PTA 1018 Professional Issues PDF

12/13/2024 PTA 1018 PROFESSIONAL ISSUES LECTURE 1: Ethics, Professionalism, Professional Literature & Critical Thinking 1  12/13/2024 LEARNING OBJECTIVES Diff...

12/13/2024 PTA 1018 PROFESSIONAL ISSUES LECTURE 1: Ethics, Professionalism, Professional Literature & Critical Thinking 1  12/13/2024 LEARNING OBJECTIVES Differentiate between medical law and medical ethics List 6 biomedical ethical principles and their roles in healthcare Discuss patient bill of rights and informed consent Discuss HIPPA and its implication on patient care Explain cultural competence in healthcare and physical therapy Discuss professionalism and review the standards of ethical conduct Discuss the 7 core values and adapt them to the physical therapist assistant’s professionalism Discuss the elements and types of research pertinent to the profession Promote critical thinking by evaluating research Copyright @StanbridgeUniversity2024 2 2  12/13/2024 MEDICAL LAW vs. MEDICAL ETHICS Medical Law: -Establishment of social rules for conduct Medical Ethics: -System of moral principles governing medical conduct -Morals are the basis for ethical conduct. Laws and ethics share a common goal of creating and maintaining social good. They are both dynamic and are in constant change Copyright @StanbridgeUniversity2024 3 3  12/13/2024 BIOMEDICAL ETHICAL PRINCIPLES 1. Beneficence: – The duty to provide the best physical therapy care for a patient 2. Nonmaleficence: – “Do no harm” – Refer to Hippocratic Oath, Appendix A (Barrett) 3. Justice: – Fair and equal treatment to all patients 4. Veracity: – Truthful relationship between patient and PT/PTA Copyright @StanbridgeUniversity2024 4 4  12/13/2024 BIOMEDICAL ETHICAL PRINCIPLES 5. Confidentiality: – Maintain privacy of entrusted patient information – Encourages patient to divulge truthful and relevant information to health care provider (HCP) – Exceptions: preventing a crime, protecting the welfare of the patient/individual – Health Insurance Portability and Accountability Act of 1996 (HIPAA) created additional patient confidentiality considerations Copyright @StanbridgeUniversity2024 5 5  12/13/2024 BIOMEDICAL ETHICAL PRINCIPLES 6. Autonomy and Patient’s Rights: Right of a patient to have control over his/her own healthcare -Right to choose provider -Access practice policy info and charges for services -Involvement in goals and selection of interventions -Knowledge of risks/benefits of intervention -Right to refuse services -Refer to Patient Bill of Rights, Appendix B (Barrett) Copyright @StanbridgeUniversity2024 6 6  12/13/2024 PATIENT BILL OF RIGHTS Patient has a right to receive info from their HCP to make an informed decision as to whether or not to receive treatment prior to treatment Patient must be considered competent to make a voluntary informed consent decision All necessary info has to be explained to patient in layman’s terms, and patient’s understanding has to be assessed For PT, informed consent usually occurs during first visit, and during reassessments Copyright @StanbridgeUniversity2024 7 7  12/13/2024 INFORMED CONSENT Elements include: Nature of decision or the procedure Reasonable alternatives to proposed intervention Relevant risks/benefits of each procedure Assessment of patient understanding Patient’s acceptance of intervention Copyright @StanbridgeUniversity2024 8 8  12/13/2024 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY-HIPAA Privacy rule: Requires appropriate safeguards to be used to protect health information Sets limits on uses of the information without patient consent Gives patients rights over their own health information Gives patients rights to obtain/examine their own health records Copyright @StanbridgeUniversity2024 9 9  12/13/2024 Hospitals EMR Medical Application Providers Physicians/Medical staff https://commons.wikimedia.org/wiki/File:HIPAA_Scree nshot.png Pharmacies Health plans Device manufacturers Employers Laboratories Healthcare Information Exchanges Copyright @StanbridgeUniversity2024 10 10  12/13/2024 HIPAA Protected Health Information (PHI): Individually identifiable health information in any form (oral, written, electronic) Part of transactions using electronic media to do: -File claims -File requests for payment/remittance -Check claims status -Coordinate benefits -Check enrollment -Make/receive referral certifications -Submit health claims -File injury Copyright @StanbridgeUniversity2024 11 11  12/13/2024 HIPAA Notice of Privacy Practices for PHI: Privacy rule states the individual has right to adequate notice of how a covered entity (HCP) may use and disclose the patient’s PHI. Must be given to patient on first visit HCP must make a good effort to have the patient’s written acknowledgement that the notice was received Copyright @StanbridgeUniversity2024 12 12  12/13/2024 HIPAA Incidental Uses and