Upholds the AOTA Code of Ethics in practice
Core Values: Altruism, Equality, Freedom, Justice, Dignity, Truth and Prudence. My professor once said that all OT students had these qualities or else they wouldn't have made it into OT school. However, there are some qualities that require months to years of honing in order to provide the best care to a client.
Principles & Standards of Conduct: Beneficence, Non-maleficence, Autonomy, Justice, Veracity, and Fidelity.
Beneficence: Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, including having had the opportunity to lead several therapy sessions where my fieldwork educator allowed me to work with the client as if I were the OT and she were the COTA. The point of the simulation was to allow me to delegate duties to her as the COTA and for me to get experience working as an OT. I achieved this by asking her to work with the child on one last goal while I documented and recorded notes to go home for carryover. I also asked her to return the student to her classroom while I retrieved the next student. It was a great trade-off because my fieldwork educator was able to give me constructive feedback that helped me improve my skills as a future occupational therapy practitioner. (Ensure that all duties delegated to other occupational therapy personnel are congruent with credentials, qualifications, experience, competency, and scope of practice with respect to service delivery, supervision, fieldwork education, and research.)
Non-maleficence: Occupational therapy personnel shall refrain from actions that cause harm (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, including this category. For instance, I had an older adult client who experienced crepitis in both her shoulders, which impacted her ability to participate in therapeutic exercises as much as she needed to improve her range of motion and strength. The crepitis in her shoulders affected her ability to readjust her positioning in bed which resulted in a bed sore developing. Both the crepitis and bed sore left her in pain. When I worked with her, I took her pain into consideration by providing enough breaks between exercises, reducing the number of repetitions and switching with more sets. Although the use of strengthening exercises may seem similar to physical therapy, I'm using these exercises for occupationally functional purposes, such as pushing self up from a chair, the toilet or the bed. I stopped therapy when she reached her limit and asked me to stop. On several occasions she expressed her appreciation and gratitude to me when I took her wants and needs into consideration and didn't push her past her limit. It was a heart-warming experience knowing that I had listened to her and she acknowledged that I had done so. (Avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees.)
Autonomy: Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, particularly for this category. For example, I had an older adult who had experienced a right-sided CVA, meaning that the left side of his body was affected, who was determined to go home unaided. When I first worked with him, I applied electrical stimulation to the muscle groups around his shoulder to start sending electrical signals to the muscles as I moved his arm on an arm bike to signal to the muscles and brain normal movement patterns in his arm and hand. After a few minutes on the bike, he asked me what all of this did. In the simplest way that I could, I explained that his muscles were "asleep" and required reawakening with electrical impulses, which is why we used the e-stim machine. The arm bike was twofold. As the muscles start to wake up, more electrical signals will be sent throughout the muscles and eventually to the brain; the movement helps increase the number of signals while also reminding the muscles about normal movement patterns. I told him if he can try "talking" to his arm to tell it to move, such as pushing and pulling the arm bike handle, that'll help reconnect those connections from the muscles to the brain. This was the first step towards being able to get back to doing functional tasks that he wanted to do when he left the facility, such as driving, bathing and dressing himself. Thoughtfully he asked if this intervention always worked. I admitted that it may not because, like the stroke itself, each person's recovery is just as unique. He was silent for a long time, then finally asked, "Even if it can't make it totally better, it can't make it worse, right?" I told him that I didn't know of any research of this particular intervention that had had adverse effects on a client. He acknowledged this answer and ruminated on the rest of my information that I had previously provided him. I am glad I explained the purpose of the intervention because this first step is necessary for my client to get back to occupations he enjoys or wants to do independently. This electrical stimulation intervention provided sensory stimulation to the nerves and muscles in his arm and shoulder while the arm bike provided normal joint movements at the elbow, wrist and shoulder, which is necessary to improve upper extremity function for basic tasks such as reaching, grasping, and manipulating objects. In addition, by educating my client of the purpose behind the intervention, it motivated him to try to help move his shoulders, his upper arm, his lower arm, and his wrist along with the arm bike in an effort to help the process along. His determination to return home helped, but he admitted later on that my explanation was the motivation that he needed to get better. (Fully disclose the benefits, risks, and potential outcomes of any intervention; the personnel who will be providing the intervention; and any reasonable alternatives to the proposed intervention (Cuesta-Gomez et al., 2017; Ikuno, Matsuo & Shomoto, 2012; Morris, 2017).)
