Physiotherapy professional and legal frameworks, ICF, ethics

What is the vision of world physiotherapy?

To move physiotherapy forward so the profession is recognised globally for it’s significant role in improving health and wellbeing.

Everyone has universal access to quality physiotherapy services when and where needed.

What is the mission of world physiotherapy?

• unite the profession internationally

• represent PT and PTs internationally

• promote high standards of PT practice, education, and research

• facilitate communication and information exchange among member organizations, regions, subgroups, and their members

• collaborate with national and international organisations

• contribute to the improvement of global health

Level 1: Legislation

Oversees the health system and sets overall policy direction.

It includes laws that govern practice, ensuring safety, regulation, and standards for physiotherapy services.

Key legislation:

• Ministry of health

  • health and safety at work act (2016)

  • health practitioners competence assurance act (2003) (HPCA)

  • standing orders

• Privacy commissioner

Level 2: Government agencies, professional associations, funding agencies

Support, regulate, and fund the physiotherapy profession

key ones include:

• ACC

• Physiotherapy Board of NZ

• Physiotherapy NZ

  • Special interest groups

  • Tae Ora Tinana

What is the purpose of the Physio board of NZ?

The physiotherapy board - statutory body - sets standards, monitor and promote competence, continuing professional development and proper conduct for the practice of physiotherapy in the interests of the public health and safety.

The Purpose of the Health Practitioners Discipline Tribunal

Protect the public

ensures health practitioners maintain professional standards. Deals with cases where the practitioner may have acted inappropriately, shown professional misconduct, been incompetent in practice, or practiced while unfit. They hear and decide on serious complaints

Section 45 of Health Practitioners Competence Assurance Act (2003)

• Duty on any health practitioner or employer to notify the relevant registration authority if any graduating student has a health problem that would not enable them to perform the functions required for practice (S45)

  • notification of inability to perform required functions due to mental or physical condition.

Section 1.6 of HPCA

practitioner will not endager the safety of the public

dean of the SoP is bound to notify Physiotherapy Board of NZ of any graduating student who falls under the above

Health and Personal issues to Practicing

• mental or physical impairment

• infectious disease

• drug and alcohol issues

Professional attitudes and behaviours

• dishonest practice and academic misconduct

• poor attendance / submission of assessments

• inappropriate professional behaviour

• contravention of professional ethical codes

Issues external to the programme

• any offence which is punishable by 3 or more months in prison

Values of World Physiotherapy

1. Connecting

   • we bring our community together through our member organizations, regions, subgroups, and the wider physiotherapy profession

2. Belonging

   • we recognize and embrace the diversity in our community and our actions create a sense of belonging

3. Empowering

   • we support our member organizations, regions, and subgroups in the service of others to create lasting change and impact.

4. Collaborating

   • we partner with our member organizations, regions, subgroups, and others who share our values and objectives.

WHO definition of mental health

A state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Eustress =

Positive stress

• motivates and focuses energy

• short term

• perceived as within our coping abilities

• feels exciting

• improves performance

Distress =

Negative stress

• causes anxiety/concern

• long/short term

• perceived as outside of our coping abilities

• feels unpleasant

• decreases performance

• can lead to mental and physical problems

Five ways to wellbeing

1. Connect - talk and listen, be there, feel connected

2. Give - time, words, presence

3. Take notice - remember the simple things that give you joy

4. Keep learning - embrace new experiences, see opportunities, surprise yourself

5. Be active - Do what you can, enjoy what you do, move your mood

relevance of sleep

• immune function

• tissue healing

• pain modulation

• cardiovascular health

• cognitive function, learning, and memory

• mental health

effects of impaired/restricted sleep

• more negative mood

• less positive mood

• impaired glucose metabolism

• increased stress

• altered immune function

• increased blood pressure and heart rate

• increased sympathetic nervous system activation

• increased inflammation

Caffeines effect

time to effect = 30-120 min

½ life = ~ 6 hours

side effects =

• psychomotor disturbances

• insomnia

• headache

• GI upset

• CV changes

• psychiatric problems exacerbated

caffeine = adenosine receptor antagonist

tolerance, intoxication and withdrawal symptoms due to adenosine receptor changes.

How does caffeine work?

Adenosine receptor antagonist = inhibits the receptor which signals sleep drive = reduces sleepiness

• also dopamine agoniost = more happy

• reduces deep sleep

Non-REM sleep

important for physical health

stage 1: easily roused, can hear

stage 2: respiratory rate, heart rate, blood pressure decreases

stage 3: brain waves become larger and slower: amplitude increase and frequency decrease due to synchronised brain activity

stage 4: DEEP SLEEP body temp drops

REM sleep

occurs at the end of each cycle, in greater amounts at the end of your sleep.

This is the dreaming phase, which is important for our mental health as it enhances our ability to cope with emotional problems. During this time, we experience irregular breathing, increase in pulse and blood pressure, and faster brainwaves such as in awake state, with muscle tone and activity twitching.

Physio role, and diversity

work with anyone that needs help improving movement, function, and overall wellbeing

Diversity = the person is always at the centre of physiotherapy

PBNZ: general scope of practice for physios in NZ

• provide services to develop, maintain, restore, and optimise health and function throughout the lifespan

  • includes services to people compromise by aging, injury, disease, or environmental factors

  • encompasses physical, psychological, emotional, and social wellbeing

• involves the interaction between physiotherapists, patients/clients, other health professionals, families/whanau, caregivers, and communities = people-centred process

• Physiotherapists apply scientific knowledge and clinical reasoning to assess, diagnose, and manage human function

• Physiotherapy is not confined to clinical practice. Encompasses patient/client care, health management, research, policy making, educating and consulting, any issue of public health and safety.

physio and cultural diversity

physios must be able to work effectively with people whose cultural realities are different from their own

requires a holistic, patient centred approach to practice.

