prof dev

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  1. Observational Learning
    • Learning through experience
    • Being in the moment
    • Use of senses - sight, sound, smell, and touch
    • Intuition
    • Accurate self-assessment skills
    • Transformative - involves recognition and reflection
    • Road to expert as a practitioner
  2. Components of Expert Practice
    • Knowledge
    • Movement
    • Clinical reasoning
    • Virtue
    • Philosophy
  3. Knowledge
    • Multidimensional - cognitive, psychomotor, affective
    • Patient centered
    • Various sources
    • Specialty knowledge
    • Reflective process
  4. Movement
    • What you know, see, value
    • What patient does
    • What PT does - what they do with their hands, timing matters, everything changes after you touch the patient
    • Hands and entire body are keys to practice
    • Experts value fine tuned kinesthetic awareness
    • Can interally represent movement
    • Can recall previous movement
    • Value patient's body as source of knowledge
    • Experts move effortlessly, fluidly
  5. Clinical reasoning
    • Highly proficient data gathering skills
    • Expanded boundaries in problem-solving
    • Entered into jointly with patients and families - collaborative
    • Focuses on maximal function as a valued outcome rather than diagnosis
  6. Virtue
    • Personally-derived standards for performance - ever-chaning and not perfectionistic
    • Commited to caring without fear - of environment, of failure/of own limitations, or of differences
    • Strong patient advocates
    • Moral agents
    • Rewarded with a passion and joy in their work
  7. Philosophy
    • Heart of our work
    • Derived from movement, knowledge, virtue, and clinical reasoning
    • Beliefs about role as PT
  8. Observational learning as a Tool
    • Connect new knowledge to existing knowledge
    • Making the most of experience
  9. Making the most of experience
    • Look, listen & feel during demonstrations and in lab
    • Classmates & patients as sources of knowledge
    • Identify and develop self-knowledge - reflection-in-action and on-action
    • Ask questions
    • Interview CIs - use of knowledge, importance of movement, types of decisions, and virtue
    • Develop your own philosophy of practice
  10. Self-knowledge
    • Dependent on ability to self-assess
    • Self-assessment forms are only the beginning
    • Practice self-reflection
    • Positive self-talk
    • Pursue additional knowledge
    • Don't expect perfection
  11. What is ethics?
    "A system of moral principles or standards governing conduct"
  12. What is a code of ethics?
    • A dynamic "living" public document
    • "Articulates the values of the profession to the public it serves and has an established mechanism to hold practitioners accountable for adhering to ethical standards
    • One credential that is a Hallmark of a profession or professionalism
  13. 1847
    AMA wrote their first Code of Ethics
  14. Code of Ethics and Discipline (1935)
    • Defined limits of practice for physiotherapists
    • Stated that diagnosis, prognosis, and treatment were responsibility of MD only
    • Showed devotion and complete deference to physicians ... DUTY TO PHYSICIANS
    • Had a profession-wide ethics committee
    • Physiotherapists could not question a doctor's judgment
  15. 1935 Code - Four major violations for PTs
    • Making a medical diagnosis
    • Offering a medical prognosis
    • Advertising for patients
    • Criticizing a doctor or other co-workers
  16. 2002 APTA Code of Ethics in Guide
    • Both documents applied to all physical therapists (APTA members or not) and physical therpaist students
    • Was our "primary source of ethical guidance"
    • Patient-centered statements - FOCUS
    • Included - incorporation of "ethical decision making in every patient interaction"
  17. Need for Change
    • 6 year process initiated by APTA's ethics and Judical committee in 2004
    • In-depth analysis of APTA code and that other profession's
    • Growing sense of inadequacy of existing document related to ethical guidance across the many aspects of our profession
  18. Missing links in 2002
    • Focused solely on patient-client role of PTs - did not acknowledge PTs work as administrators, educators, researchers, and consultants
    • Demands on autonomous practitioners and direct access not addressed-state vary
    • Complexities of current health care environemnt e.g., interrrelationships between PTs, PTAs, other health care professionals