Disclosures of PHI: -Allowed if HCP has applied reasonable safeguards and implemented minimum necessary standards Ex: avoid using patient’s name in public hallways Speak quietly when talking in waiting room Lock patient charts in locking file cabinets Passwords and safety locks on computers in facility Copyright @StanbridgeUniversity2024 13 13  12/13/2024 HIPAA Privacy rule and Students’ Training: -Does not limit HCPs from sharing info with students -Students are allowed access to patient’s PHI to improve their skills as HCPs Privacy Rule and Family Members: -Permissible for HCP to disclose PHI to a family member or other person involved in the patient’s care HCP Must: » Obtain patient’s consent » Give the patient an opportunity to object » Decide from the circumstances that the patient does not object Copyright @StanbridgeUniversity2024 14 14  12/13/2024 HIPAA Patient/Client Authorization for Uses and Disclosures of PHI: Needed for research activities Not needed for: -Patient seeking own PHI -Disclosures required by law -Victims of domestic violence/elder abuse -Law enforcement activities -Emergency situations Copyright @StanbridgeUniversity2024 15 15  12/13/2024 HIPAA Minimum Necessary Standards for Disclosure of PHI: Privacy rule requires the minimum necessary disclosures to accomplish intended purpose Exceptions to this rule include: -Disclosures required by law -Disclosures to the individual who is subject of the info -Disclosures requested by HCP for treatment purposes Copyright @StanbridgeUniversity2024 16 16  12/13/2024 HIPAA Personal Representatives of Patients/Clients: -Person authorized to act on behalf of patient/client in making health-care related decisions Parent’s Access to Minor’s PHI: -Deferred to the state law -Parent is not considered a personal rep if: Guardian other than parent determined by court If state does not require consent of parent/guardian When parent agrees to confidential relationship between child and HCP Copyright @StanbridgeUniversity2024 17 17  12/13/2024 HIPAA Patient/Client Access to Protected PHI: -Patient has right to access ANY of his/her information that reflects a decision made by HCP about the patient -Some facilities may require patient to fill out a request Includes: PHI within 6 years Accounts of disclosures Copyright @StanbridgeUniversity2024 18 18  12/13/2024 HIPAA Penalties for Violation of HIPAA: Privacy rule overseen by the U.S. Department of Health and Human Services (DHHS) Office for Civil Rights. Facilities investigated usually after complaint is filed -Facility has an opportunity to show “reasonable diligence” that corrections are being made -If not, facility can be fined Copyright @StanbridgeUniversity2024 19 19  12/13/2024 Cultural Competence in Healthcare PTA 1018 Professional Issues Lecture 2 20  12/13/2024 Copyright @StanbridgeUniversity2024 21 21  12/13/2024 Cultural Competence Is not limited to a set of prescribed skills, but more holistic According to the CDC, cultural competence is a “set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professional that enables work in cross- cultural situations” Not just limited to race or ethnicity, but can also include language, religion, age, gender identification, and much more https://www.apta.org/patient-care/public-health-population-care/cultural- competence/achieve-cultural-competence Copyright @StanbridgeUniversity2024 22 22  12/13/2024 CULTURAL COMPETENCE in Physical Therapy Cultural competence isn’t a destination, but a journey that never stops Involves understanding an appreciating differences, but also requires individuals to recognize their own biases and how those biases may affect patient care https://www.apta.org/patient-care/public-health-population-care/cultural-competence/achieve-cultural- competence Copyright @StanbridgeUniversity2024 23 23  12/13/2024 Achieving Cultural Competence in Physical Therapy No pat answers or a cookbook model to guarantee success Instead, individuals and organizations should engage in activities such as: – Self-assessment at an organizational and individual level – Develop and implement policy and guidelines – Conduct and participate in training and professional development activities – Provide a forum for safe and honest dialogue Ongoing process without and end-point https://www.apta.org/patient-care/public-health-population-care/cultural-competence/achieve-cultural- competence Copyright @StanbridgeUniversity2024 24 24  12/13/2024 CULTURAL COMPETENCE Applying Cultural Understanding o HCPs must accept, understand, and value: -Beliefs, values, traditions, and practices of a culture -Culturally defined health-related needs of individuals -Culturally based beliefs regarding etiology of illness and disease -Culture attitude toward seeking help from healthcare providers Copyright @StanbridgeUniversity2024 25 25  12/13/2024 Cultural Competence Continuum