In-Class Activity 3: Ethics

Instructions

Respond to the following prompts:

1) You are working with an individual who experienced a left CVA resulting in right-sided

movement problems. This individual requires a lot of assistance at home with all basic

daily activities, but they have good potential to benefit from occupational therapy

services to become more independent. This client’s insurance only covers the first 30

minutes of their therapy sessions. Meaning, if 120 minutes of therapy are provided, only

30 minutes of them will be reimbursed. Due to this client’s clinical presentation, they

need more than 30 minutes of treatment per session. However, because of their

insurance’s poor reimbursement structure, your employer tells you to keep all treatments

with this individual to 30 minutes.

a. What is one core value that is at stake and why?

One core value that is at stake is dignity. The reason why this is at stake is because the clients
rights are not being respected. The client has the right to receive proper care regardless of their
insurance.

b. When attempting to understand and navigate this situation, what principle will best

assist you with making sound ethical decisions and why?

The principle that would best assist me with making sound ethical decisions is beneficence. I chose this
because this principle states that OT personnel should focus on the wellbeing and safety of people. The
reason why someone is receiving services is because they are not currently satisfied in their life or
something is throwing off their sense of wellbeing. As an OT the main goal is to be able to bring meaning
back into someone’s life. This is done by providing services that will allow them to do so. If someone has
their services cut down, they will not have the full effect of OT services and their sense of wellbeing will
suffer.

b. What standards of conduct may be involved in this situation and why?

Do not engage in actions that reduce the public’s trust in occupational therapy.
This standard of conduct is involved in this situation because if clients were to find out that Ot are
not being fair in their treatment, they may tell others and word can go around and give OT a bad
reputation.

1.Bill and collect fees justly and legally in a manner that is fair, reasonable, and

commensurate with services delivered. (Principle: Justice; key words: billing, fees)
2.Ensure that documentation for reimbursement purposes is done in accordance with

applicable laws, guidelines, and regulations. (Principle: Justice; key words: documentation,
reimbursement, law)

Points 1 and 2 are standards of conduct that are involved because the therapist is not being fair on
how they are billing services.

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. (

2) You are working in a privately-owned neurological rehabilitation center with an

interprofessional team composed of occupational, physical, and speech therapists,

education specialists, athletic trainers, behavior analysts, case managers, and physicians.

There are also aides who assist with the daily treatments of the clients; clients are

typically, complex in their presentation (i.e., they have a lot of physical, behavioral, and

cognitive health problems). All professionals wear identification badges that have their

names but not their profession identified. The aides on the other hand, are identified as

Neurological Rehabilitation Specialists.

a. What is one core value that is at stake and why?

Truth because, I wouldn’t consider an aide to be a specialist. I would consider an OT, PT, or SLP
to be the specialist because they are the ones that are fully trained and experts in the
profession. The aides may have some knowledge, but they are not the experts.

b. When attempting to understand and navigate this situation, what principle will best

assist you with making sound ethical decisions and why?

Nonmaleficence, this is because if clients read their badges they may be over qualifying these individuals
and thinking they know more about the profession then they actually do. This is risky because they may
as questions that they may not know to much about which can lead them to misinform the client and
potentially but them at risk for injury or harm. (unintentionally but it may happen).

b. What standards of conduct may be involved in this situation and why?

Do not engage in actions or inactions that jeopardize the safety or well-being of
others or team effectiveness. (Principle: Fidelity; key words: relationships, clients,
service recipients, colleagues, safety, law, unethical, impaired, competence)
. Do not engage in any undue influences that may impair practice or compromise the
ability to safely and competently provide occupational therapy services, education,
or research.
These two are standards of conduct that are involved in the situation because a client may ask
the aid a question that they are not or should not answer due to level of training. This can then
cause the patient to be injured.
3) You are working with an older adult in an inpatient facility who has a terminal health

condition. This client has low energy, depression, and is generally deconditioned due to

lack of activity. In addition, they often refuse therapy because of feelings of depression,

poor timing of therapy visits, and lack of interest in the therapeutic activities the other

therapists are offering. Many of the therapists do not pay much attention to this client or

put much energy into trying to engage them in therapy because of the frequent refusals.

a. What is one core value that is at stake and why?

Equality, this is because the client has the right to all the same opportunities as the other clients
no matter what their circumstances are. The client suffers from a condition which the OT should
understand. That doesn’t mean that the OT can’t have feelings towards the situation, but they
should not treat them any differently. As an Ot they should find ways to take tasks meaningful
and enjoyable. It might require them to think outside of the box, but they should give equal
treatment.

b. When attempting to understand and navigate this situation, what principle will best

assist you with making sound ethical decisions and why?

