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GEORGIA Physical Therapy Continuing Education
Elite Learning
I nside: Mandatory Georgia Ethics and Jurisprudence, 2nd Edition
30-hour Continuing Education Package $240
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WHAT’S INSIDE
Course 1: Georgia Ethics and Jurisprudence, 2nd Edition (Mandatory)
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[4 CCHs] This course will help the physical therapist understand the importance of ethical behavior in patient care, and will familiarize them with ethical theories, principles and the guidelines of professional conduct in the State of Georgia. THIS COURSE FULFILLS THE REQUIREMENT FOR GEORGIA ETHICS AND JURISPRUDENCE Course 2: ACL Injury, Surgery, and Rehabilitation: A Science-Based and Evidence-Informed Approach
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[2 CCHs] Given the modifications and advancements in ACL surgical procedures and the proliferation of research on interventions and outcomes, many clinicians find it difficult to keep apprised of the latest evidence and integrate this new information into their clinical practice. Decisions regarding which patients are appropriate for non-operative management of an ACL-deficient knee, how to safely progress patients through a criterion-based guideline, and when to provide recommendations for a safe return back to sports after ACL injury or reconstruction are challenging. Physical therapists and physical therapist assistants will be able to use the knowledge and skills outlined in this course with their patients after ACL injury or surgery to maximize patients’ responses to exercise at their current functional level while minimizing risk of injury to the healing tissue(s). Course 3: Acute Injury and Pain: A Strategy, Management and Rehabilitation Discussion for Physical Therapists 83 [3 CCHs] Millions of Americans suffer with pain every year. Pain, both chronic and acute, is quickly becoming an increasingly dire public health issue that costs employers, patients and insurance companies billions of dollars each year. This course discuss the management of acute injuries and methods and management of pain. Course 4: Chronic Health Conditions of Physical Therapy Patients 99 [3 CCHs] This course identifies and briefly summarizes some of the common chronic conditions and health problems encountered within patients by the physical therapist in the scope of his or her daily practice. Many of these conditions require specific knowledge about the anatomy, symptoms and considerations for care that are unique to each issue. Course 5: Differential Diagnosis for Headaches and Cervical Spine Pain 111 [3 CCHs] When evaluating head and neck pain in physical therapy, we must recognize that many conditions share similar signs and symptoms. This course presents information to help the evaluating clinician determine when a client’s symptoms may be the result of systemic or viscerogenic causes and when referral to another healthcare provider is indicated. In addition, this course presents a framework for differentiating and assigning the appropriate diagnosis for neuromuscular and/or musculoskeletal conditions. Course 6: Frozen Shoulder Management and Manual Treatment Strategies 153 [2 CCHs] Shoulder dysfunctions causing painful stiffness are endemic issues, causing clinical challenges and conflicting treatment guidelines. Common terminology of frozen shoulder and adhesive capsulitis share significant and long duration impairments. This advanced course reviews pathophysiology of these conditions, the natural history associated with idiopathic frozen shoulder and essential assessment findings. Based on updated scientific evidence, a review and compilation of available interventions of conservative, medical and invasive options is presented. The role of manual therapy methodology is featured. Due to variability in patient progress and manual therapy approaches, specific guidelines on type, timing, position and amplitude are investigated to standardize joint mobilization efforts. Finally, treatment program principles of patient education, suggested number of visits, daily clinical visit structure, management of plateaus and beneficial integration with medical/invasive procedures are discussed. The purpose of this course is to provide clinicians with an evidenced- based approach on treating frozen shoulder and associated conditions. Course 7: Hip Fractures: Treatment and Prevention 166 [2 CCHs] Each year, over 250,000 people are hospitalized for hip fractures, and some of these individuals will never fully regain their prior level of function: they may require assistance to walk, and a few will even need to go to a nursing home. The physical therapist is an essential partner to assist patients in preserving, improving and maintaining the current levels of functioning within their daily lives. This course will provide an overview on the three main types of hip fractures, the differences between the approaches to surgical and non-surgical candidates for physical therapy, and prevention techniques that the physical therapist can share which will ensure a patient is knowledgeable about how to prevent future fall occurrences.