    • No reflection on elements of Vision 2020
    • Lack of definition of uniqueness of profession of physical therapy
  19. The New Code of Ethics - it is important to udnerstand that ...
    • All the principles and standards, both numbered and lettered, contain the word "shall" and are mandatory ehtical obligations
    • The language contained in the revised Code and Standards is intended to provide greater clarification of existing ethical obligations, thereby allowing the PT to have a clearer understanding of his/her existing ethical obligations
  20. Principles and standards
    • 1-duty toall individuals
    • 2-duty to patients/clients
    • 3- accountability for sound judgments
    • 4-integrity in relationships
    • 5-fulfilling legal and professional
    • 6-lifelong acquistion of knowledge, skills, and abilities
    • 7-organizational behaviors and business practice
    • 8-meeting health needs of people
  21. Standards of Practice for Physical Therapy
    • 6 standards
    • Provide foundation for assessment of PT practice
    • Essentials for high quality professional service to society
    • Includes specific Criteria for Standards of Practice
  22. 6 Standards
    • Legal/ethical considerations
    • Administration of physical therapy service
    • Provision of Service
    • Educaiton
    • Research
    • Community responsiblility
  23. administration of physical therapy services
    • statment of mission, purposes and goals
    • organizational plan
    • policies and procedures
    • administration
    • fiscal management
    • improvement of quality care & performance
    • staffing
    • staff development
    • physical setting
    • collaboration
  24. provision of services
    • informed consent
    • initial examination/ evaluation/ diagnosis/ prognosis
    • plan of care
    • intervention
    • re-examination
    • discharge/ discontinuation of intervention
    • communication/ coordination/ documentation
  25. Patient Bill of rights
    • first developed in 1972 by the American Hospital association
    • included in the Accreditation manual for hospitals
    • APTA had adopted a patient rights statement related to physical therapy
    • Generally covers right to care and respect/make informed decsions/ have information kept condifential
  26. Right to care/ respect
    • access to care
    • "undesirable" patients
    • safety
    • continuity of care
    • privacy
    • cultural/spiritual differences
  27. patient self-determination Act 1990
    a fedreal statute on right of patients and long-term care to exercise control over medical decision making, discesses advance directives
  28. right that information is kept confidential
    • information is confidential
    • patients need to know their rights and ho to proceed if have complaints
    • Privileged communication - established doctor-patient relationship & information comes form patient information and relates to care of patient
  29. health insurance portability and accountability act (HIPPA) 1996
    • protected health information includes individually identifiable health information
    • have a right to request a limit on certain uses ans releases, get a log of all releases, inspect and copy yout information, request thta information be added, and withdraw your permission to use or disclose the information
    • health care providers can use and disclose protected health information related to both payment and health care operations as specified in the law
  30. right to make decison
    • informed consent - written or oral
    • implied
    • emergency
  31. elements of informed consent
    • full disclosure - nature fo diease/condition; proposed tests and treatments; alternative treatments; risks and benefits
    • patient has capacity to comprehend
    • patient is free of coercion
  32. advanced directives
    • living will: concerns life-sustaining measures in the event of incapacitation. person must be both legally incapacitated and terminally ill
    • durable power of attorney for health care decisions: can designate anyone including a spouse, relative, attorney, friend, etc.
