professional practice lecture 1-10

The AODA applies to who?

Applies to all levels of government, nonprofits, and private sector businesses across Ontario who have one or more staff.

Why do we need a Code of Ethics

Because it gives definition to our commitment to practice in ethical terms. As regulated health professionals, we have made a promise to society to accept the responsibility and maintain the trust with which we have been invested

Values and principles are realized through adherence to specific behavioral standards example of positive Standard

Behaviors that therapists are highly encouraged to participate in, in order to benefit their clients

Values and principles are realized through adherence to specific behavioral standards example of Negative Standards

Behaviors that therapists must refrain from doing in order to prevent harm to their clients

CMTO

College of Massage Therapists Ontario

Informed Consent requires the client to have

Competent choice Voluntary consent Adequate, relevant understood information

Step one of decision making protocol

Determine if the situation poses an ethical issue or dilemma and then gather all the facts

what are ways to practice non maleficence

Ensuring a smooth transition of services from one practice or professional to the next; Avoiding exploitative relationships; Avoiding drugs and alcohol, which interfere with professional activities; Separating personal problems from professional responsibilities.

HOW DO WE STERILIZE

Exposure to steam at high temperatures (autoclave) NOTE: May not remove debris, but the surface will be sterilized.

who established the M.T.A.

CMTO

what kinds of breaches of confidentiality are there

Deliberate and Intentional Inadvertent and Unintentional

Two major categories of Boundary Violations:

Gross Violations: Breaches of the professional promise not to engage in sexual contact with clients Dual Relationships: The blending of a professional (therapeutic) relationship with another potentially incompatible relationship

What are massage therapists called besides RMT'S

Health Care Professionals

Legal guidance regarding consent comes from the

Health Care consent Act (HCCA)

The goal of Professional Practice.

To serve the health, well-being and best interests of our clients

what is Professional Commitment:

To serve the health, well-being and best interests of their clients, first and foremost at all times

principal 1: respect for persons

To value the dignity and worth of all persons regardless of age, race, culture, creed, sexual identity, gender, ability and/or health status

In order to breach client confidentiality a therapist must intentionally provide others with information about the client without his or her consent?

False, a breach in client confidentiality can be either intentional or unintentional

not all issues require mandatory reporting; when must mandatory reporting happen

Financially abuse **********Sexually abuse*********** Emotional abuse Physically abuse their clients

HCCA

Health care consent act

M.T.A.

Massage Therapists Act

Fidelity

Respect others; also requires therapists to respect other professionals and colleagues by treating them fairly and honestly. Practitioners should also avoid conflicts of interest and help correct any ethical breaches.

when is consent not valid

if client is mislead, uninformed or unaware of circumstances.

what two things must be in your clinic

registration fee schedule

ODA (2005)

Ontarians with disabilities act : demands a higher standard of accessibility

what is non violent communication

we learn to hear others; identify and clearly articulate; observe, feel, rather than diagnosing and judging; act compassionately

how do we demonstrate respect for persons

we maintain therapeutic relationship We ensure our clients provide informed consent We protect our client's right to privacy and confidentiality

In order to keep the Therapeutic Relationship professional, what do we need to do

we need to establish professional boundaries

why do we have title protection as rmt's

we need to meet a certain criteria

what must therapists have title protection

we need to meet a certain standard to put RMT by our name.

test of universality

what would happen if everybody behaved this way

MCQ

multiple choice question

Principle #3 - Integrity in Relationships in our Code of Ethics document ensures

" that we always act in our client's best interest as defined by the client's wishes and consistent with the standards of practice of the profession"

Why do we have peer assessment?

"...to evaluate whether the registrant's knowledge, skills and judgement are satisfactory, as may be demonstrated by the registrant's adherence to the standards of practice of the profession and respect for the College's code of ethics".

