OT 510: Exam 2

Ethics

-Clinical decisions based on professional judgment - Involve personal and social morals and values

Dilemma

not a right/wrong answer

Occupational Therapy Code of Ethics

-Common set of values and principles -Promotes high standards of behavior and professional responsibility

Principle 1

Beneficence

Beneficence

-Demonstrates concern and well-being for the recipients of services The term implies kindness & mercy Fair and equitable treatment Fair and reasonable fees Advocacy for the recipients Respect for differences

Principle 2

Nonmaleficence

Nonmaleficence

-Do no harm to the recipient(s) of services. Physically Socially Financially Sexually Emotionally It involves "non-action to avoid harm"

Principle 3

Autonomy and Confidentiality

Autonomy and Confidentiality

-Respect the right of the individual to self-determination Collaborate with recipients, including family members and caregivers Inform recipients of potential risks of interventions Respect recipients decisions Protect all information (HIPAA)

Principle 4

Social Justice

Social Justice

-Providing services in a fair and equitable manner Act according to AOTA's standards to ensure the common good Educate the public about OT's value in promoting health and wellness,especially on a community-wide basis Advocate for fair treatment for everyone, as well as adequate resources for all

Principle 5

Procedural Justice

Procedural Justice

-Compliance with Laws and Policies Includes awareness of and compliance with institutional, local, state, federal, and international laws and policies, as well as AOTA documents Therapists must hold appropriate credentials to practice OT Take responsibility for continuing education Ensure that duties assigned match credentials Provide appropriate supervision

Principle 6

Veracity

Veracity

-Duty to tell the truth Qualifications, education, training, and competence must be represented accurately in all forms of communication Disclose any situation that may be a conflict of interest Document in a timely manner and according to law Accept responsibilities for own actions Do not plagiarize the work of others Do not participate in false claims about patients, other employees, or students

Principle 7

Fidelity

Fidelity

Treat colleagues and other professionals with fairness, discretion, and integrity Protect confidential information about colleagues, employees, and students Enforce Code of Ethics among professions Report illegal or unethical conduct

Occupational therapy values

-Altruism -Equality -Freedom -Justice -Dignity -Truth -Prudence

Process of Ethical reasoning

-Identify the ethical dilemma -Gather relevant facts about the case -Apply ethical theories and guiding principles to analyze the case -Problem solve practical alternatives - Decide on an action -Act on that choice -Evaluate how to prevent or cope with the dilemma should you encounter it again

Ethical Jurisdiction

-AOTA -NBCOT -State Regulatory Boards

US Healthcare System

A highly regulated system -US spends more money per capita on healthcare expenditures than any other country -No "perfect system" yet

Prior to WWII

little health insurance—people paid for services "out of pocket" or bartered.

1930's

Indemnity insurance emerged (retrospective—fee for service)

1945

First Health Maintenance Organization—however, it did not dominate until the 1980's (prospective).

1960's

Medicare and Medicaid established

1970's

healthcare costs skyrocketed

1980's

Medicare Reform (Diagnoses related group's)

1990's

Market-driven healthcare versus healthcare reform

Balanced Budget Act

1997: drastic cuts in Medicare reimbursement, including areas of occupational therapy service. 2000: restoration of some Medicare benefits due to patient, family, and provider pressure.

Medicare

Federally funded program covers: -People over the age of 65 -Medically disabled (all ages) -End-stage renal disease

Medicare Parts

Part A inpatient hospitalization SNF's-skilled nursing facility HHC- home health care Hospice Care- end of life care Part B physician and outpatient services HHC- home health care DME- durable Medical Equipment

Medicaid

-Insurance for people who are unable to afford health care (must meet requirements) -Federally and state-funded -Varies by state with coverage/usage

SCHIP

State Children's Health Insurance Program

State Children's Health Insurance Program

-Created in 1997 via BBA -Health insurance to children and some parents who are not eligible for Medicaid -Federally and state-funded

IDEA

Individuals with Disabilities Education Act

Individuals with Disabilities Education Act

-Federally and state-funded school-based program -Focus of care in the school system -Highest % of OTs work in school-based programs -Partnership between state and federal governments and school systems

Managed Care Organization

A form of healthcare coverage The member's care is managed by controlling the use of services, which in turn helps contain (keep down) COSTS.

