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Intro The Physical Therapy Practice > Chapter 6 Ethics and Professionalism > Flashcards

Chapter 6 Ethics and Professionalism Flashcards

1
Q

Medical Ethics

A

Moral principles governing medical conduct

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2
Q

what are morals?

A

Morals are the beliefs, principles, values about what is right & wrong. Morals are culture based & driven

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3
Q

What are ethics?

A

-deals with the relationship of the healthcare provider to the patient, caregivers, family, insurance, etc
Ethics are important professional guides, but not legally binding

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4
Q

Medical Law

A

-Establishment of social rules for conduct that have criminal and civil liability if not followed

++•Based on professional ethics and policy statements

++•We can violate medical ethics without breaking law, but typically not vice versa

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5
Q

Biomedical Ethical Principles #1 Beneficence

A

promote what is best for the patient above other considerations

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6
Q

Biomedical Ethical Principles #2 Non maleficence

A

To do no harm to the patient

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7
Q

Biomedical Ethical Principles #3 Justice

A

Fair & equal treatment

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8
Q

Biomedical Ethical Principles #4 Veracity

A

Being truthful

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9
Q

Biomedical Ethical Principles #5 Confidentiality

A

Maintaining patient privacy

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10
Q

Biomedical Ethical Principles #6 Autonomy and Patient Rights

A

right of the patient to make their own decision & have that decision respected

•Example: right to have PT services from a provider of his/her choice

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11
Q

Confidentiality?

A

1•A PTA should refer requests for releases of confidential patient information to the supervising PT
2•The PT is permitted to release confidential information when necessary to protect the welfare of the patient or community or when required by law

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12
Q

Health Insurance Portability & Accountability Act of 1996 (HIPAA)

A

1•Created to protect the privacy of personal medical and health records and information
2•Gives patients rights to see and obtain copies of their medical record and to request correction
3•Institutions must present copies of medical records in 30 days if record is onsite, 60 days if off. Facility has the right to charge printing fee

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13
Q

Protected Health Information (PHI)

A

Protected Health Information includes identifiable health information in any form

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14
Q

Notice of Privacy Practices

A

The PT patient should be given written notice on privacy practices at initial eval

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15
Q

Clinic must use some basic safeguards

A

1•Avoid patient name use in public areas
2•Speak quietly in waiting areas
3•Verify identity on phone
4•Limit information left on voice mail
5•Lock file drawers, have passwords on computers
6•Limit access to patient charts
7•Limit information on sign-in sheets or when calling for patients

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16
Q

What is the Privacy Rule 1?

A

1•Students are permitted access to PHI when used in training

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17
Q

What is the Privacy Rule 2?

A

2•When leaving the facility, students must de-identify any documentation taken

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18
Q

What is the Privacy Rule 3?

A

3•May disclose PHI to family members or other people involved in the patient’s care

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19
Q

What is the Privacy Rule 4?

A

4•Where the patient is present, the clinician may disclose PHI if it is reasonable to infer from the circumstances that the patient does not object

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20
Q

What is the Privacy Rule 5?

A

5•If patient is present, obtain permission to discuss PHI and give opportunity to object

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21
Q

What is the Privacy Rule 6?

A

6•When the patient is not present or incapacitated, the provider may provide PHI if it is in the patient’s best interest (as judged by the provider

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22
Q

What is the Privacy Rule 7?

A

7•Patient authorization is needed for research activities

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23
Q

What is the Privacy Rule 8?

A

8•If patient has an authorized representative, this person must give authorization to disclose or request PHI

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24
Q

What is the Privacy Rule 9?

A

9•The patient has a right to request documentation on how his or her PHI was disclosed over the past 6 year

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25
Q

What is the Privacy Rule 19?

A

10•A parent is typically accepted as an authorized representative of a minor except:
1•When the state law states otherwise
2•When a court ruling modifies this
3•When a parent voluntarily agrees to waive this

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26
Q

What is the Privacy Rule 11?