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PHYSICAL THERAPY CONTINUING EDUCATION
Course 8: Knee Osteoarthritis: Overview, NonSurgical/Surgical Management and Physical Therapy Treatment 172 [2 CCHs] Knee OA is prevalent in today’s society with the active aging population. Physical therapists play an important role in
restoring function for these patients with nonsurgical and postoperative interventions. Course 9: Pharmaceuticals and Physical Therapy: Movement with Medication
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[4 CCHs] Physical therapy and pharmacology have operated alongside each other for thousands of years. This course will prioritize essential components regarding pharmaceutical principles and will discuss common pharmaceutical categories relative to application in physical therapy clinical settings. Course 10: Reducing and Eliminating Workplace Injuries through Ergonomics 196 [2 CCHs] Many companies today are using ergonomics, or the study of work, when designing workspaces that will prevent injuries and strains, as well as other disorders. This course will offer suggestions for completing a successful, comprehensive and useful ergonomics assessment that will focus on preventing musculoskeletal injuries by effectively analyzing job hazards, identifying and evaluating risk factors and offering recommendations to reduce or eliminate these risks within the workplace environment. Course 11: Therapeutic Yoga After Knee Replacement 202 [1 CCH] Knowledge of safe and effective evidence-based yoga poses for knee rehabilitation can assist physical therapists in prescribing therapeutic exercises after Total Knee Replacement. Course 12: Total Shoulder Arthroscopy and Reverse Total Arthroscopy: What Physical Therapists Need to Know 211 [2 CCHs]
Shoulder arthroplasty is the treatment of choice for severe degenerative joint disease. It is important for physical therapists to understand complications that may occur following these types of surgical procedures. This course will discuss the components of physical therapy rehabilitation following a total shoulder replacement. Final Examination Answer Sheet
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©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. ii PHYSICAL THERAPY CONTINUING EDUCATION
FREQUENTLY ASKED QUESTIONS
What are the requirements for license renewal? License Expires
CE Hours Required
Mandatory Subjects
30 A maximum of ten (10) continuing competence hours can be completed per calendar day
Four (4) hours per biennium in Georgia ethics and jurisprudence or by retaking the Georgia Jurisprudence Examination
December 31 of odd years.
How much will it cost?
COURSE TITLE
HOURS PRICE COURSE CODE
Course 1:
Georgia Ethics and Jurisprudence, 2nd Edition (Mandatory)
4
$48.00 PTGA04ET
ACL Injury, Surgery, and Rehabilitation: A Science-Based and Evidence- Informed Approach Acute Injury and Pain: A Strategy, Management and Rehabilitation Discussion for Physical Therapists
Course 2:
2
$24.00 PTGA02AC
Course 3:
3
$36.00 PTGA03AP
Course 4: Course 5: Course 6: Course 7:
Chronic Health Conditions of Physical Therapy Patients
3 3 2 2
$36.00 PTGA03CH $36.00 PTGA03DD $24.00 PTGA02FS $24.00 PTGA02HF
Differential Diagnosis for Headaches and Cervical Spine Pain
Frozen Shoulder Management and Manual Treatment Strategies
Hip Fractures: Treatment and Prevention
Knee Osteoarthritis: Overview, NonSurgical/Surgical Management and Physical Therapy Treatment 2
Course 8:
$24.00 PTGA02KN
Course 9:
Pharmaceuticals and Physical Therapy: Movement with Medication
4 2
$48.00 PTGA04PM $24.00 PTGA02WE
Course 10: Reducing and Eliminating Workplace Injuries through Ergonomics
Course 11: Therapeutic Yoga After Knee Replacement
1
$12.00 PTGA01YG
Total Shoulder Arthroscopy and Reverse Total Arthroscopy: What Physical Therapists Need to Know
Course 12:
2
$24.00 PTGA02TS
Best Value - Save $120.00 - All 30 Hours
30 $240.00
The Georgia State Board of Physical Therapy requires each licensed physical therapist and physical therapist assistant to participate in thirty (30) clock hours of experience per licensure period which is not to exceed ten (10) credit hours per calendar day. 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 an Georgia board-approved provider? Colibri Healthcare, LLC’s Ethics and Jurisprudence courses are approved by the APTA Georgia. Colibri’s courses meet the standards for physical therapy continuing education activities in Georgia. Are my credit hours reported to the Georgia board? Yes, we will report your hours electronically to the Georgia State Board of Physical Therapy on the first of each month. Remember, do not forward your CE documentation to the board; keep your certificate in a safe place for your records. Do I need to complete mandatory courses? Yes. A minimum of four (4) hours per biennium must be obtained in an ethics and jurisprudence course, or by retaking the Georgia Jurisprudence Examination (GA JAM). Colibri’s Georgia Ethics and Jurisprudence course meets this requirement. 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 topics (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:
Georgia State Board of Physical Therapy | 237 Coliseum Drive | Macon, GA 31217 Phone (404) 424-9966 | Website: https://sos.ga.gov/georgia-state-board-physical-therapy
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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 . Locate the course code found at the bottom of each course final exam page or in the table below and enter it in the example box then click GO . You will need to submit each course individually. Remember you can only complete 10-hours per day . • 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.
