Ethical decision-making by students in physical and occupational therapy

The professions of physical therapy (PT) and occupational therapy (OT) progressively have expanded their scope of responsibility, and practitioners often are placed in positions in which ethical decisions must be made. Few studies have reported the level of moral development and the effects of education on ethical decision making in PT or OT students. This research study was designed to determine the impact of the educational programs at the University of New Mexico (UNM) in PT and OT on the moral reasoning of the students as measured by the Defining Issues Test (DIT). The longitudinal design of this study followed two consecutive classes in each program (N = 94; 58 PT students and 36 OT students) from entry until graduation approximately 2 years later. The subjects completed a demographic survey and the DIT on the first day of class and again during their final semester (OT) or at graduation (PT). A factorial analysis of covariance was used to examine the effects of a professional degree program (PT and OT) and time (ENTRY and EXIT), after adjusting for the effects of age. The mean P score for this sample was between 45 and 46, which is within range for college and professional students. There was a significant relationship between age and the P score of the DIT. There were no significant differences between PT and OT students or between the entering and the exiting scores for either group of students. Based on the results of this study, these educational programs do not seem to be facilitating moral development in these students. The baseline level of moral development and the skills that PT and OT students use when making ethical decisions need to be established. Additional research is recommended with a larger sample size, including students in other locations. To optimize clinical practice, students must be taught how to make ethical as well as clinical judgments. Therapists must be capable of functioning in the changing health care environment, now and in the future. If the disciplines of PT and OT expect to graduate students who meet this challenge, the educational programs must take the responsibility for evaluating students and implementing curricula that facilitate ethical decision making.     

The educational interaction between physical therapy and occupational therapy students

The objectives of this study were to identify the prevalence of shared learning in U.S. physical therapy (PT) and occupational therapy (OT) education programs; determine what terminology is used for these courses; and identify perceived barriers, benefits, and challenges of the educational interactions. A survey, designed to collect information about the educational interaction between PT and OT students, was mailed to all program directors (n = 206) at each of the academic institutions (N = 103) in the United States with accredited or developing entry-level programs in PT and OT. A census study was conducted, and the entire study population received a survey. A total of 206 surveys were mailed, and 123 were retured (59.7% response rate). Of program directors, 40 (67.8%) of the PT and 42 (65.6%) of the OT program directors reported that their students shared courses with each other. None of the PT and only 8 (12.5%) of the OT directors reported that students shared clinical experiences. The term interdisciplinary was used most frequently to refer to shared educational experiences. Benefits of shared learning included sharing resources, collaboration, learning about the other profession, and gaining respect for the other profession. Challenges to shared learning included resource constraints, curricular differences, competition and differences between disciplines, relevance of course work, and different faculty expectations. Barriers reported by program directors whose students did not engage in interdisciplinary education were resource constraints, curricular differences, faculty attitude, and failure of past attempts. A model of interdisciplinary education that seeks to instill collaboration and understanding among professions is difficult to implement without shared clinical experiences. Most students in entry-level PT and OT programs in the United States do not currently have the opportunity to practice the teamwork that will be essential when they enter their respective professions.     

Interdisciplinary pilot project in a rehabilitation setting

This project qualitatively evaluated the planning, implementation, and outcome of an interdisciplinary model of clinical education. Expectations of physiotherapy (PT), occupational therapy (OT), and speech-language pathology (SLP) students and clinicians were assessed to determine whether the model allowed for the acquisition of the interdisciplinary knowledge and skills needed for current practice. Students from OT (n = 5), PT (n = 3), and SLP (n = 1) undertook normally scheduled five-to-eight-week clinical placements, beginning on the same start date. All students were at intermediate or senior levels in their programs. Discipline-specific activities were supervised by clinical instructors from the disciplines. Interdisciplinary sessions during the first five weeks covered cross-disciplinary activities related to clinical reasoning, interviewing techniques, professionalism, and communication skills for team reporting. Themes related to the clinical experience were derived from student and supervisor responses to pre-and post-placement questionnaires, post-placement focus group interviews, and student journals. The response to the model was positive. The students felt they had gained insights into developing interdisciplinary skills, although they did feel that some discipline-specific needs were not met. The instructors were less enthusiastic but, given better planning and communication before the placement, welcomed the opportunity to try it again.     