Evidence-based practice tools

• theoretical/scientific knowledge

• clinical knowledge and experience

• patient preferences

to treat our patients we have to understand what is important to them- NOT just about their condition

to help structure our investigations we can use Models And Frameworks of health

International classification of functioning, disability, and health (ICF)

Aim: Provide a unified and standardised language for describing and classifying health domains and health-related states - to provide a common framework for health outcome measurement

What does this mean?

• gives health professionals a common language or way to consider health

• helps us think about all aspects/domains of our patients’ lives to ensure we provide holistic person/whanau-centred care.

it is a shared language = improves communication, increases collaboration and shows gaps/overlaps

Core components of ICF model

1. Health Condition

2. Body Functions and Structure

3. Activity

4. Participation

5. Environmental factors

6. Personal factors

ICF is a dynamic interaction between all these components

Body Functions and Structure (ICF)

Any loss or abnormality of

• psychological

• physiological

• anatomical structure or function

Activity (ICF)

The nature and extent of functioning at the level of the person

These are the skills and abilities that the person can do (currently)

• you also want to know what they can do when they are not ‘impaired’

activities may be limited in nature, duration, and quality.

Need to understand what activities (skills/abilities) are our patients having difficulty with?

Participation (ICF)

The nature and extent of a person’s involvement in life situations in relation to impairment activities, health conditions and contextual factors.

Participation maybe restricted in nature, duration, and quality.

Can you think of ways in which our patient’s participation (in life) may be affected?

Contextual factors … and considerations * (ICF)

1. Personal

   • what are personal factors that would assist in their success?

   • what would be personal factors that hinders this success?

2. Environmental

   • what are environmental factors that would enable their success?

   • what are environmental factors that would challenge their success?

What is ethics?

How we should live

Concerns our sense that there are some things that are ‘right’ and others that are ‘wrong’

part of being human.

reflect our values = the things we regard as important

values come from a variety of places

and a good life (ethically speaking) is a life that is consistent with the values that we hold.

Where do ethical problems come from?

1. somebody neglects important values

2. we encounter a situation that is new

3. there is a conflict in values

the cartwright inquiry

• first public scrutiny of medical practice, research, and institutions in NZ

• led to the establishment of the health and disability commission, and the development of the ‘Code of Health and Disability Services Consumers Rights’

The inquiry focused on Dr Herbert Green's work on women with abnormal cervical cytology, which included a study of the natural history of CIN3. 

The inquiry investigated claims that patients were not treated for CIN3, and that Green's study involved monitoring patients without their consent or full knowledge. 

The Cartwright Report concluded that the treatment of these women was inadequate and, in some cases, led to serious illness and death. 

Central issue is power

Cartwright Report

• promotion of patient advocacy

• appointment of a commissioner to “define monitor and protect” patient’s rights

• National cervical cancer screening program

• independent review of research and treatment protocols

• changes to medical education to include ethics and communication skills

—>

lead to

1. health and disability commissioner act (1994)

2. code of health and disability services consumers’ rights (1996)

The Code of Patients’ Rights purpose =

• promote and protect the rights of health consumers and disability service consumer

• facilitate the fair, simple, speedy, and efficient resolution of complaints relating to infringement of those rights

“ In a legal system where injured or otherwise aggrieved patients are effectively deprived of the right to sue for malpractice, the statutory rights to claim compensation for injury from ACC and to complain to an independent advocate or the HDC assume primary importance”

Health Care Provider =

• health care practitioner

• district health boards

• private hospitals

• “any other person who provides, or holds themselves out as providing health services to the public”

• Includes complementary and alternative practitioners

HDC Complaint Triage System

1. Complaint to HDC for preliminary assessment. No further actioin required or ….

2. Refer to another agency

   • ACC (compensation)

   • Physiotherapy board (competence)

3. Refer to provider, advocacy, or mediation

4. Investigation

Possible outcomes for breach finding

1. Breach findings

2. Recommendation; report to physio board

3. Refer to director of proceedings where …

   • health practitioners disciplinary tribunal

   • human rights review tribunal

   • no further action.

Right 1 (Code of patient Rights)

The right to be treated with respect

1.1 = physical privacy

1.2 = cultural safety

Right 2 (Code of patient Rights)

The right to freedom from discrimination, coercion, harassment and exploitation

“ exploitation includes any abuse of a position of trust, breach of duty of exercise of undue influence”

Right 3 (Code of patient Rights)

Right to dignity and independence

Right 4 (Code of patient Rights)

Right to services of an appropriate standard

• standards of ‘reasonableness’

• legal and ethical standards

• standards set by the healthcare facility

• standards set by the physiotherapy board of NZ

Treatment should be:

• consistent with needs

• minimise harm and optimise quality of life

• should be cooperation between providers

Right 5 (Code of patient Rights)

Right to effective communication

• reasonable effort should be made to communicate with the patient in a manner that the patient can understand

• many of the negative outcomes in health care can be traced back to poor communication between the consumer and the provider.

Right 6 (Code of patient Rights)

Right to be fully informed

every consumer has the right to the information that a reasonable consumer in that consumer’s circumstances, would expect to receive.

Right 7 (Code of patient Rights)

Right to make an informed choice and give informed consent

7.2 = every patient is to be presumed competent

7.5 = every consumer may use an advance directive in accordance with the common law

Right 8 (Code of patient Rights)

Right to support

Right 9 (Code of patient Rights)

Rights in respect of teaching or research

i.e. should patients have a duty to participate in teaching and research?

Right 10 (Code of patient Rights)

Right to complain

• complaints can be made by patients, 3rd parties, or other health care providers

• there is no limit

• keep in mind that patients are usually looking for a ‘low level’ resolution.