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Your profession
Course Name
Course Code
Georgia Ethics and Jurisprudence, 2nd Edition (Mandatory)
PTGA04ET
ACL Injury, Surgery, and Rehabilitation: A Science-Based and Evidence-Informed Approach
PTGA02AC
Acute Injury and Pain: A Strategy, Management and Rehabilitation Discussion for Physical Therapists
PTGA03AP
Chronic Health Conditions of Physical Therapy Patients
PTGA03CH
Differential Diagnosis for Headaches and Cervical Spine Pain
PTGA03DD
Frozen Shoulder Management and Manual Treatment Strategies
PTGA02FS
Hip Fractures: Treatment and Prevention
PTGA02HF
Knee Osteoarthritis: Overview, NonSurgical/Surgical Management and Physical Therapy Treatment
PTGA02KN
Pharmaceuticals and Physical Therapy: Movement with Medication
PTGA04PM
Reducing and Eliminating Workplace Injuries through Ergonomics
PTGA02WE
Therapeutic Yoga After Knee Replacement
PTGA01YG
Total Shoulder Arthroscopy and Reverse Total Arthroscopy: What Physical Therapists Need to Know
PTGA02TS
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.
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PHYSICAL THERAPY CONTINUING EDUCATION
Chapter 1: Georgia Ethics and Jurisprudence, 2nd Edition (Mandatory) 4 CCHs
Expiration Date : March 29, 2024
Release Date: October 30, 2022
Faculty Author:
she has achieved recognition as a Neurologic Clinical Specialist and Adaptive Recreation/Sports Specialist. In addition to her role as PT Planner for Elite Professional Education, she is part of a research team improving prosthetic and orthotic devices for the Department of veterans affairs. Cristina Roy has no significant financial or other conflicts of interest pertaining to this course. objectives as a method to enhance individualized learning and material retention. ● Provide required personal information and payment information. ● Complete the mandatory Course Evaluation. ● Print your Certificate of Completion. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
Dr. Cristina Roy is a healthcare provider based in New York CIty. She works as a Researcher, Health Content Writer, Educator and Clinician in her field. She is an active member of the American Physical Therapy Association and sits on the board of the Federal Physical Therapy Section’s Amputation Care Special Interest Group. In addition to her Doctorate in Physical Therapy How to receive credit ● Read the entire course online or in print. ● Depending on your state requirements you will be asked to complete: ○ A mandatory test (a passing score of 75 percent is required). Test questions link content to learning Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. 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 Disclosures Resolution of conflict of interest
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. Learning objectives After completing this course, the learner will be able to: Define ethics, morality, and integrity. Identify the theoretical basis of ethical decision-making and the application of ethics in healthcare. Describe the laws pertaining to physical therapy practice in the Georgia General Provisions, the Georgia Physical Therapy Practice Act, and the Georgia State Board of Physical Therapy Rules and Policies. Identify the content on the Georgia Board of Physical Therapy website and current continuing education reporting procedures.
Identify the principles of the American Physical Therapy Association (APTA) Code of Ethics for Physical Therapists and the principles of the APTA Guide for Professional Conduct. Course overview The study of ethics is fundamental to the successful clinical practice of all healthcare professionals. Although most healthcare workers possess an innate desire to help others, there are additional guidelines in each profession that must be observed for the consistent delivery of quality health care. The American Physical Therapy Association's (APTA) ethics documents include
the Code of Ethics for Physical Therapists (APTA, 2020a), APTA Guide for Professional Conduct (2019a), APTA Standards of Ethical Conduct for the Physical Therapist Assistant (2020b), and the APTA Guide for Conduct of the Physical Therapist Assistant (2019c).
INTRODUCTION
Therapists are entrusted with the patient’s physical and mental well-being during the rehabilitation process; with this trust comes a great responsibility. Not only do patients physically rely upon physical therapists to provide safe, appropriate, and effective treatment techniques, but they often also rely emotionally upon physical therapists during treatment. Because
most therapists are able to spend quality time with patients, they are able to individualize treatment content and goal setting. However, this may occasionally give rise to conflict as the well- meaning therapist tries to please the patient at the same time that they try to “do the right thing” professionally.
