400 KeyTerms
KNPE 400 NOTES
Professional Issues in Allied Health
Allied Health
- Umbrella term for individuals who are trained to work individually or with others to support individuals achieve optimal health
- Association of school advancing health professions ASAHP’s definition
o Allied health encompasses a broad group of health professionals who use scientific principles and evidence based practice for the diagnosis and evaluation and treatment of acute and chronic diseases, promote disease prevention and wellness for optimum health and apply administration and management skills to support health care systems in a variety of settings
- Contribute to all realms of health care from assessment, health promotion, provisions of treatments, and rehabilitation services. Help patients manage and overcome barriers related to disability, core component to patient centred in health care systems. Allied health professionals can work individually or as part of a multi-disciplinary team alongside physicians and nurses to provide acess and effective care for patient.
Professionalism
- The patient and patient therapist relationship
o Understanding and treating the individual patient, placing the patient in the centre, having patient trust
- Knowledge skills and practice
o Recognizing and addressing limitations, having mastering and updating skills and knowledge, being part of a health care team, being a good communicator, practicing safely, getting the job done, having an evidence base, being educators, being professional, respecting professional boundaries, maintain boundaries with patients, having leadership
- Altruistic Values
o Honesty, making a difference, respecting patients’ cultures, backgrounds, values, rights, experiences, personal journeys and personal space, going the extra mile
- Communication
o Support better history taking, diagnoses and clinical decisions, increase a pateint’s adherence to recommendations and follow ups, help patients to adopt preventive health behaviours, help patients to adopt preventive health behaviours, improve satisfaction and experience of care
- Therapeutic Alliance
o The working relationship between the patient and therapist
o Established by collaboration, communication, therapist empathy and mutual respect.
o A strong therapeutic alliance positively influences treatment outcomes such as improvement in symptoms, health status, and patient satisfaction with care
- E-professionalism
o Beneficial to career when treating patients from a distance
o Negative aspects like boundaries and confidentiality arise
o Patients are changing behaviour based on information they find on line. Social media can be used to help people communicate and share ideas
o Collages protect public interest and enforce standards of practice of their profession.
§ Set standards of practice to ensure safe, ethical, and competent provision of services to the public
§ Guides practices to ensure that principles, standards, and legislation are interpreted and applied to practice
§ Includes social medial, confidentiality, privacy, consent, professional behaviours
Scope of Practice
Regulated Health Professions Act (RHPA, 1991)
- Legislative framework for regulating the scope of practice
- Intended to better protext, and serve the public interest, be an accountable system of self governance, provide modern framework for the work of health professionals, provide consumers with freedom of choice, provide mechanisms to improve quality of care
- IMPORTANT FEATURES:
o Each profession has its own act
o There’s a bunch of health regulatory colleges with rules for practice
o And a scope of practice for each profession
o Restricted titles (no one can use the title without the membership)
o Controlled acts – procedures or activities which may pose a risk to the public if not performed by a qualified professional
o Representation of qualification
o Health professions regulatory advisory council – independent body to the minister of health and long term care with a mandate to advice the minister of a number of items related to the regulation of health professions
o Health professions appeal and review board – independent third party with a mandate to review registration and complaints decisions of the health regulatory college
- Regulated V unregulated
o Professions not listen in RHPA are unregulated, and will not have a college that protects the public from the members of that profession, and they do not have to be a member of a regulatory college to call themselves a member of that profession
- Scope of practice
o
o Each regulated profession has a statement that describes their job
o It protexts the public by ensuring that care provided by practitioners is wihting their skills and knowledge
o Does not prevent others from doing the same activity
§ There is lots of overlap between jobs
- Controlled acts
o Considered high risk and could cause harm,
o Dictated by RHPA
o 14 controlled acts
1. Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.
2. Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth.
3. Setting or casting a fracture of a bone or a dislocation of a joint.
4. Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust.
5. Administering a substance by injection or inhalation.
6. Putting an instrument, hand or finger,
i. beyond the external ear canal,
ii. beyond the point in the nasal passages where they normally narrow,
iii. beyond the larynx,
iv. beyond the opening of the urethra,
v. beyond the labia majora,
vi. beyond the anal verge, or
vii. into an artificial opening into the body.
7. Applying or ordering the application of a form of energy prescribed by the regulations under this Act.
8. Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept.
9. Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eyeglasses other than simple magnifiers.
10. Prescribing a hearing aid for a hearing impaired person.
11. Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning.
12. Managing labour or conducting the delivery of a baby.
13. Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response
14. Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning.
