountabili | **Purpose of the | | 1. [Professional | ty:] | Boundary | | Communication:]{. | | Guidelines:** | | underline} | - Self-Awareness: | | | | Practitioners | - Boundary | | - Dietitians should | must be | guidelines | | demonstrate | accountable for | clarify the laws | | professionalism, | their actions and | and principles | | integrity, and | aware of the | that RDs must put | | civility in all | power and | into practice to | | forms of | privilege | maintain | | communication, | inherent in their | professional | | whether with | roles. This | boundaries with | | clients, | awareness helps | clients | | colleagues, or | avoid exploiting | | | the public. | power imbalances | - When thinking | | | and ensures | about boundary | | 2. [Transparency and | ethical practice. | issues, consider | | Ethical Business | | contextual | | Practices:]{.unde | - Public | factors such as: | | rline} | Communication: | | | | Dietitians are | 1. The | | - Advertising and | accountable to | environment | | Disclosure: When | the profession | (the setting | | advertising or | even on public | where | | promoting | platforms, where | interactions | | services, | they must act in | occur) | | dietitians must | the interest of | | | clearly disclose | public health. | 2. Your | | any financial or | | motivation/mi | | material | 2. [Reflective | ndset | | relationships | Practice and | | | with third | Continuous | 3. Client | | parties that | Learning:]{.u | motivation/mi | | could influence | nderline} | ndset | | the content of | | | | the advertising. | | **Professional | | | | Boundaries:** | | - Conflict of | - Ongoing | | | Interest: | Education: Engage | - [Purpose:]{.under | | Dietitians should | in reflective | line} | | avoid conflicts | practice to | To provide safe | | of interest that | identify learning | dietetic services | | could compromise | needs and | to individuals in | | their | participate in | need. | | professional | continuous | | | judgment. If | education, | - [Foundation:]{.un | | conflicts cannot | particularly in | derline} | | be avoided, they | areas like | Built on mutual | | should be managed | Equity, | trust, integrity, | | transparently and | Diversity, | and respect. | | publicly | Inclusion, and | | | disclosed. | Belonging | Key Considerations: | | | (EDI-B), AI | | | 3. [Trustworthiness: | ethics, and | - *Power | | ] | technology. This | Imbalance:* | | | ensures | | | - Dietitians should | competence, | - RDs hold | | make choices that | quality | authority due | | demonstrate | assurance, and | to their | | reliability, | professional | professional | | honesty, and | growth. | role, | | integrity, | | knowledge, | | building trust | - Collaborative | and client | | with the public | Learning: Support | reliance on | | and clients. | and foster | their | | | learning among | services. | | 4. [Risk | colleagues and | | | Management:]{.und | students to | - RDs have | | erline} | enhance | access to | | | professional | confidential | | - Harm Prevention: | development. | information | | Dietitians should | | and can | | be aware of | 3. [Compassionat | influence | | potential risks | e | client care | | in their practice | Practice:]{.u | decisions, | | and take | nderline} | placing | | appropriate steps | | clients in a | | to mitigate harm. | | vulnerable | | This includes | | position. | | recognizing the | - Human and | | | type and | Technological | - *RD's | | likelihood of | Interactions: | Responsibility:* | | risks and taking | Maintain a | | | protective | compassionate | - Recognize and | | actions. | approach when | manage the | | | interacting with | inherent | | - Risk Response: | individuals and | power | | While taking no | technology, | imbalance. | | action can | consistent with | | | sometimes be a | professional | - Create a safe | | valid response, | obligations. | environment | | ignoring risks | | where clients | | can lead to harm, | 4. [Self-Care | feel | | so dietitians | and | respected and | | should carefully | Competence:]{ | supported. | | evaluate and |.underline} | | | address risks as | | - Maintain | | they arise. | | clearly | | | | defined | | 5. [Equity and Human | - Well-Being: Take | professional | | Rights:]{.underli | responsibility | boundaries. | | ne} | for your physical | | | | and mental | - Always act in | | - Dietitians should | well-being, | the client\'s | | provide care that | avoiding practice | best | | reduces health | when your | interest, as | | disparities, | capacity to | legally | | protects human | deliver competent | required. | | rights, and | services is | | | promotes fairness | compromised. | Benefits of | | and equity. They | | Maintaining | | should work to | - Independent | Boundaries: | | eliminate | Decision-Making: | | | barriers for | Ensure that | - Ensures all | | underserved | decisions remain | actions and | | groups and | independent of | interactions | | address systemic | third-party | focus on what is | | racism and | interests, are | best for the | | discrimination in | client-focused, | client. | | healthcare. | and foster trust | | | | and credibility. | - Protects both RD | | 6. [Technology and | | and client within | | Autonomy:]{.under | 5. [Bias | the therapeutic | | line} | Awareness:]{. | relationship. | | | underline} | | | - Use of AI: When | | **BOUNDARY | | using technology, | | CROSSING:** | | including AI | | | | tools, dietitians | - Reflexivity: Be | - Occurs when the | | must ensure that | reflexive and | RD-client | | individuals | identify how | therapeutic | | retain their | personal biases | relationship | | decision-making | may impact | shifts from | | authority. AI | interactions with | professional to | | should be | clients, | personal, | | integrated | colleagues, and | breaching the | | responsibly to | others in the | typical limits | | enhance dietetic | professional | that define a | | services without | environment. | safe therapeutic | | compromising | | space. | | human autonomy. | 6. [Professional | | | | Conduct:]{.un | Characteristics of | | 7. [Record | derline} | Boundary Crossings: | | Keeping:]{.underl | | | | ine} | | - Can | | | | be **one-off** or | | - Dietitians should | - No Harassment: | **cumulative** | | maintain | Refrain from any | | | organized and | form of verbal, | | | accessible | physical, | | | records to | emotional, or | - One-off: A single | | promote | sexual | occurrence | | collaboration | harassment. | | | with other | | - Cumulative: | | healthcare | 7. [Competence | Multiple small | | providers, comply | and Scope of | actions, that | | with legal | Practice:]{.u | over time, blur | | requirements, and | nderline} | professional | | protect client | | boundaries | | confidentiality. | | | | | | | | 8. [Reporting and | - Know Your Limits: | | | Accountability:]{ | Practice within | - Can be expected | |.underline} | the limits of | or unexpected, | | | your competence | accidental or | | - Dietitians are | and scope. | purposeful. | | required to | Recognize when it | | | promptly report | is necessary to | - Initiated by | | inappropriate | consult, refer, | the RD, | | behavior or | or collaborate | client, both, | | treatment, | with an | or a third | | including | inter-professiona | party. | | self-reporting, | l | | | in accordance | team to ensure | | | with legal | the best care for | | | obligations. | clients. | - Impact: | | | | | | 9. [Quality and | 8. [Collegiality | - Varies | | Effectiveness:]{. | and | from little | | underline} | Collaboration | impact to | | | :] | posing a high | | - Dietitians should | | risk of | | regularly | | harm to the | | evaluate the | | client. | | quality and | - Working with | | | effectiveness of | Others: Be | - Becomes | | their services to | collegial and | problematic | | ensure they are | work effectively | when another | | meeting the needs | with others, | relationship | | of their clients | managing | or personal | | and the public. | interpersonal and | feeling inter | | | collaborative | feres | | 10. [Resource | relations with | with the | | Management:]{.und | respect. Avoid | professional | | erline} | harassing, | relationship. | | | abusing, or | | | - Dietitians should | discriminating | Comparison to | | operate | against | Conflict of | | efficiently | colleagues, | Interest: | | within the | employees, or | | | healthcare | students. | | | system, managing | | | | resources | | - Similarity: Both | | responsibly to | | involve competing | | ensure they are | | interests that | | used effectively | | interfere with | | and sustainably. | | the RD-client | | | | relationship. | | | | | | | | - Difference: In | | | | boundary | | | | crossings, the | | | | competing | | | | interest is | | | | a personal | | | | feeling, not a | | | | tangible | | | | incentive (e.g., | | | | financial gain). | | | | | | | | Risk of Boundary | | | | Crossings: | | | | | | | | | | | | | | | | - If unchecked, | | | | even minor | | | | intrusions into a | | | | client's personal | | | | space can lead | | | | to serious | | | | boundary | | | | violations. | | | | | | | | **Core Differences | | | | Between Conflict of | | | | Interest and Boundary | | | | Crossing:** | | | | | | | | **Aspect** | | | | **Boundary Crossing* | | | | * | | | | | | | | | | | | **Conflict of Inter | | | | est** | | | | ------------------- | | | | -------------------- | | | | --------------------- | | | | --------------------- | | | | --------------------- | | | | - ------------------- | | | | --------------------- | | | | --------------------- | | | | ------------------- | | | | **Definition** | | | | Shifts the RD-client | | | | relationship from pr | | | | ofessional to persona | | | | l | | | | A situation where p | | | | ersonal interests con | | | | flict with profession | | | | al duties | | | | **Nature** | | | | Can be one-off or cu | | | | mulative; may be acci | | | | dental or purposeful | | | | | | | | Always involves a c | | | | ompeting personal int | | | | erest (financial, per | | | | sonal gain, etc.) | | | | **Cause** | | | | Personal feelings or | | | | emotional attachment | | | | (e.g., affection, fr | | | | iendship) | | | | Tangible incentives | | | | or benefits (e.g., m | | | | oney, gifts, favors) | | | | **Initiation** | | | | Can be initiated by | | | | RD, client, both, or | | | | a third party | | | | | | | | Initiated by RD's a | | | | ctions or decisions i | | | | nfluenced by personal | | | | gain | | | | **Impact** | | | | Varies from minimal | | | | to significant; can h | | | | arm client trust or p | | | | rofessional judgment | | | | Undermines objectiv | | | | ity, professional int | | | | egrity, and client tr | | | | ust | | | | **Acceptability** | | | | Sometimes acceptable | | | | if managed appropria | | | | tely and does not har | | | | m the client | | | | Always unacceptable | | | | ; must be avoided or | | | | disclosed | | | | **Risk Level** | | | | Can lead to serious | | | | boundary violations i | | | | f unchecked | | | | | | | | Directly damages th | | | | e RD-client relations | | | | hip and professional | | | | reputation | | | | **Examples** | | | | Attending a client's | | | | event, sharing perso | | | | nal information | | | | | | | | Accepting gifts, en | | | | dorsing products for | | | | personal benefit | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | **The Boundary | **Early Warning Signs | f. **Dual-Relationsh | | Crossing May Be:** | of Boundary | ips** | | | Crossing:** | | | 1. **Harmless** | | - Dual | | | - Inappropriate | relationships can | | - The boundary | emotions: | blur professional | | crossing that | excessive | boundaries and | | does not | feelings of love | interfere with | | negatively impact | or dislike | the provision of | | the RD-client | | dietetic care. | | relationship. | - Daydreaming about | They occur when | | | a client | an RD has both a | | - Example: An RD | | professional | | and a client | - Discussing | relationship and | | occasionally | personal issues | a personal | | discuss light | with clients | relationship with | | topics like the | | a client, for | | weather or | - Engaging in | example, treating | | favorite foods | behaviours that | a friend, family | | during | can be | member or | | consultations. | interpreted as | colleague. | | These | flirting | | | interactions | | iv. Treating your | | remain | - Spending more | Relatives & | | professional and | time than | Friends: | | do not impact the | necessary with a | Although RDs | | therapeutic | particular client | are not | | relationship or | | prohibited | | the RD\'s | - Meeting a client | from treating | | objectivity. | in a setting | relatives and | | | which is not | friends, | | 2. **Seemingly | professional (a | unless they | | Harmless:** | coffee shop, | are romantic | | | restaurant or a | partners or | | - Actions that | bar) | spouses, it | | appear harmless | | is best to | | but can | - Deliberately | refer them to | | unintentionally | scheduling early | another RD | | or intentionally | or late | whenever | | lead to more | appointments for | possible. If | | problematic | client sessions, | referring | | boundary | when others are | them to | | crossings if not | likely to not be | someone else | | carefully | present and this | is not | | managed. | has not been | feasible, | | | requested by the | reflect on | | - Example**:** An | client | what's best | | RD sends an email | | for your | | to a client | - Excessive | relative or | | outside of | self-disclosure | friend. Be | | regular | | clear about | | appointment hours | - Exchanging | expectations, | | to check in on | personal or | fees for | | their progress or | expensive gifts | service and | | ask how they are | with a client | about your | | feeling. While | | professional | | this might seem | - Offering to help | obligations | | supportive and | a client with | as an RD. Ask | | friendly, it | something | yourself: | | could blur the | unrelated to the | | | lines between | therapeutic | - *Will you | | professional and | treatment | be able | | personal | | to | | communication, | - Providing | maintain | | leading the | preferential | your | | client to feel | treatment or | professio | | uncomfortable or | arrangements: | nal | | unclear about the | cancelling | obligatio | | nature of their | appointments with | ns, | | relationship with | others to see | regardles | | the RD. This | this client, | s | | could also set an | extending credit | of the | | expectation for | beyond usual | nature of | | ongoing personal | practice or | the | | contact that | lending money | relations | | might not be | | hip?