prof dev

• Learning through experience
• Being in the moment
• Use of senses - sight, sound, smell, and touch
• Intuition
• Accurate self-assessment skills
• Transformative - involves recognition and reflection
• Road to expert as a practitioner

• Knowledge
• Movement
• Clinical reasoning
• Virtue
• Philosophy

• Multidimensional - cognitive, psychomotor, affective
• Patient centered
• Various sources
• Specialty knowledge
• Reflective process

• What you know, see, value
• What patient does
• What PT does - what they do with their hands, timing matters, everything changes after you touch the patient
• Hands and entire body are keys to practice
• Experts value fine tuned kinesthetic awareness
• Can interally represent movement
• Can recall previous movement
• Value patient's body as source of knowledge
• Experts move effortlessly, fluidly

• Highly proficient data gathering skills
• Expanded boundaries in problem-solving
• Entered into jointly with patients and families - collaborative
• Focuses on maximal function as a valued outcome rather than diagnosis

• Personally-derived standards for performance - ever-chaning and not perfectionistic
• Commited to caring without fear - of environment, of failure/of own limitations, or of differences
• Strong patient advocates
• Moral agents
• Rewarded with a passion and joy in their work

• Heart of our work
• Derived from movement, knowledge, virtue, and clinical reasoning
• Beliefs about role as PT

• Connect new knowledge to existing knowledge
• Making the most of experience

• Look, listen & feel during demonstrations and in lab
• Classmates & patients as sources of knowledge
• Identify and develop self-knowledge - reflection-in-action and on-action
• Ask questions
• Interview CIs - use of knowledge, importance of movement, types of decisions, and virtue
• Develop your own philosophy of practice

• Dependent on ability to self-assess
• Self-assessment forms are only the beginning
• Practice self-reflection
• Positive self-talk
• Pursue additional knowledge
• Don't expect perfection

"A system of moral principles or standards governing conduct"

• A dynamic "living" public document
• "Articulates the values of the profession to the public it serves and has an established mechanism to hold practitioners accountable for adhering to ethical standards
• One credential that is a Hallmark of a profession or professionalism

AMA wrote their first Code of Ethics

• Defined limits of practice for physiotherapists
• Stated that diagnosis, prognosis, and treatment were responsibility of MD only
• Showed devotion and complete deference to physicians ... DUTY TO PHYSICIANS
• Had a profession-wide ethics committee
• Physiotherapists could not question a doctor's judgment

• Making a medical diagnosis
• Offering a medical prognosis
• Advertising for patients
• Criticizing a doctor or other co-workers

• Both documents applied to all physical therapists (APTA members or not) and physical therpaist students
• Was our "primary source of ethical guidance"
• Patient-centered statements - FOCUS
• Included - incorporation of "ethical decision making in every patient interaction"

• 6 year process initiated by APTA's ethics and Judical committee in 2004
• In-depth analysis of APTA code and that other profession's
• Growing sense of inadequacy of existing document related to ethical guidance across the many aspects of our profession

• Focused solely on patient-client role of PTs - did not acknowledge PTs work as administrators, educators, researchers, and consultants
• Demands on autonomous practitioners and direct access not addressed-state vary
• Complexities of current health care environemnt e.g., interrrelationships between PTs, PTAs, other health care professionals
• No reflection on elements of Vision 2020
• Lack of definition of uniqueness of profession of physical therapy

• All the principles and standards, both numbered and lettered, contain the word "shall" and are mandatory ehtical obligations
• The language contained in the revised Code and Standards is intended to provide greater clarification of existing ethical obligations, thereby allowing the PT to have a clearer understanding of his/her existing ethical obligations

• 1-duty toall individuals
• 2-duty to patients/clients
• 3- accountability for sound judgments
• 4-integrity in relationships
• 5-fulfilling legal and professional
• 6-lifelong acquistion of knowledge, skills, and abilities
• 7-organizational behaviors and business practice
• 8-meeting health needs of people

• 6 standards
• Provide foundation for assessment of PT practice
• Essentials for high quality professional service to society
• Includes specific Criteria for Standards of Practice

• Legal/ethical considerations
• Administration of physical therapy service
• Provision of Service
• Educaiton
• Research
• Community responsiblility

• statment of mission, purposes and goals
• organizational plan
• policies and procedures
• administration
• fiscal management
• improvement of quality care & performance
• staffing
• staff development
• physical setting
• collaboration

• informed consent
• initial examination/ evaluation/ diagnosis/ prognosis
• plan of care
• intervention
• re-examination
• discharge/ discontinuation of intervention
• communication/ coordination/ documentation

• first developed in 1972 by the American Hospital association
• included in the Accreditation manual for hospitals
• APTA had adopted a patient rights statement related to physical therapy
• Generally covers right to care and respect/make informed decsions/ have information kept condifential

• access to care
• "undesirable" patients
• safety
• continuity of care
• privacy
• cultural/spiritual differences

a fedreal statute on right of patients and long-term care to exercise control over medical decision making, discesses advance directives

