Module One

Rationale:
A. Gather more detailed information about the patient’s leisure activities, including how much time she spends playing her video games.
C. Include cognitive and mental health assessments as a part of the initial evaluation to determine if the patient’s ASD is having an impact on the cause of her carpal tunnel symptoms
E. 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.
Gathering more details about the patient’s cognitive and mental health status, video game habits, and job requirements all meet the criteria for following 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. 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. This includes: providing appropriate evaluation and a plan of intervention for recipients of occupational therapy services specific to their needs.

B. 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 she 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.
D. Pressing the patient to stop playing video games even if she becomes distressed 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.
F. Delaying contacting the patient’s supervisor violates the Code of Ethics principle of Beneficence by delaying an action that constitutes competent occupational therapy practice. However, asking the patient and her sister if it is alright to contact the supervisor follows the Code of Ethics principle of Autonomy by respecting the patient’s right to privacy regarding the disclosure of her supervisor’s actions related to her job placement at the workshop.

A. Ask the supervisor if she can schedule a work site evaluation to assess the patient’s job tasks and how the patient performs her job.
D. Discuss the effects of video game playing with the patient and her sister in a non-threatening way.
E. 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.
Performing a work site evaluation and discussing the effects of video game playing with the patient and her sister follow the Code of Ethics principle of Beneficence, by following appropriate occupational therapy evaluation and treatment procedures.
Conducting the work site evaluation over the phone rather than in person would violate this code, 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. 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 the same respect due to another professional. 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. Threatening to report the supervisor also violates these two principles.

A. The supervisor may think that the patient’s symptoms are only caused by her activities outside of work
B. The supervisor is not familiar with the causes and symptoms of carpal tunnel syndrome
E. The patient’s ASD has caused her to experience more difficulty dealing with her carpal tunnel symptoms on the job because she does not know how to communicate with the supervisor.
Concluding that the supervisor is not familiar with the causes of carpal tunnel syndrome and that the patient has had difficulty communicating her symptoms to the supervisor due to her ASD are fair conclusions based on the work-site evaluation and follow the Code of Ethics principle of Justice. The fact that the supervisor seems surprised that the physical actions of the job put stress on the carpal tunnel area could also lead the OTR® to conclude that the supervisor may think the patient’s symptoms are caused only by her activities outside of work, but the OTR® should not hold a biased attitude against the supervisor because of this conclusion. Instead, the OTR® should clarify with the supervisor what he thinks the causes of the patient’s symptoms are and educate him on how the patient’s job could contribute to her symptoms. Making assumptions about the supervisor’s personal feelings toward the patient and his attitude toward the patient’s symptoms or concern over her wellbeing violates the Code of Ethics principle of Fidelity, as the supervisor should be treated with respect and fairness during the evaluation process. Concluding that the patient has been faking her symptoms also violates the Code of Ethics principle of Fidelity as well as the principle of Justice, since the assumption does not allow for fair and objective treatment of the patient at her workplace.

A. 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 violated at work by not providing adaptations.
C. 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.
E. 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.
Writing the letter to the supervisor expressing concern over the lack of follow through follows the Code of Ethics principles of Justice and Fidelity by allowing the supervisor to directly respond to the OTR®’s concerns before any further action is taken. Bypassing the supervisor and reporting the situation to the management of the sheltered workshop or the county would violate these principles. However, providing the woman and her sister with information on how to proceed if the supervisor does not respond to the letter or make changes to the woman’s job follows the principle of Justice by empowering the woman and her sister with the ability to follow up regarding the woman’s rights at the sheltered workshop. Since the woman is not capable of advocating for herself, telling the woman’s sister to file a complaint with the management of the sheltered workshop without the participation of the woman herself violates the Code of Ethics principle of Justice. Discussing a possible leave of absence from the job, however, follows the Code of Ethics principle of Autonomy, as it allows the woman to take part in making her own decision regarding whether she should continue working.

Moving to another room, rescheduling the meeting and using Skype as long as both the OTR® and COTA® are in private areas when the meeting takes place, all take measures of keeping patient confidentiality which adheres to the principle of Autonomy.
Autonomy- Principle 3 states that occupational therapy personnel shall respect the right of the individual to self-determination, privacy, confidentiality, and consent. Maintaining the confidentiality of all verbal, written, electronic, augmentative, and nonverbal communications, in compliance with applicable laws, including all aspects of privacy laws is incorporated into this principle.
Discussing students in front of other students and teachers violates the Code of Ethics principle of Autonomy, even if others who are present may not understand the conversation and students are not named. Confidential information that may be overheard could still be identified even if names of students are not being used. Asking the teacher to remove the children from the area violates the Code of Ethics principle of Fidelity by not showing the teacher the respect they deserve. Fidelity- Principle 6 states that occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity.

The response to this request must be carefully considered to observe the Code of Ethics principles of Beneficence, Nonmaleficence, Justice and Fidelity, as the OTR® must respond to the special education director in a professional manner that is beneficial to the school while at the same time looking out for the best interests of the students. Giving estimated dates of dismissal for those students who are ready to be dismissed or requesting that their IEP annual reviews be moved up follows these principles. Telling the special education director that the OTR® will decide when students are dismissed violates the Code of Ethics principles of Autonomy and Fidelity, as it is the IEP team that makes the final decision regarding dismissal from occupational therapy services, not the OTR® alone. Putting the special education director off violates the Code of Ethics principle of Fidelity. Discussing the possible decrease in hours with the COTA®  follows the Code of Ethics principle of Veracity as the OTR® and COTA®’s are collaborating in preparation for a decrease in hours at the school.

Reporting suspected abuse is mandatory for all school personnel, but it must be handled discreetly through proper channels. Since the COTA® reports directly to the OTR®, the COTA® should report the comment directly to the OTR® or follow any pre-arranged instructions given in the case of such an event. These two actions follow the Code of Ethics principles of Nonmaleficence and Fidelity. Waiting for the OTR® to handle the situation violates the principle of Nonmaleficence because the COTA® is not doing all they can to prevent further harm to the student. Ignoring the girl’s comment violates the principle of Nonmaleficence as the comment must be taken seriously. Taking the girl’s comment seriously supports the principle of Nonmaleficence. OT practitioners are not trained to ask questions in order to clarify the situation. Bypassing the OTR® or the student’s case manager violates the principle of Fidelity.

1) Yes: This action observes the Code of Ethics principle of Fidelity because it protects the kindergarten teacher’s privacy while at the same time respecting the professional relationship between the OTR® and the COTA®. Fidelity- Principle 6 states that occupational therapy personnel shall treat clients, colleagues, and other professionals with respect, fairness, discretion, and integrity.
2) No:  This action violates the Code of Ethics principle of Fidelity. The Related Standard of Conduct states that occupational therapy personnel shall preserve, respect, and safeguard private information about employees, colleagues, and students unless otherwise mandated or permitted by relevant laws.
3) No: The comment cannot be ignored because the COTA® has violated an ethical principle.
4) Yes: This action demonstrates the core value of Altruism which involves demonstrating concern for the welfare of others.
5) No: This action violates the Code of Ethics principle of Fidelity. While the OTR® is correct, the COTA® will probably feel chastised by this remark.
6) Yes: The COTA® may have forgotten about the need to respect the privacy of other employees and requires a review of procedures to insure the situation does not happen again.