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Bioethics
The application of ethics to matters of human life
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Provides safeguards for subjects involved in research studies (Mengele and Nazi physicians)
Nuremberg Code(1947)
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National Research Act (1974)
Created criminal sanctions for human rights violations
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Provides further clarification on the ethical treatment of human subjects during medical studies
Declaration of Helsinki (1964)
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Belmont Report (1979): summarizes ethical principles and guidelines for research involving ____________.
human subjects
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Organized patterns of thought regarding the origin, purpose, and place of humans in the universe
• Morals shaped by cultural background and religious beliefs • Includes an ethical code of conduct about how people should relate to the world
Belief systems
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What shapes our ethical beliefs?
Religions and Values
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Your personal values that are highly specific to you adopted through cultural and/or professional subgroups
Value system
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Schemes of thought and action that usually include a belief system, sacred writings, faith, devotional rituals, and organizational structure.
Religious values
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“Good life”
The unique value system for each person
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Three sets of values:
personal, professional, and societal
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A moral problem that requires a choice between 2 or more opposite actions, each of which is based on an ethical principle
Ethical dilemma
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Ethics committees
made up of healthcare professionals, ethicists, lawyers, and clergy
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JCAHO
Joint Commission on the Accreditation of Healthcare Organization
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RIPS
Realm-Individual Process-Situation
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Glaser’s three realms
Individual realm: Institutional/organizational realm: Societal realm
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Societal realm
Concerned with the common good; is the most complex realm
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Concerned with the good of the organization
Institutional/organizational realm
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Individual realm: concerned with the good of the _____/_______; deals with the least complex problems
patient/client
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Moral sensitivity,Moral judgment,Moral motivation,Moral courage
Individual Processes
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recognizing, interpreting, and framing ethical situations
Moral sensitivity
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implementing the chosen ethical action even though doing so causes adversity
Moral courage
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prioritizing ethical values over financial gain or self interest
Moral motivation
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Moral judgment
deciding between right and wrong actions using the 5 ethical principles
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Problems or situation
important moral values are being challenged
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practitioner knows right course of action but encounters barrier
Distress
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Involves 2 or more ethical principles that are both correct but both cannot be followed
Dilemma
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Type B barrier:
knowing something is wrong but practitioner unable to identify it
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Choice must be made between right and wrong action
Temptation
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_______________: institutional or financial in nature, practitioner not empowered to make the decision
Type A barrier:
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Step 1: Recognize and Define the Ethical Issue • RIPS • Step 2: Reflect • Step 3: Decide the Right Thing to Do • Step 4: Implement, Evaluate, and Assess Needed Changes to Prevent Recurrence
Ethical Decision-making
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Altruism
the primary regard for or devotion to the interest of patients/clients, thus assuming the fiduciary responsibility of placing the needs of the patient/client ahead of the physical therapist’s self interest.
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the desire to identify with or sense something of another’s experience; a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others.
Compassion
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____________ competence is the lifelong process of maintaining and ___________ competence through ongoing self-assessment, development, and implementation of a personal learning plan, and subsequent reassessment.
Continuing; documenting
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is the commitment to meeting one’s obligations to provide effective physical therapy services to individual patients/clients, to serve the profession, and to positively influence the health of society.
Duty
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truthfulness, fairness, doing what you say you will do
Integrity
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The PT/PTA team works together, within each partner’s respective role, to achieve optimal patient/client care and to enhance the overall delivery of physical therapy services.
PT/PTA collaboration
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the active acceptance of the roles, obligations, and actions of the PTA, including behaviors that positively influence patient/client outcomes, the profession, and the health needs of society.
Responsibility
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Includes behaviors that positively influence patient/client outcomes, the profession, and the health needs of society.
Responsibility
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Social responsibility is
the promotion of a mutual trust between the profession and the larger public that necessitates responding to societal needs for health and wellness
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makes explicit the values and standards of the profession, providing guidance to carry out the professional responsibilities of PTs and PTAs
APTA Code of Ethics
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Intended to serve the PTA in interpreting the Standards of Ethical Conduct for the PT
Guide for Conduct of the Physical Therapist Assistant
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Standard #1:
Physical therapist assistants shall respect the inherent dignity, and rights, of all individuals.
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Physical therapist assistants shall be trustworthy and compassionate in addressing the rights and needs of patients/clients.
Standard #2
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Physical therapist assistants shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, other healthcare providers, employers, payers, and the public.
Standard #4
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Standard #5:
Physical therapist assistants shall fulfill their legal and ethical obligations
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Physical therapist assistants shall enhance their competence through the lifelong acquisition and refinement of knowledge, skills, and abilities.
Standard #6
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Standard #8:
Physical therapist assistants shall participate in efforts to meet the health needs of people locally, nationally, or globally.
