Therapeutic Relationship
What does standard 4- client interview on goals state?
- Client's goal's for the treatment -Limitations to activities of daily living (ADL) -ID of areas the client would like to focus on -Discovery of contributing factors *** Ensure client can ask questions***
What does HPRAC stand for?
Health Professions Regulatory Advisory Council
What is HPRAC?
Health Professions regulateory advisory council -5-7 members who are approved - Not members of a regulated health profession
What does policy 14- Three failures state?
-Return to school obtain another diploma
With inter professional care what is Team function?
-Uderstanding team development -Develop principles for working together -Facilitate discussion and interaction -Be active and respectful -Reflect on function with team -Confidentiality, resource, professionalism
What does policy 25- Zero tolerance - Physical state?
-Using unnessary force in the course of providing treatment
When is consent informed?
-Informatio about the treament is given and response to additional requests for information are given
What does respect of person in code of ethics mean?
- All humans have innate worth and value that has nothing to do with culture. nationality, ethnicity, age, gender, social status, sexual orientation - We have a special duty to protect those that may be considered not vulnerable (e.g. elberly, young, or those with a language barrier)
What does the HPRAC and HPARB do ?
- At the request of a registered member of a college who is subject to a complaint, they can review within 120 days a complaint that has not been disposed of by the member's college. - The board can also review a complaints committee decision -unless complaints has sent it on to discipline or the executive-
What does standard 8- Assessment/reassessment state?
- CLient can ask you to discontinue -Draping/undressing protocol (11/12) are followers -refer if out of scope, server unremitting pain, servere pain with no history of injury -assessment of pain and conditions, location, type, duration, origin, pattern, triggering, phenomena, intensity, and quality - can include PNS and CNS conditions -Can include ROM Active, passive, and resited -5 T's - Tenderness, tension, tone, temperature, texture -Testing bilateral -Identify any conditions amenable to treatment or ones that require adaption -Decision on whether to continue, modify/change or stop treatment plan -Assessment result recorded in health history within 24 hours?
What would be considered professional misconduct in relations to client and their care ?( part 1 of 3)
- Contravening a term, condition or limitation imposed on the member's certificate of registration -Contravening a standard of practice of the profession or a published standard of the college, or failing to maintain the standard of practice if the profession -Doing anything to a client for a therapeutic preventative, palliative, cosmetic or another health related purpose in a situation in which a consent is required by law without such consent -Absing a client, verbally or physically -practicing the profession while the member's ability to do so is impaired by any substance -Discontinuing professional services that are needed unless the client requests the discontinuation, alternative service is arranged, the client is given reasonable opportunity to arrange alternative services or the client is abusive the member has made all reasonable attempts to arrange alternative services -practicing in a conflict of interest -reaching agreement with a client relationship to professional services for client or fees for such service -receiving and for of benefit from the practice of massage therapy while under suspension unless full disclosure is made by themember to the college of the nature of the benefit to be obtained and prior approval is obtained from the executive committee
What does competence and accountability mean in the code of ethics?
- Depends on the integrity of the individual therapist in keeping their professional commitment to society
What does the CMTO- Quality assurance committee do?
- Develops and implements a program that develops the profession. It also deals with members referred from complaints
What happens if a massage therapist losing practice due to retirement or relocation out of area should do?
- Give clients as much notice as possible -Assist in clients with the transfer of their care -Advise them that the therapist is required to keep their records and provide information on how they may obtain a copy of records in the future. ( the retiring massage therapist tore the records or may appoint a custodian who will store and monitor access to the records) -If the member has died, his or her estate may elect to store the records and respond to client requests for information, it may choose to transfer the records to another indiviadule who will act as custodian
What does the CMTO Discipline Committee do?
- Hears of allegations of misconduct or incompetence referred from complaints or the excutive. It makes decisions and decided on penalty which could be a reprimand, suspenson or revocatio of registration
What does the CMTO- fitness to practice do?
- Hears of incpacity allegations referred drom the exective
What does standard 15- Use of personal protective equipment (PPE) state?
- In infection, intraoral or non-intact spin/open lesions -Explain use of PPE -ICG's are followed -Affected areas are avoided as much as possible -If airborne infectious disease both parties are masked -Treatment may need to be altered, terminated, postponed
What does standard 12- Position state?
- Instruct/assist the client to change positions -Tell client how and why to change positions -Sheets and pillows secured for clients comfort -Pillows sheet is secure -Ask client if they are OK in new position -Maintain respectful privacy -Don't let them fall off table
What does Standard 5- Risk ID and management state?
- Knowing of current health risk -Know signs and symptoms .-have screening tool in place -Let client know purpose of screening **Client can ask questions*** -At risk clients are treated in isolation and ICG's ( infection control guidelines) in place -Cliwnts are not discrimetaed against
What does standard 11- Pre/ post treatment protocol- undressing- assistance state?
- Let client know where you may need to touch -Touch only those areas -Record ____ and____ -Maintain_____
What does policy 21- Referral to non-regulated providers?
- MEmbers have an ethical responsibility to ensure that referrals to health care professionals are carried out within the best interest of the client - Before a referral is made: -Advise the client of the ____ treatment option -Ensure that information or an opinion provided to the client is not misrepresented -Ensure that the referral is not made when a member is in a conflict of interest
What are RHPA common elements for colleges?
- PRoposes of regulatory colleges - Satultary commitees
What does standard 14- Client health recorded state?
- Record included: health history, client's consent, on-going forms, authorizations for contact, copies of reports from other professionals -Confidential and secure -Kept 10 your from the last visit -10 years after a child turns 18
What are some considerations if you are keeping your filed electronically?
