PCLM 2 MIDTERM

what are the conflict resolution principles

• address conflicts early/directly

• active listening

• focus on problems; not personalities

• take responsibility

• use “I-messages”

• seek mutual benefit (win-win)

• manage emotions

what are the four foundational conditions of patient engagement

1. present - being present reflects PTs and patients intentions and abilities to be in the moment or embodied in time and space

2. receptive - to be receptive, PTs and pts must enter interactions with an open attitude to negotiate appropriate treatment plans, and a focused receptivity to identify issues and needs

3. genuine - to be genuine is to be real or convey sincerity in the present. being genuine in a therapeutic relationship has 3 aspects: being yourself, being honest, and investing in the personal

4. committed: this speaks to an ethic of care that encompasses PTs professional duty and the desire to be of service to others to restore patients' well-being

what are the 5 best practices for patient engagement

1. educate and inform: their condition, the purpose of different exercises, the expected outcomes, provide easily understandable resources, answer their questions thoroughly

2. set collaborative goals: involve pts in goal-setting, ask about their objectives, tailor the treatment plan to align with their aspirations

3. personalize treatment plans: recognize that every pt is unique, personalize treatment plans to suit their abilities, preferences, and limitations

4. use positive reinforcement: celebrate even small victories with patients

5. track progress: use outcome measures, leverage technology to monitor or track progress (wearable devices, apps, online platforms)

what are factors influencing parental engagement

1. quality of relationships parent/therapist/infant: communication, trust, greater parent-infant connection

2. parent education: readiness to engage, parent beliefs in educational resources, adherence

3. co-designing interventions: goals enhancing parental engagement, collaborative treatment planning

4. parent socio-economic context and education

benefits of patient engagement

• enhanced relationship with patient

• improved outcomes/results

• better treatment adherence

• better patient experience

• increased satisfaction

• cost savings

• improved communication

• empowerment and motivation

• lifelong patients

improved patient outcomes with collaborative care

1. enhanced patient care

2. reduced medical errors

3. faster treatment initiation

4. decreased healthcare utilization

5. improved patient satisfaction

6. better management of chronic conditions

7. enhanced access to care

8. cost-effectiveness

9. improved QoL

10. better coordination of care

reasons for unrealistic expectations for patients

1. too much/wrong information - Dr. Google

2. contradictory advice

3. time pressures

4. desire for quick fixes

5. overestimation of treatment efficacy

6. not setting realistic expectations

7. mismatch with PT

types of patient expectations

• predicted expectations: these are expectations that patients anticipate will happen during an encounter (what pts believe will happen)

• ideal expectations: represent specific ideas about how pts hope they will be helped. (what pts want)

• normative expectations: reflect what pts believe should happen during their care experience (standards and norms)

• unformed expectations: refer to expectations that are not clearly defined or articulated by the pt

challenges to implementation of collaborative care

1. organizational and cultural barriers

2. resource and logistical challenges

3. communication and coordination issues

4. training and education gaps

5. resistance to change

6. Implementation challenges

7. systemic barriers

8. patient-related factors

factors in the transfer of responsibility between parents to child

1. parents perceptions of the benefits of transferring responsibility (often most difficult)

2. children’s perceptions of the benefits of transferring responsibility

3. available physical, social, and psychological resources to support such a transfer

ethical responsibilities to the patient

• demonstrate sensitivity towards pts

• act in a respectful manner and do not refuse care

• maintain professional boundaries

• respect the principles of informed consent

• take all reasonable steps to prevent harm to pts

ethical responsibilities to the public

• conduct themselves with integrity and professionalism

• respect diversity and provide care that is culturally sensitive and appropriate

• assess the quality and impact of their services regularly

• work effectively in the healthcare system

responsibilities to self

• commit to maintaining the enhancing the reputation of the profession

• act honestly and transparently in all professional practices

• commit to lifelong learning and excellence in practice

• attend to own health and well being

what is the record keeping standard and what should records include

all pt records be accurate, legible, complete, and written in a timely manner. should include pt identification, session details, clinical content, informed consent, assigned tasks and coordination with others, and safety and discharge

how long must records be kept for

a minimum of 10 years for the later of the two dates:

