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.
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.