A

11•If HIPAA is violated, the provider must submit a corrective action plan & may have fines

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27
Q

When Patient Authorization is NOT needed

Situations when no authorization is needed for PHI Disclosure:

A
  • Patient/Client is seeking own PHI
  • Disclosure to Dept. of Health and Human Services (DHHS)
  • When requested per another law
  • When patient is the victim of domestic or elder abuse
  • Court proceedings or Court orders
  • Healthcare oversight institutions
  • Law Enforcement/Government Special Functions
  • Emergency situations
  • Workers Compensation
28
Q

Exceptions

•Limited disclosure of PHI is the rule, but in these circumstances, disclosure is ok:

A
  • Required by law
  • Requested by patient
  • When authorized to disclose PHI
  • When disclosing to another healthcare provider with the need to know
  • For compliance with regulations, such as government
29
Q

Patient’s Rights to PHI

A
  • The patient has a right to access his or her own PHI
  • Right to examine his or her chart and records, including billing paperwork
  • Records must be made available within 30 days if onsite, 60 days if off-site
  • Provider can charge reasonable copy cost
  • The patient also has a right to receive an accounting of PHI by the healthcare provider, up to 6 years prior
  • If the patient requests this more than once/year, then the healthcare provider can charge for the time
  • The provider cannot retaliate or terminate the patient because of these requests
30
Q

Personal Health Information (PHI)

A
  • Healthcare providers cannot use PHI for marketing without patient permission
  • All entities that gather/store PHI must have policies & procedures in place to safeguard it
  • Staff Training & Monitoring
  • Electronic firewalls
  • Staff changing passwords regularly
  • Staff logging off when completed
  • Positioning monitors for privacy
31
Q

Breach Notification Rule

A

Providers are responsible for stolen or lost information, must notify the individual & DHHS
===If negligent, must pay fines & penalties

32
Q

Patient Bill of Rights

A

Adopted by the American Hospital Association in 1973, Rights that can be exercised by the patient or designated surrogate

33
Q

APTA’s position on patient rights, Patient has a right to

A
  • Select PT of own choosing & knowledge of the identity of the PT/PTA
  • Access to information on practice policies and charges for services
  • Expectation that the referral source has no financial involvement in the referral, and if it does, to make that known the extent
  • Involvement in the development of goals, outcomes, & interventions
  • Knowledge of risks involved with exam/treatment
  • Participation in decisions in the POC, to reasonable extent
  • Access to information concerning their condition
  • Keeping personal information confidential
  • Expectation of safety in regards to equipment, environment, & services
  • Timely information about discharge and cont. care
  • Information about the resolution of complaints
34
Q

Culture

A

-patterns of human behavior that include language, thoughts, communications, actions, customs, beliefs, & values
====•Learned early, enables humans to connect and interact in meaningful way
====•Has a profound effect on person’s beliefs, values, and behaviors

35
Q

Cultural Competence

A

–Patients who are racially, ethnically, culturally, and linguistically diverse have the same right to effective, understandable & respectful care compatible with their cultural beliefs, practices & language
===•Being able to provide accessible and appropriate healthcare services

36
Q

Cultural/linguistic Competence

A

—a set of behaviors, attitudes, beliefs that enable effective work in cross-cultural situations
===•Also an awareness of, sensitivity to, and knowledge of the meaning of culture
===•Means being able to function effectively within the culture
===•Includes person’s willingness and openness to learn about cultural issues & ability to understand their own biases, values, attitudes, beliefs and behaviors
===•Depends on attitude & the outcome is respect and sensitivity for other cultures

37
Q

Summary of Cultural Competence:

A
  • An evolving process
  • An acceptance of and respect for differences
  • A continuing cultural self-assessment
  • Vigilance toward the dynamics of differences
  • Ongoing expansion of cultural knowledge & resources
  • Adaptations to services
38
Q

Biases and Stereotypes

A
  • Everyone has them!
  • Overt: Open, stated
  • Covert: Hidden, possibly unknown (unaware)
  • Come out more in times of stress
  • Acknowledging and examining one’s biases and stereotypes is the first step in overcoming their effects.
  • Dangerous to make assumptions about a group.
  • Improve by exposing yourself repeatedly to group/ situation
  • “learning from exposure” theory behind service learning
  • Appreciate the uniqueness of individuals in a group
39
Q

Health-Care Disparities

A
  • A person has a greater likelihood of developing a certain disease as a result of belonging to a certain ethnic group.
  • May be related to components of culture
  • Traditional diet, level of activity
  • More often related to socioeconomic factors
  • Education level
  • Neighborhood of residence
  • Consider the US healthcare system and steps needed to be seen by a doctor
  • Unfamiliarity with these can affect someone’s ability to access the health-care system
  • These disparities can result in stereotyping & bias in healthcare.
40
Q

