California Physical Therapy Ebook Continuing Eduction - PTC…

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CALIFORNIA Physical Therapy Continuing Education

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Inside: Mandatory

26-hour Continuing Education Package $195

Ethical Practice In Physical Therapy

ELITELEARNING.COM/BOOK Complete this book online with book code: PTCA2622B

TABLE OF CONTENTS Chapter 1: Ethical Practice in Physical Therapy (Mandatory) [2 CC hours] 1 This course covers the principles and standards of ethical practice for physical therapists and assistants. It also references the Codes of Ethics and Conduct Guides of the American Physical Therapy Association (APTA) and the Federation of State Boards of Physical Therapy (FSBPT). Ethical issues related to professional practice are discussed. Steps to identify potential conflicts and strategies for decision making to avoid and resolve ethical issues are included. THIS COURSE FULFILLS THE REQUIREMENT FOR ETHICS, LAWS, AND REGULATIONS Chapter 2: Clinical Mentorship: Teaching and Learning Strategies in Clinical Practice [3 CC hours] 13 The purpose of this intermediate-level course is to provide foundational concepts of effective clinical teaching and learning, including teaching strategies and student assessment in the clinical education environment for physical therapists. To become an effective teacher in a complex and uncertain environment such as clinical practice, one needs to demonstrate essential teaching principles, adapt to the learning needs of the student to facilitate learning, and assess the learner’s (student or new professional) knowledge, skills, and abilities to determine readiness to enter clinical practice. Upon completion of this course, the participant will gain exposure to effective teaching tools to use in the clinical setting, strategies to facilitate the clinical reasoning process of the student, and assessment of student learning during the clinical experience. This course is recommended for clinical instructors in physical therapist or physical therapist assistant. Chapter 3: Evidence-Based Management of Knee Osteoarthritis [4 CC hours] 28 The purpose of this course is to provide physical therapists and physical therapist assistants with up-to-date, evidence- based information pertaining to the diagnosis, treatment and prevention of knee OA. Although this course will be most applicable to physical therapists and physical therapist assistants who work with older individuals in outpatient settings, the increased incidence of OA makes the information in this course relevant to therapists in a variety of settings. Even therapists who specialize and treat patients in areas other than orthopaedic settings will likely encounter individuals whose OA affects their participation, mobility, or function. Chapter 4: Examination and Management of the Client with Parkinson’s Disease, Updated [4 CC hours] 45 This course is designed to provide physical therapists and physical therapist assistants with the information needed to appropriately examine and treat the client with Parkinson’s disease (PD), including differential diagnosis of individuals who exhibit signs and symptoms indicative of PD. In addition, the learner will be able to manage clients with PD by designing a comprehensive treatment program based on the use of appropriate outcome measures. Equipped with the most current evidence, the learner will be able to discuss and critically evaluate interventions directed at the specific body structure and function, activity, and participation deficits associated with PD. Chapter 5: Home Health Therapy: Using OASIS, Updated [3 CC hours] 65 The purpose of this course is to provide home healthcare physical therapists and speech-language pathologists with the information they need to understand the significance and importance of effectively using the OASIS instrument in order to deliver comprehensive, compassionate, patient-focused, and cost-sensitive skilled services in the home environment. The home health therapist will be able to use the OASIS information provided in this course to create a basis for the plan of care, to measure the patient’s progress in meeting the established home healthcare goals, and to meet the regulatory requirements for quality reporting and reimbursement. Chapter 6: Introduction to Wheelchair Seating and Positioning [5 CC hours] 80 This course, designed to provide the healthcare practitioner with a broad overview of the assessment and provision of wheelchair seating, is written at a basic to intermediate-level for the occupational and physical therapist who have little or no experience in this specialty practice area. Many people require the use of a wheelchair for dependent or independent mobility, and each wheelchair provides some form of seating. Wheelchair seating directly affects a client’s position, which in turn affects function for all of that person’s daily tasks. It is essential that occupational therapy practitioners be able to competently participate as members of the interprofessional team in determining the optimal seating and wheeled mobility interventions for a particular client. Common diagnoses for a client using a wheelchair include cerebral palsy, spinal cord injury, traumatic brain injury, multiple sclerosis, and muscular dystrophies. Chapter 7: Preventing Falls in Older Adults [5 CC hours] 125 An older adult falls every second of every day, with more than 29 million falls occuring in 2014, resulting in more than 7 million injuries. This course provides healthcare professionals in the areas of physical and occupational therapy with the knowledge they need to successfully identify those at risk for falls, assess individuals, and develop interventions targeted at reducing fall risk in older adults. Although therapists may be aware of the need to assess and treat older adults for risk for falls, they may not be fully abreast of approaches that are supported by evidence and are proven to truly reduce the incidence of falls. Final Examination Answer Sheet 148

©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials. i PHYSICAL THERAPY CONTINUING EDUCATION Book Code: PTCA2622B

FREQUENTLY ASKED QUESTIONS

What are the requirements for license renewal? Licenses Expire

CC Hours

Mandatory Subjects

Biennial renewal. Licenses are required to renew by the last day of their birth month every two years

30 (26 hours are allowed through home study)

2 hours Ethics, Laws, and Regulations 4 hours Basic Life Support

How much will it cost?