Resources:
Cuesta-Gomez, A., Molina-Rueda, F., Carratala-Tejada, M., Imatz-Ojanguren, E., Torricelli, D., and Miangolarra-Page, J.C. (2017). The use of functional electrical stimulation on the upper limb and interscapular muscles of patients with stroke for the improvement of reaching movements: A feasability study. Frontier Neurology, 8(186). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423909/pdf/fneur-08-00186.pdf .
Ikuno, K., Matsuo, A., and Shomoto, K. (2012). Sensory electrical stimulation for recovery of hand and arm function in stroke patients: A review of the literature. Journal of Novel Physiotherapies, 1(7). https://www.omicsonline.org/open-access/sensory-electrical-stimulation-for-recovery-of-hand-and-arm-function-in-stroke-patients-a-review-of-the-literature-2165-7025.S1-007.php?aid=8982 .
R. Morris (personal communication, July 2017)
Justice: Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, especially for this category. For instance, I was a part of the LEND training program, which consisted of clinical and in-class experience working in an interdisciplinary team. One experience I had that was memorable was observing a pediatrician in the Latino Pediatric Developmental Clinic as she assessed the progress of one patient and diagnosed the other. It was enlightening to learn about her typical conversations with the child and parents as well as any siblings that might have attended. The child that she diagnosed required several hours collecting information from the mother, child and his sister to form a complete picture of what the mother was concerned about and give her an answer to her question. Throughout the appointment I had made mental notes of things that had raised flags that may indicate a potential need for OT. Toward the end of the session, I had formed key points from my notes to bring to the doctor's attention should the moment arise. The moment finally came and I suggested she refer him for OT. I listed my reasons and she seemed to acknowledge my request. I went on to explain that the Rachel Kay Stevens Clinic was pro bono and if they didn't have the insurance to cover OT services then RKS would provide those services for free. Seeing that his mother only spoke Spanish, I told her there were students in the OT program who could translate if needed. The pediatrician appreciated my input and eventually referred the child for OT. I knew OT would help him and his family, but I also knew that getting those services would take longer to receive due to the waiting lists in most pediatric therapy clinics. The child was so far behind developmentally that it impacted his ability to participate in school which ultimately affected his ability to socialize with other kids. The child admitted that he often felt alone amongst his peers. When the child expressed how he felt, this upset his mother and she asked the doctor for help for her son. By referring them to OT services that could be provided right away, I knew that the child and his mother would benefit sooner and prevent him from getting further behind. (Assist those in need of occupational therapy services in securing access through available means.)
Veracity: Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, particularly for this category. For example, skilled nursing facilities require high productivity rates to ensure reimbursement for services; in short, the insurance companies want to make sure you are not wasting any time when you could be providing services to clients. High productivity rates can come at a cost and may be detrimental to the client when treatment sessions are shortened or are not effectively executed. It could also prevent future reimbursement if the facility continued to not provide the proper amount of care to the client. The facility that I worked at made sure everyone provided the best services possible while also maintaining high productivity rates. The therapists had it down to a T: record the time you started with the client, work out the math so you knew about what time you should finish with them, allow yourself enough time to transition them, and then start with the next client as soon as possible without overlapping times. Each therapist was in charge of recording his or her times, upload it into the computer, and then double check to make sure no times overlapped. This could be a problem if a PT and OT had the same client on caseload but weren't co-treating and accidentally recorded a start time that overlapped the other therapist's end time. All time sheets had to be turned in before the end of the shift too. It was one of the most efficient systems I had seen in a SNF setting. Nevertheless, this system allowed the facility to maintain high productivity levels without cutting corners to do so. It also required all therapists to accurately record their times and report them in a timely manner, all while within the facility guidelines. (Record and report in an accurate and timely manner and in accordance with applicable regulations all information related to professional or academic documentation and activities.)
Fidelity: Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, especially for this category. For instance, I promoted communication and collaboration amongst teammates by discussing intervention details that required carryover or a general game plan for who will be seeing the client next. (Promote collaborative actions and communication as a member of inter-professional teams to facilitate quality care and safety for clients.)