What is CMTO's Mission Statement? Paragraphs one and three of the CMTO Mission Statement state:

"The College of Massage Therapists of Ontario protects and serves the public by guaranteeing the competency and quality of services provided by massage therapists through maintenance of Standards and Regulations." "We will operate in a manner which encourages innovation, and which elicits a sense of pride in the job and commitment to results through the Council. We will dedicate ourselves to improving our performance through focusing on group and individual goal setting, effective performance measurement and regular feedback. We will be guided in all that we do by our primary focus to protect the public.

What is the Massage Therapy Scope of Practice?

"The practice of massage therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissues and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain." Massage Therapy Act, 1991

what is the fine for not filing a mandatory report

$ 25, 000.00

penalties under AODA Include

$50,000/day for a person or unincorporated organization $100,000/day for a corporation $50,000/day for directors and officers of a corporation.

how many days do we have to report known or alleged abuse to RHPA

30 days

how many points to consent are there

31

what does the RMTAO do

-influencing and communicating change -they represent the members interests to the government, college, Canadian massage therapy alliance. -inform therapists of changes in the health care enviornment that affect their practices.

what does the ICRC do

-sees all complaints and screens all member specific -concerns that arise from other sources, including mandatory reports -discipline committee; conducts a hearing

Model for Ethical Decision-Making - Seven Steps:

1. Identify the ethical issue or dilemma 2. Consider the relevant ethical standard(s) and legal requirements 3. Apply the tests of: justice, publicity and universality 4. Consultation 5. Explore alternatives for action 6. Assess your proposed resolutions 7. Make a decision and implement the decision

Gross Violations - fall into three categories:

1. Sexual Intercourse 2. Sexual Touching 3. Sexual Behaviour / Remarks Any of these are met with the same Zero tolerance policy and are grounds for removal from the profession.

7 points regarding social contract today

1. Sometimes clients are vulnerable; in pain, emotional 2. Client does not have the same knowledge skills as the therapist 3. Client may me In pain, trusts therapist will help; not hurt them 4. Client may be immobile 5. Client may be very young or old 6. Client may be victim of sexual abuse or physical abuse—may not disclose this. 7. Client may have a language barrier.

what year was the RHPA regulated

1991

What is a code of ethics documents?

A document which outlines the ethical requirements in terms of principles and standards required of massage therapists as regulated health professionals

Definition of a Therapeutic Relationship

A relationship which exists between two people; one being a therapist and the other a client, for the sole and expressed purpose of serving the health and well-being of the client

what does peer assessment typically involves

A review of the physical aspects of your practice setting; An interview, consisting of a variety of questions designed to help you reflect on your practice and activities related to it, and a review of your professional portfolio; A review of the contents of selected client records; A series of open-ended questions about one or two current records, designed to help you reflect on the decision-making process you use in your care of clients

Deliberate and intentional breaches

A therapist knows the information in question is confidential and knowingly and deliberately reveals it

inadvertant and unitentional breach

A therapist, through carelessness or thoughtlessness reveals confidential information about a client

what is the alternative to the complaints process

ADR; alternative dispute resolution

ACS

Accessibility Standards for Customer Service

two sets of standards that are under the AODA:

Accessibility Standards for Customer Service (ACS) and Integrated Accessibility Standards Regulation (IASR)

AODA

Accessibility for Ontarians with disabilities act. This requires inclusion for people with disabilities and a requirement for us to meet a certain standard.

ADR

Alternative dispute resolution

informed consent must be;

An ongoing process of communication between a therapist and a client which results in the client providing the therapist with their agreement or authorization to a specific treatment plan

Under the AODA, What does the IASR Show organizations

IASR shows organizations where they need to remove barriers to Information and Communications, Employment, Transportation and the Design of Public Space.

any agreements reached by the ADR must be accepted by who?

ICRC; inquiries, complaints and reports committee; who will review the settlement to ensure it maintains protection of the public interest

ICRC

Inquiries, complaints and reports committee

IASR

Integrated Accessibility Standards Regulation

One of the easiest ways to determined if we are in a conflict of interest or potential conflict of interest scenario is to test yourself with the following questions

Is this situation likely to interfere, or appear to interfere, with the independent and objective judgement that I must show as a regulated healthcare professional in performing my duties? Would others (clients, the public or peers) trust my judgement if they knew I was participating in this situation?