The principle that will assist me in making sound ethical decisions would be justice. This is because for
this client it would be important to find ways that you can include them rather than excluding them
based on a condition that they are suffering from. Justice also deals with equity which makes me think
about what can be done to make sure that they are receiving fair treatment.

b. What standards of conduct may be involved in this situation and why?

Demonstrate a level of cultural humility, sensitivity, and agility within professional
practice that promotes inclusivity and does not result in harmful actions or inactions
with persons, groups, organizations, and populations from diverse backgrounds
including age, gender identity, sexual orientation, race, religion, origin, socioeconomic status,
degree of ability, or any other status or attributes. (Principle: Fidelity;
key words: civility, cultural competence, diversity, cultural humility, cultural
sensitivity)
. Proactively address workplace conflict that affects or can potentially affect professional
relationships and the provision of services. (Principle: Fidelity; key words:
relationships, conflict, clients, service recipients, colleagues)
I chose these two because there should be someone who should address the problem that is
going on. Someone to speak up and talk about what is going on and maybe everyone can come
up with a solution and remind staff the importance of being inclusive.

4) You are working with a young adult client in a skilled nursing facility. This client has

been working with the occupational therapy assistant for several days. When you, the

supervising occupational therapist, check in with the client to see how therapy has been

going, they tell you that the assistant spends about 20 minutes with them before leaving
and uses that time to chat about daily events and do a few upper body resistance band

exercises while seated. As the supervising therapist who wrote this client’s plan of care

and reviews the assistant’s daily notes, you have concerns about what the client has told

you, especially because the assistant is billing for 60 minutes of treatment time.

a. Use the 6-step process for ethical reasoning to navigate this situation. For steps 1-5,

use the “Considerations” column to inform the process. For step 6, write a personal

reflection addressing the following:

1. The client was not getting the full 60 min of direct patient care

the client and the OTA are involved.

Clinical indications are the daily notes that are written, progress of the client, baseline of where the
client feels they are at.

2. The client is not receiving the full care that they are being billed for. Maybe the client is doing
fine with the treatment but it is not legally and ethically right to bill for a service you are not
engaging in.
The moral obligation to address the problem is the OT. At the end of the day the OT is
responsible for the progress of the client and for anyone working under the OT.
3. Code of ethics, truth, justice, non maleficence, beneficence, and justice
4. Having a conversation with the OTA, Having a conversation with the OTA and a supervisor.
5. Schedule a meeting with a higher up supervisor and the OTA and discuss the issue. I would allow
the OTA to explain why they billed for the full 60. I would then explain the legalities behind why
60 min should be billed if therapists are not working directly with the client. I would also make
sure to review ethics and codes of conduct with the OTA.
6. A possible outcome can be that the therapist does live up to the code of conduct and ethics. But
there is also a risk of the OTA resenting staff and resenting the client which can lead to unfair
treatment. What went well is that proper training was given on ethics and code of conduct what
didn’t go well was maybe the manner in which is was presented or maybe not being stern and
allowing for more mistakes to occur.

i. How did it make you feel knowing that the situation described above is a true

story? How does it make you feel knowing that some therapists and assistants

bill for services that were never provided?

I do not agree with this situation. This is unfair because the OTA is not seeking the client’s interest. A
client is not a friend and clients are there because they trust us as professionals to help them get better.
This is a waste of time to the client and even to other healthcare professionals that may be working with
this client. This does not allow for the client to be better they might even regress in treatment. I feel that
therapists and assistants who engage in this type of behavior are only there for the money, they are not
their for the greater good of the client. Unfortunately, this is something that is common in healthcare.
You often hear the term “they are here for the paycheck”.
ii. What strengths do you possess that would support your ability to effectively

navigate ethical dilemmas?

Strengths that I possess that would allow me to effectively navigate the ethical dilemma would be that I
would be very good at problem solving. I know that I would have to have a conversation with the OTA
and good about making an intervention with the client to see where their abilities are so we can adjust if
needed to meet the client where they are at.

iii. What weaknesses do you possess that would hinder your ability to

effectively navigate ethical dilemmas and what could you do to improve in

these areas?

The weakness that I would possess would be how to communicate with the OTA. This would be a
difficult conversation to have so knowing how to navigate that situation and being stern would be
difficult. What I could do to improve in these areas is to practice my communication skills and not being
afraid to speak my mind.