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The first part of this course will help the therapist understand the importance of ethical behavior in patient care, and will familiarize them with ethical theories and principles and the guidelines of professional conduct. The second part of the course will focus on the laws pertaining to physical therapy practice in the State Ethics by definition What is ethics? The study of ethics is the philosophical study of morality. This discipline concerns the examination of the principles that govern “right” and “wrong” behavior, and outlines the theories or systems of moral conduct for individuals and groups. Medical ethics involves applying guidelines, values, and shared beliefs to decision-making in patient care. To behave ethically is to act in a manner that is morally correct, honorable, and trustworthy. The study of ethics involves looking at the reasoning behind moral practices and actions. To understand ethics, therefore, it is necessary to understand the components of morality. Morality is a societal system of adhering to moral rules, which concerns the goodness and virtuousness of human character. Morality is concerned with conformity to the ideals of right human conduct, and is a guide for shaping human action for the betterment of society. It is influenced by family tradition, social custom, religion, culture, peer group, and profession; and, as such, it is a learned response. Morals are virtues, and morality establishes a framework in which people Case study #1 “Professional Accountability” Sarah has recently graduated and is working as a physical therapist at her first job in a busy outpatient clinic. Sarah has been carefully yet quickly oriented to the clinic and, after being complimented on her common sense and responsible nature, she is turned loose with her own patient list. Her confidence has been strengthened daily by successful patient care, and one afternoon she finds she is the only physical therapist left treating patients in the clinic. Sarah’s returning patient with a partial rotator cuff tear has been shown into a room by the receptionist, where Sarah greets him. As she begins treatment, she finds that he is intoxicated and unable to respond without slurring his words. Sarah worries that he will be unable to tell her when he perceives pain during range of motion or electrical stimulation,
of Georgia, including select Georgia General Provisions, the Georgia Physical Therapy Practice Act, the Physical Therapy Board Rules and Policies, and other important information to help Georgia physical therapy professionals to recognize and navigate important legal information. can positively interact with one another through an agreed-upon set of rules. Integrity is a characteristic that is inherent to the individual. It reflects an honesty, soundness, completeness, and incorruptibility of character. It has been said that a person who has integrity will do the right thing even when no one is looking. Ethics may be divided into two categories: personal ethics and professional ethics. Personal ethics involves the application of a learned moral code and personal integrity in making ethical decisions. Personal ethics is sometimes referred to as taking responsibility for one’s actions. Taking into account the consequences of one’s actions before acting enables a person to participate in analytical decision-making. Professional ethics involves adhering to a set of guidelines determined by a professional group, such as the APTA. Professional ethics requires that the therapist practice legally, respect confidentiality, obtain informed consent, document accurately, and avoid fraudulent activities. but she is afraid he will become belligerent if she refuses to treat him. Discussion Points: Sarah’s professional responsibility to her patient What should Sarah do? She and the clinic may be liable if treatment leads to further damage to his shoulder. If she can safely get him out of the clinic without harm, how will he transport himself home without injuring himself or others? What about the potential danger to Sarah or the receptionist as Sarah tries to defuse the situation? Is it medically ethical to treat this patient? Is it legally ethical to treat this patient, or to allow him to leave the clinic unescorted? Which action is morally right?
THEORETICAL BASIS OF ETHICS
Humans have struggled throughout history to establish guidelines of communication through which to more clearly understand one another. Philosophers have contemplated the interaction of human behaviors and actions since ancient times. The Golden Rule, “Do to others what you would want others to do to you,” is the basis for normative ethics, which is the setting of moral standards that regulate right and wrong conduct. There are three strategies that provide the basis of normative ethics: virtue theories, duty theories,and consequentialist theories. Virtue theories have roots in ancient Greek civilization and are the source of the oldest traditions of Western philosophy. They emphasize the responsibility of adults to morally educate the young in the development of good character habits. Greek philosopher Plato focused on the four cardinal virtues of wisdom, courage, temperance, and justice. Aristotle also considered fortitude,generosity, self-respect, and sincerity to be important (Barnes, 1984). In medieval times, Christians added the theological virtues of faith, hope, and charity to the foundation of virtue theories. The goal is the benevolent practice of virtue in human action, with the avoidance of vice. Vices may include cowardice, injustice, vanity, and insensibility. With virtue theories, individuals inherently make the correct moral decisions based on their own good character and integrity. Duty theories , also known as deontological or nonconsequentialist theories, view morality as based on obligation. (The word “duty”derives from the Greek word
“deonto.”) This group of theories became defined in the 17th and 18th centuries, and emphasizes acting with a sense of duty to God, self, and others. The individual should avoid wronging others, treat people as equals, and promote the good of others. In one of his categorical imperatives, philosopher Immanuel Kant (1797/1985) said that people should be treated as an end to themselves, not as the means to an end. Duty theories view action as a reflection of moral conviction, and include adhering to the principles of fidelity (keeping promises), reparation (compensating those we have harmed), gratitude(thanking those who have helped us), justice (improving the conditions of others), self-improvement (improving our own virtues), and nonmaleficence (not hurting others). With duty theories, individuals make the correct moral decisions based on their perceived moral obligations, regardless of the consequences. Consequentialist theories , also known as teleological theories , determine the making of moral decisions by weighing the consequences of our actions. (The word “teleology” derives from the Greek word “telos,” which means “ends.”) An act is considered morally right if the outcome is more favorable than unfavorable. Subsets of these theories are ethical egoism, ethical altruism, and utilitarianism. These are rival theories in which different outcomes may be found. Ethical egoism, or social contract theory, considers an action to be morally right if the individual performing the action has a favorable outcome. Ethical altruism considers an action morally right if everyone but the individual performing the action is benefited. Utilitarianism