WHAT IS THE RMTAO

It is the voice of the massage therapy profession in Ontario. Established in 1936, it is a member-driven, not-for-profit association that provides leadership for and advocates on behalf of Ontario's RMTs. They provides education, information, and programming that encourages professional growth and high standards for RMTs.

What does a Code of Ethics do?

It lays out clearly the massage therapy profession's values and explains what they are in terms of what we ought to do in order to protect and promote the public good, and what we must avoid doing in order to prevent harm to the public

WHAT TEMPERATURE SHOULD LINENS BE WASHED IN

Linens should be washed at 75.1 degrees Celsius to provide the most effective means of destroying microorganisms**

To whom does this Code apply?

Massage Therapists who act as practitioners, educators, researchers, administrators or policy makers are all expected to maintain a commitment to massage therapy values and to follow the principles outlined in this Code.

What is Massage Therapy?

Massage practice is a therapeutic, integral healing relationship in which the therapist assists the client in restoring, maintaining and enhancing the well being of the client

what is the CONSENT TO TREATMENT ACT 1992

Massage therapists are expected to obtain consent from clients prior to commencing any treatment. Individuals are assumed to be capable to provide consent, unless they demonstrate otherwise to the practitioner. There is no specific age that determines when an individual is deemed capable. This determination will depend on the individual's ability to understand the situation and the treatment proposed. Clients may withdraw consent to a treatment at any time, and this must immediately be respected by the Massage Therapist.

List of regulated health professionals ; SHIATSU IS NOT ON LIST

Medical Doctors Nursing Professionals Midwifery Professionals Dentists Pharmacists

who is the RHPA governed by

Ministry of health

general ethical principals;

Non maleficence: Beneficence: Fidelity:

Why is Accessibility Important?

Over 16% of Ontarians have a disability and that is expected to rise over the coming years as the population ages. By 2036, 47% of Ontario's population is expected to be over 65 years of age.

PHIPA (2004)

Personal health information protection act. i.e. health history completely confidential unless you have written consent.

General principals that guide the practice of massage therapy

Principle 1: Respect for person Principle 2: Responsible for Caring Principle 3: Integrity in Relationships Principal 4: Responsibility to Society

Principle 2: Responsible for Caring

Providing sensitive, compassionate and empathetic quality massage therapy

Define autonomy

Refers to the belief that clients have a moral right to make their own choices about their healthcare

RMTAO

Registered massage therapy association of ontario

what two things must be in clinic as rmt's

Registration fee schedule

RHPA

Regualted Health Professionals Act

when did AODA bcome law

The Accessibility for Ontarians with Disabilities Act, 2005 (AODA) became law on June 13, 2005.

Competence of therapists refers to what?

The ability to perform the responsibilities required of massage therapists as regulated healthcare professionals to the standard required for safe, effective and ethical practice

Why can ethical decision-making be a complex and difficult experience?

The application of standards and requirements is not always simple and clear

Dual Relationships:

The blending of a professional (therapeutic) relationship with another potentially incompatible relationship

STERILIZATION Definition:

The destruction of all forms of microbial life including bacteria, viruses, spores and fungi. Items must be cleaned thoroughly before effective sterilization can take place.

Professional Ethics:

The ethical values and principles that govern the practice of massage therapists

what are examples of beneficence

The following are some of the ways practitioners fold this principle into their work: Providing both an evaluation and treatment plan; Practicing strictly within their competency limits; Using only evidence-based methods; Terminating services when clients' needs have been met; Reporting unethical and illegal activities.

DISINFECTION Definition:

The inactivation of disease-producing microorganisms. Usually involves chemicals, heat or ultraviolet light. Levels of chemicals disinfection change with the type of product used.

Definition of Professional Boundaries?

