Professional Formation

what is culture?

-beliefs, social forms, and traits of a certain group

-shared attitudes, values, goes, and practices that characterize an institution or organization

-values, conventions, or social pracices associated with a certain field or activity

-the integrated pattern that depends on capacity for learning and transmitting knowledge to succeeding generations

what is the history of PT?

1. Early beginnings: depections that look like PT being done

2. Late BC: hippocrates noted the benefits of manual therapy and water for pain relief.

3. European influences: Sweden created a gymnastics gym, France scoliosis and duchenne muscular dystrophe treatments, italy created e-stim, england developed the term physiotherapy

4. In the united states during WWI, medicine helped people to surive the battle field and return to society, Also, during th polio epidemic Civilian Reconstruction Aides who were members of the US army would treat people to counteract the debilitating effects of polio.

5. 1921: Mary McMillin founded the American Women's Physiotherapeutic Association which became APTA and the profession of PT.

what is the difference between an occupation and a profession?

occupation: focuses on an activity or outcome

profession: focuses on the instrinsic value of what you do. there is a commitment to society

what is the value of the profession of PT?

PT's are movement experts that improve QOL through prescribed exercises, hands on care, and patient education

what is PTs commitment to society?

to transform society by optimizing movement to improve human experience

what are the 5 professional roles of a PT?

1. patient/client manager- this is the bread and butter of what a PT does

2. consultant

3. critical inquirer

4. educator

5. adminstrator

what is the PTs role as a consultant?

-it's simply giving professional or expert opinion or advice. this does not mean treating a patient.

-it can be given through patient/client care, development of new speciality services, enhancing reimbursement, or expert witness

what is the PTs role as a critical inquierer (researcher)?

-to apply principles of scientific method to interpret professional literature

-to participate in, plan, and conduct research

-to evaluate outcomes data

-to assess new concepts and technologies

what is the PTs role as an educator?

1. outside of the profession: to educate patients, community makers, or policy makers

2. entry level and post-professional trainess: to provide academic instruction and clinical education

what is the PTs role as an administrator?

to provide leadership within healthcare systems, be clinic leaders, and deal with health policy

what is the path to physical therapy and the education continuum?

1. pre-professional (entry-level) education

2. DPT program

3. National boards

4. State boards and licencure

5. Post-professional Education

what makes up post-professional education?

1. clinical specialization

2. continuing education

3. evidence based practice- learning clinical reasoning by taking into account evidence, clinical expertise, and patient values and circumstances

what are the parts of clinical specialization?

1. the continuum of care: these are the specific settings that a PT can work in; prevention and wellness, acute hospitalization, inpatient rehab/skilled nursing facility, home health/outpatient care, increasing functional independence

2. Practice areas: getting specialized- there are 10 specialist certifications governed by ABPTS

discuss the history of specialization.

-concept first approved in 1976

-the first speciality council, which oversees the integrity and maintenance of the certification, was cardiopulomonary PT created in 1985

what are the elements of specialization?

1. Specialization is not required

2. You can work in practice areas without board certification

3. the process has oversight to make sure it is a coordinated process

what is the 2 ways to specialization and their goal?

1. complete an accredited residency in the area of specialization

2. complete 2000 hours of direct patient care in that area of specialization

GOAL: obtain specialized knowledge and skills to apss the board exam

what is the path to specialization?

1. identify an area of specialization

2. learn about the requirements

3. plan

4. create an application

5. sit for the exam

6. maintain expertise

what is the importance of continuing education?

-state licensure requires that PTs complete a minimum amount of CEU to maintain the ability to practice

-this can be completed through APTA CSM, annual academy conferences, or training in specific techniques/areas

what is the difference between PT and PTA?

PT: graduate from CAPTE accredited doctoral program over 3 years; get advanced training in clinical reasoning and evidence based practice; pass nation and state board and licensure; maintain CEU

PTA: graduate from CAPTE accredited PTA program that is 2 years; pass nation and state board and licensure; maintain CEU

what are the traits of a doctoring profession?