Course Title

CC Hours

Price

Chapter 1: Ethical Practice In Physical Therapy (Mandatory)

2 3 4 4 3 5 5

$16.00 $24.00 $32.00 $32.00 $24.00 $40.00 $40.00

Chapter 2: Clinical Mentorship: Teaching and Learning Strategies in Clinical Practice

Chapter 3: Evidence-Based Management of Knee Osteoarthritis

Chapter 4: Examination and Management of the Client With Parkinson’s Disease, Updated

Chapter 5: Home Health Therapy: Using OASIS, Updated Chapter 6: Introduction to Wheelchair Seating and Positioning

Chapter 7: Preventing Falls in Older Adults Best Value - Save $13.00 - All 26 Hours

26

$195.00

How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you a California board-approved provider? Colibri Healthcare, LLC is an Approved Continuing Education (CE) Program through the California Physical Therapy Association (Approved CE Program status number CPTAAP-28). Are my credit hours reported to the California board? No. The California Board of Physical Therapy perform audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Physical-Therapy you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory subjects (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.

Licensing board contact information: Physical Therapy Board of California 2005 Evergreen Street, Suite 2600 I Sacramento, CA 95815 Phone: (916) 561-8200 I Fax: (916) 263-2560 Website: https://www.ptbc.ca.gov/

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Book Code: PTCA2622B

PHYSICAL THERAPY CONTINUING EDUCATION

Please read these instructions before proceeding. Read and study the enclosed courses and answer the final examination questions. To receive credit for your courses, you must provide your customer information and complete the evaluation. We offer three ways for you to complete. Choose an option below to receive credit and your certificates of completion. How to complete continuing education

Fastest way to receive your certificate of completion

Online • Go to EliteLearning.com/Book . Use the book code PTCA2622B and enter it in the example box that pops up then click GO . • If you already have an account created, sign in to your account with your username and password. If you do not have an account already created, you will need to create one now. • Follow the online instructions to complete your final exam. Complete the purchase process to receive course credit and your certificate of completion. Please remember to complete the online survey. By mail • Fill out the answer sheet and evaluation found in the back of this booklet. Please include a check or credit card information and e-mail address. Mail to Elite, PO Box 37, Ormond Beach, FL 32175 . • Completions will be processed within 2 business days from the date it is received and certificates will be e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.

By fax • Fill out the answer sheet and evaluation found in the back of this booklet. Please include credit card information and e-mail address. Fax to (386) 673-3563 . • All completions will be processed within 2 business days of receipt and certificates e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.

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PHYSICAL THERAPY CONTINUING EDUCATION

Book Code: PTCA2622B

Chapter 1: Ethical Practice in Physical Therapy (Mandatory) 2 CC Hours

By: Gordon Ward, MPT Learning objectives

Š Define the standards and principles for ethical practice from the American Physical Therapy Association Code of Ethics for Therapists and Assistants. Š List and explain the five roles of physical therapy. Š Identify and give examples of the scope of practice. Š State the purpose, mission, and vision of the Model Practice Act for Physical Therapy. Course overview This course covers the principles and standards of ethical practice for physical therapists and assistants and references the Codes of Ethics and Conduct Guides of the American Physical Therapy Association (APTA) and the Federation of State Boards Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative

Š Define dual- or multiple-role relationships between practitioners and clients and strategies to maintain boundaries. Š Identify and define the steps for ethical decision making using the RIPS Model.

of Physical Therapy (FSBPT). Ethical issues related to professional practice are discussed. Steps to identify potential conflicts and strategies for decision making to avoid and resolve ethical issues are included.

to diagnostic and treatment options of a specific patient’s medical condition.

