Standards of Practice, Ethics, and Clinical Reasoning

OT Standards of Practice

requirements for OTs and OTAs for the delivery of OT services

• Provides education, exam, and licensing requirements

• Definitions for OT terminology

• The 5 standards required for OTPs to provide OT services

What 3 main things does the OT Standards of Practice document provide?

OTPs, insurance companies, legislators

Who uses the OT Standards of Practice document?

No, the NBCOT used its own separate code of conduct.

Does NBCOT use the same code of conduct as AOTA?

• Graduated from an OT program accedited by ACOTE

• Completed a period of supervised fieldwork 

• Pass the NBCOT

• Meets their state licensing requirements

What are the OT requirements for education, exam, and licensing to be able to practice?

OTA difference is only in that they graduated from an OTA program accredited by ACOTE (not OT)

What is the only education, etc. difference that OTAs have?

activities, assessment, client, evaluation, intervention, outcome, screening, re-evaluation, transition, occupation, discontinuation of services

terminology definitions provided in the Standards of Practice document

1) Professional Standing and Responsibility

2) Service Delivery

3) Screening, Evaluation, and Reevaluation

4) Intervention Process

5) Outcomes, Transition, and Discontinuation

What are the 5 standards of practice for OT?

following AOTA standards/ethics and licensure requirements, provide safe, client-centered care, use professional reasoning, obtain consent, advocate for clients, and collaborate with the team

standard 1 (professional standing and responsibility)

• May provide direct (in-person, group), or indirect (telehealth, etc.) services

• Responsible for client safety and continual evaluation of the client

standard 2 (service delivery)

• OT responsible for all aspects of service (screening, evaluation, and reevaluation)

• completes an occupational profile and assessment of occupational performance

• OT initiates and directs processes; OTA contributes and can be delegated assessments to administer

standard 3 (screening, evaluation, and reevaluation)

• never interpret the data

• never lead an assessment or an evaluation

• never take responsibility (that is the OT’s job)

What are 3 things that OTAs are never allowed to do when providing OT services?

OT has responsibility for everything involved in the intervention process (development, documentation, implementation)

standard 4 (intervention process)

• Ethically reporting outcomes

• Implementing and interpreting outcome measures 

• Documenting progress towards outcomes

• Determining transition to other services or discontinuation of services

standard 5 (outcomes, transition, discontinuation)

the 7 core values (altruism, equality, freedom, justice, dignity, truth, prudence)

What is the OT Code of Ethics based on?

beneficence, nonmaleficence, autonomy, justice, veracity, fidelity

code of ethics

doing good, positive actions to benefit others

beneficience

using assessments that are current, evidence-based, and within the scope of OT practice

beneficience in OT (related standards of conduct/RSC’s)

do not do things that cause harm to the client/avoid these things

nonmaleficence

avoid treatments that could be harmful, don’t falsify documents, remedy personal problems

nomaleficence in OT

due care: the goals pursued must justify the risks that are taken to achieve those goals

How do you weigh risk vs benefit in honoring nonmaleficence?

Self-determination; honor the client’s rights to make decisions for themselves

autonomy

• client guides the process

• Honor their choices and povs, explain everything that you will be doing including risks and benefits, obtain proper consent, obtain confidentiality and privacy

Autonomy in OT

fair, equitable, impartial treatment of persons

justice

providing individuals with the care, resources, etc. that THEY need to progress (focus is on individual needs)

What does equitable mean?

keep updated on laws, respond to requests in a timely manner

justice in OT

being truthful and honest

veracity

document and interpret data accurately, explain what OT is, document results and processes

veracity in OT

means being loyal; being faithful to our clients and colleagues; respectful towards everyone

fidelity

• expose COIs (ex. PT services from doctor), self-identify your own biases, share all assessment findings with the client

• *being honest with the client even if you think what you say will hurt their feelings

fidelity in OT

Standards of Conduct

bring clarity to an array of activities and situations that present ethical dimensions and ethical dilemmas

• Do not engage in COIs and COCs

• Respect and honor clients’ wishes

• Establish a collaborative relationship to promote shared decision-making

• Respond to requests for OT in a timely manner requested by laws, regulations, or policies

• Maintain privacy and truthfulness

• Treat everyone fairly

Standards of Conduct examples

Sets the expected ethical behaviors for OTs and identifies behaviors that are not acceptable in OT practice

What do Related Standards of Conduct provide?

guides decisions, at the core of an evaluation

clinical reasoning

scientific reasoning

background information (diagnoses, symptoms, vital signs)

scientific reasoning

Which type of reasoning gives you a brief picture of the client/starting point?

Yes, they renamed clinical professional so it would make more sense when applied to non-clinical settings such as home health or cbp.

Are clinical and professional reasoning the same?

functional limitations regarding occupations

What does diagnostic reasoning allow you to determine about a client?

diagnostic reasoning

applying the scientific reasoning to the client, combining the evidence with the personal information

• thinking beyond the diagnosis

diagnostic reasoning

reasoning that would allow you to think of possible limitations of a client (Ex. Parkinson’s patient may have balance issues, tremors, gait issues → bring a walker and utensil for the evaluation)

procedural reasoning

following policies and procedures (following the rules)

• ex. following safe transferring policies or evaluation policies in your facility

interactive

reasoning that involves the connection/relationships with the client

• using TUS

interactive reasoning

What reasoning would this be an example of?

• seeing that your client is not responding and appears to be grumpy so you take everything slow and use a calm tone of voice when explaining

narrative reasoning

listening to the client, giving them a chance for them to tell you their story

narrative reasoning

What reasoning would this be?

• A Parkinson’s patient tells you that he is the caregiver for his wife, who has dementia, and he is worried about fulfilling that job/role in his life. You refer him to social work so he can get some assistance with possible stress, anxiety in his life.

pragmatic

practical type of reasoning

• thinking about what is possible for the client given the setting, time, resources available, # of session provided etc.

ethical reasoning

guides what you can do and what you cannot do in an evaluation

conditional reasoning

integration of all types of reasoning; is learned through experience