Unit #1
Preparing for Patient Care Activities
Objectives
Interprofessional & Professional Collaborations
Discuss interprofessional & professional collaborations, emphasizing the benefits of a holistic approach to patient care.
Explain patient orientation, including the steps to properly introduce oneself and verify patient identity.
Discuss awareness of cultural diversity, including cultural humility and responsiveness.
Understand what is HIPAA/informed consent, detailing their legal and ethical implications.
Learn principles of patient management, from examination to termination of treatment.
Identify and mitigate safety concerns to ensure a secure environment for patients and staff.
Understand the role and importance of the Joint Commission in healthcare accreditation and quality improvement.
Interprofessional & Professional Collaborations
Team Composition
Organizations utilize a diverse team of caregivers (interprofessional) for optimal, holistic patient outcomes, especially for complex cases.
Teams may include:
Physical Therapists (PT) and Physical Therapist Assistants (PTA)
Occupational Therapists (OT) and Occupational Therapist Assistants (OTA)
Registered Nurses (RN) and Certified Nursing Assistants (CNA)
Speech-Language Pathologists (SLP)
Social Workers
Physicians and Physician Assistants (PA)
Dietitians
Functions of Assistants
Assistants operate with direction and guidance from licensed professionals, ensuring tasks are within their scope of practice and competence.
Frequent communication, both verbal and written, is vital to adjusting the plan of care based on patient progress or changes in condition.
Supervision levels are defined by state practice acts and organizational policies.
Patient Orientation
Patient Chart Review
Review the patient’s chart thoroughly prior to treatment to understand their medical history, precautions, contraindications, current medications, physician orders, and recent progress notes.
Self-introduction
Clearly introduce yourself and your professional title (e.g., "Cory Oliva, Physical Therapist Assistant") to the patient and any family members present. Maintain a professional demeanor and build rapport.
Verification of Patient Identity
Verify patient using at least two identifiers to prevent medical errors:
Full name
Date of birth
Confirm or verify diagnosis by reviewing the chart and asking the patient, if coherent enough, about their understanding of their condition.
Ask for consent to treat, explaining the planned intervention. Document oral consent in the patient's medical records.
Patient Interview
Interview the patient for relevant subjective information, including:
Current pain level using a pain scale (e.g., ).
Functional status and prior level of activity.
Changes in symptoms since the last visit or new complaints.
Living situation, support system, and home environment.
Establish realistic treatment goals and functional outcomes collaboratively with the patient’s input, ensuring they align with their personal values and needs.
Review the treatment plan and past treatments, explaining the rationale for interventions.
Cultural Diversity
Awareness and Understanding
Recognize and respect a variety of cultures, norms, and traditions that may influence patient care preferences and health beliefs.
Acknowledge differences in verbal (e.g., language barriers, directness of communication) and non-verbal languages (e.g., eye contact, personal space, gestures).
Take the initiative to understand religious norms and traditions, as these can impact treatment decisions, dietary needs, and modesty concerns.
Cultural Humility
A lifelong process of self-reflection and self-critique, examining one’s own biases, beliefs, and assumptions while continuously learning about others. It involves recognizing power imbalances.
Cultural Responsiveness
The ability to learn from and relate respectfully to individuals from various cultures by adapting communication styles, involving family in decision-making when appropriate, and respecting belief systems to foster trust and better adherence to care.
Suspected Abuse Reporting
Legal Obligations
All states require health information professionals to report suspected child abuse, with many also including spouse and elder abuse. This is a critical ethical and legal obligation.
This reporting obligation is an exception to the patient confidentiality requirement of licensure law, as it prioritizes the safety of vulnerable individuals.
Types of abuse include physical, emotional, sexual abuse, and neglect.
Kansas Law
Professionals are mandated to report certain forms of abuse or neglect of children to the Kansas Department for Children and Families (KDCF).
If KDCF is closed or the report involves other types of abuse (e.g., elder abuse), reports should go to the appropriate law enforcement agency.
Failure to report as required is a class B misdemeanor; knowingly making a false report also constitutes a misdemeanor, carrying potential penalties.
Health Insurance Portability and Accountability Act (HIPAA)
Overview
Enacted in 1996 and fully implemented in 2003, HIPAA protects sensitive healthcare-related information, ensuring patient privacy while allowing necessary information flow for quality care.