©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. INTRODUCTION The Legal Information Institute provides the following overview of the term ethics : FSBPT strives to live by a clearly defined mission and vision. Our mission conveys the direction of our organization and

The word “ethics” is derived from the Greek word ethos (character), and from the Latin word mores (customs). Together, they combine to define how individuals choose to interact with one another. In philosophy, ethics defines what is good for the individual and for society and establishes the nature of duties that people owe themselves and one another. Most professions have highly detailed and enforceable codes for their respective memberships. In some cases these are spoken of as “professional ethics.” Professional codes of ethics are likely to have some effect on judgments about professional conduct in litigation. Generally, failure to comply with a code of professional ethics may result in expulsion from the profession or some lesser sanction (LII, 2017b). In the physical therapy profession, codes of ethics state the principles and rules of conduct to guide professional therapists and assistants to make decisions between right and wrong actions. Codes of ethics are used to protect the welfare of the patient and standardize practice for therapists following professional standards. The Federation of State Boards of Physical Therapy (FSBPT) administers the National Physical Therapy Examination (NPTE), the examination that every graduate of a physical therapy or physical therapist assistant must pass to become a licensed physical therapist or licensed/certified physical therapist assistant in the United States (APTA, 2015a). The FSBPT governs practice through collaboration with state regulatory boards and the APTA. Through the Model Practice Act, it outlines penalties or sanctions if ethical violations occur. The FSBPT provides the following statements on promoting safety and competence:

our vision inspires us to achieve a common purpose. Our Mission : To protect the public by providing service and leadership that promote safe and competent physical therapy practice. Our Vision : To achieve a high level of public protection through a strong foundation of laws and regulatory standards in physical therapy, effective tools and systems to assess entry-level and continuing competence, and public and professional awareness of resources for public protection (FSBPT, 2017). The FSBPT continues to support research and evidence-based practice to advance the profession and provides information and support to state regulatory boards. The Model Practice Act is one tool developed by FSBPT: The Model Practice Act for Physical Therapy: A Tool for Public Protection and Legislative Change (MPA) is the preeminent standard and most effective tool available for revising and modernizing physical therapy practice acts. This [act] is enacted for the purpose of protecting the public health, safety, and welfare, and provides for jurisdiction administrative control, supervision, licensure, and regulation of the practice of physical therapy. The continuing movement to update physical therapy practice acts helps ensure that these documents provide the legal authority to fully protect the public while allowing for the effective regulation of the profession. The sixth edition adds three duties of the Board giving them the power to do background checks, report to an Exam, Licensure and Disciplinary Database (ELDD), and collect workforce data. It also adds background checks for all PT/PTA applicants (FSBPT, 2016).

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The APTA provides the following statement concerning ethics and professionalism: Physical therapists and physical therapist assistants should strive to apply principles of altruism, excellence, caring, ethics, respect, communication and accountability in working Glossary ● 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 (APTA, 2013a). ● Autonomy : Self-directing, freedom from the will of others, including moral independence (Merriam-Webster, 2017). ● Bright-line rule : An objective rule that resolves a legal issue in a straightforward, predictable manner. A bright-line rule is easy to administer and produces certain—though arguably, not always—equitable results (LII, 2017a). ● Dual or multiple relationships : A multiple relationship occurs when a therapist or assistant is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the therapist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person (American Psychological Association, 2017). ● Informed consent : Informed consent is a process, not just a form. Information must be presented to enable persons to voluntarily decide whether to participate. It is a fundamental mechanism to ensure respect for persons through provision

together with other professionals to achieve optimal health and wellness in individuals and communities (APTA, 2015b). The APTA Ethics and Judicial Committee (EJC) provide PTs/PTAs with educational materials, articles, interpretations, and opinions on professional ethics topics to promote ethical practice and decision making. of thoughtful consent for a voluntary act. The procedures used in obtaining informed consent should be designed to educate the subject population in terms that they can understand. Therefore, informed consent language and its documentation must be written in lay language, that is, understandable to the people being asked to participate. The written presentation of information is used to document the basis for consent and for the subjects’ future reference. Informed consent documents must be revised if any processes change or risks are identified during the course of therapy (Health and Human Services, 2017). ● Fiduciary duty : The highest standard of care. It involves acting in good faith and honesty in the best interest of the patient. Maintaining confidentiality is part of this duty (LII, 2017c). ● Personal bias : Subliminal obstacles that can undermine impartial decision making. A personal bias commonly introduces unwarranted opinions and feelings into contemplation of an issue, making it hard to come to an objective and neutral decision (Quizlet, 2017). ● Veracity : The principle that one should tell the truth, that honesty is the best policy (LaSalle, 2005).