Principles & Standards of Conduct: Beneficence, Non-maleficence, Autonomy, Justice, Veracity, and Fidelity.
Beneficence: Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, including having had the opportunity to lead several therapy sessions where my fieldwork educator allowed me to work with the client as if I were the OT and she were the COTA. The point of the simulation was to allow me to delegate duties to her as the COTA and for me to get experience working as an OT. I achieved this by asking her to work with the child on one last goal while I documented and recorded notes to go home for carryover. I also asked her to return the student to her classroom while I retrieved the next student. It was a great trade-off because my fieldwork educator was able to give me constructive feedback that helped me improve my skills as a future occupational therapy practitioner. (Ensure that all duties delegated to other occupational therapy personnel are congruent with credentials, qualifications, experience, competency, and scope of practice with respect to service delivery, supervision, fieldwork education, and research.)
Non-maleficence: Occupational therapy personnel shall refrain from actions that cause harm (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, including this category. For instance, I had an older adult client who experienced crepitis in both her shoulders, which impacted her ability to participate in therapeutic exercises as much as she needed to improve her range of motion and strength. The crepitis in her shoulders affected her ability to readjust her positioning in bed which resulted in a bed sore developing. Both the crepitis and bed sore left her in pain. When I worked with her, I took her pain into consideration by providing enough breaks between exercises, reducing the number of repetitions and switching with more sets. Although the use of strengthening exercises may seem similar to physical therapy, I'm using these exercises for occupationally functional purposes, such as pushing self up from a chair, the toilet or the bed. I stopped therapy when she reached her limit and asked me to stop. On several occasions she expressed her appreciation and gratitude to me when I took her wants and needs into consideration and didn't push her past her limit. It was a heart-warming experience knowing that I had listened to her and she acknowledged that I had done so. (Avoid inflicting harm or injury to recipients of occupational therapy services, students, research participants, or employees.)
Autonomy: Occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, particularly for this category. For example, I had an older adult who had experienced a right-sided CVA, meaning that the left side of his body was affected, who was determined to go home unaided. When I first worked with him, I applied electrical stimulation to the muscle groups around his shoulder to start sending electrical signals to the muscles as I moved his arm on an arm bike to signal to the muscles and brain normal movement patterns in his arm and hand. After a few minutes on the bike, he asked me what all of this did. In the simplest way that I could, I explained that his muscles were "asleep" and required reawakening with electrical impulses, which is why we used the e-stim machine. The arm bike was twofold. As the muscles start to wake up, more electrical signals will be sent throughout the muscles and eventually to the brain; the movement helps increase the number of signals while also reminding the muscles about normal movement patterns. I told him if he can try "talking" to his arm to tell it to move, such as pushing and pulling the arm bike handle, that'll help reconnect those connections from the muscles to the brain. This was the first step towards being able to get back to doing functional tasks that he wanted to do when he left the facility, such as driving, bathing and dressing himself. Thoughtfully he asked if this intervention always worked. I admitted that it may not because, like the stroke itself, each person's recovery is just as unique. He was silent for a long time, then finally asked, "Even if it can't make it totally better, it can't make it worse, right?" I told him that I didn't know of any research of this particular intervention that had had adverse effects on a client. He acknowledged this answer and ruminated on the rest of my information that I had previously provided him. I am glad I explained the purpose of the intervention because this first step is necessary for my client to get back to occupations he enjoys or wants to do independently. This electrical stimulation intervention provided sensory stimulation to the nerves and muscles in his arm and shoulder while the arm bike provided normal joint movements at the elbow, wrist and shoulder, which is necessary to improve upper extremity function for basic tasks such as reaching, grasping, and manipulating objects. In addition, by educating my client of the purpose behind the intervention, it motivated him to try to help move his shoulders, his upper arm, his lower arm, and his wrist along with the arm bike in an effort to help the process along. His determination to return home helped, but he admitted later on that my explanation was the motivation that he needed to get better. (Fully disclose the benefits, risks, and potential outcomes of any intervention; the personnel who will be providing the intervention; and any reasonable alternatives to the proposed intervention (Cuesta-Gomez et al., 2017; Ikuno, Matsuo & Shomoto, 2012; Morris, 2017).)