1. Unique body of knowledge: provides extensive specialized training and skill development as well as a doctoral education

2. autonomous decision making: allows PT's to treat and make decisions without physician referral or oversight

3. formal organization and internal governance: controls/guides the profession members. the profession of PT has APTA which provides a strategic plan, core values, code of ethics, and a board of directors and house of delegates. Also, CAPTE guides education, ABPTS guides specialization, and ABPTRFE guides residency.

4. societal contract and licensure requirements: provides services to individuals with an orientation to benefit society, externally recognition by society, and binds the profession through national exams and scope of practice

what is the patient/client management model used as a result of having autonomous decision making as PT’s?

1. Examination

2. Evaluation

3. Diagnosis

4. Prognosis

5. Intervention

6. Outcomes

7. Re-evaluation

what are the threats facing the PT profession?

1. Unmet responsibility

2. Lack of effort towards lifelong learning

3. poor societal interactions: people wont seek out treatment

4. poor interactions with other healthcare professionals: can’t work interprofessionally or gain referrals

5. poor values and/or ethics: issues such as power abuse, discremination, arrogance, greed, conflict of interest, and mirepresentation makes it hard to trust PTs

6. Not generating supporting evidence: practice becomes outdated and can’t meet needs of society

what is the structure and governance of APTA?

• 501c6 non-profit

• federated model including 50 states and 1 district chapters and 18 special interst sections/academies referred to as components that each have their own elections, leaderships, and bi-laws

• governed by the APTA Board of Directors which is made up of 16 members— 15 elected by the House of Delegates and a public member appointed by the Board. Also has an executive committee made up of the president, vice president, secretary, and treasurer

what are the roles of the Board of Directors?

• sets mission and vision

• creates and impliments strategic plan

• sets public policy agenda to fight things in the legislature

• makes all major association decisions

• fiduciary responsibility for >$50 million dollar budget

• establishes association policies and positions

• hires and oversees the APTA CEO who leads the staff

what are the goals of APTA?

1. member value: to grow membership and give members more bang for their buck

2. sustainable profession: improve the sustainability of the profession by increasing pay while decreasing the cost of eduction

3. quality of care: increase the quality of care by providing new evidence based resources and improve higher eduction through specialization and residency

4. demand and access: create greater ability for people to access PT

what is the mission and vision of APTA?

mission: building a community that advances the profession of physical therapy to improve the health of society

vision: transforming society by optimizing movement to improve the human experience

what are the APTA sections and academies?

setting based: acute care, education, federal, home health, private practice

treatment type: aquatics, clinical electro and wound management

patient type: cardiovascular and pulmonary, geriatrics, hand and upper extremity, neurology, oncology, orthopaedics, pediatrics, pelvic health, sports

for everyone: leadership and innovation, research

what are the councils in the APTA?

they are based on representation from each chapter

1. PTA council

2. APTA payment chairs council

3. student council: 69 representatives in total. each chapter and section select one student council representative who applies through APTA engage to serve and 8 of them can be elected to serve on steering group or as chair. they are elected by the council reps

what are the networks and societies that are part of APTA?

• networks (information sharing): Health Promotion and Wellness; Residency and Fellowship Education; Frontiers in Rehabilitation, Science and Technology Network

• Societies (achievement or experience based): Board of Director Alumni, Catherine Worthingham Fellows

discuss the House of Delegates of the APTA.

• comprised of >430 voting chapter and section/academy delegates, plus non-voting delegates and consultants. the number of delegates is based on proportion of members in each state

• annual meeting led by Speaker, Vice-Speaker, and Secretary

• debates and establishes policies and positions for the profession

• elects the BOD and nominating committee

• students can apply to serve as student ushers or 2 can be selected as Student Delegates

what are the issues facing the profession of PT that APTA works to counter?