SCOPE OF PRACTICE

The APTA provides the following definition of scope of practice and clarification of association role: Scope of practice has three components: Professional, jurisdictional, and personal. The professional scope of practice of physical therapy is defined as practice that is grounded in the profession’s unique body of knowledge, supported by educational preparation, based on a body of evidence, and linked to existing or emerging practice frameworks. APTA shall take the role as the primary organization for determining whether particular practices fall within the professional scope of practice of physical therapy. APTA shall prepare Purpose The Guide for Professional Conduct (Guide) provides interpretation for some subsections of the APTA Code of Ethics for the Physical Therapist (Code) for professional conduct (APTA, 2013a). The APTA House of Delegates in June of 2009 adopted a revised Code, which became effective on July 1, 2010, and was updated in 2013 (APTA, 2013c). The Guide provides a framework for physical therapists, assistants, and students with the focus on ethics and professional conduct. These guidelines are subject to change by the Ethics and Judicial Committee (EJC) as the dynamics of the profession change and new patterns of health care delivery are developed

such determinations in collaboration with appropriate stakeholders. APTA shall also be a resource for stakeholders to address inquiries regarding jurisdictional and personal scope of practice for physical therapists. The Model Practice Act governing the specific physical therapist’s license establishes jurisdictional scope of practice, and the rules adopted pursuant to that act. Personal scope of practice consists of activities for which an individual physical therapist is educated and trained, and that he or she is competent to perform (APTA, 2015c).

THE APTA CODE OF ETHICS FOR THE PHYSICAL THERAPIST AND GUIDE FOR PROFESSIONAL CONDUCT

and accepted by the professional community and the public (APTA, 2013c). Interpreting ethical principles The EJC provides interpretation on specific areas of the Code of Ethics in the Guides for therapists and assistants. The Code was designed as a stand-alone document, so not all subsections require interpretation. The Code and Guide cannot cover every ethical issue that the therapist or assistant may cover, but the APTA and FSBPT websites contain additional educational tools and resources beyond the Code and Guide to assist in ethical decisions and practice. The purposes of the Code of Ethics are to: 1. Define the ethical principles that form the foundation of physical therapist practice in patient/client management, consultation, education, research, and administration. 2. Provide standards of behavior and performance that form the basis of professional accountability to the public. 3. Provide guidance for physical therapists facing ethical challenges regardless of their professional roles and responsibilities.

The APTA Code of Ethics Preamble to the Code

The APTA Preamble states as follows: The Code of Ethics for the Physical Therapist (Code of Ethics) delineates the ethical obligations of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association (APTA, 2013c).

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4. Educate physical therapists, students, other health care professionals, regulators, and the public regarding the core values, ethical principles, and standards that guide the professional conduct of the physical therapist. 5. Establish the standards by which the American Physical Therapy Association can determine if a physical therapist has engaged in unethical conduct. (APTA, 2013a) Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of No code of ethics is exhaustive nor can it address every situation. Physical therapists are encouraged to seek additional advice or consultation in instances where the guidance of the Code of Ethics may not be definitive. The Code of Ethics is built upon the five roles of the physical therapist (management of patients/clients, consultation, education, research, and administration), the core values of the profession, and the multiple realms of ethical action (individual, organizational, and societal). Physical therapist practice is guided by a set of seven core values: accountability, altruism, compassion/caring, excellence, Ethics may not be definitive (APTA, 2013c). The Preamble is followed by this explanation: The Code of Ethics for the physical therapist Principles The following information from the principles and subcategories of the APTA Code of Ethics (APTA, 2013c) has been summarized and should be viewed in its entirety on the APTA website contained on the reference page. The interpretations from the Guide (APTA, 2013a) have been included. Remember, not all subsections have interpretations, but additional clarification can be found on the APTA and FSBPT websites. Principle #1: Physical therapists shall respect the inherent 1A. Physical therapists shall act in a respectful manner toward each person regardless of age, gender, race, nationality, religion, ethnicity, social or economic status, sexual orientation, health condition, or disability. 1B. Physical therapists shall recognize their personal biases and shall not discriminate against others in physical therapist practice, consultation, education, research, and administration. Interpretation: Respect ( APTA, 2013a). Principle 1A addresses the display of respect toward others. There is no universal consensus about what respect looks like in every situation. For example, direct eye contact may be respectful and courteous in some cultures and inappropriate in others. The therapist should assess the appropriateness of behavior in various situations. dignity and rights of all individuals. ( Core values : Compassion, integrity. ) Principle #2: Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients. (Core values: Altruism, compassion, professional duty.) 2A. Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients/ clients over the interests of the physical therapist. 2B. Physical therapists shall provide physical therapy services with compassionate and caring behaviors that incorporate the individual and cultural differences of patients/clients. 2C. Physical therapists shall provide the information necessary to allow patients or their surrogates to make informed decisions about physical therapy care or participation in clinical research. 2D. Physical therapists shall collaborate with patients/clients to empower them in decisions about their health care.