  33. competency vs. proxy
    • competency is a legal term. the courts consider all adults competent unless judged otherwise by a court of law
    • proxy is a designated person to make health care decision (durable power of attorney of health care). this has the force of law and the doctor is expected to follow the proxy's instruction
  34. assisted suicide vs. euthanasia
    • assisted suicide is when the physican provides the patient with a means for suicide
    • euthanasia is when the physican actually performs a procedure that causes death
  35. oregen suicide law
    1997 voters in oregon approved making oregon the first state to legalize physician-assisted suicide
  36. IRB consent
    • started after WWII and nazi war crimes
    • set procedures to inform patients of purpose of research, risks, and benefits
    • signed consent forms
    • change in protocol and consent has to be approved
  37. consent form IRB
    • written so that subject unerstand purpose of research, what they will do if they partiipate in it, the possible risks, the possible benefits
    • also, that the data will be confidential, subject can refuse without any penalty, can call if have questions, and has a contact if any injury occurs because of the research
  38. patient responsibilities
    • accurate and complete information
    • comply with instructions
    • finanaces
    • facility rules and regulations
    • respect for other patients and personnel
  39. PT/PTA relationship
    • intedependent
    • entails skillful communication
    • knowledge of PTAs education, training and skills
    • trust
  40. successful PT/PTA teams
    • understand job descriptors
    • common goals
    • mutual confidence/ trust
    • mutual respect
  41. PTA - education, supervision, delegation
    • education: associate's degree form an accredited program
    • supervision: must work under direction and supervision of PT
    • delegetion: can provide slected interventions, can progress patient, and provide patient safety and comfort
  42. Responsibilities that cannot be delegated to the PTA
    • Interpretation of referral
    • inital evaluation, problem indentfication and PT diagnosis/prognosis
    • Development or modification of interventions and plan of care or re-examination and which includes physical therpay goals and outcomes
    • determination of when the expertise and decision-making capability of the PT requires the PT to personally render PT interventions and when the PTA is appropriate
    • Re-examination of the patient/ client in light of their goals and reision of the POC when indicated
    • Discharge plan and discharge summary
    • oversight of all documentation for services rendered
  43. determining what can be delegated to the PTA
    • predictability
    • stability of the situation
    • observability of basic indicators
    • liability and risk management concerns
    • msision of pt for setting
    • needed frequency of re-examination
    • reimbursement
  44. PTA authority
    • part of delefation
    • based on policies of facility and your professional judgment: contact other health professionals, purchase equipment, and provide patient/family education
  45. Supervision of PTA by PT
    • PT must be accessible by telocommunications at all times while the PTA is treating patients
    • regularly scheduled and documented conferences with the PTA RE: patients
    • supervisory visit will be made at leat 1X/month or more frequently based on needs of patient and/or statutes
    • when PTA requests re-examination, when change in POC is needed, prior to discharge
    • supervision must be documented
  46. 7 domains of cultural competence
    • values and attitudes
    • communication styles
    • community/sonsumer participation
    • physical environment and resources
    • policies & procedures
    • population-based clinical practice
    • training and professional development
  47. culture
    • more than a reflection of race or ethnicity
    • consider relgion, educaiton, family, socioeconomic class
  48. self-assessment (CC)
    • individual level: cultural idenity grid
    • systems level: cycle of socialization
  49. examine cultural interactions
    • recognize the differences
    • search for common ground
    • distinquish between necessary & customary
    • avoid negative assumptions/stereotyping
    • assume commonality is discoverable
  50. Why is defensible documentation important?
    • record of patient care-ensures safety and quality of care
    • communication tool among healthcare providers
    • compliance with lawa/regulations
    • reimbursements for 3rd party payers
    • lets others know what PTs do
    • evidence in potential legal situation
    • research purposes (outcome analysis)
  51. What hsould you include in your documentation?
    • history
    • systems review
    • tests and measures
  52. History
    • general demographics
    • social history
    • emplyment/work
    • growth and development
    • living environment
    • general health status
    • general health status
    • social/health habits (past and current)
    • family history
    • medical/srgical history
    • current conditions/ chief complaints
    • functional status and activity level
    • medication
    • other clinical tests
  53. system review - cardio/pul
    • blood pressure
    • edema
    • heart rate and rhythm
    • Respiratory rate
  54. system review - integumentary
    • texture/ pliability
    • presence of scar formation
    • skin color
    • skin integrity
  55. system review - musculoskeletal
    • gross range of motion
    • gross strength
    • gross symmetry
    • height, weight
  56. system review - neuro
    • gross coordinated movement (tranfers, balance, gait)
    • motor function (motor control, motor learning)
  57. system review - communication
    • ability to make needs known
    • affect
    • cognition
    • consciousness
    • expected emotional/behavioral responses
    • language
    • learning styles/ preferences
    • learning barriers (health literacy)
    • orientation (person, place, and time)
  58. tests and measures
    • aerobic capacity
    • assistive and adaptive equipment
    • circulation
    • peripheral and cranial nerve integrity
    • motor funciton
    • motor performance
    • pain
    • posture
    • ROM and muscle length
    • self care
  59. top 10 complaints
    • poor hand writing
    • incomplete documentation
    • no documentation for date of service
    • abbreviations
    • documentation does not support billing
    • does not demonstrate skilled care
    • does not demonstrate medical necessity
    • does nto demonstrate progress
    • no change in patient status - restating the same thing day after day
    • intervention- no clarification of time, frequency, duration
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prof dev
prof dev
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