HIPAA Privacy Rule
Protects individually identifiable health information, known as Protected Health Information (PHI). This includes demographic details, medical history, test results, and insurance information.
Patients have the right to access their information, but it cannot be shared with others without their explicit permission, except in specific situations defined by law (e.g., treatment, payment, healthcare operations).
Guidelines to Avoid Violations
Do not leave paperwork with patient identifiers in public areas or unsecured locations.
Avoid discussing patient care in public places (e.g., elevators, hallways, cafeterias) where conversations might be overheard.
Ensure computer screens showing patient information are not visible to others and always log off electronic health records when stepping away.
Securely dispose of patient-identifiable documents through shredding.
Consequences of Violating Privacy Rule
Violations may involve internal disciplinary actions such as termination, corrective action plans, damage to professional reputation, and in severe cases, significant fines and even imprisonment.
Informed Consent
Definition and Importance
Informed consent requires that patients are provided with sufficient information regarding the therapy's benefits, alternatives, anticipated timelines, costs, and potential risks, allowing them to make an educated decision to consent to or refuse treatment. It upholds patient autonomy and promotes shared decision-making.
It is required prior to any medical intervention, procedure, or participation in research.
Requirements for Informed Consent
Patients must be:
Given sufficient, understandable information, including the nature of the condition, proposed intervention, risks, benefits, alternatives (including doing nothing), and prognosis if untreated.
Able to understand the information and make a voluntary decision (be competent).
Assisted by a legal guardian or appointed surrogate if under legal age (a minor) or if they lack the capacity to make their own decisions due to cognitive impairment.
It is essential to thoroughly document that consent was given, the information provided, and the patient's understanding in their medical record.
ICF Model of Disability
Overview
Established by the World Health Organization (WHO), the International Classification of Functioning, Disability and Health (ICF) classifies functioning, disability, and health into various interrelated domains, providing a comprehensive, holistic framework beyond just a medical model:
Health Condition (e.g., disease, disorder, injury)
Body Structure and Function (impairments)
Activity Limitations
Participation Restrictions
Environmental Factors
Personal Factors
Health Condition Defined
Refers to diseases, disorders, injuries, traumas, or circumstances (e.g., aging, stress) that cause impairments. It focuses on the diagnosis itself.
Impairments: Problems related to body function (physiological systems) or body structure (anatomical parts), such as a significant deviation or loss (e.g., muscle weakness, joint stiffness, visual loss).
Components of Body Function and Structure
Body Function: Physiological functions of body systems (e.g., respiration, digestion, muscle contraction, sensory perception, mental functions).
Body Structure: Anatomical parts of the body (e.g., organs, limbs, bones, nervous system).
Composite Impairments
Result from multiple underlying origins, such as a painful knee leading to reduced movement, which then causes muscle weakness and difficulty walking. This accounts for both direct and indirect effects on function.
Activity Limitations and Participation Restrictions
Activity Limitations
Difficulties an individual may experience in executing tasks or actions, such as walking, eating, dressing, bathing, driving, or performing skilled movements.
Participation Restrictions
Consequences on social involvement, relating to daily life activities and societal roles. These are difficulties an individual may experience in involvement in life situations, such as working, engaging in social activities, civic duties, or family responsibilities.
Performance Qualifiers
Assessments use qualifiers to describe the extent of a problem, ranging from mild to severe. The capacity qualifier evaluates an individual’s ability to execute a task or action in a standardized environment (what one can do), while the performance qualifier describes what an individual does in their current environment.
Contextual Factors in ICF Model
Environmental Factors
External elements that can significantly affect an individual's functioning and participation. These include both the physical world and social attitudes, such as:
Abusive relationships or social support systems.
Physical surroundings (e.g., living in a multi-story home with stairs, accessibility of public transport).
Products and technology (e.g., assistive devices).
Attitudes of others (e.g., societal stigma).
Services, systems, and policies (e.g., healthcare access, legal systems).