integrity, professional duty, and social responsibility. Throughout the document the primary core values that support specific principles are indicated in parentheses. Unless a specific role is indicated in the principle, the duties and obligations being delineated pertain to the five roles of the physical therapist. Fundamental to the Code of Ethics is the special obligation of physical therapists to empower, educate, and enable those with impairments, activity limitations, participation restrictions, and disabilities to facilitate greater independence, health, wellness, and enhanced quality of life (APTA, 2013c). Interpretation The 2010 revision of the Code of Ethics contains the word shall , and the principles should be interpreted as mandatory ethical obligations. The Preamble states: “No Code of Ethics is exhaustive nor can it address every situation.” The Preamble also states that physical therapists “are encouraged to seek additional advice or consultation in instances in which the guidance of the Code may not be definitive.” Potential sources for advice and counsel include third parties and the myriad resources available on the APTA website. Inherent in a physical therapist’s ethical decision-making process is the examination of his or her unique set of facts relative to the Code (APTA, 2013a). 2E. Physical therapists shall protect confidential patient/client information and may disclose confidential information to appropriate authorities only when allowed or as required by law. Interpretation: Altruism (APTA, 2013a). Principle 2A reminds physical therapists to adhere to the profession’s core values and act in the best interest of patients/clients over the interests of the physical therapist. Often this is done without thought, but sometimes it is a conscious decision. For example, the physical therapist may need to decide between leaving on time and staying at work longer to see a patient who was 15 minutes late for an appointment. Interpretation: Patient autonomy (APTA, 2013a). The purpose of Principle 2C is to respect patient autonomy. A physical therapist shall communicate to the patient/ client the findings of his or her examination, evaluation, diagnosis, and prognosis. A physical therapist shall use sound professional judgment in informing the patient/client of any substantial risks of the recommended examination and intervention and shall collaborate with the patient/client to establish the goals of treatment and the plan of care. A physical therapist shall respect the patient’s/client’s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal. Principle #3: Physical therapists shall be accountable for making sound professional judgments. ( Core values : Excellence, integrity. ) 3A. Physical therapists shall demonstrate independent and objective professional judgment in the patient’s/client’s best interest in all practice settings. 3B. Physical therapists shall demonstrate professional judgment informed by professional standards, evidence (including current literature and established best practice), practitioner experience, and patient/client values. 3C. Physical therapists shall make judgments within their scope of practice and level of expertise and shall communicate with, collaborate with, or refer to peers or other health care professionals when necessary. 3D. Physical therapists shall not engage in conflicts of interest that interfere with professional judgment. 3E. Physical therapists shall provide appropriate direction of and communication with physical therapist assistants and support personnel.

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Interpretation: Professional judgment (APTA, 2013a). Principles 3, 3A, and 3B state that it is the physical therapist’s obligation to exercise sound professional judgment based on his or her knowledge, skill, training, and experience. Principle 3B describes the physical therapist’s judgment informed by three elements of evidence-based practice. In the patient/client management role, once a physical therapist accepts an individual for services, he or she shall be responsible for the examination, evaluation, and diagnosis of that individual; the prognosis and intervention; reexamination and modification of the plan of care; and the maintenance of adequate records, including progress reports. A physical therapist shall establish the plan of care and shall provide and/or supervise and direct the appropriate interventions. A physical therapist has primary responsibility for the physical therapy care of a patient and shall make independent judgments regarding care consistent with accepted professional standards. If the diagnostic process reveals findings outside the scope of the physical therapist’s knowledge, experience, or expertise, or that indicate the need for care outside the scope of physical therapy, the physical therapist shall inform the patient/client and shall refer the patient/client to an appropriate practitioner. A physical therapist shall determine when a patient/client will no longer benefit from physical therapy services. When a physical therapist’s judgment is that a patient will receive negligible benefit from physical therapy services, the physical therapist shall not provide or continue to provide services if the primary reason for doing so is the financial self-interest of the physical therapist or his or her employer. A physical therapist shall avoid overutilization of physical therapy services. See Principle 8C. Interpretation: Supervision (APTA, 2013a). Principle 3E describes circumstances where sound professional judgment is required through the appropriate direction of and communication with physical therapist assistants and support personnel. Further information on supervision via applicable local, state, and federal laws and regulations (including state practice acts and administrative codes) is available. See Principles 5A and 5B. Principle #4: Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public. ( Core value: Integrity. ) 4A. Physical therapists shall provide truthful, accurate, and relevant information and shall not make misleading representations. 4B. Physical therapists shall not exploit persons with whom they have supervisory, evaluative, or other authority (e.g., patients/clients, students, supervisees, research participants, or employees). 4C. Physical therapists shall discourage misconduct by healthcare professionals and report illegal or unethical acts to the relevant authority, when appropriate. 4D. Physical therapists shall report suspected cases of abuse involving children or vulnerable adults to the appropriate authority, subject to law. 4E. Physical therapists shall not engage in any sexual relationship with any of their patient/clients, supervisees, or students. 4F. Physical therapists shall not harass anyone verbally, physically, emotionally, or sexually. Interpretation: Integrity in relationships (APTA, 2013a). Principle 4 addresses the need for integrity in relationships and is not limited to relationships with patients/clients, but everyone physical therapists come into contact with