The physical and emotional limits that are appropriate in the therapeutic setting. Physical boundaries can be easier (more tangible) than emotion limit setting

CLEANING Definition:

The physical removal of foreign material, e.g. dust, soil, organic material such as blood, secretions, excretions and microorganisms. The terms "decontamination" and "sanitation" may be used for this process in certain settings. Cleaning reduces or eliminates the reservoirs of potential pathogenic organisms. Cleaning agents are the most common chemicals used in housekeeping activity

Massage therapists, by virtue of the Social contract with society, are committed to entering into a type of relationship termed the

Therapeutic Relationship.

Dual Relationships can take many forms, such as:

Therapist who becomes a Teacher when you begin school Bartering for Goods and Services Providing therapy for relatives and friends Socializing outside of treatment Being emotionally or sexually intimate with a client

Being fully present requires work and focused intent. What must therapists be aware of when practicing

Therapists must be self-aware and conscious of their intent when in practice.

when must informed consent happen

This must occur before each and every treatment Consent must be recorded on each treatment note

Principal 4: Responsibility to Society

To be accountable to society and conduct ourselves in a manner that fosters and promotes high ethical standards

What is the primary duty or purpose of massage therapists as regulated health professionals

To be legally and ethically accountable to society

Principle 3: Integrity in Relationships

To practice with integrity, honesty and diligence in our professional relationships with ourselves, our clients, our professional colleagues and society.

What does the test of justice require?

We apply our sense of fairness and ask how we would like to be treated if our positions were reversed

how do therapist keep boundaries and a degree of personal and professional autonomy

We make our own individual decisions and choices We have rights as well as responsibilities Setting limits to our services Receiving appropriate remuneration for our work Ensuring that we are treated with respect by our clients

HOW DO WE DISINFECT

We use alcohols 60 - 90%, or boiling for 20 minutes. NOTE: Debris may not necessarily be removed, but the surface will be disinfected.

what are the ethical and legal requirements in a concerning situation that presents itself

What does our Standards of Practice have to say about this situation? Are there any applicable legal requirements? What does our Code of Ethics have to say about this situation? What do General Ethical Principles have to say about this situation?

Transference:

When the client projects unto the therapist old feelings or attitudes that they had about significant people in their past (often parental figures)

explain Transference:

When the client projects unto the therapist old feelings or attitudes that they had about significant people in their past (often parental figures)

Counter-Transference:

When the therapist projects unto the client old feelings or attitudes that they had about significant people in their past

explain Counter-Transference:

When the therapist projects unto the client old feelings or attitudes that they had about significant people in their past

ARE WATERLESS HAND SCRUBS ACCEPTABLE

YES; (Alcohol gels, rinses, rub, etc) containing at least 60% alcohol may be used as an alternate to soap and water when water and soap is not available

A conflict of interest can be defined as

a situation in which a person in a position of trust and authority allows their personal or private interests to interfere with their client's best interest.

what is the best way we can ensure we maintain the trust and confidence of the public

acting with integrity when performing our responsibilities and obligation

what is integrity

acting with sincerity, honesty, respect, responsibility and diligence. Recognizing and honouring the best part of humanity

Test of justice

apply your sense of fairness and ask yourself how would i like to be treated if positions were reversed.

child abuse of minor under 16 what kind of responsibility

civil responsibility; everyone falls under this category

The role of integrity & ethics in what we do.

code clearly lays out the massage therapy profession's values and explains what they are in terms of what we ought to do in order to protect and promote the public good, and what we must avoid doing in order to prevent harm to the public.

what is the ADR

committee whereby disputes are resolved internally by informal mediation, involving complainant, person making complaint and third party.

