Monday 4 February 2013

THE QUALITY NEEDED BY PHYSIOTHERAPISTS


1.       The Position on Physical Therapy as a Health Profession.

Physical Therapy is a health profession whose primary purpose is the promotion of optimal health and function. This purpose is accomplished through the application of scientific principles to the processes of examination, evaluation, diagnosis, prognosis and intervention to prevent or remediate impairments, functional limitations and disabilities as related to movement and health.

 

The primary role of a physical therapist involves direct patient care. For this reason, the Board of Directors of the APTA (American Physical Therapy Association) approves the Standard of Practice for Physical Therapy to identify “conditions and performances that are essential for provision of high-quality physical therapy”.

A physical therapist participates in clinical practice and patients’ recovery is the main objective for why therapists doing treatment. Patients’ disability to move or walk and do exercises should be eliminated after treatment finished. However, it is not a simple job to heal the patient. It takes much effort and of course, quality is the primary subject to hit the goal.

While doing treatment, a physical therapist should follow the rules and ethics as shown in Code of Ethics of The American Physical Therapy Association. This Code of Ethics shall be binding on all physical therapists to maintain and promote ethical practice.

 

Principles

 

Principle #1: Physical therapists shall respect the

inherent dignity and rights of all individuals.

(Core Values: Compassion, Integrity)

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.

 

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.

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.

 

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.

 

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 over whom

they have supervisory, evaluative or other authority (eg,

patients/clients, students, supervisees, research participants,

or employees).

4C. Physical therapists shall discourage misconduct by health

care 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 patients/clients, supervisees, or

students.

4F. Physical therapists shall not harass anyone verbally, physically,

emotionally, or sexually.

 

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 with

reasonable skill and safety shall report this 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.

 

 

 

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 physical therapist 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.

 

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 therapists shall fully disclose any financial interest

they have in products or services that they recommend to

patients/clients.

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.

7F. Physical therapists shall refrain from employment arrangements,

or other arrangements, that prevent physical therapists

from fulfilling professional obligations to patients.

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.

 

This Code of Ethics especially Principle 1-7 really promote quality in doing treatment for patient. 

If all therapist follow the ethics and law in treatment, public will seek for physical therapists’ care because they see the perfect outcome after doing treatment with physical therapists. The treatment also will be more valuable and we get high expectation from people.

In spite of that, we have the Standards of Practice for Physical Therapist that we can follow to provide an optimum level of service delivery and to strive for excellence in practice. The Standards provide a foundation for assessment of physical therapy practice. All physical therapists should consider the standards before and when doing the treatment. It starts from Ethical Consideration, Organization, Policies, Plan of Care, and Intervention until Community Responsibility.

 

 


 

 

 

 STANDARDS OF PRACTICE FOR PHYSICAL THERAPY HOD S06-10-09-07 [Amended HOD S06-10-09-06; HOD S06-03-09-10; HOD 06-03-09-10; HOD 06-99-18-22; HOD 06-96-16-31; HOD 06-91-21-25; HOD 06-85-30-56; Initial HOD 06-80-04-04; HOD 06-80-03-03] [Standard]

 

Preamble

The physical therapy profession’s commitment to society is to promote optimal health and functioning in individuals by pursuing excellence in practice. The American Physical Therapy Association attests to this commitment by adopting and promoting the following Standards of Practice for Physical Therapy. These Standards are the profession’s statement of conditions and performances that are essential for provision of high quality professional service to society, and provide a foundation for assessment of physical therapist practice.

I. Ethical/Legal Considerations

A. Ethical Considerations

The physical therapist practices according to the Code of Ethics of the American Physical Therapy Association.

The physical therapist assistant complies with the Standards of Ethical Conduct for the Physical Therapist Assistant of the American Physical Therapy Association.

B. Legal Considerations

The physical therapist complies with all the legal requirements of jurisdictions regulating the practice of physical therapy.

The physical therapist assistant complies with all the legal requirements of jurisdictions regulating the work of the assistant.

II. Administration of the Physical Therapy Service

A. Statement of Mission, Purposes, and Goals

The physical therapy service has a statement of mission, purposes, and goals that reflects the needs and interests of the patients/clients served, the physical therapy personnel affiliated with the service, and the community.

B. Organizational Plan

The physical therapy service has a written organizational plan.

C. Policies and Procedures

The physical therapy service has written policies and procedures that reflect the operation, mission, purposes, and goals of the service, and are consistent with the Association’s standards, policies, positions, guidelines, and Code of Ethics.

D. Administration

A physical therapist is responsible for the direction of the physical therapy service.

 

 

E. Fiscal Management

The director of the physical therapy service, in consultation with physical therapy staff and appropriate administrative personnel, participates in the planning for and allocation of resources. Fiscal planning and management of the service is based on sound accounting principles.

F. Improvement of Quality of Care and Performance

The physical therapy service has a written plan for continuous improvement of quality of care and performance of services.

G. Staffing

The physical therapy personnel affiliated with the physical therapy service have demonstrated competence and are sufficient to achieve the mission, purposes, and goals of the service.

H. Staff Development

The physical therapy service has a written plan that provides for appropriate and ongoing staff development.

I. Physical Setting

The physical setting is designed to provide a safe and accessible environment that facilitates fulfillment of the mission, purposes, and goals of the physical therapy service. The equipment is safe and sufficient to achieve the purposes and goals of physical therapy.

J. Collaboration

The physical therapy service collaborates with all disciplines as appropriate.