Cultural Cultural Culture Blindness Cultural Pre- Cultural Cultural Proficiency Destructiveness Incapacity competence Competence Seeking to eliminate Trivializing or Not acknowledging Increasing Aligning personal Holding the vision that references to culture of stereotyping; the cultures of awareness of what values and you and the others in the school and makes the culture others in school; you don’t know behaviors and the organization are community of others appear not recognizing about working in school’s policies instruments for creating inferior different needs diverse settings and practices that a socially just are inclusive of democracy, advocating other cultures for life-long learning See the difference and See the difference See the difference See the difference See the difference See the difference and stomp it out. and make it and act like you and at times, and value it. embrace it as an wrong. don’t. respond advocate for equity. inappropriately. Adapted with permission from Zachary D. Travis, PhD, MPH Western University of Health Sciences Copyright @StanbridgeUniversity2024 26 26  12/13/2024 Adapted with permission from Zachary D. Travis, PhD, MPH Western University of Health Sciences Copyright @StanbridgeUniversity2024 27 27  12/13/2024 Chester Pierce, MD, was the first to introduce the idea of microaggressions in 1970 “Most offensive actions are not gross and crippling. They are subtle and stunning. The enormity of the complications they cause can be appreciated only when one considers that these subtle blows are delivered incessantly. Even though any single negotiation of offense can be considered of itself to be relatively innocuous, the cumulative effect to the victim and to the victimizer is of an unimaginable magnitude. Hence, the therapist is obliged to pose the idea that offensive mechanisms are usually a microaggression.” Copyright @StanbridgeUniversity2024 28 28  12/13/2024 Microaggressions are subtle statements and behaviors that unconsciously communicate denigrating messages to people who identify with certain social groups (Sue, 2010) Type Definition Micro-assaults Intentionally and explicitly derogatory verbal or non-verbal attacks. (Often consciously done) Micro-insults Rude and insensitive subtle put-downs of someone’s racial heritage or identity. (Usually unconsciously done) Micro-invalidations Remarks that diminish, dismiss or negate the realities of people’s social groups. (Usually unconsciously done) Center for a Diverse Healthcare Workforce 29 Copyright @StanbridgeUniversity2024 29  12/13/2024 Examples of Microaggressions Alien in own land “Where are you from?” (assumption foreign-born) Microaggressions “You speak good English.” Ascription of intelligence “Did you really get an A on that exam”? (assuming intelligence based on race) Color blindness “When I look at you, I don’t see color.” (indication that White person does not want to “America is a melting pot.” acknowledge race) Criminality Person of color (POC) being followed in a store (assumption of danger based on race) White person clutching bag near POC Denial of individual racism “I have black/Asian/Hispanic friends.” (denying racial bias) Myth of meritocracy “Everyone can succeed if they just work hard” (race does not play a role in success) Myth of Diversity We had to lower our standards to admit students of color (indicating success can only apply to majority “You were only admitted/hired as a diversity student/employee” culture) Pathologizing culture Asking an Asian individual: “You shouldn’t be so quiet…Speak up…etc.” (values & communication style of the dominant Women being emotional or aggressive vs assertive culture are ideal) *Adapted from Sue et al., 2007 30  12/13/2024 Microaggressions Are: ❖ Not always consciously done. ❖ Powerful because they are subtle-sometimes invisible, especially to those who do not share the identity. ❖ Instances that cause the recipient to experience strong emotions, try to understand what was meant, and then decide how to respond. Copyright @StanbridgeUniversity2024 31 31  12/13/2024 Microaggressions versus Macroaggressions 32 Copyright @StanbridgeUniversity2024 32  12/13/2024 Recipient ACTION Bystander Source ARISE ASSIST Ackerman-Barger, K. & Jacobs, N.N. (2020) 33  12/13/2024 When you are the recipient ❖ It is important to understand that, when you are being mistreated. ❖ Be careful to not respond in a way that makes the situation worse, or even makes you seem like the aggressor. ❖ Consider whether you are safe both physically and in terms of your status. ❖ Addressing the issue at a later time does not equate to letting it go. Seek the wise council of a trusted individual that can help you make an informed plan about how to respond. ❖ Addressing it in the moment is also an option, but only if your motivation is to uphold the principles of community and to take advantage of a teachable moment. If your motivation is emotion-based, there is a possibility that the situation will escalate. ❖ Reporting the incident gives the institution the opportunity to create a more supportive environment. 