Ethics&Laws in Physical Therapy Profession PDF

Ethics&Laws in Physical Therapy Profession Assist.Prof.Dr / Hussein Mogahed Assistant Professor of Physical Therapy Cairo University Values A common framework used when analyzing medical ethics is the "four principles" approach p...

Ethics&Laws in Physical Therapy Profession Assist.Prof.Dr / Hussein Mogahed Assistant Professor of Physical Therapy Cairo University Values A common framework used when analyzing medical ethics is the "four principles" approach postulated by Tom Beauchamp and James Childress in their textbook. It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application. The four principles are: Respect for autonomy – the patient has the right to refuse or choose their treatment. Beneficence – a practitioner should act in the best interest of the patient. Non-maleficence – to not be the cause of harm. Also, "Utility" ‫ – ﺟﺪوى‬to promote more good than harm. Justice – concerns the distribution of health resources, and the decision of who gets what treatment. refers to two types of consequences that may be produced by a single action, and in medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence. A commonly cited example of this phenomenon is the use of morphine or other analgesic in the dying patient. Such use of morphine can have the beneficial effect of easing the pain and suffering of the patient while simultaneously having the maleficent effect of shortening the life of the patient through the deactivation of the respiratory system. PART (II) Ethics and Professionalism in Physical Therapy 1  Qualifications of Physical Therapist Physical therapists must have full understood of ethical codes, customs, traditions and responsibilities especially with regard to patients, other team members and society. There are some essential qualifications of physical therapist as: 1- Good communications skills. 2- Respect all the patient’ s values. 3- his work, clinic and private cases. 4- 5- truth not cheating or stealing. 6- of basic sciences of physical therapy, general information about different aspects of life and community surround. Also, they should know a complete idea about customs and traditions of different types of patients to avoid any inconvenience ‫ﻋﺪم ارﺗﻴﺎح‬. Physical therapy is a hands-on profession that requires a science heavy education. Practitioners must earn a bachelor’ s degree with an emphasis on courses in anatomy, physiology, biology and chemistry. Physical therapists need to be able measure, calculate, reason and analyze data. They have to interpret and evaluate information to diagnose patients. The capability to prioritize therapies and measure and record outcomes is essential. 7- be able of accepting delay, annoyance or suffering from patients and others without complain. 8- saying or doing the right thing at the right time with patients and others. 2 9- mental process of forming an idea and creating a problem solving items to the patient's complaint. 10- strong feeling of admiration (feeling of satisfaction and warm approval) or interest. 11- the patient's problem at the first look and visit. Also, during application of treatment modalities, physical therapist can observe any unusual changes or new symptoms revealed. Physical therapists diagnose and treat through observation. The ability to focus on details is important. They have to be able to accurately observe patients at a distance and nearby. 12- helping others especially patients. This requires a good amount of activity and energy. 13- his emotional reactions toward patients, i.e. not involve himself in patient's problems. 14- Humor cannot be learnt, it is goodness of heart, of patience, of tolerance and of human kind. 15- The physical therapist should profession. 16- beneficences. 17- community and valid advancement. 18- Other qualities; because physical therapists work with patients who experience pain and frustration, physical therapists should be people. What’ s more, therapists work with diverse patients in many settings, from hospitals and outpatient clinics to homes. That calls for flexibility, adaptability and cultural sensitivity. ‫ﻗﻮة‬ 3 ‫ﺗﺤﻤﻞ‬ physical therapists often spend long hours on their feet assisting patients. Basic Principles of Ethics for Rehabilitation Teams Rehabilitation is defined as restoration of a disable person to some degree of normal life by appropriate training. Physical therapist is one of the rehabilitation team. Physical therapist is included in the whole management of the patient. For the rehabilitation team, ethics may be classified in a number of ways. One method is by the focus of ethical responsibility. All members of the rehabilitation team have ethical responsibilities to: 1- Themselves, 2- Their clients "patients", 3- Their team (s), 4- Their disciplines, ‫اﻟﺘﺨﺼﺼﺎت‬ 5- Society as a whole. 4  1- Ethical responsibilities of the rehabilitation team to themselves "rehabilitation professional domains": They will act on their own behalf to maintain reasonable levels of emotional and physical health. 2- Ethical responsibilities of the rehabilitation team to their client s "patients" "Client domain": · Showing active kindness and act to benefit their clients. · Take reasonable precautions to prevent harm to their clients. · Protect the privacy and confidentiality rights of their clients. · Keep themselves away from all forms of physical, emotional, financial and social exploitation. · Identify the limits of their skills and expertise and seek supervision, consultation or even refers the patient to other specialty when necessary. · Respect the rights of the patients to make their own decision about therapy including the rights to refuse treatment. · Provide services in a manner equitable to all individuals. 3- Ethical responsibilities of the rehabilitation team to their team(s) "team domain": · Ensure that those carrying out duties with professional ethics and the laws. · Work towards common goals and objectives of the team. · Report barriers to team and work with team members to eliminate such barriers. 