- Delegation of controlled acts
o Permitted in order to make delivery of health care more efficient and effective for clients, but it must be in the patients best interests and as safe and effective as it would be by the person delegating
o Responsibility always remains with the person who delegated the act
Privacy Legislation
RHPA 1991 sets rules for
- Registering members, handling complaints, conducting investigations, carry out discipline hearings, handling fitness to practise hearings, quality assurance program, patient relations program, mandatory reporting, funding for victims of sexual abuse by members, appeal processes regarding registration and complaint decisions
Personal Information Protection and Electronic Documents Act (PIPEDA)
- Created in 2004
- People have the right to access their personal information held by an organization. They also have the right to challenge its accuracy
- IT can only be used for the purposes for which is was collected, if an organization is going to use information for other purposes they must obtain consent again
- 10 Fair information principles
1. Accountability
2. Identifying Purposes
3. Consent
4. Limiting Collection
5. Limiting Use, Disclosure and Retention
6. Accuracy
7. Safeguards
8. Openness
9. Individual Access
10. Challenging Compliance
Federal Privacy Act (1985, amended 2019)
- Purpose is to extend the laws that protect the privacy of indiviudals with respect to personal information about themselves held by a government institution and that provide individuals with a right of access to that information
- Federal government runs health care in National Defence and Correctional Service of Canada department
Canada’s anti-spam legislation (CASL)
- An act to promote the efficiency and adaptability of the Canadian economy by regulating certain activities that discourage reliance on electronic means of carrying out commercial activities and to amend the Canadian Radio-Television and telecommunications commission act, the competition act, the personal information protection and electronic documents act and the telecommunications act
- Aims to protect consumers and businesses from the misuse of digital technology, including spam and other electronic threats and to help businesses stay competitive in a global digital marketplace
Personal Health Information Protect Act of Ontario PHIPA
- Ontario’s health specific privacy legislation, governs how personal health information may be collected, used, and disclosed in the health sector
- Regulated health information custodians and individuals and organizations that receive
- Creates a consistent approach to protecting personal health information across the health sector
- Designed to give individuals greater control over how their personal health information is collected, used, or disclosed
- Requires custodians to obtain consent before PHI is collected, used, or disclosed
- Provides individuals with the right to access and request a correction to their PHI, and a means for independent review and resolution of complaints through the office of the information and privacy commissioner of Ontario IPC when privacy rights relating to PHI have been violated
- Health Information Custodian (HIC)
o A person or organization that has a reason to know personal health information
o Includes: health care practitioners, community care access corporations, hospitals, psychiatric facilitates, pharmacies, Canadian blood services etc
o Agent must notify custodian if personal health care information the agent is handling is lost, stolen, or accessed by unauthorized people
What is PHI?
- Information that can identify an individual (or can be combined to identify an individual), and relates to
o Mental or physical health of indivudal, including information that consists of health history of individuals family
o Providing health vare ot the individual including the identification of a person as a provider of health care to the individual
o The plan that sets out home and community care services for the individual to be provided by a health service provider or OHT under connecting care act
o Payments or eligibility or coverage
o Donation or testing of an individual’s body part or bodily substance
o Individual’s health number or
o Identification of substitute decision maker
Practice, is it PERSONAL HEALTH INFORMATION:
| Personal Health info | Why |
Paper with name, DOB and address | NO | Not related to health |
Paper or electronic record with names of client and kinesiologist providing care | yes | Link to provider
|
Phone message or email reminding client of next clinical appointment | maybe | Would be yes if message has name and health care info in the email |
Paper or electronic record with client’s initial DOB, clinic where they are getting treated and diagnosis | yes | Link between all of the information |
A phone call by Rkin to family physician about a client describing treatment plan but omitting client’s name | Nope | Cannot link in the client |
A conversation between OT and nurse about a patient whom they are both caring for | Yes | Easy to link |
Rough notes taken by a student during an assessment they are planning referring to in a formal assessment report | Yes | Info that connects it Also just feels wrong
|
A photo on health care students one they took on placement of smth in a patient’s medical chart as a way of taking notes | yes | The PHI is moving outside of the chart |