A variables associated with occupational and physical therapy stroke rehabilitation utilization and outcomes

Many studies have reported the benefits of a comprehensive stroke team including occupational therapy/physical therapy (OT/PT) services; however, factors associated with access to these services are less known. This study used a subsample of the Health and Retirement Study database, a cross-sectional survey of more than 11,126 Americans aged 65 to 106 years within the contiguous United States. The purposes of this study were to determine the associational factors that contribute to attending OT/PT and determine if attending OT/PT leads to a reduced report of stroke-related problems. The findings indicated that fewer than 10% of stroke survivors in a noninstitutionalized, community-based setting were currently accessing OT/PT. Additionally, access to OT/PT services was highly associated with report of having an attending physician, report of stroke-related weakness, higher monthly income, and older age. The increased odds of reported continued problems associated with a past stroke were associated with failure to access OT/PT services, lower monthly income, Hispanic culture, and age. OT/PT services were typically provided to patients who reported a higher level of physical dysfunction. Despite the greater degree of severity, OT/PT intervention led to reports of lower levels of disability and problems over time.     

Integration of International Service Learning in Developing Countries within Occupational Therapy Education: Process and Implications

International service learning (ISL) is included in an increasing number of courses at post-secondary levels of education, including programs which educate future occupational therapy practitioners. There is a limited amount of literature and research concerning best practices for course-based occupational therapy education featuring ISL experiences, in particular within developing countries. The purpose of this paper is to (a) to review key literature on ISL, (b) explicate key elements which can help design course-based ISL experiences; and (c) suggest areas for further research and development of course-based ISL. The seven elements of focus that provide a base to guide occupational therapy educators who create ISL courses with an immersion component in a country with a developing economy are discussed, as well as future challenges and possibilities when providing occupational therapy services to a global society.     

Attitudes and knowledge of students in the allied health professions toward their future professional team members

The investigators wished to explore final-year allied health students' knowledge of their future colleagues. A survey developed by Felsher and Ross (1994) was adapted and administered to 35 occupational therapy (OT), 35 physical therapy (PT), and 35 speech-language pathology (SLP) students. Findings suggested that all students had a good understanding and knowledge of their own professions. Differences were found among the three groups of students regarding their understanding of other disciplines and the overlap in OT and SLP roles. Specifically, OT and SLP students perceived their own professions as the primary providers of cognitive treatment. Ways to foster student understanding and collaboration are suggested.     

Musculoskeletal diagnoses,comorbidities, and physical and occupational therapy use among older adults with and without cerebral palsy

BackgroundMusculoskeletal (MSK) disorder in adults with cerebral palsy (CP) is higher than in the general population. Evidence lacks about physical therapy (PT) and occupational therapy (OT) service utilization among older adults (65> years) living with CP.ObjectiveWe compared the presence of comorbidities and patterns of PT and OT use among older adults with and without CP seeking care for MSK disorders.MethodsA 20% national sample of Medicare claims data (2011–2014) identified community-living older adults with (n = 8796) and without CP (n = 5,613,384) with one or more ambulatory claims for MSK diagnoses. The sample matched one CP case to two non-CP cases per year on MSK diagnoses, age, sex, race, dual eligibility, and census region. Exposure variable was the presence/absence of a CP diagnosis. Outcomes were use of PT and OT services identified via CPT and revenue center codes, and the presence/absence of Elixhauser comorbidities.ResultsIn older adults with MSK diagnoses, less than a third regularly utilized PT and/or OT services, and adults with CP utilized significantly less PT than adults without CP, and for some MSK diagnoses had fewer visits than their matched peers. Older adults with CP were at greater risk for secondary conditions that influence morbidity, mortality, and quality of life compared to their age-matched peers without CP.ConclusionsOlder adults with CP and MSK diagnoses had a greater prevalence of numerous comorbidities and lower use of PT services relative to their non-CP peers.     

Does moral judgement improve in occupational therapy and physiotherapy students over the course of their pre-licensure training?

Healthcare professionals often encounter moral dilemmas in clinical practice that require increased responsibility and accountability for ethical decision-making. This paper reports the results of a 6-year longitudinal study that explored changes in moral judgement of five consecutive cohorts of occupational therapy (OT) and physical therapy (PT) students over the course of their professional training. The training programme included an ethics education component. The Defining Issues Test (DIT) developed at the University of Minnesota was used to measure moral judgement. A total of 548 students participated in the study. At entry into their professional training, the DIT scores of the OT and PT students were similar but higher overall than the norms established for college level students or for graduates from professional programmes in the DIT standardization sample. At the time of graduation, results showed no significant differences in moral judgement scores between males and females, their chosen programme of study (OT or PT), year of entry, or previous education. Comparing entry scores to exit scores from both programmes for 288 students who provided data at both times, we found that moral judgement scores increased significantly in both OT and PT students over the 2-year programme of study. No differences were found in scores across gender, programme, year of entry, or previous education. Implications are discussed for including a formal ethics education component in the curricula of all health professional training programmes. Recommendations for future research are outlined.     