* | | sustainable or | - Doing something | | | appropriate in a | unethical or | - *How will | | professional | illegal for a | you | | setting. | client, such as, | handle | | | providing false | disagreem | | 3. **Purposeful | receipts or | ents | | Behavior with | checking the | with the | | Harmful | hospital records | client? | | Consequences:** | of the client's | Will you | | | relative | be able | | - Actions intended | | to accept | | to help the | +------------------+ | the | | client but result | | **Boundary | | choices | | in an inadvertent | | Checklist:** | | made by | | invasion of the | +==================+ | the | | client's personal | | - Assessing | | client if | | space or privacy. | | whether a | | you | | | | boundary | | disagree | | - Example: An RD | | crossing may | | with | | touches a | | be | | them?* | | client's hand to | | occurring, | | | | offer comfort | | ask | | - *What | | during a session. | | yourself: | | about the | | While the gesture | | | | financial | | is meant to be | | | | arrangeme | | supportive, the | | | | nts? | | client might find | | - Is this in | | Are both | | this physical | | my client's | | sides | | contact | | best | | happy | | uncomfortable or | | interest? | | with | | inappropriate, | | | | those | | potentially | | - Whose needs | | arrangeme | | harming the | | are being | | nts? | | therapeutic | | served? | | Do you | | relationship. | | | | feel | | | | - Could this | | pressured | | 4. **Misuse of | | action | | to | | Power:** | | affect my | | provide | | | | services to | | services | | - When the RD's | | the client? | | for free | | actions are more | | | | or at a | | focused on | | - Could I tell | | reduced | | meeting their | | my | | rate? How | | personal needs | | spouse/partn | | will you | | rather than those | | er | | deal with | | of the client, | | about this? | | payment | | even | | | | issues, | | unintentionally. | | - Am I | | should | | | | treating the | | they | | - Example: An RD | | client | | arise?* | | begins to share | | differently? | | | | their own | | | | - *Are you | | personal | | - Is this | | prepared | | challenges with a | | client | | to | | client to seek | | becoming | | discontin | | empathy or | | special to | | ue | | support. This | | me? | | services | | shifts the focus | +------------------+ | if | | away from the | | necessary | | client's needs | **Common Categories | ?* | | and places an | of Boundary | | | emotional burden | Crossing:** | - *Will the | | on the client, | | family | | undermining the | a. **Self-Disclosure | member | | professional | :** | expect | | relationship. | | special | | | - Helps build | treatment | | 5. **Consequences of | rapport but must | from | | Boundary | be managed | you?* | | Crossings:** | carefully. | | | | | v. Becoming | | - It can [damage | - Risks: | Friends with | | the | | A client: | | trust]{.underline | - Misinterpreta | Avoid this | | } | tion: | dual | | between an RD and | Clients may | relationship. | | a client. | see personal | Clients | | | sharing as a | should not be | | - It can [interfere | sign of a | placed in the | | with an RD's | desire for a | position | | professional | more personal | where they | | judgment]{.underl | relationship. | feel they | | ine} | | must become a | | to the detriment | - Dependency: | friend of | | of the client | There is a | their RD. It | | because the RD | risk that the | may be | | values an | RD may start | difficult for | | emotional or | relying on | clients to | | other benefit | the client | communicate | | over the client's | for emotional | that they do | | well-being, or | support, | not want to | | because of fears | harming the | be friends. | | that | professional | If you become | | inappropriate | relationship. | friends with | | conduct involving | | an existing | | the client will | - Client | client, many | | be exposed. | Discomfort: | of the | | | Clients may | complications | | - It can [hinder a | feel uneasy | listed above | | client\'s ability | about | in "Treating | | to question | self-disclosu | Your | | treatment]{.under | re | Relatives and | | line} | but might not | Friends" will | | suggestions | express it | come into | | | for fear of | play and may | | - It can | offending the | negatively | | [compromise a | RD or | interfere | | client's ability | jeopardizing | with what was | | to provide | the care they | otherwise a | | voluntary | are | healthy, | | consent]{.underli | receiving. | professional | | ne}. | | RD-client | | | b. **Accepting or | therapeutic | | *E.g. A client | Giving Gifts** | relationship. | | may feel | | | | obligated to | Risks: | vi. Interacting | | follow the RD\'s | | with Clients | | recommendations | - Emotional Impact: | on Email, | | out of a sense of | Gifts can alter | Telephone, or | | loyalty or | the dynamics of | Social Media: | | emotional | the professional | Separate your | | attachment, even | relationship and | professional | | if they have | may imply a | from your | | doubts about the | personal | personal | | plan or do not | connection is | communication | | fully understand | forming. | s | | the potential | | via email, | | risks and | - Confusion: Both | telephone and | | benefits. In such | giving and | social media. | | cases, the | receiving gifts | Be mindful | | consent provided | might blur the | that even on | | may not be | lines between | the phone or | | entirely | professional and | through | | voluntary or | personal | email, | | informed.