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Answer Key for Module 1 Ethics Scenario Set : Question 1


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Clinical Simulation 1

During the initial interview, the patient informs the OTR® that her hands become very painful when she is performing her job which consists of dipping metal blades into a liquid coating and then hanging these blades on a drying rack. Despite the patient’s sister “having had words” with the patient’s supervisor about her job placement at the workshop, the supervisor has refused to move the patient to another job. How should the OTR® proceed based on this information?


Your Response
Yes    No		 Answer Key Action
No 1.
Yes 2.
No 3.
No 4.
Yes 5.
Yes 6.

Rationale

1.
2.
3.
4.
5.
6.

When the OTR® contacts the patient’s supervisor about the patient's job, the supervisor states that he believes the patient’s carpal tunnel syndrome is the direct result of her obsessive playing of video games when she is at home. He does not believe that the patient’s job has caused her condition and feels that the patient is trying to get out of working. How should the OTR® respond in this situation?


Your Response
Yes    No		 Answer Key Action
Yes 1. Inform the supervisor that there are many ways that repetitive motion injuries can develop and a full assessment of the patient’s daily living tasks, including her job, will help to develop a plan to alleviate her symptoms
No 2. Report the supervisor for failure to act in the best interests of the employee
Yes 3. If the supervisor does not co-operate, the OTR® should not threaten him that they will report him to the head of the non-profit agency
No 4. Ask the supervisor if he is aware of the many causes of repetitive motion injuries and offer to send him information on the subject
No 5. Do not schedule a work site evaluation due to the conflict between the patient’s sister and the supervisor. Ask the supervisor over the phone about the specifics of the patient’s job
Yes 6. Ask the supervisor if a work site evaluation can be scheduled to assess the patient’s job tasks and how the patient performs her job

Rationale

1. Informing the supervisor of how work-related musculoskeletal injuries can occur and stating the necessity of workplace evaluation follow the Code of Ethics principle of Beneficence. Informing the supervisor that the evaluation is necessary to develop an appropriate treatment plan which will help his employee function at work follows the Code of Ethics principle of Fidelity by interacting with the supervisor with respect.
2. Reporting the supervisor for failure to act without following any protocols is not an appropriate course of action and violates the core principles of occupational therapy.
3. If the OTR® were to threaten the supervisor, they would be behaving in an illegal and unethical way, violating the ethical principles of Justice and Fidelity. Justice- Do not engage in illegal actions, whether directly or indirectly harming stakeholders in occupational therapy practice. Fidelity- Do not engage in actions that reduce the public’s trust in occupational therapy.
4. Questioning the supervisor about his knowledge of repetitive motion injuries implies that the supervisor is negligent in his duties toward the patient, violating the Code of Ethics principles of Veracity and Fidelity. Veracity- Occupational therapy practitioners shall represent the profession in a thorough, objective, and accurate manner. Fidelity- one of the standards of conduct is that the OT practitioner shall not engage in actions that reduce the public’s trust in occupational therapy.
5. Conducting the work site evaluation over the phone rather than in person would not be best practice, as the OTR® will not know if the supervisor is reporting the specifics of the patient’s job accurately or considering factors about the job that may be contributing to the patient’s symptoms.
6. Performing a work site evaluation follows the Code of Ethics principle of Beneficence, by following appropriate occupational therapy evaluation procedures. Furthermore, informing the supervisor about the necessity of a workplace evaluation establishes the need for skilled occupational therapy intervention. The supervisor may require justification for the work site evaluation, so informing him that the evaluation is necessary to develop an appropriate treatment plan follows the Code of Ethics principle of Fidelity by interacting with the supervisor with respect.

The OTR® completes the work site evaluation at the sheltered workshop. During the evaluation, the OTR® observes that the patient’s job requires her to tightly grip a small wire hook which is attached to a metal blade to pick up and dip the blade into a liquid coating for approximately 20 seconds. The patient is then required to lift the blade to hang it on a drying rack. Each metal blade weighs approximately 3 pounds, and this process is repeated until the patient has completed her quota for the day. The patient’s supervisor reports that the patient begins work at 9am and ends her shift at 3pm. When the OTR® enquires why the patient has not been assigned to another job, the supervisor states that there are only 4 people physically capable of completing the job, and the patient is one of them. The supervisor appears surprised when the OTR® informs him that the physical requirements of this job place significant stress on the carpal tunnel area. The OTR® concludes that the supervisor is unaware that the job is contributing to the patient’s carpal tunnel syndrome, and the patient is having challenges advocating for herself. What actions should the OTR® take based on the work site evaluation and conclusions?