34 Copyright @StanbridgeUniversity2024 34  12/13/2024 Recipient: ACTION Approach 35 Copyright @StanbridgeUniversity2024 35  12/13/2024 When You Are the Source Avoid becoming defensive: Whether your intention was to hurt another person or not, and regardless of whether you and the recipient are seeing the situation differently this is a great opportunity for you to learn about someone else’s experience. Be present and listen. Confirmation Bias is a tendency to gather information or respond to a circumstance in a way that confirms an already established belief or idea. Commitment confirmation supports confirmation bias. It is when our minds become attached to particular points of view, even when they are wrong, and can lead to a form of confidence bias or self-motivated reasoning. This is an over attachment to being right rather than a genuine seeking of the truth. 36 Copyright @StanbridgeUniversity2024 36  12/13/2024 Source: ASSIST Approach 37 Copyright @StanbridgeUniversity2024 37  12/13/2024 When You Are the Bystander Assess the Situation: Every situation is different. Consider the safety of all individuals. Is this the time and place? What would be the best strategy for interrupting the interaction? How do I preserve the dignity of the individuals and the relationships? Rebuild: During a microaggression there are threats to the reputations of all involved. The recipient may be seen as oversensitive, the source as racist, and the bystander(s) as a coward. Rebuilding gives all involved the opportunity to restore their reputations and repair. 38 Copyright @StanbridgeUniversity2024 38  12/13/2024 Bystander: ARISE Approach 39 Copyright @StanbridgeUniversity2024 39 12/13/2024 40  12/13/2024 PTA 1018 Professional Issues Lecture 3: Evidence-based Practice and Elements of Research Review 41  12/13/2024 Evidence-Based Practice (EBP) EBP is central to providing high-quality care and decreasing unwarranted variation in practice. EBP includes the integration of best available research, clinical expertise, and patient values and circumstances related to patient and client management, practice management, and health policy decision-making. Using clinical decision-making and judgment is key. The patient's wants and needs are a key part of the evidence- based process. Incorporating a patient's cultural considerations, needs, and values is a necessary skill to provide best practice services. Link: https://www.apta.org/patient-care/evidence-based-practice-resources Provides tools on implementing evidence-based practice Copyright @StanbridgeUniversity2024 42 42  12/13/2024 PROFESSIONAL RESEARCH Studies published in professional journals Develops body of knowledge for the physical therapy profession Evidence from research serves as a guide in clinical practice Determines the effectiveness of physical therapy procedures Improves patient care Copyright @StanbridgeUniversity2024 43 43  12/13/2024 ELEMENTS OF RESEARCH Independent variables – Manipulated by the researcher; believed to cause a change that can be seen and measured in the dependent variable. Dependent variables – Outcome or results of the research Research question – Address questions that contribute to scientific knowledge base; research question should be answerable and realistic Hypothesis – Educated guess about the outcome of the study – Statement of the expected relationship between variables – Null hypothesis: stating no relationship exists between variables – Research hypothesis: there is a relationship between variables; researcher’s true expectation of results Copyright @StanbridgeUniversity2024 44 44  12/13/2024 ELEMENTS OF RESEARCH Reliability – The degree of consistency with which an instrument measures a variable – Intrarater reliability: degree to which one rater can obtain the same rating on multiple occasions – Interrater reliability: can one rater get the same results as another? And how often? – Test-Retest reliability: consistency of repeated measures made by one individual on separate occasions. Takes into account effects of fatigue, learning, and changes in the characteristics of what’s being measured Copyright @StanbridgeUniversity2024 45 45  12/13/2024 ELEMENTS OF RESEARCH Validity – How meaningful test scores are; degree to which an instrument measures what it is intended to measure – Face validity: the degree to which a measurement appears to test what it is supposed to. (Does the patient sense that the measurement tests what their specific problem is?) Copyright @StanbridgeUniversity2024 46 46  12/13/2024 ELEMENTS OF RESEARCH Validity – Content Validity: the degree to which a measurement reflects the meaningful