4- Ethical responsibilities of the rehabilitation team to their disciplines "disciplinary domain": · Adequately trained and hold appropriate credentials to practice. · Use procedures and perform all assessment and interventions based on accurate information. 5  5- Ethical responsibilities of the rehabilitation team to society as a whole "societal domain": · Carry out their professional duties in accordance with the laws of the society. · Ensure that all services are culturally and socially normal and available in equitable manner. Management in Physical Therapy Management can be defined as physical means, it’ s limited in meaning. It concern the treatment only which limited view which is wrong concept because, now physical therapy is define as a system for assessing problems of function of musculoskeletal or neurophysiologic nature including those of pain and of psychosomatic origin and of dealing with or preventing them by natural methods based on manual therapy movement and physical agencies. 1- There are increasing number of physical therapy are dealing with client who are not ill e.g. physical therapy who works in general fitness, activity and teaching others how to deal with problems such as lifting an elderly relative. 2- Physical therapy increased who working in fields as ergonomic. 3- In a number of countries physical therapy no longer require patients to be referred by a doctor. We can summarize that in: People with problems can be dealt with physical therapy service. (A) People with solved problem. (B) People with unsolved problem. Physical therapist had teaching, advice and decisions role. According to the purpose of the service expected to fulfill. After assessment we must have: 1- Long term goals. 2- Sort term goals. 6  Management in physical therapy is about ensuring that expertise&skills of physiotherapists are used to best effect. The Effectiveness of Physical Therapy Patients are individuals and react in different ways to their conditioning, to the therapists and to treatment. Evaluation Classification: Because of this great variety in all aspects some classification or grouping of patients in terms of evaluation of treatment is necessary if only to make further progress. The proposed classification groups together, patients with conditions where the etiology is known and the outcome of treatment. Evaluation can be considered in similar way, there are 4 groups or four categories: Group (1) or Category "I" or "Evaluation group I": This category includes patients with soft tissue injuries who will be often limited to one side of the body. For example sprain, tendon injury, tenosynovitis these conditions are usually self limiting and resolution and recovery are expected (may delay) these patient form major of the work of many outpatient departments. 1- To relieve symptoms such as pain and swelling by assisting the resolution of local effects of injury of disease. 2- To increase range of motion "ROM" and restore muscle strength. 3- To prevent the development of deformity or recurrence. 4- To improve function. the condition is self-timing and recovery is expected must be seen in terms of hastening the process of recovery. 7  Measurement of symptoms must be as objective as possible and here the reliability of instruments needs careful testing. Where a condition in this group is localized to one site; the evaluation of the effect of treatment is perhaps more monitoring of patients over specified time periods. Group (2) or Category "II" or "Evaluation group II": This category includes patients who have conditions which essentially require other management or treatment, i.e. Physical therapy forming only part of treatment program e.g. fracture, orthopedic surgery or other surgery or in intensive care unit (ICU). Recovery is expected with correct management, evaluation here is complicated because physical therapy represents one part of the total management. The aims: are the same in group one but it must be specific with patient symptoms. E.g. recovery with correct management. Assessing the outcome of treatment for patients in this group is complicated by the fact that physical therapy form only part of the total treatment and it may be difficult to isolate its effect for many patients who fractures or orthopedic surgery it will be an integrate part of their post-fracture or post-operative management. Group (3) or Category "III" or "Evaluation group III": Patient with conditions which involve irreversible damage to or loss of body tissue resulted in disability, e.g. (C.V.A.) cerebrovascular accident, head or spiral injury, amputation&C.P. (cerebral palsy). Aims of group (1) and (2) still applicable with emphasis on the following: 1- Function ability, achieve or maintained or regaining. 2- Achieving, regaining or maintain patient life at home. 3- Adaptation the patient with his case. Problems of evaluating the outcome of therapeutic intervention for many of the patients are complicated. 8  loss of, or damage to body tissue. Group (4) or Category "IV" or "Evaluation group IV": Patients with progressive deterioration expected e.g. Rheumatoid arthritis, malignant, disseminated sclerosis "DS" motor neuron disease and muscle disease. Aims: 1- Relieve symptoms. 2- Generally to regain and maintain levels of functional ability. Patients in this group are from a large part of the work in many physical therapy departments. The main problem here in evaluating outcome is that if the course of the disease is progressive and characterized by remissions and exacerbations it will not always be possible to separate the effects of treatment from those natural remissions. Treatment given at a time exacerbation may help to minimize the disability but again this will be difficult to demonstrate. Patient reports are important here in assessing. Recurrence of symptoms may relate to progress of the disease rather than ineffective treatment.  and remissions. 9