Personal health information protect act (PHIPA) terms
- Collect: gather, acquire, receive, or obtain the information by any means from any source
- Use: view handle or otherwise deal with the information
- Disclose: make information available to another health information custodian or another person
PHIPA principles again but with more info this time
1. Accountability
o HIC must take reasonable steps to ensure a number of things including that records are kept in a manner that ensures that legislation and professional standards are respected
2. Identifying Purposes
o HIC are their agents must ensrue that the purpose for which they routinely collect, use, disclose or retain PHI is clear to the individuals whose PHI they are managing
3. Consent
o When PHI is being collected, used, or disclosed there must be informed consent, either by the individual whose PHI it is, or by their substitute decision maker (SDM) if the individual is not capable of making the decision autonomously
4. Limiting Collection
o Only collecting data for the purposes they are required, the purposes for which individuals provide consent
5. Limiting Use, Disclosure and Retention
o Legally permitted uses of PHI are: for which is was created for collecting, for planning, delivering or monitoring services for which the custodian allocates funding or other resources, risk management or other activities to maintain quality of care, for educating agents to provide health care, for obtaining payment, verifying or reimbursing claims etc, and for research conducted by the custodian (subject to restrictions)
o Legally permitted disclosures are: within circle of care, outside circle of care with consent of patient or SDM, to SDM, within the organization for certain audit or accreditation purposes, to a successor with attempt to gain consent if a planned succession
o Custodians are responsible for ensuring that retention policies and standards are followed
6. Accuracy
o Custodians are responsible for ensuring that reasonable steps are taken to ensure records are accurate, complete and up to date
7. Safeguards
o Custodians must take reasonable steps against theft, loss and unauthorized use or disclosure and to ensure that the records containing the information are protected against unauthorized copying modification or disposal
8. Openness/transparency
o Custodian must display or make available a written public statement about its privacy policies
9. Individual Access
o Custodian must provide individuals with access to their personal health information upon request with rare exceptions, and a valid request for access can be oral or in writing
10. Challenging Compliance
o Information privacy commissioner of Ontario (IPC-O) and regulatory health colleges to investigate complaints from the public and to enforce penalties on practitioners who fall short of the expectations under the law
Health Care Consent Act, 1996
- Provides rules with respect to consent to treatment that apply consistently in all settings
- Facilitate treatment for persons lacking the capacity to make decisions about such matters
- Enhance the autonomy of persons who whom treatment is proposed by
o Allowing people found to be incapable to apply to the consent and capacity board for review of the finding
o Allowing incapable persons to request that a representative of their choice be appointed by the board for purpose of making decisions on their behalf concerning treatment
o Requiring adherence of the treatment wishes expressed by persons while capable after attaining 16 years of age
- Intended to
o Promote communication and understanding between health care practitioners and their patients
o Ensure a significant role for supportive family registrants when a person lacks the capacity to make a decision about a treatment
o Permit intervention by the public guardian and trustee only as a last resort in decisions on behalf of incapable persons concerning treatment
Colleges Associations and Alliances
Regulatory body
Purpose
- Protect the public
- Created by legislation to regulate the profession of kinesiology in the public interest
Membership
- Mandatory
- Requires passing an exam
- Requires continuing proof of competency
Roles
- Sets requirements
- Develops standards of practice
- Receives and investigates complaints about practitioner’s practice and administers appropriate disciplinary action when necessary
- Maintains a register of individuals eligible to practice
Governance
- By peers and members of the public appointed by the government
- Accountable to the public and Ontario government and members of college
Association
Purpose
- To advocate on behalf on members
- Mandate is to advance awareness of the profession and market the profession to the public and other jobs
Governance
- board of directors who are elected members
- accountable to the members of the association
Membership
- voluntary
- based of professional designation
- membership fees not proof of competency
Roles
- advocates with policy makers and the interest of members
- markets and promotes the profession
- represents the members interests by monitoring developments which may impact scope of practice, employment opportunities and enhancing relationships with related professions
COKO
- regulatory body overseeing kinesiologists in Ontario