1. Term and Title Protection: Physical Therapy is NOT a generic term as it describes the care and services by or under the direction of a licensed physical therapist. so other health care providers cannot attempt to classify care as PT

2. Protects Scope of Practice: chiropractors or acupuncturist attempting to remove the practice of spinal manipulations and dry needling from PT

3. it is the only professional organization advocating for adequate re-imbursement for physical therapy services. ie increasing PT salary

why are core values so important?

they guide decision making, inspire and permeate the scope of PT activites, retain the PT as responsible for services provided and for oversight of PTAs who work under them

what are core values?

root beliefs that a person or organization operates from. principle perspectives that guide a person or organization’s behavior with others. specifially, they guide behaviors for PTs and PTAs to provide the higheest quality of care.

why is it good that core values are NOT personality traits?

we can grow in them and engage in them more

who came up with the core values for physical therapists?

the house of delegates

discuss the core value of accountability

active acceptance of responsibility of the PT and PTA including self regulation and other behaviors that influence patient outcomes, the profession, and the health needs of societydi

discuss the core value of altruism

the primary regard for or devotion to the interest of patients, placing their needs ahead of the PTs or PTas

ex: last patient of the day comes in late but therapist stays later to give them full time

discuss the core value of collaboration

working together with patients, communities, other health professions and field to achieve shared goals. also specifically encompasses the PT and PTAs work together. this is teamwork

discuss the core value of compassion and caring

compassion: the desire to identifity with or sense something of anothers experience. it takes the element of action

caring: the concern, empathy, and consideration for the needs and values of others

ex: truly taking time to talk with pts and get to know them and their needsd

discuss the core value of duty

the committment to meeting one’s obligations to provide effective PT services to patients, serve the profession, and influence the health of societyw

discuss the core value of excellence

with the PT or PTA uses current knowledge and skills while understanding personal limits, integrate the patient perspective, embraces advancement, and challenges mediocrity

discuss the core value of inclusion

creating a welcoming environment for all. if the patient doesnt feel welcome, they will share less relevant informatoin that the therapist could use to help them

this includes providing a safe space, elevating diverce and minority voices, and acknowledging personal biases that may impact care

discuss the core value of integrity

adherence to high ethical prinicples, being truthful, ensuring fairness, following through on committments, and verbalizing to others that rational for actions

discuss the core value of social responsibility

promoting mutual trust between the profession and society by responding to societal needs for health and wellness.

ex: working at a probono clinicc

why are ethics important for the profession?

they go beyond the law

they improve the value of our profession and remove threats/challenges

t/f something can be unethical but legal or ethical but illegal.

true

what does the code of ethics do for the profession?

establishes the ethical framework guiding the conducts of all members of the profession

provides the public with ethical standards to hold the profession accountable

provides a responsibility for student PTs and PTAs to adhere to

what are the ethical principles in the code of ethics that provide a lens through which to make decisions?

autonomy: independence, the right to make an informed choice

beneficience: benefiting others

veracity: honesty and truthfulness

fidelity: treat all individuals with respect, fairness discretion, and integrity

non-malificence: do no harm

justice: fair, equigable and appropriate treatment of persons

what are the ethical committment in the code of ethics?

respect

integrity

accountability

maintaining professional relationships

compassion and trust

responsible business and organizational practices

direction and supervision

professional expertise

societal responsibility

what are the 4 steps for ethical decision making?

Recognize

Reflect

Decide

Implement

what do we use to recognize there’s an ethical decision to make?

RIPS model

what is the RIPS model?

Realm: they are independent but one is usually more important— individual, organizational/institutional, societal

Individual process: what does the ethical situation require most of me?

Situation: classify the ethical situation

what are the parts of individual process of the RIPS model?

moral sensitivity: recognize the ethical situation

moral judgement: decide between right and wrong

moral motivation: put moral value above other values

moral courage: impliment a decision and take action

how do we classify an ethical situation using the RIPS model?

issue/problem: important values are present or may be challenged

dilemma: right vs right

distress: you know the right course of action but are not authorized or empowered to do it

temptation: right vs wrong choice in which you may benefit from doing the wrong thing

silence: ethical values are challenged but no one is speaking up about ti

what questions should we ask when reflecting when trying to make an ethical decision?