Workman's Compensation

-State-run programs -Pay for healthcare related to a work injury (e.g., PT, OT, medical services) -Pay for medical services, salaries, vocational training, and for disability if determined by an MD

Uninsured

Approximately 46 million people in 2008

Implications

-OT's must be knowledgeable about reimbursement systems -Documentation is crucial -Need to be your client's advocate in dealing with third-party payers -Must stay up-to-date on regulations

Health-Care Organization Accreditation

-Nonprofit organizations serve to obtain quality care and services to protect the consumer using their services. -These organizations are called Accreditation Agencies. -These agencies set standards involving: delivery of services, quality care, documentation, and patient satisfaction/education.

JCAHO

Joint Commission on Accreditation of Health Care Organizations

Joint Commission on Accreditation of Health Care Organizations

-JCAHO evaluates the organization's compliance with the standards established -The organization being evaluated must comply with essential standards in order to receive Medicare reimbursement -Hospitals utilize this organization by choice

NCQA

National Commission for Quality Assurance

National Commission for Quality Assurance

-Assesses and reports on the quality of managed care plans -Voluntary service for MCO's -Standards relate to member satisfaction, quality of care, access, and services provided

CARF

Commission on Accreditation of Rehabilitation Facilities

Commission on Accreditation of Rehabilitation Facilities

Voluntary organization for rehabilitation providers

National organizations

AOTA, NBCOT

State organizations

State Regulatory Board, NHOTA

AOTA

American Occupational Therapy Association

American Occupational Therapy Association

- responsible for writing, revising, and enforcing the OT code of Ethics "...responsible for guiding and developing occupational therapy's standards and code of ethics and for defining the profession's scope of practice" (Brayman, 2009, pg. 231). -Began in 1917 as NSPOT and changed to AOTA in 1927 -Includes OT's, COTA's, and OT students

HIPAA

part of the OT code of ethics

NBCOT

National Board for Certification in Occupational Therapy

National Board for Certification in Occupational Therapy

Credentials OT's and COTA's to be able to work within the profession An examination is taken after a master's education and 6 months of fieldwork

State Regulatory Board

After passing the certification exam (NBCOT) an OT/COTA can apply for licensure within the state in which they want to practice. Each state has specific criteria regarding the duties and responsibilities of the OT/COTA.

NHOTA

-New Hampshire Occupational Therapy Association -Advances the profession within the state -Provides continuing education opportunities -Independent from AOTA, but they collaborate

ACOTE

Accreditation Council for Occupational Therapy Education

Accreditation Council for Occupational Therapy Education

-Works within AOTA -Sets standards for OT and COTA educational programs -Evaluates programs on a regular basis

Education, Credentialing and Licensing

-Certified at a professional level -Masters Degree -Accredited program by ACOTE -6 months of fieldwork- Level II -Certification by NBCOT -State licensed -Evaluation and intervention -Supervises COTA

Competence

-Practitioners are expected to be competent when they provide services -How does someone become competent? -on-going supervision -continuing education -experience -observation (of others and by others) -demonstration -communication

Levels of competence

Practitioners can obtain advance certification in specialty areas: CHT- certified hand therapist CPE- certified professional ergonomist SCLV- specialty certification in low vision

Important rule

If you don't know what you're doing or why you're doing it, don't do it!

Communication

-Is key in all that you do as an occupational therapist -Influences patient care -Influences peer interactions -Influences all roles you acquire

OT/COTA Team

-Supervision -Service Competency -Collaboration

Supervision

-Depends on skill, experience, and knowledge -Promotes learning, autonomy, and professional growth -Includes respect and trust -Communicates needs and type of supervision (also regulated by each state)

Service Competency

-Demonstration and verification of skills and knowledge of treatment This can be done by: - co-treatment - observation - individual education

Collaboration

-clear understanding of each other's role -agreement about each other's role -effective communication -respect for one another -clear expectations -dependability

A successful team

-Shared mission/goals -Clear communication -Clear expectations -Mutual respect -Open-mindedness -Effective support and resources

Interdisciplinary

-professionals may do an assessment together, with each one looking for discipline specific info. communication is usually done via team meeting -Team members have shared responsibility for providing services and support one another's goals for treatment. Separate assessments, then shared results to develop integrated and coordinated care.