professionally. Demonstrating integrity could encompass working collaboratively with the health care team and taking responsibility for one’s role as a member of that team. Interpretation: Reporting (APTA, 2013a). When considering the application of when appropriate under Principle 4C, keep in mind that not all allegedly illegal or unethical acts should be reported immediately to an agency/ authority. The determination of when to do so depends upon each situation’s unique set of facts and applicable laws, regulations, and policies. Depending on those facts, it might be appropriate to communicate with the individuals involved. Consider whether the action has been corrected, and, in that case, not reporting may be the most appropriate action. Note that when an agency/authority does examine a potential ethical issue, fact finding will be its first step. The determination of ethicality requires an understanding of all of the relevant facts but may still be subject to interpretation. The EJC Opinion titled “Topic: Preserving Confidences: Physical Therapist’s Reporting Obligation with Respect to Unethical, Incompetent, or Illegal Acts” provides further information on the complexities of reporting (APTA, 2010). Interpretation: Exploitation (APTA, 2013a). The statement is fairly clear: sexual relationships with their patients/clients, supervisees, or students are prohibited. This component of Principle 4 is consistent with Principle 4B. Next, consider this excerpt from the EJC Opinion titled “Topic: Sexual Relationships with Patients/Former Patients”: A physical therapist stands in a relationship of trust to each patient and has an ethical obligation to act in the patient’s best interest and to avoid any exploitation or abuse of the patient. Thus, if a physical therapist has natural feelings of attraction toward a patient, he or she must sublimate those feelings in order to avoid sexual exploitation of the patient (APTA, 2013a). One’s ethical decision-making process should focus on whether the patient/client, supervisee, or student is being exploited. In this context, questions have been asked about whether one can have a sexual relationship once the patient/ client relationship ends. To this question, the EJC has opined as follows: The Committee does not believe it feasible to establish any bright-line rule for when, if ever, initiation of a romantic/sexual relationship with a former patient would be ethically permissible. The Committee imagines that in some cases a romantic/ sexual relationship would not offend if initiated with a former patient soon after the termination of treatment, while in others such a relationship might never be appropriate (APTA, 2013a). Principle #5: Physical therapists shall fulfill their legal and professional obligations. ( Core values : Professional duty, accountability. ) 5A. Physical therapists shall comply with applicable local, state, and federal laws and regulations. 5B. Physical therapists shall have primary responsibility for supervision of physical therapist assistants and support personnel. 5C. Physical therapists involved in research shall abide by accepted standards governing protection of research participants. 5D. Physical therapists shall encourage colleagues with physical, psychological, or substance-related impairments that may adversely impact their professional responsibilities to seek assistance or counsel. 5E. Physical therapists who have knowledge that a colleague is unable to perform their professional responsibilities