elements of a construct and the items in a test adequately reflect the content domain of interest and not extraneous elements. Ex. McGill Pain Questionnaire has greater content validity than a visual analogue pain scale because it tests pain intensity as well as location, quality and duration of pain. Copyright @StanbridgeUniversity2024 47 47  12/13/2024 ELEMENTS OF RESEARCH Validity – Construct Validity: the degree to which a theoretical construct is measured by a test or measurement. Ex. MMT scores would have construct validity as indicators of innervation status of a muscle if there was a relationship between MMT scores and electromyographic testing (EEG) Copyright @StanbridgeUniversity2024 48 48  12/13/2024 ELEMENTS OF RESEARCH Scales of Measurement – Communicate information in objective terms – Nominal scale: classifies variables into 2/more categories – Ordinal scale: classifies and ranks variables in terms of the degree to which they have a common characteristic; not necessarily equal intervals – Interval scale: classifies and ranks variables based on predetermined equal intervals; no true zero – Ratio scale: classifies and ranks variables based on equal intervals; most precise level of measurement; there is a true zero Subjects – Voluntary participants in the research, who have given informed consent Copyright @StanbridgeUniversity2024 49 49  12/13/2024 TYPES OF RESEARCH Experimental – True experimental, quasi-experimental, single-subject experimental, within subject design, and between subjects’ design – At least one independent variable is manipulated by researcher – Ex: 2 separate groups of subjects, randomly assigned to experimental or control group. Experimental receives treatment, control does not. Control group provides a baseline for interpretation of results. Copyright @StanbridgeUniversity2024 50 50  12/13/2024 TYPES OF RESEARCH Nonexperimental – Categories: Case studies, correlation research studies, developmental research (prospective cohort), qualitative research, and historical research (retrospective cohort), survey – No manipulation of an independent variable – Examines records of past, existing, or new phenomena/topics – Ex: Case Studies- can assist clinicians in sharing clinical experiences, identify problem-solving skills, or develop new hypotheses for new research Copyright @StanbridgeUniversity2024 51 51  12/13/2024 TYPES OF RESEARCH Probability Sampling – Simple random sampling: “luck of the draw” random computer-generated sampling – Systematic sampling: subjects are selected by taking every nth subject from the population. The size of the interval is based on the size of the population and the desired sampling size. Copyright @StanbridgeUniversity2024 52 52  12/13/2024 TYPES OF RESEARCH Probability Sampling – Stratified random sampling: population is divided into homogenous groups (strata) and then a simple random sample is drawn from each. This assures equal number of people from each strata. – Cluster sampling: population is divided into clusters or areas (usually geographic) and random sample of the clusters is selected. This assures even distribution of the population spread across a wide geographic area. Copyright @StanbridgeUniversity2024 53 53  12/13/2024 TYPES OF RESEARCH Non-Probability Sampling – Convenience sampling: sample is selected from subjects who are convenient or readily available to the researcher – Purposive sampling: subjects are deliberately selected based on predefined criteria chosen by the investigators Copyright @StanbridgeUniversity2024 54 54  12/13/2024 ELEMENTS OF A RESEARCH ARTICLE Title and Abstract – Summary of article that informs reader about content Introduction – Gives rationale behind the research, the objectives, the type of study. Methods – Information about the subjects, study design, equipment used, research procedures, issues of validity, data analysis – Determines the alpha level-lower the alpha level, better the experiment Acceptable Alpha level 0.05: reject null hypothesis, accept research hypothesis If statistical alpha level is equal or lower than alpha level set: expected difference is due to chance Alpha level typically set between 0.05 – 0.01 Copyright @StanbridgeUniversity2024 55 55  12/13/2024 ELEMENTS OF A RESEARCH ARTICLE Results -Present research findings objectively -Show if results are statistically significant Discussion and Conclusion – Interpretation of research results – Supports conclusions using evidence from the experiment and from generally accepted knowledge Copyright @StanbridgeUniversity2024 56 56  12/13/2024 Copyright @StanbridgeUniversity2024 57 57  12/13/2024 EVALUATING RESEARCH Title and Abstract – What is the article about? – Is the abstract a good overview of the paper? Introduction – Has the problem been clearly stated? – Is the problem important? – Did the researcher provide the context of