what does consent through the HCCA look like; (health care consent act)

consent must be voluntary client must be informed of treatment risks, benefits and side effects must be discussed consent must not be obtained through fraudulent promises alternatives to treatment and consequences of treatment must be outlined

what are some things you should NOT do if involved in a complaint

contact the complainant alter/falsify any records relating to the client

What do you need for certificate of registration

diploma/from accredited college meet provincial standards passing marks on certification exams/practical and written proof of insurance valid CPR criminal records check

what qualifies you to be a regulated health professional

experts with complex knowledge and training. researching and continual upgrading autonomy to regulate own actions accountability. we are committed to the direct benefit of their clients and only secondary to making a profit

financial abuse, sexual abuse . emotional abuse, physical abuse should all be reported, however which ones are more ethical obligations

financial abuse emotional abuse physical abuse

The AODA is made up of;

five parts, or Standards, each covering an aspect of daily living

what is required before each and every treatment

full and informed consent

What is the single most important procedure for preventing nosocomial infections (Nosocomial = acquired or occurring in a hospital)

handwashing

what are the 2 key exceptions to breaking confidentiality

harm to self harm to others

what is our goal as a health care professional

helping people achieve and maintain healthy lives and restoring wellness/health to maximum attainable levels.

test of publicity

how would i feel if my behaviour were to be made public

What is the first step in attempting to understand an ethical issue or dilemma?

identifying whether the situation poses an ethical issue or dilemma

Beneficence

is rooted in the human acts of mercy, kindness and charity.

what is a code of ethics

it is a statement which expresses the primary ethical values, obligations and goals of the profession. It is a commitment which serves to bear witness to our promise as a profession to uphold the values and ethical obligations expressed in the Code

what is express or implied consent

it is reasonably assumed that the client consents to an action. for example making an appointment and showing up expresses desire to be interviewed, assessed and receive treatment.

what is expressed or implied consent

it is when it is reasonably assumed the client consents to an action. i.e. making an app. and showing up.

what is the timing for filing a mandatory report

must be submitted within 30 days of incident.

what must a mandatory report include

name of the person filing the report name of member who is subject to the report an explanation of the alleged sexual abuse; incompetance or incapacity

does consent have to do with age

no; it is about capacity to understand

can the cmto help a therapist with a response to an allegation against them

no; they must remain impartial during an investigation.

OSCE

objective structured certification exam

what must mandatory reports be;

objective, emotionless and factual

Under the AODA, What does the ACS outline

outlines where organizations need to remove barriers to customer service for people with disabilities, no matter whether your organization is a non-profit, public sector, or private business

if records are kept on computer what does PHIPA require

password protection back ups done regularly be careful with social media in regards to your practice

PIPEDA

personal information protection and electronics device act; i.e. keeping clients private information requires password protection

What does the CMTO do

puts together guidelines on how we look and act professional ensure competancy and quality of care provided my RMT'S

WHAT DOES CLEANING REMOVE

removes debris, utilizing plain soaps or detergents

are mandatory reports filed to our college or the other health practitioner's college

reported to the other therapists college

a conflict of interest can take many forms such as

self dealing accepting benefits i.e. gifts influence peddling; accepting things from suppliers using confidential information

What is the CMTO quality assurance program

sets CEU; continuing education requirements reviews standards and expectations and adherence to current and best practice standards.

Non-maleficence

simply means RMTs will not intentionally hurt someone. Some of the guidelines to help practitioners follow this ethical pathway include the following

Confidential information about a client can only be shared if?

the client provides written consent -it is required by law

Informed consent refers to

the ethical and legal right of the client to decide what healthcare services she or she will utilize. Part of our obligation is to inform the client of risks, side effects benefits and alternatives to treatment, empowering their decision making

what does govt do under AODA

the government of Ontario has developed mandatory accessibility standards that identifies, removes, and prevents barriers for people with disabilities.

massage therapists have entered into a social contract. explain?

therapists agree to serve and protect the well being and best interests of the clients first and foremost. society agrees to provide the profession with autonomy to govern itself and with priviledges and status afforded regulated healthcare professionals

explain dual relationships

theses relationships can be low risk, medium risk or high risk. High risk dual relationships (such as dating) WILL RISK YOUR LICENSE as they are also gross violations of your promise to society as a therapist.

how do we as therapists protect client vulnerability

we demonstrate client confidentiality; which is also a legal requirement of RHPA

how do we Develop policies to support our boundaries

we develop No show or cancellation policies Policies about respect for self and others in this wellness space Policies about referral, and responsibility for self (home care compliance, etc)