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with reasonable skill and safety shall report the information to the appropriate authority. 5F. Physical therapists shall provide notice and information about alternatives for obtaining care in the event the physical therapist terminates the provider relationship while the patient/client continues to need physical therapy services. Interpretation: Colleague impairment (APTA, 2013a). The central tenet of Principles 5D and 5E is that inaction is not an option for a physical therapist when faced with the circumstances described. Principle 5D states that a physical therapist shall encourage colleagues to seek assistance or counsel. Principle 5E addresses reporting information to the appropriate authority. 5D and 5E both require a factual determination by the therapist. This may be challenging in the sense that the therapist might not know or it might be difficult to determine whether someone, in fact, has a physical, psychological, or substance-related impairment. In addition, it might be difficult to determine whether such impairment may be adversely affecting his or her professional responsibilities. Moreover, once the therapist makes these determinations, the obligation under 5D centers not on reporting, but on encouraging the colleague to seek assistance. However, the obligation under 5E does focus on reporting. Note that 5E discusses reporting when a colleague is unable to perform, whereas 5D discusses encouraging colleagues to seek assistance when the impairment may adversely affect his or her professional responsibilities. So 5D discusses something that may be affecting performance, whereas 5E addresses a situation in which someone is clearly unable to perform. The two situations are distinct. In addition, it is important to note that 5E does not mandate to whom the therapist should report and gives the therapist discretion to determine the appropriate authority. Principle #6: Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors. ( Core value : Excellence. ) 6A. Physical therapists shall achieve and maintain professional competence. 6B. Physical therapists shall take responsibility for their professional development based on critical self- assessment and reflection on changes in practice, education, health care delivery, and technology. 6C. Physical therapists shall evaluate the strength of evidence and applicability of content presented during professional development activities before integrating the content or techniques into practice. 6D. Physical therapists shall cultivate practice environments that support professional development, lifelong learning, and excellence. Interpretation: Clinical competence (APTA, 2013a). 6A requires a physical therapist to maintain professional competence within one’s scope of practice throughout one’s career. Maintaining competence is an ongoing process of self-assessment; identification of strengths and weaknesses; acquisition of knowledge and skills based on that assessment; and reflection on and reassessment of performance, knowledge, and skills. Numerous factors— including practice setting, types of patients/clients, personal interests and the addition of new evidence to practice—will influence the depth and breadth of professional competence in a given area of practice. Interpretation: Professional growth (APTA, 2013a). 6D elaborates on the physical therapist’s obligations to foster an environment conducive to professional growth even when not supported by the organization. The essential idea is that

it is the physical therapist’s responsibility, whether or not the employer provides support. Principle #7: Physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society. ( Core values : Integrity, accountability. ) 7A. Physical therapists shall promote practice environments that support autonomous and accountable professional judgments. 7B. Physical therapists shall seek remuneration as is deserved and reasonable for physical therapist services. 7C. Physical therapists shall not accept gifts or other considerations that influence or give an appearance of influencing their professional judgment. 7D. Physical therapist assistants shall ensure that documentation for their interventions accurately reflects the nature and extent of the services provided. 7E. Physical therapists shall be aware of charges and shall ensure that documentation and coding for physical therapy services accurately reflect the nature and extent of the services provided. Interpretation: Charges and coding (APTA, 2013a). Principle 7E provides that the physical therapist must make sure that the process of documentation and coding accurately captures the charges for services performed. Where charges cannot be determined because of payment methodology, physical therapists may review the House of Delegates policy titled “Professional Fees for Physical Therapy Services.” Additional resources on documentation and coding include the House of Delegates policy titled “Documentation Authority for Physical Therapy Services and the Documentation and Coding and Billing” on the APTA website. Principle #8: Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally. ( Core value : Social responsibility. ) 8A. Physical therapists shall provide pro bono physical therapy services or support organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. 8B. Physical therapists shall advocate to reduce health disparities and health care inequities, improve access to health care services, and address the health, wellness, and preventive health care needs of people. 8C. Physical therapists shall be responsible stewards of health care resources and shall avoid overutilization or underutilization of physical therapy services. 8D. Physical therapists shall educate members of the public about the benefits of physical therapy and the unique role of the physical therapist. Interpretation: Pro bono services (APTA, 2013a). The key word in Principle 8A is or. If a physical therapist is unable to provide pro bono services, he or she can fulfill ethical obligations by supporting organizations that meet the health needs of people who are economically disadvantaged, uninsured, and underinsured. In addition, physical therapists may review the House of Delegates guidelines titled “Guidelines: Pro Bono Physical Therapy Services.” Additional resources on pro bono physical therapy services are available on the APTA website. 8A also addresses supporting organizations to meet health needs. In terms of supporting organizations, the principle does not specify the type of support required. Physical therapists may express support through volunteerism, financial contributions, advocacy, education, or simply promoting their work in conversations with colleagues.