Multidisciplinary

-several disciplines come together and work with a patient individually vs collaboratively -Team members work side-by-side one another. Roles are clearly defined and team members are aware of each others' scope of practice. (through documentation)

Transdisciplinary

-all team members share responsibility and are accountable for the established goals of the client -Team members share roles and have fluid ways of functioning together in order to provide comprehensive services. Often seen in early intervention settings.

The Occupational Therapy Process

-involves the interaction between the practitioner and the client -Collaborative -Dynamic process with the focus on occupation

Occupational Therapy Process 3 areas

-evaluation -intervention -outcomes

Evaluation Process

-Purpose: is to find out what the client wants and needs -Procedures are based on the client's age, diagnosis, developmental level, education, socioeconomic status, cultural background, and functional abilities -the therapists level of experience may affect the initial evaluation with a client

Referral

Starts the OT process -A request for service for a particular client is made -From MD, nurse, PT, other health practitioner

Screening

-The OT practitioner gathers preliminary information about the client and determines whether further evaluation and OT interventions are warranted. -Involves a review of the clients records, the use of a brief screening test, an interview , observation, and discussion with the referral source

Occupational Profile

-identifies the clients history and patterns of living -Gather basic demographics : age, gender, reason for referral, diagnosis -It provides the practitioner with a history of the clients background and functional performance with which to design interventions

Occupational Performance Analysis

-Uses the profile information to provide a direction to the practitioner to the areas that need further examination -Involves analyzing all aspects of the occupation to determine the client factors, patterns, skills and behaviors required to be successful -The evaluation requires the OT gather accurate and useful information to identify the needs and problems of the client to plan intervention. -Noted in three areas: interview, skilled observation, and formal evaluation procedures.

Analysis of occupational performance

select specific assessments to determine problem areas

process skills

includes motor, process, communication, and emotional components

Interview

-The primary mechanism for gathering information for the occupational profile -Planned, organized to gather needed information -Checklists -Questionaires -Quiet -Private -Build your rapport here ( initial contact, gather info, closure)

Observation

-Is the means of gathering information about a person or an environment by watching or noticing -Examples: posture, dress, social skills, one of voice, behavior, and physical abilities -Structured Observation: involves watching the client perform a predetermined activity

Formal Assessment

-Tests -Instruments -Strategies that provide guidelines

Intervention

Involves working with the client through therapy to reach client goals

5 Intervention Approaches

1.Create/promote 2.Establish/Restore 3.Maintain 4.Modify 5.prevent

Intervention review

modify plan if appropriate

Activity deamnds

includes analysis of social and space demands, objects used, and necessary activities

Purpose of Code of Ethics

1. Provide aspirational core values that guide members toward ethical courses of action in professional and volunteer roles 2. Delineates enforceable principles and standards of conduct that apply to AOTA members

Professional Reasoning

-Also called "clinical reasoning" -Used by practitioners to plan, direct, perform, and reflect on client care -Complex -Multifaceted -Metacognitive - thinking about thinking -Effected by the amount of experience one has

Professional Reasoning

It's a whole body process that involves: Thinking Observing Seeing Feeling Smelling Relatively automatic in expert practitioners

Schemata

building up a representation of what to expect based on experience -developing schemata and scripts is influenced by the therapists level of experience

Cognitive Processes used in Professional Reasoning

Schemata and scripts -Development of schemata and scripts take time and repetition of a therapist before clinical reasoning becomes automatic.

Scripts

rules to guide thinking (processes from initial treatment to discharge).

Types of Professional Reasoning

-Scientific Reasoning -Narrative Reasoning -Pragmatic Reasoning -Ethical Reasoning -Interactive Reasoning

Scientific Reasoning

-connected to understanding the condition -Focuses on the diagnosis of the illness or condition Is guided by theory Considers evidence from research to guide practice Does not consider the patient on a personal level

Narrative Reasoning

-to understand the person's meaning of occupation -Personal -Includes information from the patient and family -Focuses on the patient's history and "story"—past, present, and future -Considers the patient's culture -Helps the therapist make sense of the patient's circumstances