Your Response
Yes    No		 Answer Key Action
No 1. The OTR® should advise the patient to schedule a meeting with her supervisor to ask for a rotating work schedule
Yes 2. The OTR® should ask the patient and her sister if they are aware that the patient has the right to accommodations in the workplace under the Americans with Disabilities Act
Yes 3. The OTR® should provide the supervisor with education of common work related musculoskeletal disorders and overuse injuries
Yes 4. The OTR® should begin implementing assertiveness training with the patient to improve her communication and advocacy in the workplace
No 5. The OTR® should schedule a meeting with the supervisor to discuss staffing rotation options for the sheltered workshop
No 6. The OTR® should advise the patient to tell her co-workers that she has ASD which is making it challenging to communicate the difficulties she is experiencing in the workplace

Rationale

1. The patient is unable to adequately communicate and advocate for herself at this time. The OTR® should first implement assertiveness training and role-play interventions as evidence-based treatments before advising the patient to schedule a meeting to advocate for herself. The selection of this answer choice shows inappropriate grading of intervention by the OTR®.
2. The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination and guarantees that people with disabilities have the same opportunities as everyone else to take part in their communities. Individuals with a diagnosis of Autism Spectrum Disorder (ASD) are protected under the ADA. The ADA prohibits discrimination against individuals with disabilities related to job application procedures, hiring, promotion and firing of employees, workers’ compensation, training, and other terms, conditions, and privileges of employment. Discrimination may include, creating a hostile work environment, and failing to make reasonable accommodations to enable an individual with a disability to do the work he or she is otherwise qualified to do.
3. Providing education to the supervisor about carpal tunnel and other overuse injuries is an important part of the OTR®'s role. This is a form of advocacy and allows the supervisor to make informed decisions while running the workshop. This action also promotes the Principle of Beneficence.
4. Assertiveness training is a positive action based on the conclusions the OTR® made from the work-site evaluation. An assertiveness training program will support the patient's role as a worker and address her deficits in communication and social skills. This action promotes the Principle of Beneficence which includes all forms of action intended to benefit other persons. Beneficence requires taking action to benefit others- in other words, to promote good, to prevent harm, and to remove harm
5. Advising a supervisor on staffing options and work schedules for individuals whom the OTR® is not treating is not within the OTR®'s scope of practice. Secondly, this step is premature in the intervention process.
6. Advising the patient to discuss her diagnosis and personal challenges with her co-workers is not a positive course of action. The OTR® is unaware of the patient's desire to disclose or not disclose her diagnosis and personal challenges. Discussing personal challenges with co-workers is not supportive to her role as a worker and it will not improve her social skills or ability to engage in meaningful work. In fact, it my harmful to the patient to disclose her diagnosis and the OTR® would then be violating the Ethical principle of Nonmaleficence- Occupational therapy practitioners shall take reasonable precautions to avoid inflicting harm on others..

After 6 weeks of occupational therapy intervention, the patient’s carpal tunnel symptoms have improved, but she is still having problems at work. Despite the OTR® providing written recommendations to the patient’s supervisor and education in the causes and symptoms of carpal tunnel syndrome, he has refused to provide any adaptations to the patient’s job or place her on another job. The only accommodation he has allowed is rest breaks every hour to allow the patient to ice her wrists. The patient and her sister are both very upset with the supervisor and the sheltered workshop. The supervisor has not returned the OTR®’s emails. How should the OTR® proceed?


Your Response
Yes    No		 Answer Key Action
No 1. Write a letter to the management of the sheltered workshop informing them that the supervisor is violating the Americans with Disabilities Act by not providing adaptations for the patient
No 2. Inform the patient and her sister that the OTR® has done all that can be done and it is the responsibility of the sheltered workshop to follow through with the recommendations
No 3. Report the sheltered workshop to the county’s social services office for violating the patient’s rights
Yes 4. Discuss with the patient and her sister how she feels about her job and if she should consider taking a leave of absence to recover from her symptoms. Allow the patient and her sister to come to their own decision regarding the leave of absence
Yes 5. Give the patient and her sister information on what further action they can take if the supervisor does not respond to the letter from the OTR® or make changes to the patient's job
Yes 6. Write a letter to the supervisor expressing concern over the lack of follow through with the recommendations for adapting the patient's job. The letter should explain how the patient's rights are being violated at work by not providing adaptations

Rationale

There are 2 main principles at play in this scenario, the Ethical principles of Justice and Fidelity. Justice relates to the fair, equitable, and appropriate treatment of persons. Fidelity requires the OT practitioner to abide by policies, procedures, and protocols when serving or acting on behalf of a professional organization or employer to fully and accurately represent the organization’s official and authorized positions. Not engaging in actions that reduce the public’s trust in occupational therapy.

1. By allowing the supervisor the opportunity to directly respond to the OTR®’s concerns before any further action is taken, follows the principles of Justice and Fidelity. Whereas, bypassing the supervisor and reporting the situation to the management of the sheltered workshop or the county would violate these principles.
2. Informing the patient and her sister that the OTR® has done all that can be done violates the principles of Justice and Fidelity, and Beneficence- Occupational therapy practitioners shall demonstrate concern for occupational therapy patients.
3. By allowing the supervisor the opportunity to directly respond to the OTR®’s concerns before any further action is taken, follows the principles of Justice and Fidelity. Whereas, bypassing the supervisor and reporting the situation to the management of the sheltered workshop or the county would violate these principles.
4. Discussing a possible leave of absence from the job, follows the principle of Autonomy, as it allows the patient to take part in making her own decisions regarding whether she should continue working.
5. Providing the patient and her sister with information on how to proceed if the supervisor does not respond to the letter or make changes to the patient’s job follows the principle of Justice by empowering the patient and her sister with the ability to follow up regarding the patient’s rights at the sheltered workshop.
6. Writing the letter to the supervisor expressing concern over the lack of follow through follows the principles of Justice and Fidelity.

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