the study? – Did the researcher utilize the research literature for the study? – Is the type of study design clear? – Are the purposes of the study and the hypothesis stated clearly? Copyright @StanbridgeUniversity2024 58 58  12/13/2024 EVALUATING RESEARCH Methods – How were the subjects selected, how many used? – Was the design of the research study identified and appropriate? – Was randomization used when subjects were used? – Was a control group used? – How many independent variables were used? – How often were treatments and measurements applied? – Were the reliability and validity documented? – Were data collection procedures described in detail? – Were statistical analyses appropriate? – Was the research question addressed in data analysis section? – What was the alpha level? Copyright @StanbridgeUniversity2024 59 59  12/13/2024 EVALUATING RESEARCH Results – Did the researcher present the results clearly? – Did the researcher present the figures and table accurately? – Are the results statistically significant? probability that an effect is not likely due to just chance alone Discussion and Conclusion – How did the researcher interpret the results? – Did the researcher clarify if the hypothesis was accepted or rejected? – Were alternative explanations considered? – Are the discussion of the results supported by the research literature? – Does the researcher provide limitations of the study? – Are the results clinically important? – Does the researcher mention how the results apply to clinical practice? – Does the researcher provide suggestions for further study? – Do the research conclusions flow logically from the obtained results? Copyright @StanbridgeUniversity2024 60 60  12/13/2024 PTA 1018 Professional Issues Lecture 4: Professionalism and Core Values 61  12/13/2024 PROFESSIONALISM For PTs/PTAs includes: Ethical principles Attitudes of PTs, PTAs Decision making Behaviors Judgments Relationship of PTs and PTAs with other professionals and the public Integration of core values Copyright @StanbridgeUniversity2024 62 62  12/13/2024 PROFESSIONALISM PTA Standards of Ethical Conduct: PTAs are responsible for maintaining high standards of conduct while assisting PTs The PTA shall act in the best interest of the patient/client The PTA shall provide selected interventions only under the supervision and direction of the physical therapist. Refer to APTA Code of Ethics for PTs and Standards of Ethical Conduct for PTAs, Appendix C, D (Barrett) Copyright @StanbridgeUniversity2024 63 63  12/13/2024 PROFESSIONALISM: Core Values Copyright @StanbridgeUniversity2024 64 64  12/13/2024 PROFESSIONALISM Accountability: Active acceptance of the responsibility for the diverse roles, obligations and actions of the PT/PTA Responding to patients’/clients’ needs Adhering to standards of ethical conduct Acknowledging/accepting consequences of his or her actions Communicating accurately i.e., to PTs, insurance companies, other health care professionals Copyright @StanbridgeUniversity2024 65 65  12/13/2024 PROFESSIONALISM Altruism: Primary regard for or devotion to your patients/clients, placing their needs ahead of the PT/PTA’s self interest Providing pro-bono services (under the direction of a PT) Completing patient care prior to attending to personal needs (under direction of PT) Providing services to the under-served and underrepresented population (under direction of PT) Copyright @StanbridgeUniversity2024 66 66  12/13/2024 PROFESSIONALISM Compassion/Caring: Desire to identify with or sense something of another’s experience. Concern, empathy, consideration of others. Understanding sociocultural, economic and psychological influences on the individual’s life in their environment Demonstrating respect for others regardless of their beliefs; consideration of their value Recognizing and refraining from acting on one’s own biases (sexual, gender, social, cultural) Copyright @StanbridgeUniversity2024 67 67  12/13/2024 PROFESSIONALISM Excellence: A practice that consistently uses current knowledge and theory while understanding personal limits, integrates judgment and the patient/client perspective, embracing advancement. Investment in the profession of physical therapy Conveying intellectual humility in interpersonal situations Engaging in acquisition of new knowledge Copyright @StanbridgeUniversity2024 68 68  12/13/2024 PROFESSIONALISM Integrity: A steadfast adherence to high ethical principles or professional standards; truthfulness and fairness. Abiding by the rules, regulations, laws and codes applicable to the profession Being trustworthy Adhering to the highest standards of the profession (ethics, reimbursement, honor code) Copyright @StanbridgeUniversity2024 69 69  12/13/2024 PROFESSIONALISM Professional Duty: The commitment to meeting one’s obligations to provide effective physical therapy services to our