Pragmatic Reasoning

- includes treatment resources, organization's culture, team relationships, and reinbursment -"Practical" reasoning -Considers the realities of current service delivery -Scheduling options -Payment -Equipment needed and available -Therapist's skills -Organizational policies -Not focused on the client's condition but the realities of providing services

Ethical Reasoning

-utilized to decide what is the best course of action for the person -A systematic approach to a moral conflict -Analyzes the dilemma -Helps generate alternative solutions -Determines actions needed

Interactive Reasoning

-connected to trust, motivation, and outcome of the theraputic relationship -Thinking that helps the therapist build a positive relationship with the patient -Uses positive interaction and communication skills -Allows for collaboration in treatment -Identify problems -Solve problems

How professional reasoning applies to the assessment process:

-Collaborative -Designed to understand the interaction between the individual, their occupational patterns, and the environment in which they live.

Clinical Reasoning

-Clinical reasoning is multi-faceted. -Clinical reasoning improves with experience and becomes more automatic. -Clinical reasoning is not simple. -Your clinical reasoning, time, and effort can change a person's life!

Genesis Rehab Services

- Genesis Hackett Hill Center - 70 bed Skilled Nursing Facility (SNF) - Rehab Team - 2 OTR's + 3 COTA's -2 PT's + 2 PTA's -SLP -Short Term Rehab and Long Term Care -Supervision of 2 COTA's

Short Term rehab

-Acute conditions following a hospitalization -Falls -Cardiac and Pulmonary Conditions -Orthopedic Conditions -Neurological Conditions -Behavioral/Emotional Component -Drug and alcohol recovery as a secondary diagnosis is becoming more frequent -It is rare for a SNF patient to have just one diagnosis -Patients at a SNF and other settings usually have a combination of multiple diagnosis which affect their course of treatment -SNF is a lot all at once and can be overwhelming (spiderweb) -Up to 90 days of coverage in medicare treatment for SNF

Comprehensive Evaluation and Treatment

-Occupational profile, prior level of function and home environment - what is their goal and what is their home life like -Strength and ROM (range of motion) -Sensory - finger tips/how they feel -Pain/Integumentary - what are they feeling -Respiratory status - amount of time it takes for them to be out of breath, how is their breathing -Cognition - family and patient understanding -Balance - can they balance, what does it look like -Standardized testing - shows progress -SNF takes about an hour to perform all of these with nothing more and nothing less done

Long Term Care

-Seating and positioning - increases safety (ex. How high is the wheelchair? Are their feet on the ground correctly? Do they need a cushion to lean them back or forward more?) -Contracture management (ex. If their hand is stuck together use a tool to open their hand a little bit to alleviate pressure) -Strengthening and balance re-education -Fall prevention -Functional skills training -Adaptive equipment training at meal time -Development of a routine for participation in occupations -Caregiver education is a major part of LTC (long term care)

interdisciplinary team

-OT/PT/SLP -Nursing -Social Services -Activities -Doctor/Nurse Practitioner -Psych services -Palliative care/Hospice -Consulting physicians - orthopedics, neurologist

Alicia Wood - College

Utica College of Syracuse, Class of 2001

Alicia Wood - Level I Fieldwork

Chemung County Psychiatric Hospital, Elmira NY -Inpatient and Outpatient services -Community reintegration -Mostly adults -Worked closely with recreation Seneca Lake Terrace, Geneva NY -LTC and Skilled Nursing Facility -Observed home evals -Multiple Diagnosis served

Alicia Wood - Edward White Hospital (Level II A)

Divided into 2 experiences -Acute Care, ICU, and Transitional Care Unit - 1st 6 Weeks -Rehab to home -Ortho, CVA, cardiac -Outpatient, CHT - 2nd 6 Weeks -Workers comp and work hardening -Hands -Heavy modality use

Alicia Wood - Level II B

-United Cerebral Palsy, Boome County, NY -Early Intervention thru Preschool -Sensory Integration -Oral Motor -Wheelchair positioning -Home visits

Alicia Wood - Professional Life Facts

-Worked in skilled nursing/long term care for 20+ years -Initially worked under a temp license until taking the NBCOT exam -Became a manager young and spent 13 years in that role -7 years ago she went back to treating OT and has enjoyed it since -Transitioned from SNF/LTC to homecare 1 year ago