- Records must be kept for every client on either electronically or by an optical storage system (I.e CD, DVD). The therapist must make sure that these files are free from being tampered with, lost, stolen, or used by any unauthorized individual
Who are the responsibilities of the college around the notice of meetings? What needs to be included?
- Registrar ensures that the meeting is open to the public notice is posted in newspaper ni less than 14 days before the meeting in English and French -Including date, time, place, purpose, contact address, and phone number -Upon request, the registrar may provide notice of council meeting to members of the public (request made in writing)
What does standard 9- Determine if massage is indicated states?
- Related to health history and assessment -If massage contraindicated then referral or modification - referrals are documented
What does standard 11- pre/post-treatment protocol- off table and lubricant state?
- Tell client how to get off table -Ask if they need help -tell them they may fee light headed or dizzy if too quick -Chosen with allergies and preferance in mind -Ensure contaminant-free dispensing
What is RHPA- Quality Assurance?
- The RHPA requires that every college has place quality assurance program it is up to wach college to develop their own unique program - Given that there is an overlap of scopes of practice the professions must collate to find ways to validate the quality of care provided
What does the CMTO inquiries, Complaints, Reports Committee do?
- The committee can dismiss or caution the member or refer
What is RHPA- strengthening the traditional approach?
- The traditional approach regulatory environment largely remained unchanged. That is it was pretty well business as usual in the sense of promoting good care for the public.
What does standard 1- prepare the treatment area state?
- Treatment area and materials are clean -Draping allows for full coverage -Don't interfere with clients getting on/off table -Spills cleaned up -Equitment is maintained ( keep log)
What is a code of ethics?
- helps therapists with decision making and informs the public of our responsibilities - it's about how we live our professional promise to serve the health and well-being of our clients - 4 parts of code of ethics -person, caring, integrity, society
What does integrity in relationships mean in the code of ethics?
- vital to the development if the profession and to the maintenance of public confidence - honesty, openness, objectivity, minimal bias, conflict of interest -besides that, we need to be self-aware and critical. we need to know how our personal need and values an affect and influence our actions - the public trusts that we will serve their best interests in the events of real or potential conflict of interest scenarios
How is consent determined of capacity by?
-A capable person is considered to be someone who is able to understand the information being provided about the treatment being proposed and is able to appreciate the consequences of having the treatment or not -No specific age at which individual is deemed capable -Ability to provide consent will depend on cognitive and maturity level of the person, the risks associated with the treatment proposed and the complexity of the issue -Must tell incapable client that a substituted decision maker will assist the clients in understanding the treatment and inform the person of reasons for the use of a substitute decision maker -IF client disagrees on the finding gin capacity, they must be informed of there rights to go to the consent and capacity review board -IF the client disagrees with the need for a substitute decision maker because if the finding of incapacity, or disagrees with the involvement of the present substitute, the member must advise the client of his/her options
What are some considerations around appointment and equitment service records? What must financial records contain?
-A daily appointment record shall be kept that sets out the name of each client whom the member examines or treats or to whom the member renders any service and the time of the appointment -An equipment service record shall be kept that sets out the servicing of equipment used to examine or treat clients or to render any service to clients - The particulars of the treatment or procedure rendered - The fee charged for the service provided - a copy or records of the receipt issued for payment of the service provided
What does policy 17- Mandatory reporting of client sexual abuse by educator?
-A massage therapist engaged in massage therapy instruction at an educational institution is required to report suspected incident involving the sexual abuse of a client to the appropriate regulatory college, under the RHPA -An instructor who becomes aware of a situation where a regulated health professional has sexually abused the student under their direct care should: -obtain the professional name from the student, -encourage the student to report the situation, -Advise the client of the massage therapists duty to report information to the appropriate regulatory college regardless of whether or not the client files a complaint -Seek the client's permission to disclose his/her name to the college -Notify the complaint department
What does policy 12- Massage therapist history to complaints?
-Information relating to a massage therapistès current and previous involvement with the complaint process -Decisions of the discipline committee involving the RMT under review by the complaints committee in which the RMT is found guilty y the discipline committee will be brought to the attention of the complaints committee if related issues were invilved in that hearing
What happens if a client of a student reports sexual abuse to an instructor?
-A massage therapy instructor, who while supervising a students clinical practice becomes aware of a situation should: -Obtain the profession name from the clients -Encourage client to report the incident to the appropriate regulatory college -Advise the client of the massage therapist duty to report the information to the appropriate regulatory college regardless of whether or not the client files a complaint -seek clients permission to disclose his/her name to the college -notify the complain department -Prior to filling the report, advice can be ought from the college -if the info is obtained indirectly through a clients disclosure to a student, the instructor should assist the student in following the above procedure, Technoquely the student does not have mandatory obligation to report
What is accountability of RHPA?
-A regulated health profession does not have an absolute right to practice. S/he practice by virtue of their membership in a profession which, by law, is required to govern itself -The public has delegated authority to us. The people have this authority because health professions carry with them a risk of harm -Acts are meant to maintain a series of checks and balance on the professions. One of the strongest checks is that, under the RHPA, Public representation on college councils ranges between 42% and 49% - The public gets a high standard of practice, competent care, and ethical conduct. The profession through good governance strengthen itself
What do we have to consider with age and ageism?
-A stigma exists with being old: -People may patronize -People think of the elderly as being asexual. People don't see their need for contact -One of the most depriving conditions for the elderly is an absence of physical contact especially if people are already isolated -Researchers have shown that other patients are more likely to receive poorer quality of health service
What do we have to consider with personal biases?