• information is confidential
• patients need to know their rights and ho to proceed if have complaints
• Privileged communication - established doctor-patient relationship & information comes form patient information and relates to care of patient

• protected health information includes individually identifiable health information
• have a right to request a limit on certain uses ans releases, get a log of all releases, inspect and copy yout information, request thta information be added, and withdraw your permission to use or disclose the information
• health care providers can use and disclose protected health information related to both payment and health care operations as specified in the law

• informed consent - written or oral
• implied
• emergency

• full disclosure - nature fo diease/condition; proposed tests and treatments; alternative treatments; risks and benefits
• patient has capacity to comprehend
• patient is free of coercion

• living will: concerns life-sustaining measures in the event of incapacitation. person must be both legally incapacitated and terminally ill
• durable power of attorney for health care decisions: can designate anyone including a spouse, relative, attorney, friend, etc.

• competency is a legal term. the courts consider all adults competent unless judged otherwise by a court of law
• proxy is a designated person to make health care decision (durable power of attorney of health care). this has the force of law and the doctor is expected to follow the proxy's instruction

• assisted suicide is when the physican provides the patient with a means for suicide
• euthanasia is when the physican actually performs a procedure that causes death

1997 voters in oregon approved making oregon the first state to legalize physician-assisted suicide

• started after WWII and nazi war crimes
• set procedures to inform patients of purpose of research, risks, and benefits
• signed consent forms
• change in protocol and consent has to be approved

• written so that subject unerstand purpose of research, what they will do if they partiipate in it, the possible risks, the possible benefits
• also, that the data will be confidential, subject can refuse without any penalty, can call if have questions, and has a contact if any injury occurs because of the research

• accurate and complete information
• comply with instructions
• finanaces
• facility rules and regulations
• respect for other patients and personnel

• intedependent
• entails skillful communication
• knowledge of PTAs education, training and skills
• trust

• understand job descriptors
• common goals
• mutual confidence/ trust
• mutual respect

• education: associate's degree form an accredited program
• supervision: must work under direction and supervision of PT
• delegetion: can provide slected interventions, can progress patient, and provide patient safety and comfort

• Interpretation of referral
• inital evaluation, problem indentfication and PT diagnosis/prognosis
• Development or modification of interventions and plan of care or re-examination and which includes physical therpay goals and outcomes
• determination of when the expertise and decision-making capability of the PT requires the PT to personally render PT interventions and when the PTA is appropriate
• Re-examination of the patient/ client in light of their goals and reision of the POC when indicated
• Discharge plan and discharge summary
• oversight of all documentation for services rendered

• predictability
• stability of the situation
• observability of basic indicators
• liability and risk management concerns
• msision of pt for setting
• needed frequency of re-examination
• reimbursement

• part of delefation
• based on policies of facility and your professional judgment: contact other health professionals, purchase equipment, and provide patient/family education

• PT must be accessible by telocommunications at all times while the PTA is treating patients
• regularly scheduled and documented conferences with the PTA RE: patients
• supervisory visit will be made at leat 1X/month or more frequently based on needs of patient and/or statutes
• when PTA requests re-examination, when change in POC is needed, prior to discharge
• supervision must be documented

• values and attitudes
• communication styles
• community/sonsumer participation
• physical environment and resources
• policies & procedures
• population-based clinical practice
• training and professional development

• more than a reflection of race or ethnicity
• consider relgion, educaiton, family, socioeconomic class

• individual level: cultural idenity grid
• systems level: cycle of socialization

• recognize the differences
• search for common ground
• distinquish between necessary & customary
• avoid negative assumptions/stereotyping
• assume commonality is discoverable

• record of patient care-ensures safety and quality of care
• communication tool among healthcare providers
• compliance with lawa/regulations
• reimbursements for 3rd party payers
• lets others know what PTs do
• evidence in potential legal situation
• research purposes (outcome analysis)

• history
• systems review
• tests and measures

• general demographics
• social history
• emplyment/work
• growth and development
• living environment
• general health status
• general health status
• social/health habits (past and current)
• family history
• medical/srgical history
• current conditions/ chief complaints
• functional status and activity level
• medication
• other clinical tests

• blood pressure
• edema
• heart rate and rhythm
• Respiratory rate

• texture/ pliability
• presence of scar formation
• skin color
• skin integrity

• gross range of motion
• gross strength
• gross symmetry
• height, weight

• gross coordinated movement (tranfers, balance, gait)
• motor function (motor control, motor learning)

• ability to make needs known
• affect
• cognition
• consciousness
• expected emotional/behavioral responses
• language
• learning styles/ preferences
• learning barriers (health literacy)
• orientation (person, place, and time)

• aerobic capacity
• assistive and adaptive equipment
• circulation
• peripheral and cranial nerve integrity
• motor funciton
• motor performance
• pain
• posture
• ROM and muscle length
• self care

• poor hand writing
• incomplete documentation
• no documentation for date of service
• abbreviations
• documentation does not support billing
• does not demonstrate skilled care
• does not demonstrate medical necessity
• does nto demonstrate progress
• no change in patient status - restating the same thing day after day
• intervention- no clarification of time, frequency, duration