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considers an action morally right if everyone involved has a favorable outcome. Jeremy Bentham and John Stuart Mill in the 19th century considered that the consequences of possible pleasure and pain led to moral decision-making. Actions are Case study #2 “Ethical Behavior” Brad is working in a skilled nursing facility that admits many Medicare Part A patients for subacute rehabilitation. There are physical therapy orders to evaluate and treat a 76-year- old new patient, Mrs. Sloan, who is post-operative for a total hip replacement. The patient arrived last night and has been resting comfortably. The nursing staff informs Brad that Mrs. Sloan refused to get out of bed this morning, and they would like his help in transferring her into a wheelchair. Brad sees Mrs. Sloan, who says that she won’t get out of bed and doesn’t want therapy; she just wants to go home. Even after Brad explains the benefits of therapy and informs her that she needs to be able to walk before she can be released, Mrs. Sloan continues to refuse therapy. What does Brad do? Discussion Points: Brad’s ethical dilemma Applying virtue theories to Case Study #2, Brad might try to find other motivating factors to convince his patient to participate by mentally putting himself in her shoes and trying to relate to her
morally right if all participants are benefited,with a net result of happiness. With consequentialist theories, individuals make the correct moral decisions based on perceived outcomes, or consequences. own goals and desires. Using duty theories, he might conclude that his moral obligation rests with respecting Mrs. Sloan’s right to refuse treatment, and he might approach her again at a later time. Using consequentialist theories, there are different outcomes: Social contract theory may direct Brad to force the patient to get up with the help of the nursing staff, so he would benefit by “getting the job done.” Ethical altruism theory might direct him to ask a different therapist to approach the patient, trying to appeal to Mrs. Sloan from a different perspective for her good in the long run. Utilitarianism might suggest that Brad approach the nursing staff to ensure that Mrs. Sloan has taken her pain medications and then begin with bedside exercises to engage the patient’s trust and cooperation for mutual benefit. There is no one correct answer to this scenario, but combining the analysis of his own natural tendencies with the understanding of these theories may help Brad to be better able to cope with ethical dilemmas in patient care.
APPLICATION OF ETHICS IN HEALTHCARE
Applied ethics involves the analysis of specific and possibly controversial moral issues in a given context. Ethics may be applied in a variety of settings, including medicine, business, and the environment. Medical ethics may concern issues such as patient rights,confidentiality of medical records, a physician’s responsibility to tell the truth, abortion, euthanasia, animal rights in medical research,and other life and death decisions. Business ethics may concern issues such as employee rights, job discrimination, deceptive advertising, drug testing, and affirmative action. Environmental ethics may concern issues such as animal experimentation, land usage, and oil drilling. Ethical principles In biomedical ethics, there are primary ethical principles that offer guidance to physical therapists and other healthcare practitioners. These principles include beneficence, nonmaleficence, autonomy, and justice. These principles are incorporated into The APTA Code of Ethics for the Physical Therapist (The Code ; APTA, 2020a) which will be discussed in detail in the next section. Select examples are included here to illustrate how these principles underpin the APTA Code . 1. Beneficence . The principle of beneficence implies acting for the good of the patient. The term beneficence connotes acts of mercy, kindness,and charity (Beauchamp & Childress, 2019). The principle of beneficence is at the heart of healthcare professionals, as the goal of medicine is to promote the well-being of patients (Beauchamp & Childress, 2019). Examples of beneficence include promoting health and welfare of the patient, removing harm, and putting the patient’s best interest ahead of their own. Principle 2A from the Code incorporates this principle by stating that “Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients and clients over the interests of the physical therapist” (APTA, 2020a). 2. Nonmaleficence . Nonmaleficence obligates healthcare professionals to refrain from causing harm, injury, or risk of harm to patients. Harm can be defined as “thwarting, defeating, or setting back some party’s interests” (Beauchamp & Childress, 2019, p. 158). In healthcare, negligent behavior can lead to harm by either knowingly failing to protect a patient from harm, or by carelessly or accidentally causing harm. From the Code , Principle 3C speaks to this principle by stating “Physical therapists shall make judgments within their scope of practice and level
Regardless of context, the application of ethical principles is similar. The normative principles of applied ethics include consideration of potential personal or social benefits as well as behaving with benevolence (acting for the benefit of others),honesty (truthfulness, uprightness, fairness), autonomy (the duty to maximize the individual’s right to make decisions), and justice(the duty to treat all fairly). The additional guiding standards of nonmaleficence (do no harm) and respect for other people’s rights during the analysis of moral dilemmas transcend the setting in which ethical principles are applied. of expertise” (APTA, 2020a). Failing to do so could lead to harm. 3. Autonomy . The principle of autonomy stipulates respect for a person’s freedom of self-determination (Spike & Lunstroth, 2016). This means that the patient has the right to make decisions regarding their healthcare. Important aspects of this principle include informed consent and confidentiality. The Code speaks to the principle of autonomy in the following examples: ○ Principle 2C : “Physical therapists shall provide the information necessary to allow the patients or their surrogates to make informed decisions about physical therapy care or participation in clinical research.” ○ Principle 2D : “Physical therapists shall collaborate with patients/clients to empower them in decisions about their healthcare.” 4. Justice . The principle of justice is complex and vast and includes the principle of distributive justice. While justice connotes fair and appropriate treatment, distributive justice is described as “fair, equitable, and appropriate distribution of benefits and burdens”(Beauchamp & Childress, 2019, p. 268). The implies a focus on striving to minimize the effect of social inequality on healthcare. In the APTA Code , Principle 8, as shown below, states that “physical therapist shall participate in efforts to meet the health needs of people locally, nationally or globally,” and in Principle 8A that “physical therapists shall advocate to reduce health disparities and healthcare inequities” (APTA, 2020a).