-A tendency to interpret a word or action in terms of some personal significance assigned to it -Can be based in cultural bias but can include a number of other sources -Recgonizing our own biases allow for better interaction with clients -We see what people show us but sont understand -Our likes and dislikes will filter our interactions
what can advertising may not contain?
-A testimonial from a client or former client or by friend or relative of a client or former client -CLains or guarantees about treatment that cannot be verified -Any wording that world imply that staff of the facility are members of the college when they are not -AN endorsement of a product or line of products -Anything that is false or misleading or deceptive -Any sexual innuendo or language of a sexual nature -Any statements that discriminate on the basis of a protected status under human rights legislation -Factual info that a member cant verify -Any comparison with another practice or member that may be reasonably regarding as a representation of superiority over another practice or member -Anything that is undignified or may negatively impact public confidence in the practice of the profession
What are the major themes of RHPA?
-Accountable public interest -Public access -Patient choice -Eradication of sexual abuse -Equity -Proactive regulation
What does responsibitiy mean to society in the code of ethics?
-Achieve by developing the profession's body of knowledge and by conducting its affairs I wants that are ethical and accountable
What does the CMTO Executive committee do?
-Addresses immediate issues between sittings of the council. In certain instances, it can also initiate discipline and incapacity proceedings
What does position 1- Conducting a clinical massage therapy practice -Physical set-up state?
-Adequate space -Office must be clean, well maintained, well lit, and arranged to allow sufficient privacy -Client should be offered choices -The setting should not contain inappropriately placed mirrors or cameras -Hands-on massage therapy treatment is to be provided only by the massage therapist.Individuals involved in treatment to client should be readily identifiable
What does policy 2-Advertising state?
-Advertisement must identify the massage therapist who chiefly responsible for the practice and note that they are a member of the college of massage therapy of Ontario -General information about the practice, such as its location, accessibility, hours of operation, address and telephone number -Indnetifactation of the educational qualification of the staff -Information on the types of services available at the facility
What is the line of responsibility: Health Professions Regulatory Advisory Council (HPRAC)?
-Advises the minister on matters of regulation and deregulation -Suggests amendments -Looks at Quality Assurance programs the colleges undertake -Acts on any matter the minister puts forth in term of regulations and professions -Also monitors each college's Patient relations programs
What would be considered professional misconduct with the respect to records?
-Allowing any person to examine a clients health records or giving any information, to a person except as required or allowed by law -Failing to provide copies of a clients health records for which the member has primary responsibility -Failing to make arrangements with a client for the transfer of the clients records I the care of a member when the member retires, changes office location, or requested to do so by the client
What do we have to consider with personal Biases?
-An individual's feeling about a particular person or thing that affects his or her interpretation of it -Thsi can lead to favorable or less than favorable treatment
Who is able to be a consent substitute decision maker?
-An official guardian appointed by the courts -An attorney for personal care -A representative appointed by the consent and capacity review board to act for the client -A spouse, partner or relative in the following order: 1 spouse or partner 2 children if 16 or older or the custodial parent 3 parent who has only a right of access 4 brother or sister 5 any other relative
What does position 3- Inhalation therapy state ?
-CMTO position is that inhalation of steams of essential oil is not a controlled act
What does policy 10- Criminal record screening state?
-Intial registration are required to notify the CMTO of any criminal covictions no more than six months before application -Registration requires a criminal check
What does policy 7- consent state?
-COnsent from clients prior to commencing any treatment. Individuals are assumed to be capable to provide consent unless they demonstrate otherwise to the practitioner -Determination will depend on the individual's ability to understand the situation and the treatment proposed -The HCCA states that consent must: relate to the treatment being proposed, be informed, be voluntary, must not be obtained through this representation or fraud -The RMT, when explaining the proposed treatment to a client, must explain: Nature of the treatment, benefits, risks, side effects, alternative options, consequences of not having treatment
What is a policy?
-COuncils opinion on specific issues -Borders explaination -Violation eqauls professional misconduct
What do we have to consider with sexual preference?
-Can certainly be a bias -in 80' and 90's, there was a lot of fear and mistrust of the gay community becAUSE OF HIV/AIDS -People were often shunned even within the medical community -Like the elderly, those with HIV/AIDS often live in isolation to this day -Also, as with the elderly, they may be devoid of caring touch
What does standard 11- Pre/ post treatment protocol- positioning/covering state?
-Client agrees to position -Instructions to client are clearly provided -Client is advised on role of sheets -Is assistance need then comfort an issue -Maintain respect -Client can ask questions -Let client know of steps to avoid falling
What does position 8- Treatment of sensitive areas state?
-College positions that for treatment of sensitive areas, chest wall, musculature, breast tissue, Inner thigh, and gluteal region, a signed form acknologedging that information sharing and informed choice has occured should be placed in the clients file. CHanges to this consent should also be recorded as they occur
What does standard 10- Treatment and treatment plan -explain state?
-Communicate the course of treatment -Plan is consistent with scope -Any changes to consent are obtained before each treatment -CLient can ask questions
What is the Lines of responsibility: Health professions board?
-Conducts hearings and reviews that are referred to it -Also, performs duties that are assigned to it under acts
What does policy 5- CMTO approved Acupuncture courses state?
-Currently, 18 provides of education -List is reviewed costintly
What does policy 11- Direct client care state?
-DIrect client care is defined as professional activity o behalf of a client or supervision of direct client care -Assessment of the soft tissue and joints, treatment planning, treatment -Engage in research in massage therapy that involves the assessment or treatment of client with soft tissue or joint disorder where the member is directly engaged with the client -Overseeing and evaluating massage therapist or massage therapy students -Supervising research in massage therapy that involves the assessment or treatment of clients requiring massage therapy services where the member is directly engaged with the client
What happens after a referral is made?