• adults: the date of the last pt encounter

• children: the date the pt reached or would have reached 18 years of age

what acts can a PT not delegate to a PTA

acupuncture, spinal manipulation, internal pelvic work, and communicating a diagnosis, and anything they are not able to perform themselves

what is the duty of care standard

PT must prioritize pt interests and ensure continuity of care once a therapeutic relationship is established by shared decision making, warranted care, and respecting autonomy

when can a PT discontinue care without providing for continuity of care

• the pt requests it or alternate services are arranged

• the PT lacks the resources to meet practice standards

• the pt has failed to pay after reasonable attempt were made to facilitate payment

• the pt is abusive or there are reasonable grounds to assume they may become abusive

• the pt is non-compliant to the point where services are ineffective

• a professional boundary has been breached despite attempts to manage the behaviour

what is the supervision standard

PTs remain accountable and responsible for all PT services delivered by supervisees, including PTAs, students, residents, and other PTs

key obligations for supervision standard

• informed consent for all services provided by supervisees and clearly communicate their roles

• identification - supervisees must be easily identifiable thru introductions or name tags

• supervision strategies: PTs must use direct or indirect supervision based on the supervisees competence, pt needs, and environmental risks

• conflict of interest: PTs should not supervise individuals with whom they have a close personal relationship with

• availability: if a PT is unavailable, they must reassign supervision to another qualified PT

assessment, diagnosis, treatment standard

requires PTs to be proficient in three core areas to deliver safe, effective, and patient-centred care

what is the communication standard

PTs must communicate professionally, clearly, effectively, and in a timely manner

what are the core communication expectations in the standard

• professionalism - PT does not engage in communication that is disrespectful, dishonest, or misleading

• active listening - PTs must attend to what a speaker is saying and repeat it back to confirm

• addressing barriers - PTs are responsible for identifying potential communication barriers and making reasonable efforts to address them

• coordination of care - communication with pts and team members should facilitate collaboration and coordination of services

risk management and safety standard

promote and maintain a safe environment for pts, themselves, and other providers. the core expectation is to ensure that pts remain safe while in a PTs care and that any pt safety incidents are addressed and disclosed transparently

what is cultural safety

• refers to an environment perceived as safe by the ppl who seek services; free of microaggressions, racism, discrimination, or denial of a person’s identity and what they need

who determines whether care is culturally safe

the patient

why is cultural safety required for health equity

it addresses power imbalances, racism, and systemic factors that drive inequities, whereas cultural competency focuses on individual knowledge and skills. health equity can only be achieved when pts define safety, providers critically examine their power and bias, and health systems are held for accountable for equitable outcomes

what are the limitations to cultural competence

• it is the individual level that perpetuates a process of othering that identifies those who are thought to be different from oneself

• promote oversimplified understanding of other cultures based on stereotypes

• places problems with the affected individuals or communities, overlooking the role of the health professional and health system

• assumes that competency can be achieved thru acquiring knowledge, skills and attitudes

how does cultural safety address power

• acknowledge inherent imbalance

• relocate the focus to the culture of the clinician

• redistribute power to the pt

• challenge taken for granted structures

how does cultural safety address institutional discrimination

• systemic and organizational focus

• critically oriented knowledge by drawing attention to racialization

• institutional accountability where organizations are held accountable to provide culturally safe care

• mandating transformation to ongoing self-reflection within the organization

• altering colonial relationships by creating safe spaces for indigenous ppls to reshape the system itself

how does cultural safety differ from cultural humility

• cultural humility is an internal “interpersonal stance” and a lifelong commitment by the practitioner to self-evaluation

• cultural humility is framed around the pt-physician dynamic and the PTs way of being in the world

• cultural humility focuses more on building mutually beneficial partnerships

• cultural humility is an active process with no specific endpoint or goal of mastery

what is cultural sensitivity

being aware that cultural differences and similarities each exist, and both affect values, learning, and behaviour

what is cultural humility

a process of openness, self-awareness, being egoless, and incorporating self-reflection and critique after willingly interacting with diverse individuals. The results of achieving cultural humility are mutual empowerment, respect, partnerships, optimal care, and lifelong learning

what is cultural competence

the ability of systems to provide care to pts with diverse values, beliefs, and behaviours, including tailoring delivery to meet pts social, cultural, and linguistic needs. it is the ability to learn a quantifiable set of attitudes and skills that will allow ppl to work effectively within the pts cultural context

what is cultural responsiveness

the capacity of the healthcare services and professionals to respond situationally to the needs of ppl within sociocultural contexts

what are the 6 steps to the Cultural Competence Continuum

1. cultural destructiveness

2. cultural incapacity

3. cultural blindness

4. cultural pre-competence

5. cultural competence

6. cultural proficiency

what is cultural destructiveness in the continuum

attitudes, policies, and practices which are destructive to cultures and consequently to the individuals within the culture

what is cultural incapacity in the continuum

no intention to be destructive to culture but lacks capacity to help ppl of different cultures. the dominant pt group serves as the norm and ppl who are different are not welcomed. the expectation is that ppl of the minority will adapt to, accept, and even be grateful for the care provided

what is cultural blindness in the continuum

The existence of cultural differences is often denied in a desire to be unbiased and treat all clients identically, emphasizing equality over equity.