•Golden Rule vs. Platinum Rule

A
  • Treat others the way you want to be treated (golden rule)
  • Treat others the way they want to be treated (platinum rule)
  • With cultural differences do not assume a patient wants to be treated like you would want to be treated.
  • Ask Questions
  • Self-reflection- identification/awareness of biases
  • Increase interaction with cultural groups, service learning
41
Q

Spirituality

A

a component of culture that many people are uncomfortable discussing
•As a clinician, you may not understand or agree with patient healthcare decisions based on religion, however, it is important to respect them and their decisions.
•Developing comfort in discussing issues of spirituality is similar to developing cultural competence
•Self-examination, reflecting on one’s own beliefs
•Increased familiarity with other beliefs, practices
•Acknowledge patient’s feelings without providing false hope
•Consider (ahead of time) your willingness to discuss your own beliefs and/or pray with patients, Only if patient initiates
•Refer to others if not comfortable

42
Q

DHHS National Standards for Cultural and Linguistic appropriate services to be inclusive of all cultures, proposed as a means to correct inequities in the provision of health services and make services more responsive to patient needs: first part

A
  1. Patients receive effective, understandable & respectful care that is compatible with their cultural beliefs, practices, and preferred language
  2. Institutions recruit, retain and promote diverse staff
  3. Institutions provide ongoing education in culture & linguistically appropriate service
  4. Institutions provide language assistance services, including bilingual staff and interpreting services at no cost
  5. The notices and offers of these services should be provided in written & verbal form to the patient in both languages
  6. Provide competent language services, not rely upon family/friends to translate
  7. Make available easily understood patient materials & post signage in common languages for groups common in the area
  8. Organizations develop, implement & promote a written strategic plan to provide culturally competent services
43
Q

DHHS National Standards for Cultural and Linguistic appropriate services to be inclusive of all cultures, proposed as a means to correct inequities in the provision of health services and make services more responsive to patient needs: last part

A
  1. Healthcare organizations conduct self-assessments of cultural & linguistic services
  2. Healthcare organizations maintain collection of data of patient’s race, ethnicity, spoken, & written language
  3. Healthcare organizations maintain current demographic and cultural profile of community
  4. Healthcare organizations develop collaborative partnerships with the community to facilitate delivery of culturally appropriate services
  5. Health organizations ensure that conflict resolution are culturally sensitive
  6. Healthcare organizations regularly make available to the public about their pursuits in cultural competence
44
Q

Civil Rights Act of 1964:

A

“No person in the US shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal assistance”.
•Cultural and Linguistic appropriate services are current federal requirements for all recipients of federal funds

45
Q

US demographics are changing

A

by 2060, ethnic minorities will make up 57% of population

46
Q

Cultural Diversity

A

-awareness & acceptance of racial characteristics & national origin, religious affiliations, physical size, spoken language, sexual orientation, physical and mental disability, age, gender, socioeconomic status, political orientation, geographic location & occupational status

47
Q

Strategies to Improve Cultural Competence

Healthcare organizations can:

A
  • Provide training to increase cultural awareness & skills
  • Recruit and retain minority workers
  • Provide interpreter services
  • Provide linguistic services to all parts of patient care departments
  • Use community health workers
  • Utilize culturally competent health promotion
  • Include family and community members in decision making
  • Locate clinics in geographic areas convenient to populations
  • Expand hours of operation
  • Be willing to make clinical settings more accessible
  • Recognize biases against cultures
48
Q

Developing Cultural Competence in PT
•Identify personal cultural biases
•Ethnocentrism-

A

act of judging another culture based upon one’s own cultural customs and standards
•Example: patient listed as “non-compliant with home exercise program (HEP); see if there is a language barrier, and figure out whether it is linguistic, jargon, or comprehension issues

49
Q

Understand general cultural differences

A

1•Requires actively seeking knowledge of other cultures
2•Example: Hispanic patient always late, and studying to find out that timeliness is not a high priority for many Hispanics

50
Q

Accept and respect cultural differences

A

Example: Pt doesn’t perform HEP because as the “family leader”, the family doesn’t let him do it on his own. Try involving the family