• what are the relevant facts and contextual information

• who are the major stakeholders

• what are the possible consequences (intended and unintended)

• what are the relevant laws, duties, obligations, and ethical principles

  • what professional resources speak to the situation (core values, code of ethics, state practice acts)?

how do we determine if a situation is a right vs wrong situation?

the legal test: is it something illegal?

the stench test: does this feel wrong? what does my gut say?

the front page test? would you like this to be on the front page

the mom test: if i were a parent, would i do this?

the social media test: would i want this going viral?

the professional ethics test: does the code of ethics, guide for professional conduct, or the core values prohibit or dicrousage this action

how do you decide between a right vs right choice?

rule based: follow the rules, duties, obligations or ethical principles already in place

ends based: determine the consequences or outcomes of alternative actions and the good or harm taht will results for all the stakeholders

care based: resolve dilemmas according to the relationsihps and concern for others

what are the limitations for ethical frameworks?

rule based: does not always consider context; who determines the most important rules?

ends based: whose interests should be considered? does not always protect rights some consider absolute?

care based: unclear what the care based would recommend? decision may be made based on emotion. is that just?; do men and women view ethical behavior differently?

what all does implementation include when making an ethical decision?

• develop an action plan

• ask what questions were learned

• determine what new ethical situations arose

• determine the barriers to implementation

what happens when it’s time to report ethical violations?

1. talk to the individual or work with your administration

2. report to your local chapter

3. report to your state board

4. report to the APTA

disciplenary actions will be determined and can include the suspencion or revoke of license, reprimeands, probation, fees

Why is licensure important?

It offers assurance to the public that the regulated individual is competent to provide certain services in a safe and effective manner.

what is the state licensure timeline?

1. graduate from an accredited DPT program

2. pass the national board exam

3. apply for licensure with a state

4. complete any state specific licensure requirements— graduate from accredited DPT program, pass board exam, background check, juris prudence exam

what are the major responsibilities of the licensing board?

1. establish entrance requirements (made through law so difficult to change) to the profession— eduction, training, and experience; assessing initial competency and safety

2. rule making

3. discipline

4. assuring continued competence— through eduction

what is the difference between the APTA and licensing boards?

membership: APTA voluntary; licensing board mandatory

purpose: APTA promotes the profession; licensing board protects the public

service: APTA to the membership; licensing board to the public

discuss the creation of the NPTE.

initially created by the APTA but the problem with this is that there is conflict of interest as their mission is to promote PT which would mean they pass more people

1993 the federating of state boards of physical therapy (FSBPT) took over as a 3rd party to provide accountability and protect the public

what is the purpose of the NPTE?

designed to assess minimal entry level competence of the candidate

provides consistent and defensible standards for evaluation of entry level candidates

state boards are created by the practice act which defines the scope of practice for physical therapists and gives the board the power to…

draft regulations

enforce the practice act

what is the PT compact?

allows PTs to practice outside of the state without having to get licensed

applies to the location of the patient when being treated

in order to use the compact…

1. state must adopt the compact language to their practice

2. boards develop a method for issuing the compact

3. you have to have a license in your home state to apply for the compact

what is scope of practice?

what the law dictates a PT can or can’t do

to change, you have to introduce legislation. however, this is hard because other professionals are worried about practice encroachment so need to choose wisely when want to open the practice act up to change

what are the requirements needed to maintain and renew your license?

avoid discipline

keep licensure in “good standing”

continue to maintain competence

outlines fees, requirements, and timelines for renewals

Can you be licensed to practice in south carolina if you fail the national board exam 6 times?

no

can physical therapists in south carolina prescribe non-steroidal anti-inflammatory medicine or x-rays?

No

in the absence of a referral from a licensed medical doctor/dentist, can a physical therapist provide services beyond 30 days after the initial examination and'/or prescription?

yes, you can treat them indefinitely

who pays for an investigation of chargers of improper practice if the accused is found guilty? innocent?

you; the board

how long is a physical therapy license valid for in south caroline?

two years

can a new DPT graduate, who has not taken the national exam, practice under a professional license?

no

what type of supervision is required in south carolina for student physical therapists?

on site

what are the permisable duties for a physical therapy aid?

permisable:

1. transport patients

2. preparing, cleaning, and maintaing the treatment area and equipment

3. preparing patients for treatment

4. attending to the personal needs of patients during treatment sessions

5. clerical and housekeeping activities

restrictions:

what are the non permisable duties for a physical therapy aid?