- Protects the public
o Sets requirements for entry-level practice
o Maintains a list of individuals qualified to practice kin
o Develops rules and guidelines for kin practice and conduct
o Investigates complaints
o Requires R.Kins participate in program that helps ensure that their knowledge and skills are up to date
- Receives its authority form kinesiology act 2007 and regulated health profession act 91
Practice standards and guidelines
Practice Standards
Outline the expectations for kinesiologists that contribute to the public protection, inform kinesiologists of their accountabilities and the public of what to expect of kinesiologists
Practice guidelines
Help kinesiologists understand their responsibilities and how to make safe and ethical decisions in their practice
1. Advertising
o Information must be accurate, true, verifiable by kinesiologist, professional and not misleading by omitting relevant information or including nonrelevant information
o Advertised services must be in Rkin practice scope
o Must be comprehensible by the audience and in accordance with the generally accepted standards of good taste of both its intended audience and profession
o Must not include anything that could be interpreted as intending to promote a demand for unnecessary services
o Do not contain information that could be a testimonial or endorsement of a member or his or her practice from an individual or organization
o Any advertised fees or prices meet the expectations for truth and accuracy
o Cannot contain statements with guarantees, comparative or superlative statements about quality/people. Testimonial by anyone, endorsement of a drug product or brand, communication undignified or in poor taste
o May not solicit patents by public medium
o Must be with the colleges practice standard on conflicts of interest
2. Conflicts of interest
3. Consent
o Fully informed, voluntarily given, related to patients/clients condition and circumstances, not obtained through fraud or misrepresentations, where appropriate, evidenced in a written form signed by patient or otherwise documented
o Informed consent: the nature of assessment/examination or treatment, why the patient should have it, the alternatives, the effects/risks/side effects, and what might happen if patient choses not to
4. Discharging a client
5. Dual health care
o Dual health care practices occur when COKO practices as Kin and in another health care discipline (regulated or unregulated)
o Must kept the two separate (even with one client)
§ Separate bookings, entries in records, billing, obtaining consent for each role
o Ensure that treatments are based on clients needs, ensure that clients are provided with information to understand the persons role and accountability in performing treatment
o Ensure clients are provided with services they sought
o Ensure records demonstrate which services have been provided each time
o Claiming only time worked withing scope of Kin for continued hours with college
o Ensuring that any care provided by the member in another discipline is not done in effort to avoid COKO standards
6. Fees and billing
7. Infection control
8. Professional boundaries
9. Professional collaboration
10. Record keeping
11. Supervision and education of students and support personnel
***end of lecture as questions about what would you do in the scenarios
Code of ethics
Defines the ways kinesiologists should uphold the integrity of the profession, serve the interests of patients/clients and act in all manner that justifies public trust
Essential Competencies of Practice for Kinesiologists in Ontario
Defines the knowledge skill judgment and attitudes required to practice in public interest
Ethical Foundations
Morals: sense of right v wrong, related to values duty and character
Ethics: a systematic study of and reflection on morality, a system of moral beliefs that deal with right and wrong
Personal Morality – the values and principles individuals personally live by and believe to be morally right and sound
Group Morality – the values that are adopted as part of a self selected subgroup
Societal Morality – what our society approves of being right and acceptable
Ethical Theories or foundational constructs
Teleological
– focus is on the effect the consequences or the end result, minimizing adverse consequences while bring about the greatest good
– “The ends justifies the means”
Deontological theory
- Focus in on rules without particular concern for consequences
- Forms basis for religious commandments and edicts, professional codes of conduct and societal laws
- “Don’t lie, don’t steal, don’t cheat”
Biomedical ethics
- Study of professional practice interested in ethical issues related to health
- Field continues to grow with advances in medical technology
Health care ethics
- Unique as patients are injured or in pain and are more vulnerable
- Delivery is often emergency basis
- Consequences of decisions can be life altering
Ethical Principles
· Autonomy
o Self determination that is free from controlling interferences by others and personal limitations preventing meaningful choice
o To be autonomous
· Beneficence
· Patient care in in best interest
· Only do good
· Non maleficence
o Doing no harm
o Providing care without doing harm by omission or commission
· Justice
o Fairness
o Distributive
§ Social level. This health care equitably distributed.