-Document the particulars of the referral to include the name of the non-regulated health provider, the modality, and the reason for the referral -Document outcomes at the next visit, and expected length of treatment. Continue to follow the client through the duration of the treatment
How do you work with transference?
-Don't talk to client about their transference -understand that transference isn't really about you -Know when transference is about you -Keep boundaries extra clear -Be respectful -Keep giving the power baack
What does standard 12- draping state?
-Draping is secure -CLient requests for accommodations are honored as long as you are OK -Female breast is not exposed except for technique standard 15/16 -Genitalia and gluteal not exposed -Female client may be exposed in labor or child delivery -Accommodations required -Consent obtained and recorded -Privacy and respect -Infants may be treated undraped with parental or substitute decision-maker consent -Check comfort and support
What is RHPA registration?
-Each college sets out in regulatory requirements that must be satisfied for regulation. After being issued a certificate of registration a member is then qualified to practice the profession and use the protected titles and perform the controlled acts -registrations requirements vary from profession to profession -The RHPA allows a college to refuse to register an individual or to impose terms, conditions or limitations. This occurs when there is a history of improper, illegal or immoral conduct. It also counts in case of incapacity. -When someone submits a registration application the registrar can either register the applicant or refer them to the registration committee
What would be considered professional misconduct in relations to client and their care ?( part 2 or 3)
-Employing or otherwise benefiting from a suspended member with respect to the practice of massage therapy unless full disclosure is made by the member to the college of the nature of the benefit to be obtained and prior approval is obtained from the executive committee -Failing to maintain the members practice premises in a safe and sanitary manner -Failing to reveal the exact nature of a secret remedy or treatment used by the member following a request to do so by a client representative or the college -Making a claim in respecting the utility of remedy treatment, device or procedure that than a claim which can be supported by reasonable professional opinion
What is the line of responsibility: Ministry of health?
-Ensures health professions regulated and coordinated in the public interest -Ensures that appropriate standards are developed -Ensures that an individual has access to the professional of choice and is treated with sensitivity and respect -The minister can iquire,review,amend, or revoke regulation -Requires HPRAC to carry out the intent of the act
What does position 1- Conducting a clinical massage therapy practice- Equipment state?
-Equipment must be cleaned and maintained on a regular basis. A written record of all repairs and maintenance must be kept -Sheets and towels must be available -Linens and towels, pillowcases, sheets ect. are to be changed as describe in the college standards of practice document
With inter professional care what is Communication?
-Establish communication principles -actively listen to the team -Communicate care decisions -Develop trusting relationships -Use information and technology to improve care
What is RHPA- patient/client relations?
-Every college needs a committee and program which included measures for dealing with professional misconduct of sexual nature. There is a _______ policy in regard - the program will include educational requirements, guidelines for member conduct, training for colleges staff and the provision of information to the public -The committee also administers funds for victims of sexual abuse that need therapy or counseling. If you are found guilty of professional misconduct of a sexual nature you are required to pay all legal fees as well as costs related to follow-up therapy and counseling. No form of professional liability insurance cover your cost
What do we have to consider with cultural biases?
-Everyone interprets actions, facial expressions, choices of words and other types of communication according to his/her cultural conditioning and past experiences -We don't live in isolation -Definition: A tendency to interpret a word or action according to ti some culturally defined meaning to it -People may have different attitudes towards pain, illness etc. -Understanding where people are coming from is integral to good interactions
What does standard 13- Self-care state?
-Explain self-care including untended effects possible negative reactions -Client is told to stop if severe negative reaction - You demonstrate exercise -You witness client understands (get them to demenstrate to you)
What does standard 2- Fees and agreement state?
-Fee schedule is posted or a copy is provided to client -Explain the use of time in the treatment time -Explain/ post a cancellation policy -Allow client to ask questions about fee -Any changes to fee are discusses, agreed upon and documented
If therapist is selling practice what should he or she due?
-Give clients as much notice as possible -Facilitate the transfer of care -Advise the client of the arrangements that have been made for storage and access
What do we have to consider with Socioeconomic status?
-Healthcare professionals tend to be white and in the middle to upper class. Income and status may create barriers to interaction with clients -THsi may hinder clients from asking questions -It may create a barrier to the healthcare profession from showing empathy -The health care professional may not have a good sense of what everyday life is like for the client
What does RHPA do?
-Identifies the power of the ministry of health establishes the health professions regulatory advisory council (HPRAC) and the health professions board and sets their duties -The RHPA also sets 13 controlled acts that could be potentially harmful to the public if performed by an unqualifies person -The health professions procedural code sets out common elements for all regulatory colleges -Colleges have same rights -The public can expect the same rights and remedies from any college -The RHPA is accompinaed by 26 professon-specific acts -Defines the scope of practice and the controlled act authorized to each profession and provide for protection of title -Ours is massage therapy act(MTA)
What does standard 16- Discharge state?
-If goals met -If goals not met -If beyond skills, ability, or scope -If client is abusive -Need to explain reasoning for sicharge -Discussion before or after not during -CLient can ask questions -Referal is arraged prior to discharge -Files are stored/transferred according to client
What does policy 15- Examination failure in other jurisdictions state?
-If jurisdiction is using a competency model adopted from Ontario this constituted a failure in Ontario
What does policy 18- Outside of scope modalities state?
-If primary intent, focus, and practical use of modality is outside the definition of massage therapyès scope of practice, the modality is considered not in the scope of practice
What is RHPA registration referred?