1. an activity that requires licensure

2. an activity that requires exercise of professional judgement of a physical therapist

3. the interpretation of referrals, screenings, assessments, evaluations, or reassessments

4. development or modification of treatment plans or discharge plans

how often must a patient be re-evaluated by a physical therapist if also being seen by a PTA?

every 8th treatment of every 60 calendar days

is it permissable for a student PT to supervise a student PTA?

no, they are both under the supervision of a licensed PT or PTA

how many CEU’s must a licensed PT or PTA earn?

3 CEUs per biennium period

what is the maximum number or recommended full-time equivalent PTA positions that a PT in SC should supervise?

three

in which jursidiction does the practice of PT occur— the patient location or the physical therapists address?

patient location

why are communication skills crucial?

66% of medical error are attributed to poor communication so they decrease these medical errors

increase patient/client satisfaction

increase outcomes

increase provider satisfaction

increase efficiency

decrease patient/client anxiety

decrease malpractice claims (70% malpractice claims are due to communication problems)

history taking can provide _____ of the information needed to determine the source of symptoms. why?

80%; type of questions you ask matters to help you rule out things. so the more targeted and organized your history the more true this is

what are the goals of patient history taking?

1. establish rapor

2. identify communication barriers

3. identify learning styles

   1. establish goals

what is a therapuetic alliance?

a cooperative working relationship between the PT and the patient

on what aspects of the patient centered model should we focus our history?

exploring the problem and effect on life

provide realistic expectations

enhance the therapeutic alliance

advocating for the prevention and health promotion

finding common ground

understanding the person

what are the actions of expert communicators?

1. enters the life of their patients

2. listens well

3. detects confusion

4. seeks clarification

5. patient and family centered

6. know they are being understood

what are the communication strategies that can be used to facilitate a therapeutic alliance?

active listening, non-verbal communication, the environment, the message and mode (what you are communicating and how your communicating it)

what are active listening strategies used to facilitate a therapuetic alliance?

1. periodically summarize what you hear— forces you to demonstrate that the information has really been passed between you and your patient

2. awareness of language or cultural differences

3. control nonverbal communication

what are nonverbal strategies used to facilitate a therapeutic alliance?

awareness of your…

• appearance

• posture

• body movement (facial expressions, gestures)

• eye contact

• voice (tone, pitch, volume cadence)

• touch— communicates a sense of caring and acknowledgin

what are the environmental strategies used to control the environment to reduce distractions to facilitate a therapeutic alliance?

appropriate lighting

comfortable seating

minimize cluster and sound

promote readiness of equipment and prevent interruption

what are the message and mode strategies used to facilitate a therapeutic alliance?

present information in patient preferred modes (written, verbal, visual)

limit complexity and use common terms— use patient friendly language

people tend to remember what they hear first, believe is important, and is repeated

first impressions and meaningful and hard to overcome. communication well often takes longer with a focus on ________.

listening

when interviewing patients, remember:

1. patients typically have 3 complaints

2. their first concern is not always the primary concern

3. often patients are interrupted every 18-23 second

what is the AIDET framework?

Acknowledge

Introduce

Duration

Explanation

Thank you

What is diagnostic interviewing?

Begins with open ended questioned which are used to determine what they have difficulty with. Then move to closed ended questions which are used to rule in or out options. they should be able to respond with yes or no to these.

what is motivation interviewing?

trying to structure questions to increase the patients buy in

O: ask open ended questions

A: use affirmations, or positive statements that demonstrate an authentic interest in the patients own perspectives

R: reflective listening reinforces this interest and offers opportunity to clarify information or make inferences that invite the patient to continue to share his or her thoughts and opinions

S: the provider can pause the conversation to summarize information, pulling together pieces of the dialogue in a way that inspires action