o Comparative
§ Individual level, reimbursement and denial of care for individual
§ Distinct treatment based on page disability gender etc
· Fidelity
· Maintaining commitments to patients, profession, employer etc
· Veracity
· Duty to be truthful and honest
COKO Principles of Ethics – REACH
Respect, Excellence, Autonomy/wellbeing, Communication, collaboration and advocacy
ETHICAL FRAMEWORK
RIPS MODEL
1. Recognize and define the ethical issues
· Incorporates gathering information, identify Realms processes and situation
· Realm:
o Individual: concerned with good of patient, focusing on the rights duties and relationships with the patient
o Organizational/institutional – concerned about the good of the organization and focuses more on structures and systems
o Societal: focuses on common good and is the most complex
· Individual process: What does the ethical situation require of me
o Moral sensitivity: recognizing, interpreting and framing ethical situations
o Moral judgment: deciding on right v wrong actions
o Moral motivation: emphasis on ethical values over other values, self-interest, status, financial gain
o Moral Courage: implementing the chosen action, develop a plan in the face of barriers
· Situation: Define the situation
o Issue or problem: Important values are present and may be challenged
o Dilemma: two alternative courses of action may be taken “right v right”
o Distress: you know the right course of action but are not authorized to empower or perform it
o Temptation: “right v wrong” situation in which you may stand to benefit from doing wrong thing
o Silence: Ethical values or challenged, but no one is speaking about this challenge to values
2. Reflect
· Who are interested parties
· What are relevant laws, regulations, professional standards, codes of ethics
· What are possible consequences – intended or unintended
· Are any of the right v wrong tests positive (legal, stench, front page, mom)
3. Decide the right thing to do
· For ethical dilemmas: situations where there are two right answers
· Rule based: follow the rules, duties, obligations or ethical principles in place
· Ends based: determine the consequences or outcomes of alternative actions and good/harm that will result from all interested parties
· If right v wrong go to step 4
4. Implement, evaluate, re-assess
· Implement your plan
· Reflect personally and professionally, what has been learnt
Cultural Competence
Definition of culture
· The customary beliefs, social forms, and material, traits of racial, religious, or social group
· Characteristic features of everyday existence shared by a people in place or time
· The shared attitudes, values, goal, and practices that characterize an institution or organization
· The set of values, conventions or social practices associated with a particular field, activity or societal characteristic
· The integrated pattern of human knowledge, belief and behaviour that depends on the capacity for learning and transmitting knowledge to succeeding generations
Dimension of cultural groups/ identities
· Indigeneity, ethnicity, religion, language, place/region of origin
· Gender identity / sexual orientation
· Disability or other experience driven culture
· Age assumptions
· MORE!
Canadian values:
· Autonomy
· Veracity
Definitions
- Cultural sensitivity
o Being aware that cultural difference and similarities each exist and have effects on values, learning and behaviour
- Cultural safety
o Refers to an environment perceived as safe by the people who may seek services, free of microaggressions, racism, discrimination, or denial of a person’s identity and what they need/seek
- Cultural competence
o Set of congruent behaviours, attitudes and policies that come together to enable a system, organization, or professionals to work effectively in cross cultural situations
- Cultural humility
o Process of openness self awareness, being egoless, 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
Cultural competence Continuum
Useful for considering how health care practitioners may think about intercultural interactions
Cultural destructiveness
- Attitudes, policies, and practices which are destructive to cultures and consequently to the individual within the culture
Cultural incapacity
- No intenion to be destructive to culture but lack capacity to help people of a different cultures
- Dominant client group serves as norm for all care
- System conveys that people who are different are not welcome or valued
- Expectation is that people of minority cultures will adapt to, accept and even be grateful for the care provided
Cultural blindness
- The existence of cultural difference is denied in a desrie to be unbiased and treat all clients identically
- Emphasizing equality over equity
- “I don’t see colour”
Cultural pre competence
- Recognizing some needs based on culture, making some movement to meet those needs
Cultural competence
- Recognition of and respect for differences among people
- Ongoing efforts at self assessment and working with diversity
Cultural proficiency
- Beyond competence, looking for opportunities to create new knowledge and innovative practices.
Continuum limitations
- Assumes healthcare professionals can learn a quantifiable set of attitudes and skills that allow them to work effectively within the cultural context of patient and client
- Focuses on knowledge acquisition and does not focus on social justice
- Presented as technical and communication technique
- Potential to stereotype cultural groups
Cultural Humility
A dynamic and lifelong process focusing on self reflection and personal critique
Goes beyond the concept of cultural competence to include:
- A personal lifelong commitment to self-evaluation and self critique
- Recognition of power dynamics and imbalances a desire to fix those power imbalances and to develop partnerships with people and groups who advocate for others
- Institutional accountability
Cultural Competemility
5 key principles
- Cultural awareness
o Process of conducting a self-examination of one’s own biases towards other cultures and the in depth exploration of one’s cultural and professional background
o Being aware of existence of documented racism in health care deliver
- Cultural knowledge
o Results from “process of seeking and obtaining sound educational foundation about the worldviews of different cultures. Patients in rehabilitation search for meaning of illness or disability. IT is their worldview that deeply influences what meaning they attach to their health, illness, and disability, as well as what they should do when they become ill or disabled”
- Cultural Skill
o The ability to conduct a cultural assessment to collect relevant cultural data regarding the clients presenting problem as well as accurately conducting a culturally-based physical assessment
- Cultural Encounter
o The process which encourages the healthcare professional to directly engage in face to face cultural interactions and other types of encounters with clients from culturally diverse backgrounds in order to modify existing beliefs about a cultural group and to prevent possible stereotyping
- Cultural Desire
o The motivation of the health care professional to want to engage in the process of becoming culturally aware, knowledgeable, skillful and seeing cultural encounters, not having too