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Physical therapist assistants shall support organizational behaviors and business practices that benefit patients/clients and society
Standard #7
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An administrative body, called a board, within each state defines the scope and regulates the practice of physical therapy
State Physical Therapy Boards
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Each board writes rules and regulations that give detailed requirements for educational institutions and practitioners regarding the scope of practice, licensure, competency, disciplinary sanctions, and supervision of physical therapy assistants and aides
State Physical Therapy Boards
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How physical therapy is defined and legally regulated falls within the jurisdiction of each individual state
State Practice Acts
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How many licensing boards are there in the US states and territories?
53
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Access to physical therapy services without requiring a referral from another healthcare provider (i.e., MD)
Direct Access
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When did Georgia enact a physical therapy practice act?
1965
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Provides definitions for physical therapy, PT, PTA, aide, etc. • Describes the Board, its members, and its duties • The license required for a PT, PTA, and aide • Requirements for practicing as a PT, PTA, and aide • Supervision requirements • License requirements: reciprocity, renewal • Training permit requirements • Revoked or suspended licenses
• Georgia State Practice Act •
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means a person licensed to practice physical therapy as defined in this chapter and whose license is in good standing
"Physical therapist"
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shall be designated by the initials "P.T.A."
"Physical therapist assistant" or "physical therapy assistant"
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The Georgia board shall consist of _______ members, as provided in Code Section 43-33-6, each of whom shall be appointed by the ________ and confirmed by the ______ for a term of three years and until a successor is appointed and qualified.
Eight, Governor, Senate
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In addition to being a state resident, what is the eligibility requirements for appointment to the Georgia board?
Six members of the board shall be licensed as physical therapists under this chapter who have practiced or taught physical therapy for at least three years. • At least one member shall be licensed and practicing as a physical therapist assistant for at least three years. • The eighth member appointed from the public at large and shall have no connection with the practice or profession of physical therapy
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All licenses must be renewed _________ (December 31st of odd years)
Biannually
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30 hours of continuing education are required for license renewal (including _______________________)
(4 hours of ethics & jurisprudence)
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License designation must be displayed where?
on a name tag
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In home health settings the PT must meet with the PTA at least ________ _________ to review the caseload
once weekly
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In school settings the PT must make an once-site visit no less than every ____ months for students scheduled for weekly sessions with the PTA and every ___ months for students scheduled one visit/month or less with the PTA
two; five
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Students (PT/PTA) may not treat and bill for patients under Medicare ____
B
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How many aides can a licensed PT or PTA supervise a maximum at any given time?
2 aides at any given time
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joint federal and state program; must be authorized by agency of state government in order to provide PT services
Medicaid
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Medicare Part A
hospital insurance
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Medicare Part B
medical insurance
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Federal healthcare plan for people 65 of age and over, those who are disabled, and those with kidney failure; must be authorized by agency of federal government in order to provide PT service
Medicare
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Social Security Amendments of 1965
Medicare; Medicaid
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Americans with Disabilities Act of 1995
prohibits discrimination based on disability • Protects the rights of people with variety of ailments • Provisions include many issues of special concern to PTs and PTAs • Access to public buildings • Equal protection of disabled persons • Nondiscrimination in employment
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• Limits the extent to which health insurance plans may exclude care for pre-existing conditions • Sets standards regarding the electronic exchange of private and sensitive health information
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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Requires the consent of clients to use and disclose protected health information • Grants clients the right to inspect and copy their medical records • Give clients the right to amend or correct errors • Requires all hospitals and healthcare agencies to have specific policies and procedures in place to ensure compliance with such rules
HIPAA’s Privacy Standards
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any information, oral or recorded, relating to the health of an individual, the health care provided to the individual, or payment for the health care provided to that individual
Heath information
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Refers to physical therapy clinics and other venues in which therapists practice
Covered entities
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PHI:
Personally-identifiable heath information
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Minimally necessary information: refers to the amount of ____________ required to accomplish the intended treatment/purpose
information
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Three primary goals of the Patient's Bill of Rights issued in 1997
• Strengthen consumer confidence • Reaffirm importance of strong patient-health care provider relationship • Reaffirm critical role consumers play in safeguarding own health
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articulated seven sets of rights and one set of responsibilities
Patients’ Bill of Rights
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1. The Right to Information 2. The Right to Choose 3. Access to Emergency Services 4. Being a Full Partner in Health Care Decisions 5. Care Without Discrimination 6. The Right to Privacy 7. The Right to Speedy Complaint Resolution • Taking on New Responsibilities
Rights and responsibilities articulated by the Patient's Bill of Rights
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11 specific duties of the Georgia board:
Approve applicants for licensure • Determine applicant licensure qualifications • Determine qualifications of educational programs for PTs and PTAs • Investigate violations of the GA practice act • Conduct all hearings in cases • Provide disciplinary action to licensees • Adopt an authorized state seal • Establish licensing fees • Adopt and publish a code of ethics • Issue training permits • Adopt rules and regulations for enforcement of board laws
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