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APPLIED ETHICS IN PHYSICAL THERAPY
The principles of medical or healthcare ethics provide guidelines that can help in the resolution of moral dilemmas. Physical therapists are in a unique position with patient care issues, because PTs often act as liaisons between patients and their family members, physicians, and other healthcare practitioners. Patients are physically and mentally vulnerable when the need for therapeutic intervention arises, and the treating physical therapist or physical therapist assistant must be aware of the level of trust the patient places in them. Patients share their current and past medical history, describe their home situations, and present their bodies for inspection. Occasionally, they state their perceptions of the therapist’s fellow healthcare workers’ attitudes and actions. Most of the time, they quickly come to regard the therapist as a friend and trust the physical therapist or physical therapist assistant to keep their opinions, hopes, and fears confidential. Case study #3 “Professional Boundaries” Fran is a physical therapist who has been practicing for two years in a large neurological rehabilitation center. She enjoys treating neurologically-impaired patients, and gets along well with the other therapists working there, although she still thinks of herself as a“new grad.” On occasion, she feels uncomfortable when some of the therapists talk to each other about other patients during treatment sessions. One day, Fran notices family members exchanging looks when two of her coworkers share a private joke about a patient while treating their loved one who is recovering from a head injury.
Therapists must continually regard the patient with respect, and protect the patient’s autonomy at all times. It is important to treat patients with care and compassion, and to provide an environment of support. Patients should be able to feel safe and secure in the knowledge that their cases are being treated confidentially. Therapists need to inform and educate patients about their condition,effectively empowering and allowing them to make informed decisions. A physical therapist or physical therapist assistant explaining their logic and actions before physically approaching the patient not only allows the patient to feel respected, but also decreases the potential for lawsuits in the event that the patient misconstrues the therapist’s actions. The Golden Rule provides overall guidance inpatient interaction, as it is helpful for a physical therapist or physical therapist assistant to consider how they might like to be treated or to have a beloved family member treated in a similar circumstance. Discussion Points: Setting professional boundaries with Fran What does Fran do? Is there a way to tactfully approach her peers and remind them of respecting confidentiality? Can Fran defuse the current situation? If the other therapists are behaving so casually during this patient’s treatment, could there be times when patient confidentiality is breached? Fran wonders how she would feel if one of her relatives were being treated with apparent indifference or disrespect.
THE APTA AND ETHICS
Professional organizations establish a code of ethics to set a specific standard by which the conduct of its members can be measured. The APTA’s House of Delegates has identified standards for physical therapists in the Code of Ethics for the Physical Therapist (the Code ; APTA, 2020a) and for physical therapist assistants in the Standards of Ethical Conduct for the Physical Therapist Assistant (the Standards ; APTA, 2020b). These standards are further illuminated in the APTA Guide for Professional Conduct (APTA, 2019a) and APTA Guide for Conduct of the Physical Therapist Assistant (APTA, 2019c). Although not all physical therapists are APTA members, the Code and Standards are binding on all physical therapists and physical therapist assistants regardless of membership status. As a group, physical therapists tend to be people of integrity, with a strong sense of personal ethics and a desire to help others. The Code describes virtues, obligations, and moral ideals for the physical therapist to aspire to and be guided by. The purpose of both codes is to define ethical principles that form the foundation of physical therapy practice and to provide standards of ethical behavior as it relates to physical therapy. The APTA Code of Ethics for the Physical Therapist is built on APTA Code of Ethics The following section provides the preamble to the Code of Ethics for the Physical Therapist (APTA, 2020a) and lists the eight main principles of the Code . Each principle is further divided into subsections that elaborate on the main principle. The principles found in the Standards of Practice for the Physical Therapist Assistant are very similar and are not provided here. To view the Code and other APTA ethics and professionalism documents in their entirety, see the Resources section for links. Preamble 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). The purposes of this Code of Ethics are to: 1. Define the ethical principles that form the foundation of physical therapist practice in patient and client
the roles of the physical therapist (e.g. management of clients, consultation, education, research, and administration). In the document Core Values for the Physical Therapist and Physical Therapist Assistant (APTA, 2019b), the APTA has defined eight professional core values that guide Physical Therapy (PT) practice and support the ethical principles set forth in the APTA Code of Ethics for the Physical Therapist : ● Accountability. ● Altruism. ● Collaboration. ● Compassion/caring. ● Duty. ● Excellence. ● Integrity. ● Social responsibility. The core values that support the eight principles in the APTA Code and Standards are indicated in parentheses below. The principles in both of these ethics documents address individual, organizational, and societal ethical actions. 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. 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.