51
Q

Apply cultural understanding

A

Develop a strategic plan and set goals to improve

52
Q

Informed Consent:

A

Consent from the patient permitting examination or treatment after they have had it explained to them first and they understand the explanation.
•Should be obtained from your patient (patient signs at evaluation) and then verbal consent for each intervention
Nature of the decision or procedure
Reasonable alternatives to the intervention
Relevant risks, benefits, and uncertainties
Assessment of patient understanding
Patient acceptance of the intervention
•Consent must be voluntary, not coerced
•Talk clearly and simply, explaining in layman’s terms
•Repeat information and break down information as necessary

53
Q

Standards of Ethical Conduct for the Physical Therapist Assistant (PTA)
•Standard #1:

A

Physical therapist assistants shall respect the inherent dignity, and rights, of all individuals. (Core Values: Compassion and Caring, Integrity)

54
Q
  • Standards of Ethical Conduct for the Physical Therapist Assistant (PTA)
  • Standard #2:
A

Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients and clients. (Core Values: Altruism, Collaboration, Compassion and Caring, Duty)

55
Q
  • Standards of Ethical Conduct for the Physical Therapist Assistant (PTA)
  • Standard #3:
A

Physical therapist assistants shall make sound decisions in collaboration with the physical therapist and within the boundaries established by laws and regulations. (Core Values: Collaboration, Duty, Excellence, Integrity)

56
Q
  • Standards of Ethical Conduct for the Physical Therapist Assistant (PTA)
  • Standard #4:
A

Physical therapist assistants shall demonstrate integrity in their relationships with patients and clients, families, colleagues, students, research participants other health care providers, employers, payers, and the public. (Core Value: Integrity)

57
Q
  • Standards of Ethical Conduct for the Physical Therapist Assistant (PTA)
  • Standard #5:
A

Physical therapist assistants shall fulfill their legal and ethical obligations. (Core Values: Accountability, Duty, Social Responsibility)

58
Q
  • Standards of Ethical Conduct for the Physical Therapist Assistant (PTA)
  • Standard #6:
A

Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities. (Core Value: Excellence)

59
Q
  • Standards of Ethical Conduct for the Physical Therapist Assistant (PTA)
  • Standard #7:
A

Physical therapist assistants shall support organizational behaviors and business practices that benefit patients and clients and society. (Core Values: Integrity, Accountability)

60
Q
  • Standards of Ethical Conduct for the Physical Therapist Assistant (PTA)
  • Standard #8:
A

Physical therapist assistants shall participate in efforts to meet the health needs of people locally, nationally, or globally. (Core Value: Social Responsibility)

61
Q

Professionalism-

A

A systematic and integrated set of core values”. (APTA)

  1. Accountibility
  2. Altruism
  3. Compassion/caring
  4. Excellence
  5. Integrity
  6. Professional duty
  7. Social responsibility
62
Q

1)Accountability:

A

Being responsible for completing duties to your patients, employer, community

63
Q

2)Altruism:

A

Placing the needs of the patient above the PTA
•Providing pro bono service (under the direction of the PT)
•Providing PT services to the underserved
•Completing patient care prior to taking care of personal needs

64
Q

4) Excellence:

A

Always trying to improve, utilize “best practices”
•Personal plan for continued lifelong learning
•Career advancement through education and learning
•Sharing knowledge with others

65
Q

5) Integrity:

A

Steadfast adherence to high ethical principles or professional standards: truthfulness, fairness, following through, and speaking up.
•Abiding by rules, laws, and ethics
•Knowing one’s limitations and acting accordingly
•Choosing employment situations congruent with ethical standards
•Fighting fraud (intentionally taking something not entitled), abuse (same thing, unintentionally), and waste
•Therapist being paid for services not provided will incur fines & damages, but most sadly, loss of integrity

66
Q

6) Professional duty:

A

commitment to meeting one’s obligation to provide effective PT services to patients, serve the profession, and community

67
Q

•7) Social Responsibility:

A

Promotion of a mutual trust between the profession and society
•Advocacy for health & wellness needs, policy changes, lawmaking
•Participating with collaboration with healthcare providers in the community and profession
•Ensure blending of social justice and economic efficiency of services
•Promote volunteerism
•Promote cultural competence

Intro The Physical Therapy Practice (12 decks)

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