-If referred the registrar must provide ground as well as by providing the opportunity for appeal within 30 days. Most of the time the registrar will provide the relevant documentation unless there is safety issue -A panel of 3 members of the committee who is a public member considers the application. -The meeting is closed to the public and the applicant is entitled to appear.
What does policy 25- Zero tolerance state?
-In defining abuse, it is important for the professional to be cognizant of the imbalance of power that exists in the client professional to be cognizant of the imbalance of power that exists in the clienté professional relationship. -A member of the profession has the power by virtue of the authority, knowledge, access to privileged information and the influence they potentially hold over the client to exploit -Verbal abuse may include rude, sarcastic, demeaning, or seductive remarks. It is also important to note that the tone of verbal communication will also characterize how wards are perceived. Members of the profession must be aware that age, culture, social-economic status and particular sensitivities affect how client ma perceive communications with a member
What does policy 8- Contact with complainant state?
-In the absence of expressed written consent from the registrar, members are not at liberty to contact complaints, directly or indirectly, following receipt of notice that complaint has been filed with the college -Once a complaint has been submitted to the college, a member who contacts a complainant may be accused of: Interfering with college investigation of the matter and/or trying to intimidate the complainant into withdrawing the complaint, or verbal contact particular places a member at risk as the complainant may use conversation to add new issue to the existing complaint
What does standard 10 - Treatment and treatment plan- developed/ record state?
-Includes goals, type, focus of treatment, areas to be treated, frequency, duration, anticipated response, schedule reassessment, remedial exercise, hydrotherapy -plan us consistent with the scope
What does standard 14- Recording treatment state? Also what should a health history record include?
-Including date, time, duration, fee, assessment results, summary of technique yes used and areas treated -Client reactions are recorded -used or recommended remex, hydro or self -care -History is updated as obtained within 24 hours -Name and address of primary care physician or referring health professional -medical history -History of massage -Findings of examinations, clinical findings, assessment findings -Every written report received by the member with respect to examinations, tests, consultations or treatments performed by another person -PArticulars of advice given by member -fee and amount charged -cope of every written consent, assessment, and treatment plan -particulars of treatment applied each visit and name of the member who performed treatment
What do we have to consider with culture?
-Is learned, shared or symbolically transmitted design for living -Culture can include ethnic origin, sexual preference, residence, age -It also includes your choice of profession: terms, concepts, ways of thinking, Ethnocentrism
With inter professional care what is role classification?
-Know roles -Recognized/respect diversity -Perform in a culturally respectful way -Access other's roles, skills and knowledge -Integrate roles into care
What do we have to consider with culturally sensitive care?
-Knowledge: Begins with a desire to understand others. We need to understand other cultures -Mutual respect: this means consciously avoiding unfair judgment about other person traditions, values, and beliefs -Negotiation: means finding a place where we can exercise professional judgment yet incorporate the values and beliefs of others -Requires therapist to make a conscious effort to not judge other people's traditions, values or beliefs
With inter professional care what is Centered care?
-Let client/family/community/participate -Share information to encourage discussion and decision-making -Support and educate -Listen respectfully
What does policy 16- Maintenance of clients records state?
-Make and maintain client records relating to the provision of massage therapy services -Maintain client record for up to 10 years from the date of last entry, or if the client is less than 18 years old, 10 years from the date the client becomes 18 years of age, Massgae therapist may retain personal possession of the records -Ensure that the confidentiality of client information is maintained -Release information contained in the client's health record with the client's consent
What does position 9- Use of titles or credentials state?
-Massage therapist -M.T. -Registered Massage therapist -R.M.T -MAssage therapy -Theraputic massage
What does policy 9 -CPR and 1st aid state?
-Massage therapist may have to deal with an emergency involving one o their clients or staff in the clinic or other setting where they are providing massage therapy
What does policy 20 -record retention state?
-Massage therapist when commencing employment, or entering into group practice should develop an agreement that explicitly covers procedures for record storage, covering the following situations: -termination of employment, partnership or other agreement -Closing, relocation or selling of the practice -A copy of the records should be kept by the massage therapist or an agreement reach allowing the massage therapist access -Info on the massage therapist new practice and location -College believes that the departing massage therapist has a responsibility to contact clients and notify them the he/she is leaving practice
What does policy 1- Acupuncture state?
-Massage therapist will limit their use of this modality to within the acope of practice of massage therapy -As a massage tharpy modality requires specialized training of a significant nature and is subjective to minimus educational requirements
What does policy 13-Dual registration state?
-Massage therapists must give careful consideration to whether they are using their additional skills and knowledge within the scope of practice of massage therapy -Dual practice by registrant of the college creates confusion around issues of jurisdiction and impairs the resolution of complaints in the public interest -Through the appropriate separation if practice -When signing the mandatory declaration at the time of renewal of registration each year, the registrant is permitted to include only hours practiced as a massage therapist -Registrants will issue separate receipts for treatment provided in the role of the other health profession
What does standard 6- Obtain , update and record health history state?
-Minimum requirement: please refer to specific standard -Inform client that they need to inform of health changes -Explain need for health history ** CLient can ask questions** -Inform client that info is confidential and can only be released by means of written authorization -Any infectious diseases are recognized and measures were taken -A new one after an absence of 1 year -Updated every year at a minimum - You inquire about allergies or sensitivities ( E.g. lotion) - contraindications to massage therapy or techniques are recognized
What is the RPHA- Peer Assessment ?