Personal Factors
Individual attributes that influence how an individual experiences health and disability, not part of the health condition itself. These include:
Age (e.g., 18-year-old female)
Gender
Education and profession
Coping styles and past experiences
Social background and lifestyle
Fitness and habits
Patient Management Principles
Start with Differential Diagnosis
Accurate diagnoses drive better treatment decisions and outcomes, helping to rule out serious conditions, identify the primary problem, and reduce medical errors and inappropriate treatments.
Patient Examination and Assessment
Thoroughly assess the patient's medical record and current status.
Collect subjective (patient-reported symptoms, history, goals) and objective (clinically assessed measures like range of motion, strength, balance, gait analysis, special tests) data.
Perform appropriate tests and measures that help to determine the current condition, functional limitations, and potential impairments.
Clinical Judgements and Treatment Planning
Collaborate with the PT to select evidence-based treatment activities and techniques that are effective for achieving established functional outcomes. This involves clinical reasoning and critical thinking.
Develop a patient-centered plan considering their unique needs, preferences, and circumstances.
Termination of Treatment
Evaluate the need to terminate treatment appropriately when goals have been met, no further significant progress is anticipated, the patient requests discharge, or there is a significant change in their medical condition requiring different care.
Implementation of the Plan of Care (POC)
Execution of Care Plans
Implement the established plan of care diligently, ensuring all interventions are performed safely and effectively.
Apply selected techniques, activities (e.g., therapeutic exercise, functional training), and modalities (e.g., heat, ice, electrical stimulation, manual therapy) to maximize functional outcomes.
Continuously revise treatment plans based on patient progress, responses to interventions, and any changes in their symptoms or condition.
Communication with Family
If applicable and with patient consent, instruct family members or caregivers on supportive care, home exercise programs, and precautions, providing ample practice time and ensuring their comprehension.
Together with the PT, develop a comprehensive home exercise program (HEP) tailored to the patient’s needs and document it thoroughly in the medical record.
Steps in Patient Management
Sequential Steps
Examination of the patient
Evaluation of data and identification of problems
Determination of PT diagnosis
Determination of Plan of Care (POC)
Implementation of the POC
Reexamination of the patient and evaluation of outcomes
Detailed Breakdown
Examination
Involves gathering comprehensive data through history taking (chief complaint, past medical history, social history, review of systems), systems review, and applying specific tests and measures to identify impairments and functional limitations.
Evaluation
Conducted by the Physical Therapist to organize, analyze, and interpret findings from the examination, developing clinical hypotheses and prioritizing impairments and restrictions based on their impact on the patient’s function.
Diagnosis Determination
Establishes the disease or condition (medical diagnosis) and its functional impact at systemic and personal levels (physical therapy diagnosis), guiding the scope of intervention.
Plan of Care Components
Prognosis: The anticipated level of recovery and the estimated timeline for achieving the expected outcomes.
Goals and Expected Outcomes: Specific, measurable, achievable, relevant, and time-bound (SMART goals) drafted using the ABCD method (Audience - who is doing the behavior, Behavior - what is the action, Condition - under what circumstances, Duration - by when).
Regular Reassessment of Goals: Measure progress regularly against established goals and adjust the plan of care as necessary to ensure continued relevance and effectiveness.
Safety Considerations
Patient Safety as Priority
“No harm or injury should occur to the patient during treatment.” Practitioners have a primary responsibility to maintain a safe environment and ensure all equipment is functioning correctly before and during use.
Implement proper body mechanics for patient transfers, maintain clear pathways, ensure appropriate infection control measures, and educate patients on safety.
Common Safety Issues
Include accidentally dropping patients during transfers, leaving them unattended on equipment, utilizing faulty or improperly maintained equipment, medication errors, patient falls, and nosocomial (healthcare-acquired) infections.
Joint Commission Standards
Organizational Quality and Safety
The Joint Commission is an independent, non-profit organization that accredits and certifies healthcare organizations and programs in the United States. Its standards focus on quality issues within the care environment, enhancing patient safety and quality of care.
They conduct unannounced surveys emphasizing direct observation of care processes, document review, and patient interviews to ensure compliance.
They utilize “tracer methodology” to track patients’ course throughout the facility, evaluating adherence to standards at each point of care, from admission to discharge.
Consequences of Non-compliance
May lead to sanctions, public reprimand, conditional accreditation, or in severe cases, loss of accreditation, which can impact Medicare/Medicaid reimbursement and public trust.