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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 APTA Guide for Professional Conduct and Core Values for the Physical Therapist and Physical Therapist Assistant provide additional guidance. This Code of Ethics describes the desired behavior of physical therapists in their multiple roles (e.g., management of patients and clients, consultation, education, research, and administration), addresses multiple aspects of ethical action (individual,organizational, and societal), and reflects the core values of the physical therapist (accountability, altruism, collaboration,compassion and caring, duty, excellence, integrity, 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. Principle #1 : Physical therapists shall respect the inherent dignity and rights of all individuals. (Core Values: Compassion and Caring, Integrity) Principle #2 : Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients and clients. (Core Values: Altruism, Collaboration, Compassion and Caring, Duty) APTA Guide for Professional Conduct The Guide for Professional Conduct (the PT Guide ; APTA, 2019a) is intended to serve physical therapists in interpreting the Code in matters of professional conduct. The PT Guide provides guidelines by which physical therapists may determine the propriety of their conduct. It is also intended to guide the professional development of physical therapist students. The Code and the PT Guide apply to all physical therapists. These guidelines are subject to changes as the dynamics of the profession change and as new patterns of healthcare delivery are developed and accepted by the professional community and the public. The PT Guide is subject to monitoring and timely revision by the APTA Ethics and Judicial Committee. The interpretations expressed in the PT Guide reflect the opinions, decisions, and advice of the APTA Ethics and Judicial Committee. These interpretations are intended to assist a physical therapist in applying general ethical principles to
Principle #3 : Physical therapists shall be accountable for making sound professional judgments. (Core Values: Collaboration, Duty, Excellence, Integrity) Principle #4 : Physical therapists shall demonstrate integrity in their relationships with patients and clients, families, colleagues,students, research participants, other health care providers, employers, payers, and the public. (Core Value: Integrity) Principle #5 : Physical therapists shall fulfill their legal and professional obligations. (Core Values: Accountability, Duty, Social Responsibility) Principle #6 : Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills,abilities, and professional behaviors. (Core Value: Excellence) Principle #7 : Physical therapists shall promote organizational behaviors and business practices that benefit patients and clients and society. (Core Values: Integrity, Accountability) Principle #8 : Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally. (Core Value: Social Responsibility) specific situations. They should not be considered inclusive of all situations that could evolve. The PT Guide is intended to clarify and explain the eight principles listed in the Code . The APTA Ethics and Judicial Committee revises and updates the PT Guide to assist PTs in staying current with changing times. The Guide for Conduct of the Physical Therapist Assistant ( PTA Guide , APTA, 2019b) similarly provides a detailed interpretation of the Standards , and is amended as needed by the APTA Ethics and Judicial Committee. In addition to the Code and PT Guide , Georgia physical therapists must be familiar with and understand the Georgia Physical Therapy laws. At no time is it permissible to practice outside of the law. The Georgia Board of Physical Therapy requires a course on ethics and Georgia jurisprudence with each license renewal.
GEORGIA JURISPRUDENCE
Physical therapists and physical therapist assistants in the state of Georgia are obligated to know the applicable laws that govern their practice. These laws are covered in the Georgia General Provisions (1981/2016), Georgia Physical Therapy Practice Act(1972/2019), and the Georgia Board Rules and Board
Policies. Abridged versions of these laws are covered in the following sections; the full versions may be found on the Georgia Board of Physical Therapy website https://sos.ga.gov/index. php/licensing/plb/39. Links to each document and the Board of Physical Therapy can also be found in the Resources section. (3) “Professional licensing board“ means any board, bureau, commission, or other agency of the executive branch of state government which is created for the purpose of licensing or otherwise regulating or controlling any profession, business, or trade and which is placed by law under the jurisdiction of the director of the professional licensing boards division within the office of the Secretary of State.
Georgia General Provisions (O.C.G.A. §§ 43-1-1 through 43-1-34) § 43-1-1. General Provisions As used in this title, the term: (1) “Division“ means the professional licensing boards division created under Code Section 43-1-2.
(2) “Division director“ means the individual appointed by the Secretary of State as director of the professional licensing boards division within the office of the Secretary of State.