patients/clients and to positively influence the health of society. Demonstrating “optimal care” Preserving patient safety, security and confidentiality Taking pride being a PT/PTA Facilitating each individual’s achievement of goals for function, health, and wellness Copyright @StanbridgeUniversity2024 70 70  12/13/2024 PROFESSIONALISM Social Responsibility: The promotion of a mutual trust between our profession and the larger public/community, responding to societal needs for health and wellness. Advocating for access to healthcare and PT services Promoting cultural competence Advocating for changes in laws, regulations, standards and guidelines that affect PT service provision Promoting community volunteerism Copyright @StanbridgeUniversity2024 71 71  12/13/2024 PTA 1018 PROFESSIONAL ISSUES LECTURE 5: Professional Issues Professional Development 72  12/13/2024 PROFESSIONAL ISSUES: LEARNING OBJECTIVES Discuss the supervisory role of the physical therapist on the health care team Describe the differences in role, function, and supervisory relationships of the physical therapist, physical therapist assistant, and other health care personnel List the events taking place in the collaborative path between physical therapist and physical therapist assistant Compare and contrast the types of health care teams Identify the members of the rehabilitation team and their responsibilities List employment setting for physical therapists and physical therapists assistants Discuss employment and physical therapy clinical practice issues such as policy and procedure manuals, meetings, budgets, quality assurance, and risk management Copyright @StanbridgeUniversity2024 73 73  12/13/2024 DIRECTION AND SUPERVISION OF PTA Level of Supervision (per APTA): – General – PT not required to be physically present on-site – PT must be available by phone at all times – Differs between types of insurance – Differs between states Must comply with the state you practice in In California: One PT can supervise up to 2 PTAs Copyright @StanbridgeUniversity2024 74 74  12/13/2024 ROLE OF PTA IN A CLINICAL SETTING Review PT’s evaluation/examination and plan of care of patient, asks for clarification if necessary Makes observations of patient at each visit, take vitals, subjective information. Compares these results to those made originally by the PT Performs interventions as directed Communicates with PT regarding any changes in patient’s progress Documents daily notes Can supervise PT aide, PTA student, other personnel, where allowable by law Copyright @StanbridgeUniversity2024 75 75  12/13/2024 ROLE OF PTA IN A CLINICAL SETTING May not evaluate patients May not develop or change plan of care May not discharge a patient or write a discharge plan May not perform joint mobilizations or sharp debridement of wounds in certain States; acceptable in CA. Copyright @StanbridgeUniversity2024 76 76  12/13/2024 COLLABORATION PATH BETWEEN PT AND PTA Allows appropriate communication and patient care Characterized by trust, mutual respect, value and appreciation for individual and cultural differences PTA’s role is to offer feedback, carry out specified activities, and be able to freely express concerns about clinical issues or other difficulties Copyright @StanbridgeUniversity2024 77 77  12/13/2024 COLLABORATION PATH BETWEEN PT AND PTA Initial exam by PT PT evaluates all data collected at initial exam and interprets it PT establishes diagnosis of patient’s issue PT develops prognosis and time frame in which it shall be achieved PT establishes goals/outcomes and plan of care PT performs interventions and delegates certain interventions to PTA PTA performs interventions as delegated PTA collects data throughout patient care to track patient’s progress/lack of progress since initial eval PT perform re-examination as necessary and produces new outcomes and plan of care PT performs new interventions and delegates new interventions to PTA PTA performs new interventions as delegated, continues to communicate patient’s progress to PT PT performs discharge evaluation when outcomes are met Copyright @StanbridgeUniversity2024 78 78  12/13/2024 COLLABORATION PATH BETWEEN PT AND PTA Supervising PT must be accessible by phone at all times while PTA treating patients Regularly scheduled and documented conferences between supervising PT and PTA Consideration of contraindications, precautions, special circumstances for patient Supervisory visits by PT made when: – PTA requests it – Change in POC is needed – Prior to any planned discharge – A change in patient’s medical status – At least once a month, more frequently in inpatient settings – Should include on-site re-examination, on-site review of POC with appropriate revision/termination, evaluation of need and recommendation for use of outside resources Copyright @StanbridgeUniversity2024 79 79  12/13/2024 HEALTH CARE