-One way on which the public is accrued of quality. A therapist is chosen randomly and visited by a volunteer assessor. -Members must cooperate with the peer assessment, If there is a suspicion that there may be grounds for misconduct, incompetence or incapacity, the committees may disclose the name and allegation to the Executive. Results of an assessment, in the case, cannot be introduced as evidence -There is also self-assessment. The therapist is given a portfolio for self-assessment. The tool helps the individual evalute the quality of his/her practice and helps in planning for professional development. You portfolio will be reviewed by your peer
What does policy 19- Receipts state?
-Only for those services that fall within the scope of practice -The date of the financial transaction, the description of the service, duration of treatment and the name of the payer must appear on the receipt. Receipts issued for Massage Therapy treatment also require that the name of the therapist is printed or stamped on the receipt along with the Massage Therapist's registration number and signature and GST# -Description must read Massage therapy treatment -Receipt issued for missed or canceled appointment just be clearly marked -If duplicate receipt must me mark duplicate -When a gift certificate is purchased, the description of the service is gift certificate and the dollar amount listed is on the receipt. if the recipient of the massages to receive a receipt, the dollar amount listed must be gift certificate redeemed with no dollar amount given
Who and under what conditions, can record be supplied to?
-The member can ask for a fee for providing the information -The member must provide copies to authorized person under subsection 2 -Clients health record can be shown to a health professional -Can provide info if its uses for health administration, health research or epidemiological studied -Can be released to the minister if it is in the public interest -if the client is removed from information or copies
What does policy 4- registration certificate state?
-Only one wall certificate and photo id card will be issued to each registrant and they remain the property of the college -Not be transferred, photocopied, or duplicated in any manner -A massage therapist may not rent or sell the certificate of registration or the corresponding registration number -The wall certificate and photo id card must be returned to the college when a members registration is suspended it is revoked -IF a member holds an inactive certificate of registration, he/she may not display it in a place of business -If a retired member wishes to keep the certificate and/ or ID card, the member must notify the college in writing of this request when the wall certificate and photo id are returned -It is the responsibility of the massage therapist to protect his/her wall certificate, photo id card and registration number from fraudulent use by others -Certificate is to be posted in the member's primary place of employment, if a massage therapist practices in more than one location, the photo id card must be used -Massage therapist is responsible for taking the wall certificate with them upon leaving their place of primary employment
What do we have to consider with The elderly and health care encounters?
-PErsonal and psychological problems may be viewed as being normal in the elderly -Low functional goals may be set for recovery -An older person with an amputation may not recieve a prosthesis -The overuse of drugs( chemical straight jackets) may reflect the devalutuion of the elderly
What do we have to consider with place of residence?
-Place of resedince may have an impact on our interactions with clients. For example rural clients may have to travel further. Moreover, they may relate healthcare needs primarily to their work activities
What is a position?
-Position statement are often developed o response to registrants questions -you may be required to conduct or actions
How has RHPA changes massage therapy?
-Prior to 1994 the profession practiced under the drugless practitioner act - We were registered as 'masseur' or 'Masseuse' -Under RHPA our title was changed to MAssage therapist and we became of 26 self-regulating health profession -the legislation provides professional with a guarantee of fair process and spells out and establishes the rights and remedies of the public -RHPA is a general act
What do we have to consider with religion?
-Religion can give meaning to illness, pain, and suffering. BEliefs may challenge a healthcare professionals ability to tolerant andaccomidating. -Ideally, we should respectfully open beliefs that we don't share
What does the CMTO Registration Committee do?
-Reviews applicants referred by the Registrar and that directs
What does policy 3-Ancillary and related activities state?
-Selling massage -related supplies for home use -Teaching massage-related courses -Publication or selling of books or videos related to massage -The temporary investment of surplus funds earned by corporation -Ancillary or related to practice of the profession if they are carried on in the context of an active massage therapy practice -May not be covered under the members professional liability insurance and it may be necessary to make arrangements for separate insurance coverage for these activities
What are the number of considerations around business practices?-
-Submitting an account or charge for service that the member knows is false or misleading -CHarging or accepting a fee or amount that is excessive or unreasonable -Failing to post the fees for the professional services provided by the member -Charging a fee in excess of the posted fee without prior informed consent -Charging a fee less than the posted fee without noting the reduction and the reason for it in the clients financial records -Charging or accepting a fee or amount under agreement, if the fee or amount is excessive or unreasonable -Failing to advise, in advance of service being rendered, of the fee proposed to be charged for the service to be rendered -Failing to abide by a written undertaking given by the member to the college or to carry out an agreement entered into with the college -Offering or giving a deduction for prompt payment of an account -Failing to itemize an account for professional services, if requested to do so by the client or the person or agency who is to pay -Selling or assigning a debt owed to the member for professional service. this does not include the use of credit card to pay for professional services
What are some considerations around provisions of copies (13 #3-5)?
-THerapist are to be paid for making copied of clients records; that therapist can make copies for other health care practitioners when it related to and aids specific clients care -A therapist may provide copies to a person who is conduction research studies or planning health care administration -IF the health minister requests copies and it is deemed in the public;s best interests, a therapist may provide copies as long as the clients identifies information is removed
What does policy 6- Complementary modalities state?
-THere are a number of modalities that can be integrated into treatment plan by an RMT -If used exclusively in and of them, would not fall within the generally accepted practice of the profession -MEmbers teaching a complementary modality should note that teaching a course on complementary modality is ______ practicing Massage therapy -Not be billed as massage therapy as such if performed _____ -May be billed as massage therapy if they were______ into a treatment -May be necessary to make arrangements for separate insurance coverage for these activities
What does position 6- Termination relationship state?