what is cultural pre-competence in the continuum

recognizing some needs based on culture, and making some mvmt to meet those needs but also not fully meeting the needs, risking a false sense of accomplishment and later frustration that ppl still dont seem to be grateful

what is cultural competence on the continuum

recognition of, and respect for, differences among ppls. ongoing efforts and self-assessment and working with diversity. taking the culture into account and adapting

what is cultural proficiency in the continuum

beyond competence, looking for opportunities to create new knowledge and innovative practices

what is individualism

• everyone is supposed to take care of themselves and their immediate family only

• right of privacy

• speaking ones mind is healthy

• others classified as individuals

• personal opinion expected: one person one vote

• transgression of norms lead to guilt feelings

• languages in which the word “I” is indispensable

• The purpose of education is learning how to learn

• task prevails over relationship

what is collectivism

• ppl are born into extended families families or clans which protect them in exchange for loyalty

• stress on belonging

• harmony should always be maintained

• others classified as in-group or out-group

• transgression of norms leads to shame feelings

• languages in which the word “I” is avoided

• purpose of education is learning how to do

• relationship prevails over task

what is low-context communication

• often associated with individualistic cultures

• focuses on being direct, explicit, and efficient

• emphasizes what info will be transmitted and the words used to convey the message

• the characterizing phrase might be “listen to my words”

• objective data is prioritized (ROM, outcome measures)

• evidence-based, individualized protocols

• fixed appointment times

• structured agendas

• soap notes

• formal consent and rule-based processes

• PT generally fits into this

what is high-context communication

• often associated with collectivist cultures

• what is communicated depends heavily on the situation, who is communicating, under what circumstances, and with what purpose

• non-verbal cues play a significant role in this style, emphasizing that “its not what is said that is most important, but how it is said, including what is not”

what does structural responsiveness require

• anticipating structural barriers

• adapting service delivery models

• advocating within institutional systems

• challenging exclusionary policies

how frequently are professional interpreters used in rehab

professional health care interpreters are used significantly less than ad hoc interpreters

what associations were observed between professional interpreter use and rehab outcomes

• there was a positive association between the number of professional interpreter interactions and total FIM gain

• the rate of hospital re-admission within 6 months of discharge was significantly lower for those who received interpreter services

• pts who received professional interpreters generally had longer rehab stays and lower fxnl scores on admission, suggesting that interpreters may be prioritized for more medically complex or debilitated cases

what are the barriers for accessing health care services for immigrants

• language barriers

• cultural barriers

• financial barriers

• stigma

• lack of transportation

• dissatisfaction with pt/provider interaction

• long waiting time

• lack of time

what are the barriers to accessing health care services - refugees

• language barriers

• cultural barriers

• financial barriers

• stigma

• lack of transportation

• dissatisfaction with pt/provider interactions

• long waiting time

• lack of time

• lack of social support

• specific barriers for women

what is the difference between an interpreter and a translator

interpreter

• converts spoken language → spoken language

• real-time communication

• clinic visits, meetings

• requires rapid listening and speaking

translator

• converts written text → written text

• not used for real time clinical conversations

• documents, forms

• requires careful reading and writing

• cannot replace an interpreter as pts must be able to ask follow up questions, clarify meaning, and ensure understanding

what is a professional medical interpreter

• in-person interpreter

• phone interpreter

• video interpreter

• they are preferred for clinical encounters

what is an ad hoc interpreter

• family member or friend

• another health care provider “who speaks the language”

what are the risks to an ad hoc interpreter

• not confidential

• could emotionally affect the person

• may not be available depending on own schedules and responsibilities

• not a professional

what are caregivers roles after discharge

• providing care and assistance

• advocating for the pt

• enacting vigilance

• being a source of comfort

• acting as a translator

what are the outcomes of having caregivers involved

• improved understanding for the pt

• improved adherence by facilitating follow up care

what process changes could improve caregiver involvement during hospital discharge?

