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Answer Key for Module 1 Ethics Scenario Set : Question 1


You have scored 27 of 36 points

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. Proceed with occupational therapy treatment and wait to contact the patient’s supervisor at the sheltered workshop until the patient’s symptoms have subsided
No 2. Inform the patient and her sister that playing video games can cause carpal tunnel syndrome and instruct the patient to immediately refrain from playing video games
Yes 3. Include cognitive and mental health assessments as part of the initial evaluation to determine if the patient’s ASD is contributing to her carpal tunnel syndrome
No 4. Contact the patient’s supervisor at the sheltered workshop to find out why the patient has not been assigned to another job
Yes 5. Gather more detailed information about the patient’s leisure activities, including how much time she spends playing her video games
Yes 6. Ask the patient and her sister for permission to contact the patient’s supervisor at the sheltered workshop to gather more information about the patient’s job

Rationale

1. Delaying contacting the patient’s supervisor violates the Code of Ethics principle of Beneficence- by delaying an action that constitutes competent occupational therapy practice. Asking the patient and her sister for permission to contact the supervisor follows the Code of Ethics principle of Autonomy- by respecting the patient’s right to privacy.
2. Insisting the patient stops playing video games violates the Code of Ethics principle of Nonmaleficence, as the patient may need to play video games for stress relief. Nonmaleficence obligates OT personnel to abstain from causing harm to others. The Principle of Autonomy expresses the concept that occupational therapy personnel have a duty to treat the client or service recipient according to their desires, within the bounds of accepted standards of care, and to protect their confidential information. Often, respect for Autonomy is referred to as the self-determination principle. Respecting the Autonomy of service recipients acknowledges their right to their own views and opinions and their right to make choices in regard to their own care and based on their own values and beliefs.
3. Assessing the patient's cognitive and mental health status is part of conducting a comprehensive evaluation. Even though she was referred for her carpal tunnel symptoms, her ASD cannot be ignored. By assessing the patient's cognitive levels and mental health, the OTR® is looking at the patient as a whole which is following the principle of Beneficence. Only by conducting a thorough evaluation will the OTR® be able to devise the best intervention plan that will meet all the patient's needs.
4. Asking the supervisor why the patient has not been assigned to another job violates the Code of Ethics principle of Veracity, as the OTR® is basing this question on subjective information that they received from the patient’s sister. Veracity is based on the virtues of truthfulness, candor, and honesty. The Principle of Veracity refers to comprehensive, accurate, and objective transmission of information. This includes refraining from using or participating in the use of any form of communication that contains false, fraudulent, deceptive, misleading, or unfair statements or claims.
5. Gathering more details about the patient’s video game habits is an essentail part of gathering all the necessary information needed for a comprehensive evaluaution of her abilities, challenges and needs. The OTR® is adhering to the Code of Ethics principle of Beneficence which includes all forms of action intended to benefit other persons such as providing appropriate evaluation and a plan of intervention for recipients of occupational therapy services specific to their needs.
6. Beneficence includes all forms of action intended to benefit other persons, and requires taking action by helping others, in other words, by promoting good, by preventing harm, and by removing harm. Only by gathering more details about the patient’s job requirements, will the OTR® be able to provide recommendations that will help the patient and prevent further harm, both of which form part of the Code of Ethics principle of Beneficence. This principle states that Occupational Therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services.

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
No 1. Report the supervisor for failure to act in the best interests of the employee
Yes 2. 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
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. 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.
2. 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.
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 tell her co-workers that she has ASD which is making it challenging to communicate the difficulties she is experiencing in the workplace
Yes 2. The OTR® should begin implementing assertiveness training with the patient to improve her communication and advocacy in the workplace
Yes 3. 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
No 4. The OTR® should advise the patient to schedule a meeting with her supervisor to ask for a rotating work schedule
No 5. The OTR® should schedule a meeting with the supervisor to discuss staffing rotation options for the sheltered workshop
Yes 6. The OTR® should provide the supervisor with education of common work related musculoskeletal disorders and overuse injuries

Rationale

1. 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..
2. 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
3. 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.
4. 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®.
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. 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.

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
Yes 1. 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
Yes 2. 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
No 3. 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
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
No 5. Report the sheltered workshop to the county’s social services office for violating the patient’s rights
No 6. 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

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. Writing the letter to the supervisor expressing concern over the lack of follow through follows the principles of Justice and Fidelity.
2. 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.
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. 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.
6. 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.