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§ 43-1-2. Appointment and General Powers of Division Director; Members and Meetings of Professional Licensing Boards; Examination Standards; Roster of Licensees; Funding A. 1. There is created within the office of the Secretary of State the professional licensing boards division as a successor to the office of the joint-secretary of the state examining boards. The Secretary of State is authorized and directed to appoint a director of the professional licensing boards division. 2. Any action of the joint-secretary taken with regard to any state examining board prior to July 1, 2000, shall thereafter be deemed to be action taken by the director of the professional licensing boards division and that division director shall thereafter act in the stead of such joint-secretary and succeed to the powers and duties of the joint-secretary with those state examining boards. The rights, privileges, entitlements, or duties of parties to contracts, leases,agreements, or other transactions entered into by the joint-secretary prior to July 1, 2000, shall continue to exist and shall not be impaired or diminished by reason of the succession of the division director to the powers and duties of the joint-secretary. B. The salary of the division director shall be fixed by the Secretary of State, and he or she shall hold office at the pleasure of the Secretary of State. C. The Secretary of State, notwithstanding any other provisions of law to the contrary, shall employ personnel as deemed necessary to carry out this chapter and to provide for all services required by each of the professional licensing boards and shall establish within the guidelines provided by the laws and rules and regulations of the State Personnel Board the qualifications of such personnel. D. The division director, with the approval of the Secretary of State, notwithstanding any other provisions of law to the contrary,shall enter into such contracts as are deemed necessary to carry out this chapter to provide for all services required by each of the professional licensing boards. E. The Secretary of State, notwithstanding any other provisions of law to the contrary, shall have the power to employ and shall set the qualifications and salary for a deputy division director and shall appoint executive directors as required who shall act in the absence of the division director and who shall perform such other functions of the division director under this chapter as the division director may designate. The deputy division director and executive directors has appointed shall be in the unclassified service and shall be excluded from the classified service as defined in Article 1 of Chapter 20 of Title 45. F. Notwithstanding any other provisions of law to the contrary, each member of the various professional licensing boards may receive the expense allowance as provided by subsection (b) of Code Section 45-7-21 and the same mileage allowance for the use of a personal car as that received by all other state officials and employees or a travel allowance of actual transportation cost if traveling by public carrier within the state. Any board member shall also be reimbursed for any conference or meeting registration fee incurred in the performance of his or her duties as a board member. For each day's service outside of the state as a board member, such member shall receive actual expenses as an expense allowance as well as the same mileage allowance for the use of a personal car as that received by other state officials and employees or a travel allowance of actual transportation cost if traveling by public carrier or by rental motor vehicle. Expense vouchers submitted by members of the various professional licensing boards are subject to approval of the president or chairperson of the respective board and the division director.
G. All meetings and hearings of the respective professional licensing boards shall be held in the capitol, at the site of the office of the respective board, or at such other site as may be requested by the chairperson or president of a professional licensing board and approved by the division director. H. A majority of the appointed members of a professional licensing board shall constitute a quorum for the transaction of business by that board. 1. Members of a professional licensing board shall serve until the expiration of the term for which they were appointed and until their successors have been appointed and qualified unless otherwise specified under the provisions of this title. I. A schedule of all meetings and hearings of the various professional licensing boards shall be maintained at the office of the division director and be available for public review. J. The division director may establish administrative standards for the examination of applicants for licensure by the various professional licensing boards, notwithstanding any other provisions of law to the contrary. These administrative standards may include the setting of date, time, and location of examinations, subject to the approval of the respective professional licensing boards. Notwithstanding any other provisions of law to the contrary, examination criteria, examination grading procedures,examination fees, examination passing score requirements, and other matters pertaining to the examination of applicants for licensure may be adopted by rules of the respective professional licensing boards as necessary to implement such examination standards. Examination standards, including examination criteria, grading procedures, and passing score requirements, developed in agreement or in conjunction with a national association of state boards or other related national associations for the administration of a nationally recognized uniform examination may be adopted in lieu of state standards by the respective professional licensing boards. K. The division director shall prepare and maintain a roster containing the names and addresses of all current licensees for each of the various professional licensing boards. A copy of this roster shall be available to any person upon request at a fee prescribed by the division director sufficient to cover the cost of printing and distribution. The following shall be treated as confidential and need not be disclosed without the approval of the professional licensing board to which application is made: 1. Applications and other personal information submitted by applicants, except to the applicant, staff, and the board; 2. Information, favorable or unfavorable, submitted by a reference source concerning an applicant, except to the staff and the board; 3. Examination questions and other examination materials, except to the staff and the board; and 4. The deliberations of the board with respect to an application, an examination, a complaint, an investigation, or a disciplinary proceeding, except as may be contained in official board minutes. L. Funding for the office of the division director and the various professional licensing boards served by such offices shall be contained in a common budget unit as defined in Part 1 of Article 4 of Chapter 12 of Title 45, the “Budget Act.“
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