• intentional inclusion - explicitly including caregivers changes the dynamic and strengthens the relationship with the medical team

• provide clear written instructions

• provide education and paper work earlier in the hospital stay rather than on day of discharge

what problems can occur when caregivers are not involved in discharge planning

• poor adherence and adverse events

• logistical failures - unable to attend follow ups

• caregiver unpreparedness

• information gaps for pts

how many Canadians provide unpaid care to a family member or friend with health needs

about 20% of the population - more females than males

what challenges do family caregivers commonly experience that may affect their ability to support a loved one at home?

• high levels of fatigue, anxiety, and depression

• social isolation and a decreased QoL

• continuous grieving and coping with “multiple connected losses” from the past

• a “24 hr a day job”

• uncertainty and fear regarding the progression of the disease and the future

what positive or meaningful experiences can sometimes emerge from caregiving despite its challenges

• strengthened relationships and a sense of being brought closer to the loved one

• a deeper appreciation for life

• personal growth, including increased patience and the development of inner strength

• new life skills such as enhanced problem solving abilities

• increased self-confidence and self-worth derived from the caregiving role

what four “prescriptions” are important for caregiver well-being

• quality physical activity

• support services rooted in the community

• multiple support networks

• toolkits with information

what does recognizing mean in terms of caregiver centered care

identifying the family caregivers, their contributions, and consequences of caregiving

what does communicating mean in caregiver centered care

communicate with family caregivers in a timely and respectful manner

what does partnering mean in caregiver centered care

establish collaborative relationships and include them in care planning and decision making

how have PTs negatively impacted the 2SLGBTQIA+ community

• incorrect assumptions about their sexuality and gender identity

• discomfort surrounding exposure and physical proximity of bodies

• fear of experiencing discrimination

• PTs lack of knowledge about the specific health needs of the community

what is gender

refers to ones innermost concept of self as male, female, and blend of both, or neither. it is how ppl perceive themselves and call themselves

what is sexual orientation

refers to an enduring emotion, romantic, or sexual attraction to other ppl where sexual orientation is independent of gender identity

what is heteronormativity

ideology that heterosexuality is the normal sexual orientation including the assumption that sexual and marital relations are appropriate only between two ppl of the opposite sex

what is cisnormativity

belief that all individuals identify as the same gender as their assigned biological sex, and individuals who identify as a different gender than their assigned sex are viewed inferior by the rest of society

how can we disrupt the intersecting systems of inequalities for 2SLGBTQIA+ communities

• centering the leadership of 2SLGBTQIA+ PTs

• creating a safe and comfortable learning environment

• educating future PTs about 2SLGBTQIA+ health care

examples of heteronormativity at the organizational level

• intake forms that only allow male/female to be checked off

• having posters and signs that only depict heterosexual and normative families

• maternity/paternity leave

• dress codes for men and women

examples of cisnormativity at the organizational level

• policies requiring legal ID to match gender presentation before accessing care

• lack of gender-neutral washrooms

• electronic medical records that don’t allow chosen name/pronouns

examples of heteronormativity at the interpersonal level

• presumption of heterosexuality by assuming a colleagues partner’s gender

• heterosexual males being seen as hypersexual when needing to make physical contact with a female, but men who are gay are allowed to and encouraged

• jokes or comments that make heterosexuality the norm

examples of cisnormativity at the interpersonal level

• misgendering a patient

• asking invasive questions about someones body or transition

• assuming someone is not trans because of how they look

examples of heteronormativity at the individual level

• positioning ones self “as normal as a straight person”

• adhering to heteronormativity thru aesthetics such as wearing a ring or putting traditional family pictures up at work

• wearing clothes that are gender-conforming

examples of cisnormativity at the individual level

• believing there are only two genders

• assuming pronouns based on appearance

• thinking being transgender is abnormal or rare

what are some strategies to disrupt heteronormativity and/or cisnormativity at the individual level

• self-reflection and bias awareness

• actively learn inclusive language

• seek education

• normalize pronoun practice

what are some strategies to disrupt heteronormativity and/or cisnormativity at the interpersonal level

• use inclusive, open-ended language

• ask and respect pronouns/name

• repair mistakes appropriately

• create psychologically safe environments

• interrupt microaggressions

strategies to disrupt heteronormativity and/or cisnormativity at the institutional level

• inclusive documentation systems

• policy changes

• training and accountability

• physical environment changes

• equitable care protocols

• apply queer theory to challenge norms