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Book Code: PTCA2622B

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SCOPE OF PRACTICE Guidelines for physical therapist scope of practice (APTA, 2014)

○ Work (job/school/play), community, leisure integration or reintegration (including instrumental activities of daily living). 2. Alleviating impairment and functional limitation by designing, implementing, and modifying therapeutic interventions that include, but are not limited to the following: ○ Coordination, communication, and documentation. ○ Patient/client-related instruction. ○ Therapeutic exercise. ○ Functional training in self-care and home management (including activities of daily living and instrumental activities of daily living). ○ Functional training in work (job/school/play) and community and leisure integration or reintegration activities (including instrumental activities of daily living, work hardening, and work conditioning). ○ Manual therapy techniques (including mobilization/ manipulation). ○ Prescription, application, and, as appropriate, fabrication of devices and equipment (assistive, adaptive, orthotic, protective, supportive, and prosthetic). ○ Airway clearance techniques. ○ Integumentary repair and protection techniques. Electrotherapeutic modalities. ○ Physical agents and mechanical modalities. ○ Dry needling. 3. Preventing injury, impairment, functional limitation, and disability, including the promotion and maintenance of health, wellness, fitness, and quality of life in all age populations. 4. Engaging in consultation, education, and research.

Scope of practice is limited to the care and services provided by or under the direction and supervision of a physical therapist and includes the following four points: 1. Examining (history, system review, and tests and measures) individuals with impairment, functional limitation, and disability or other health-related conditions to determine a diagnosis, prognosis, and intervention; tests and measures may include the following:

○ Aerobic capacity/endurance. ○ Anthropometric characteristics. ○ Arousal, attention, and cognition. ○ Assistive and adaptive devices.

○ Circulation (arterial, venous, lymphatic). ○ Cranial and peripheral nerve integrity. ○ Environmental, home, and work (job/school/play) barriers.

○ Ergonomics and body mechanics. ○ Gait, locomotion, and balance. ○ Integumentary integrity. ○ Joint integrity and mobility.

○ Motor function (motor control and motor learning). ○ Muscle performance (including strength, power, and endurance). ○ Neuromotor development and sensory integration. ○ Orthotic, protective, and supportive devices. ○ Pain. ○ Posture. ○ Prosthetic requirements. ○ Range of motion (including muscle length). ○ Reflex integrity. ○ Self-care and home management (including activities of daily living and instrumental activities of daily living). ○ Sensory integrity. ○ Ventilation and respiration/gas exchange.

CODE OF ETHICS FOR PHYSICAL THERAPY ASSISTANTS

APTA Guide for Conduct of the Physical Therapist Assistant Purpose This Guide for Conduct of the Physical Therapist Assistant (Guide) is intended to serve physical therapist assistants in interpreting the Standards of Ethical Conduct for the Physical Therapist Assistant (Standards) of the American Physical Therapy Association. The APTA House of Delegates in June of 2009 adopted the revised Standards, which became effective on July 1, 2010, and were updated in 2013. The Guide provides a framework to inform the physical therapist assistants on issues related to professional conduct. These guidelines are subject to change as the dynamics of the profession change and as new patterns of health care delivery are developed and accepted by the professional community and the public (APTA, 2013b). Interpreting ethical standards The interpretations expressed in this Guide reflect the opinions, decisions, and advice of the Ethics and Judicial Committee (EJC) (APTA, 2013b). The interpretations are set forth according to topic. These interpretations are intended to assist a physical therapist assistant in applying general ethical standards to specific situations. They address some, but not all, topics addressed in the Standards and should not be considered inclusive of all situations that could evolve.

This Guide is subject to change, and the EJC will monitor and timely revise the Guide to address additional topics and Standards when necessary and as needed. Preamble to the standards The Preamble states as follows: The Standards of Ethical Conduct for the Physical Therapist Assistant (Standards of Ethical Conduct) delineate the ethical obligations of all physical therapist assistants as determined by the House of Delegates of the American Physical Therapy Association (APTA). The Standards of Ethical Conduct provide a foundation for conduct to which all physical therapist assistants shall adhere. Fundamental to the Standards of Ethical Conduct is the special obligation of physical therapist assistants to enable patients/clients to achieve greater independence, health, and wellness, and enhanced quality of life. No document that delineates ethical standards can address every situation. Physical therapist assistants are encouraged to seek additional advice or consultation in instances where the guidance of the Standards of Ethical Conduct may not be definitive (APTA, 2013d).

Standards of Ethical Conduct for the Physical Therapist Assistant The following is from the APTA documents on ethical conduct

The revisions were written, and the word shall added, to make the standards and ethical directives clearer so they could be understood without additional explanation: The Preamble states that “No document that delineates ethical standards can address every situation.” The Preamble also states that physical therapist assistants “are encouraged to seek additional advice or consultation in instances where

(APTA, 2013d). Interpretation

The Standards of Ethical Conduct for the Physical Therapist Assistant were amended in 2010 and updated in 2013. The APTA notes that the standards contain the word shall and describes them as mandatory ethical obligations (APTA, 2013b).

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Book Code: PTCA2622B

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