Resources:
Cuesta-Gomez, A., Molina-Rueda, F., Carratala-Tejada, M., Imatz-Ojanguren, E., Torricelli, D., and Miangolarra-Page, J.C. (2017). The use of functional electrical stimulation on the upper limb and interscapular muscles of patients with stroke for the improvement of reaching movements: A feasability study. Frontier Neurology, 8(186). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423909/pdf/fneur-08-00186.pdf .
Ikuno, K., Matsuo, A., and Shomoto, K. (2012). Sensory electrical stimulation for recovery of hand and arm function in stroke patients: A review of the literature. Journal of Novel Physiotherapies, 1(7). https://www.omicsonline.org/open-access/sensory-electrical-stimulation-for-recovery-of-hand-and-arm-function-in-stroke-patients-a-review-of-the-literature-2165-7025.S1-007.php?aid=8982 .
R. Morris (personal communication, July 2017)
Justice: Occupational therapy personnel shall promote fairness and objectivity in the provision of occupational therapy services (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, especially for this category. For instance, I was a part of the LEND training program, which consisted of clinical and in-class experience working in an interdisciplinary team. One experience I had that was memorable was observing a pediatrician in the Latino Pediatric Developmental Clinic as she assessed the progress of one patient and diagnosed the other. It was enlightening to learn about her typical conversations with the child and parents as well as any siblings that might have attended. The child that she diagnosed required several hours collecting information from the mother, child and his sister to form a complete picture of what the mother was concerned about and give her an answer to her question. Throughout the appointment I had made mental notes of things that had raised flags that may indicate a potential need for OT. Toward the end of the session, I had formed key points from my notes to bring to the doctor's attention should the moment arise. The moment finally came and I suggested she refer him for OT. I listed my reasons and she seemed to acknowledge my request. I went on to explain that the Rachel Kay Stevens Clinic was pro bono and if they didn't have the insurance to cover OT services then RKS would provide those services for free. Seeing that his mother only spoke Spanish, I told her there were students in the OT program who could translate if needed. The pediatrician appreciated my input and eventually referred the child for OT. I knew OT would help him and his family, but I also knew that getting those services would take longer to receive due to the waiting lists in most pediatric therapy clinics. The child was so far behind developmentally that it impacted his ability to participate in school which ultimately affected his ability to socialize with other kids. The child admitted that he often felt alone amongst his peers. When the child expressed how he felt, this upset his mother and she asked the doctor for help for her son. By referring them to OT services that could be provided right away, I knew that the child and his mother would benefit sooner and prevent him from getting further behind. (Assist those in need of occupational therapy services in securing access through available means.)
Veracity: Occupational therapy personnel shall provide comprehensive, accurate, and objective information when representing the profession (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, particularly for this category. For example, skilled nursing facilities require high productivity rates to ensure reimbursement for services; in short, the insurance companies want to make sure you are not wasting any time when you could be providing services to clients. High productivity rates can come at a cost and may be detrimental to the client when treatment sessions are shortened or are not effectively executed. It could also prevent future reimbursement if the facility continued to not provide the proper amount of care to the client. The facility that I worked at made sure everyone provided the best services possible while also maintaining high productivity rates. The therapists had it down to a T: record the time you started with the client, work out the math so you knew about what time you should finish with them, allow yourself enough time to transition them, and then start with the next client as soon as possible without overlapping times. Each therapist was in charge of recording his or her times, upload it into the computer, and then double check to make sure no times overlapped. This could be a problem if a PT and OT had the same client on caseload but weren't co-treating and accidentally recorded a start time that overlapped the other therapist's end time. All time sheets had to be turned in before the end of the shift too. It was one of the most efficient systems I had seen in a SNF setting. Nevertheless, this system allowed the facility to maintain high productivity levels without cutting corners to do so. It also required all therapists to accurately record their times and report them in a timely manner, all while within the facility guidelines. (Record and report in an accurate and timely manner and in accordance with applicable regulations all information related to professional or academic documentation and activities.)
Fidelity: Occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity (AOTA, 2015).
Over the past 36 weeks, I have upheld the AOTA Code of Ethics in practice as a Level 2 Fieldwork student, especially for this category. For instance, I promoted communication and collaboration amongst teammates by discussing intervention details that required carryover or a general game plan for who will be seeing the client next. (Promote collaborative actions and communication as a member of inter-professional teams to facilitate quality care and safety for clients.)