* | relationships, | sharing too | | | leading to | much personal | | **Learn to Identify | confusion. | information | | the Early Warning | | may signal | | Signs of Boundary | - If giving gifts, | the beginning | | Crossing:** | consider: why do | of a | | | I want to give a | friendship. | | - **Gradual | gift to this | Use the phone | | Harm:** Boundary | client? Are my | or email for | | crossings can | reasons | friendly but | | start with small, | client-centered? | professional | | barely noticeable | Am I giving all | communication | | steps and can | my clients a | s | | eventually lead | gift? If not, why | only. Keep | | to significant | is this one | your personal | | harm to clients. | special? | life private. | | | | It is not | | - **Personal | Guidelines: | appropriate | | Weaknesses:** Bou | | for RDs to | | ndary | | accept | | crossings often | | clients as | | arise from an | - A small token of | friends on | | RD's areas of | appreciation | their | | personal | purchased while | personal | | weakness, such | on a vacation, | Facebook page | | as: | given around the | or to | | | holidays, or at | interact with | | - *[Emotional | the end of | them on other | | Vulnerabiliti | treatment may be | personal | | es]***:** | acceptable. | social media | |  If | | sites. | | an RD has a | - Professional | Friending, | | tendency to | Judgment: | linking or | | seek approval | Evaluate the | interacting | | or | situation and | with clients | | validation, | intentions before | on personal | | they might be | giving or | social media | | more | accepting gifts. | would be a | | susceptible | Consider the | boundary | | to developing | potential impact | crossing and | | overly close | on the | could | | relationships | therapeutic | potentially | | with clients | relationship | interfere | | in an attempt | | with the | | to feel | - Most of the time | professional | | appreciated | it is best to | RD-Client | | or valued. | avoid accepting | relationship. | | | or giving gifts | | | - *[Psychologic | to protect the | vii. Personal | | al | professional | Relations | | Factors:]{.un | RD-client | with a | | derline}* An | therapeutic | Client's | | RD with a | relationship. | Family: For | | \"rescuer\" | | the same | | mentality | - Organizational | reasons as | | might | Policies: Follow | outlined | | struggle with | any specific | above, | | maintaining | policies set by | refrain from | | boundaries, | your organization | developing | | as they might | regarding | personal | | feel | gift-giving to | relationships | | compelled to | clients. | or forming | | go beyond | | friendships | | professional | c. **Ignoring | with a | | limits to | Established | client's | | \"save\" or | Social, Cultural, | partner or | | help clients. | and Economic | any other | | | Conventions** | family member | | - *[Professiona | | (e.g. parent, | | l | - Dietetic services | sibling, | | Inexperience: | should always | son/daughter, | | ]* Less | occur in a | etc.) while | | experienced | professional | the client is | | RDs might | environment | in your care. | | have | appropriate for | | | difficulty | the services | viii. Entering | | setting and | being delivered. | into Business | | maintaining | Having treatment | Relationships | | boundaries | sessions over a | with Clients: | | due to a lack | meal at a | Refrain from | | of experience | restaurant or | engaging in | | or confidence | drinks in a bar | business | | in managing | is a | transactions | | complex | professionally | or financial | | client | risky activity as | dealings with | | interactions. | it blurs the | clients. Do | | | lines between the | not ask for | | | professional | money. Be | | | relationship and | cautious | | | friendship. | about | | | | business | | | d. **Starting a | dealings | | | Romantic | [with former | | | Relationship with | clients, as | | | A client:** | power | | | | imbalances | | | - The most extreme | may persist | | | boundary crossing | even after | | | is having a | the | | | romantic or | professional | | | sexual | relationship | | | relationship with | ends.]{.under | | | a client. It is | line} | | | never permitted | | | | to have a | ix. Treating your | | | romantic or | Romantic | | | sexual | Partner or | | | relationship with | Spouse: It is | | | a client. This is | never | | | considered sexual | permitted to | | | abuse and is | treat a | | | strictly | romantic | | | prohibited by | partner, | | | law. | including | | | | your spouse. | | | e. **Rescue | This is | | | Fantasies** | considered | | | | sexual abuse | | | Most RDs like to | and is | | | help people. A | strictly | | | rescue fantasy | prohibited by | | | occurs when an | law. | | | RD's desire to | | | | help goes too | x. Treating your | | | far. The help | Boss, | | | goes beyond the | Colleague or | | | RD-client |