-The CMTO advises that massage therapist should not enter into a sexual relationship with a formal client for a period of one year following the date of the last professional contact with the client
What does position 4- Interprofessional Disagreement - Guidlince state?
-The client is not placed in the middle -The client's consent is obtained prior to speaking -The concern is provided with the most accurate information possible -The clients choice of provider and treatment approach is respected
With written request record can be given to?
-The client themselves -clients spouse, son, daughter, parent -Representative of the client -a lawyer A committee of the client may be given records if the client is deemed mentally incompetent
What does position 7- RMT designation state?
-The council of the college has determined that, in the interest if transparency RMT should be the oly designation ised by the members of the college
What is the CMTO council?
-The policy making body. It is compoed of professional members who are elected and public memers who are appointrd by the government
What does position 5- Massage therapy graduates/students practicing prior to registration state?
-The public has rights to safety -Insurance concerns (Coverage and liability) -CMTO has no jurisdiction -massage therapy student or graduates who have not yet taken, or have failed the certification examinations are not yet members of the college. The college believes that it is not in the public's best interest for students is unregistered graduates to practice massage therapy before they are registered with the college -RMTs can't supervise and/or bill for massage therapy -CMTO will investigate a complaint -The registration committee will review
What does Policy 24- Suspension of Ancillary roles state?
-The registrar shall contact the member to provide notice that the memberès duties with the college have bee immediately suspended until further notice -In the event a member is found guilty of a professional misconduct, the member shall be removed from any and all ancillary position with the college
What are the responsibilities of the college around hearings? what needs to be included?
-The registrar shall ensure that information concerning every hearing of a panel of the discipline committee respecting allegations of a member's professional misconduct or incompetence is given to every person who requests it in writing -Where possible at least 30 days before intended date of the hearing, for the requests received by that date -Or requests received after that date, as soon as reasonably possible after the request is made - Information must include the name of the member against whom allegations have been made, the member's principal place of practice, the intended date, time and place of hearing and a statement of the purpose of the hearing -Information must be available in English and French -No hearing is invalid simply because a person has not strictly complied with a requirement of this part
What does position 2- COnducting public education course state?
-Those taking courses are not clients -Class members should e referred for specific concerns -Education does not equal registration -Massage therapist should offer a certificate of completion -Massage therapists should have information on more formal massage therapy training available
What is RHPA - advancing a new approach?
-Traditionally a practitioner who violated standards of practice or conduct was dealt with solely through a complaints and discipline process. The problem was that the complaints were typically dealt with after the fact. In addition, there was not a universal standard of care. - The RHPA added a quality assurance to the process. THis shifts concern away from individuals and direct it more correctly towards the profession
With inter professional care what is Conflict resolution?
-Value the positive in conflict -See potential for conflict and plan for it -Id common situations -Have guildlines to work with conflect -Have safe place -Allow people to be heard
Why does a client need to feel safe?
-Vulnerable because they are fully or partially unclothed -May associate touch with violence or sexuality -Touch may bring up uncomfortable feelings or memories
What does standard 3- washing state?
-Washing any skin surface that comes in contact with the client -Soap and water or alcohol based hand sanitizer -Wash a minimal of 10 seconds (15-20) -Before and after every client (also any time you leave the client)
What does position 4- Interprofessional Disagreement state?
-We have an ethical obligation to advise the client if she/ he has concerns about the treatment mythology or philosophy being used by another clinician -The obligation to the client takes precedent over any emplyment obligation when the two values conflicy
What does Policy 23-Release of records state?
-When a request is made for information from a clients file, the massage therapist should ensure the following procedures are followed: -A signed consent ( from the client or the clients representative) authorizing the release of the information. THe consent form should be dated within the last six months -Once consent has been obtained, the requested copy, summary, report, or medical/legal report should be prepared -A fee that reflects the cost of material issued, the time required to prepare the material, and the cost of sending it to the requester should be established. The massage therapist may request payment of the fee propr to provide the documentation
What does policy 25- Zero tolerance - Emotional state?
-Where a member of the profession uses the position of power to intimidate or show insensitvity towards a client
What does policy 22- Refresher course state?
-Who do not meet the requirement to have completed 500 hours directed client care in the previous three years, or members/applicants who have been away from practice for three or more year -The member/applicant will complete the standards and regulations e-workshop and the refresher competence assessment tool(RCAT) -AN approved tutor will verify that the member has the competencies and then design a course remedy the memberes competence
With inter professional care what is Collaborative leadership?
-Work interdependently to outcomes -Facilitate team process and decision-making -Foster climate of collaboration and shared leadership -Foster continuous quality improvement
For credit CEUs, how many years are involved? how is it reported to the college?
-You have a three-year cycle. it is reported to the college by mail notice (CMTO now allows for electronic submission)
What do we have to consider with Cultural variation?
-You will, in practice, deal with clients from a variety of backgrounds -Think of cultural diversity as an iceberg -WE may know clients race and gender. We may have an idea of age and nationality - The point is that there is a lot of individuals that we don't know -In the absence of facts, we extrapolate from our own bias and experience -We all have Biases -AS health professionals we need to self-examine. this can be a difficult process -The college is to look below the iceberg and see what else is unique about an individual
What are considerations for an inactive certificate?
-applicant must have previously held a general certificate (i.e you can not hold an inactive certificate of initial registration
What do we have to consider with culture and Ethnicity?
-historically it was quite easy to identify variation -people were often stunned with the norms that they saw in other cultures -today we live in an incredibly heterogeneous world
What are some of the actions that can come out of the peer reviews?