 

III. Patient/Client Management

A.      Physical Therapist of Record The physical therapist of record is the therapist who assumes responsibility for patient/client management and is accountable for the coordination, continuation, and progression of the plan of care.

 

B.      . Patient/Client Collaboration

Within the patient/client management process, the physical therapist and the patient/client establish and maintain an ongoing collaborative process of decision making that exists throughout the provision of services.

 

C. Initial Examination/Evaluation/Diagnosis/Prognosis

The physical therapist performs an initial examination and evaluation to establish a diagnosis and prognosis prior to intervention.

 

D. Plan of Care

The physical therapist establishes a plan of care and manages the needs of the patient/client based on the examination, evaluation, diagnosis, prognosis, goals, and outcomes of the planned interventions for identified impairments, activity limitations, and participation restrictions.

The physical therapists involve the patient/client and appropriate others in the planning, implementation, and assessment of the plan of care.

The physical therapist, in consultation with appropriate disciplines, plans for discharge of the patient/client taking into consideration achievement of anticipated goals and expected outcomes, and provides for appropriate follow-up or referral.

 

E. Intervention

The physical therapist provides or directs and supervises the physical therapy intervention

consistent with the results of the examination, evaluation, diagnosis, prognosis, and plan of care.

 

F. Reexamination

The physical therapist reexamines the patient/client as necessary during an episode of care to evaluate progress or change in patient/client status and modifies the plan of care accordingly or discontinues physical therapy services.

 

G. Discharge/Discontinuation of Intervention

The physical therapist discharges the patient/client from physical therapy services when the anticipated goals or expected outcomes for the patient/client have been achieved.

The physical therapist discontinues intervention when the patient/client is unable to continue to progress toward goals or when the physical therapist determines that the patient/client will no longer benefit from physical therapy.

 

H. Communication/Coordination/Documentation

The physical therapist communicates, coordinates, and documents all aspects of patient/client management including the results of the initial examination and evaluation, diagnosis, prognosis, plan of care, interventions, response to interventions, changes in patient/client status relative to the interventions, reexamination, and discharge/discontinuation of intervention and other patient/client management activities. The physical therapist of record is responsible for “hand off” communication.

IV. Education

The physical therapist is responsible for individual professional development. The physical therapist assistant is responsible for individual career development.

The physical therapist and the physical therapist assistant, under the direction and supervision of the physical therapist, participate in the education of students.

The physical therapist educates and provides consultation to consumers and the general public regarding the purposes and benefits of physical therapy.

The physical therapist educates and provides consultation to consumers and the general public regarding the roles of the physical therapist and the physical therapist assistant.

V. Research

The physical therapist applies research findings to practice and encourages, participates in, and promotes activities that establish the outcomes of patient/client management provided by the physical therapist.

 

 

VI. Community Responsibility

The physical therapist demonstrates community responsibility by participating in community and community agency activities, educating the public, formulating public policy, or providing pro bono physical therapy services.

 

In addition, physical therapists have their other professional roles while facing the clients/patients.

·         Consultation

It refers to service provided by the physical therapist in making recommendations concerning the current or proposed physical therapy plan of care. It usually involves examination but not intervention. It is also an advice to patient from physiotherapist such as suggestion for health care policies.

·         Education

Because instruction is an inherent part of any patient care activity in physical therapy, physical therapists are constantly providing education to a variety of audiences. Patients or maybe caregivers are taught exercises or techniques to enhance function.

So, in order to give such instructions the physical therapists first require knowledge and skills that must be conveyed. Instruction also occurs when students are supervised during internship. Demonstration, supervision, and feedback are important to practice and perfect skills.

·         Critical inquiry

Critical inquiry is essential in physical therapy for capability/viability of the profession. We must be able to answer those who pay for our services when questioned about the choice and efficacy of our direct interventions. Our practice and answer cannot be verbal only. We have to prove why it is very suitable to be used. The only way to prove is through researches. Our practice must be based on sound evidence that comes from well-designed research (evidence-based practice).

 

Reference: Introduction to Physical Therapy Second Edition Michael A. Pagliarulo, PT, EdD by Mosby Inc, 2001. Chapter 1-6 Pg 3-109.



 Quality in communication

1.      Don’t use jargon

:: How’s your range of motion now?

:: We can improve your biceps and triceps performance.

:: Be careful, don’t overstress your hands otherwise you will dislocate your  glenohumeral joint.

 

2.      Don’t use complex sentence structures. Use the clearer and simpler words.

:: We have done with the observation; your eyes have been infected by bacteria that disturb your sight and blood circulation. Normal blood circulation is good for our body.  . Not enough oxygen is transported when the blood circulation is weak. We should give you medicine to overcome this problem.

3.      Don’t confuse the patient by asking more than one thing at a time.

:: Have you eaten the medicine? How about the exercise, have you done with it? You should do that twice a day so that you will feel better.

4.      Don’t assume anyone will know what you mean.

:: Have you followed the instruction in the paper? (Which paper?)

5.      Don’t use double negative questions. Ask the questions positively.

:: Why didn’t you eat the medicine yet? Didn’t I advise you to eat that for every six hours?

6.      Do ask questions in an unbiased, unemotional way.

:: You didn’t eat the medicine; it serves you right that you are not feeling better like my other patients. If you followed the schedule correctly, certainly you will be better than this.

 

Reference: Research Methods for Clinical Therapists. Applied project an Design and Analysis, Carolyn Hicks 4th edition. Page 19-22.