TEAM Patient, family members, caregivers, HCPs, insurance companies Intradisciplinary – Team members work together within the same discipline; other disciplines are not involved Multidisciplinary – Members work separately and independently in their different disciplines; do not meet or try to collaborate with one another Interdisciplinary – Team members from different disciplines work together, collaborate with one another; evaluations/interventions are performed independently Copyright @StanbridgeUniversity2024 80 80  12/13/2024 REHABILITATION TEAM PT Director RN PT Social worker PTA ATCs OT OTA PT aides ST/SLP PT volunteers Orthotist/prosthetist SPT, SPTA Kinesiologist Home health aides PCP PA Copyright @StanbridgeUniversity2024 81 81  12/13/2024 PHYSICAL THERAPY CLINICAL SETTINGS Acute care facilities Subacute care facilities Outpatient facilities (Private practice, or through hospital) Acute rehabilitation hospitals Skilled nursing facilities Chronic care facilities/Long term care Hospice care facilities Home health care Schools Copyright @StanbridgeUniversity2024 82 82  12/13/2024 CLINICAL PRACTICE ISSUES Policy and Procedure Manual: – Required by governing bodies – The practice’s mission, goals, benefits, policies, and what is expected of its employees – What should be done and how it should be done Examples: time off, vacation, dress code, incident reports, equipment management, training requirement, safety and emergency procedures, disciplinary procedures for violations of policies Copyright @StanbridgeUniversity2024 83 83  12/13/2024 CLINICAL PRACTICE ISSUES Departmental Meetings: – Staff Regularly scheduled to discuss departmental business – Team Involve interdisciplinary team members Coordinate patient care services – Supervisory Between a supervisor and staff, or PT and PTA – Strategic planning Departmental planning for future Copyright @StanbridgeUniversity2024 84 84  12/13/2024 CLINICAL PRACTICE ISSUES Budgets: – Financial projection/estimate of funds allocated to cover specific aspects of operating a PT department over a specific period of time – Explains anticipated income and expenses – Provides a way to assess the success of the practice, programs, and projects – Types: Operating expense: daily/regular expenses Capital expenses: large items for future use Accounts receivable/income: expected money to be received Accounts payable/debts: projected money owed Copyright @StanbridgeUniversity2024 85 85  12/13/2024 CLINICAL PRACTICE ISSUES Costs: – Direct costs: Ex: salaries, equipment, supplies – Indirect costs: Ex: utilities, marketing, laundry, housekeeping – Variable costs: Vary depending on volume of services – Ex: linen costs, utilities – Fixed costs: Fixed regardless of changes in volume of services – Ex: rent of space Copyright @StanbridgeUniversity2024 86 86  12/13/2024 CLINICAL PRACTICE ISSUES Quality Assurance: Activities and programs designed and implemented in clinical facility to achieve high- quality levels of care Monitors quality of PT services Monitors appropriateness of PT care (medical necessity) Resolves any identified problems related to quality of service and patient care Copyright @StanbridgeUniversity2024 87 87  12/13/2024 IMPLEMENTING QUALITY ASSURANCE Utilization Review: – Evaluation of necessity, quality, effectiveness, efficiency of services. – In PT can be implemented through written plan for reviewing resources and deciding if they are medically necessary or cost effective Ex: Analyze the use of ultrasound on patients with neck pain. If patient outcomes are positive, then the use of US is appropriate and cost effective Copyright @StanbridgeUniversity2024 88 88  12/13/2024 IMPLEMENTING QUALITY ASSURANCE Peer Review: – Improve quality of care and determine how well PT services are being performed – Can be retrospective (past), or concurrent (current) – Evaluation of the quality of the work effort of an individual by his/her peers. PTAs can review PTAs Third-party payers can review PTs, PTAs Copyright @StanbridgeUniversity2024 89 89  12/13/2024 IMPLEMENTING QUALITY ASSURANCE Risk Management: – Identify health care delivery problems in an institution – Develop guidelines to enhance quality of care – Anticipate future problems – General purposes of PT risk management: Maintaining equipment safety; ongoing staff safety education with use of equipment Identify potential staff or patient injuries Identify potential property loss or damage Have all staff certified in CPR Complying with CDC regulations Emergency preparedness Copyright @StanbridgeUniversity2024 90 90  12/13/2024 IMPLEMENTING QUALITY ASSURANCE Risk Management: – Incident Reporting Date, time, place What happened Who was involved Witnesses How was the injured person treated What will happen in the future to remedy the situation and prevent from further occurrence Copyright @StanbridgeUniversity2024 91 91