-imposing of terms, condition or limitations on a members certificate of registration, for a period not exceeding six months
What would be considered professional misconduct in relations to client and their care ?( part 3 of 3)
-inappropriate using a term, title or designation in respect of the member's practice -using a name other than the members name as set out in the register in the course of providing or offering service within the scope of practice of massage therapy -Falling to identify himself or herself, by name or certificate number, on the request if a client, a client representative or another health professional -failing to pay any money owing to the college -Failing to take reasonable steps to ensure that any information provided by or on the behalf of the member to the college is accurate -Failing to reply appropriately or within a reasonable time to a written inquiry made reprimand of the discipline committee -Failing to permit entry at a reasonable time or to co-operate with an authorized representative of the college conducting an inspection or examination of the member's office, records, equipment or practice
What does responsible caring mean in code of ethics?
-minimize harm and maximize benefits to their clients. This means we need to be competent and self-aware e.g. knowing what falls within our scope of practice -it also means that we have to acquire and use the most current knowledge and skills in order to serve the best interests of their clients -we also need to reflect on our own values, attitudes and experiences and how they might influence our actions, choices or recommendations - recognizes and respects the ability of an individual to make decisions for themselves with regard to heath care
What does standard 11- Pre./post treatment protocol- undressing state?
-reason for removal of clothing - Instruct client on removal of what they are comfortable removing -Client can ask questions -Given privacy -get permission to re-enter the room -Ask client if they need assistance where merited -CLient told what item needs to be removed -Removing only what has been agreed on
What is the Lines of responsibility: CMTO
-regulate and govern members (RMT'S) in accordance with acts -serve and protect the public interest -historically the roles of the college(CMTO) and the association(RMTAO) have been confused -Develop, establish and maintain standard of qualification for registration -Develop, establish, and maintain quality assurance programs - Develop, establish, and maintain standards of knowledge and skill. This was initially based on the number of hours of learning but now is based on competency standards -Develop, establish, and maintain standard of professional ethics -Develop, establish, and maintain programs to help the public -The college administers the act as well as policies that they establish for safe and effective client care -Are required by the RHPA to have 7 standing committees
How does the RHPA defines sexual abuse?
-sexual intercourse or other forms of physical sexual relations -Touching of sexual nature, of a patient by a member -Behviour or remarks of a sexual nature by the member towards the patient
What does policy 25- Zero tolerance - Financial state?
-the inappropriate use of a clients funds, property or resourses. May include such behaviours: -Persuading, tricking, or threatening the client to part with their funds -Recommending excessive treatments -Use of clients money for purpose other than that intended by the client
For peer assessment how are members selected for peer review?
-their name being randomly drawn by the CMTO -Being referred to by the complaint committee or the executive committee -Failure to complete the minimum amount of credits before the end of the credit cycle -Failure to show proof of completing the minimum amount of credits
What do we have to consider with culturally sensitive care requires?
1. Being tuned in and sensitive to cultural issues 2.Recognizing a lack of knowledge and training in working with different cultural groups 3.being open and willing to examine persona; prejudice and biases 4.Developing a genuine desire to learn more about other cultures
What is the power differential?
1. built-in 2. Therapist should not take transference as positive or negative 3.Transference is normal; it's just accentuated in our choice of profession 4.Signs of transference; passivity- encourage client to ask questions, the captive audience- people referring you, idolizing you, having a crush, Lost souls- people have gone everywhere your their last hope, Sexual feelings- may have feelings for you, gift giving, increasing in conversation
What does supporting behaviors mean in code of ethics?
1.Adhering to the profession's code of ethics 2.Discussing and consulting on difficult professionals issues 3.bringing to the attention of the college ethical issues that require further verification or further development of new guidelines or standards 4.Reporting professional misconduct and incompetence to the appropriate college or legal body 5. Cooperating with this committees of the college concerned with investigating and disciplining members
What does the CMTO- Patient relations
As the name says they handle the patients relations between therapist and patient
What does standard 7- Consent state?
For assessment, reassessment, and treatment -Treatment is consistent with our scope -Consent is voluntary -No fraud or misrepresentation -NAture and purpose include body part(s) -Risk, benefits, complications, contraindications -Client can stop or modify at any time -Client will be checked in for comfort -Client can ask questions -Special considerations around substitute decision- making -Informed consent is recorded within 24 hours
What is HPARB?
Health profession review board - 12 to 20 ministial appointees - Not health care professionals
What is a professional boundary?
Physical and emotional limits appropriate for the therapeutic relationship. Does not mean we need to be aloof and clinical
What does RHPA stand for?
Regulated Health Professions Act
Who to do you appeal of registration decision when the applicant is notified of their right to appeal?
The appeal committee
What is considered part of the quality assurance program? what are the member's responsibilities with the respect to the professional portfolio?
The member's responsibilities with the respect to the professional portfolio are: - The must maintain a professional portfolio including a self-assessment and an education and professional activities -Include self-assessment documents consists of a list if completes continuing request of the committee -Submit the professional portfolio, either to the committee after 30 days of being requested, or to assessor immediately upon request
What is RHPA Scope of practice/Controlled acts?
This model gives the public an opportunity for choice. If further protects the public bt restrictions or controlling certain acts which may be harmful - The scope of practice is meant t overlap. Again this gives the public choice - Each profession has a profession-specific scope of practice -A controlled act is potentially harmful of done by someone who is unqualified. There are 14 controlled acts -MAssage therapy currently has partial access to " performing a prescribed procedure on tissue below the dermis or mucous membrane" - Restriction of titles is in place to protect the public. The can ascertain who is qualifie to provide care and are thus informed
Who is a professional?
_ Minimal social control - Knowledge - credential or designations -Dedictar to the people