Learning styles of allied health students using Kolb's LSI-IIa

The purpose of this study was to assess the learning style preferences of students enrolled in various allied health professional programs. Five professions were examined: nursing, physician assistant (PA), occupational therapy (OT), physical therapy (PT), and speech-language pathology (SLP). The assessment instrument used was the Kolb Learning Style Inventory LSI-IIa. The study included 89 subjects from the various allied health care programs enrolled at a small midwestern university. Findings indicated similar learning style preferences between nursing, OT, PA, and SLP student groups. Students from these groups exhibited a close balance between all four learning styles. The nursing and SLP groups showed a slight preference for concrete experimentation, whereas the OT and PA groups preferred abstract conceptualization. The learning style of the PT students was that of converger, with a strong tendency toward active experimentation versus reflective observation. An emphasis needs to be placed on student learning styles and its impact in the educational process. An understanding and incorporation of learning styles in the education of health care providers could have a positive impact not only on the teaching and learning process but also on the effectiveness of interdisciplinary team interactions and the patient educational process.     

Changes in Therapy Utilization at Skilled Nursing Facilities Under Medicare's Patient Driven Payment Model

ObjectivesThe Patient Driven Payment Model (PDPM) was implemented in October 2019 to reimburse skilled nursing facilities (SNFs) based on Medicare patients’ clinical and functional characteristics rather than the volume of services provided. This study aimed to examine the changes in therapy utilization and quality of care under PDPM.DesignQuasi-experimental design.Setting and ParticipantsIn total, 35,540 short stays by 27,967 unique patients in 121 Oregon SNFs.MethodsUsing Minimum Data Set data from January 2019 to February 2020, we compared therapy utilization and quality of care for Medicare short stays before and after PDPM implementation to non-Medicare short stays.ResultsThe number of minutes of individual occupational therapy (OT) and physical therapy (PT) per week for Medicare stays decreased by 19.3% (P < .001) and 19.0% (P < .001), respectively, in the first 5 months of PDPM implementation (before the COVID-19 pandemic). The number of group OT and PT minutes increased by 1.67 (P < .001) and 1.77 (P < .001) minutes, respectively. The magnitude of PDPM effects varied widely across stays with different diagnoses. PDPM implementation was not associated with statistically significant changes in length of SNF stay (P = .549), discharge to the community (P = .208), or readmission to the SNF within 30 days (P = .684).Conclusions and ImplicationsSNFs responded to PDPM with a significant reduction in individual OT and PT utilization and a smaller increase in group OT and PT utilization. No changes were observed in length of SNF stay, rates of discharge to the community, or readmission to the SNF in the first 5 months of PDPM implementation. Further research should examine the relative effects of individual and group therapy and their impact on the quality of SNF care.     

The Development and Validation of a Screening Instrument to Identify Hospitalized Medical Patients in Need of Early Functional Rehabilitation Assessment

The purpose of this study was to develop a scale that identifies hospitalized patients in need of physical therapy (PT) and/or occupational therapy (OT) assessments. Preliminary scale items were tested for reliability among 52 patients and remaining items were then administered to 299 patients and items that were associated with the concept of 'need for an assessment' on multivariate analyses were selected as final scale items. The concept of need was based on the clinical judgment of physical and occupational therapists. Receiver operator characteristic (ROC) curves were constructed to determine a cut-off score and the predictive ability of this score in determining length of stay and utilization of services was evaluated among 200 patients. The final scale contains two components. The PT component addresses ambulation, falls, breathing, and activities of daily living (ADL). The OT component addresses swallowing, ADL and instrumental activities of daily living (IADL). The area under the ROC curves of the PT and OT components were 0.71 and 0.72, respectively. Both components predicted length of stay and utilization (p < 0.05). In summary, this scale provides a mechanism for targeting patients for early PT and OT assessment and provides a basis for testing the effectiveness of early PT and OT interventions.     

An ethical framework for community health workers and related institutions

The aim of this article is to provide practical ethical guidance and to foster further critical reflection on ethical issues in the work, education, and training of community health workers. The analysis includes implications for associated institutions. We first summarize the roles of community health workers and some evaluations of their work. After next highlighting ethical elements from the literature, we then give a justification for the ethical framework that follows. The article then provides a detailed discussion of a set of basic ethical principles for the field of community health work. Among the principles, we argue that the following 3 should have a foundational role: equal and substantial respect, justice, and care. Among these, respect is most fundamental.     

Characteristics, perceptions, and factors influencing the decision making of physical therapy chairpersons in 2000

The physical therapy (PT) profession is changing. A mailed survey elicited characteristics of current PT chairpersons, such as time spent on responsibilities, influences on decision making, perceptions of working relationships, and satisfaction with decision making, as well as information about their supervisors and the faculty they managed. Chairpersons of 115 (54.28%) accredited PT programs responded. They had been in their positions for a mean of 6.04 years; 63 (57.8%) held doctoral degrees. They had a mean of 25.6 years of experience in PT practice and 17.5 years in academic positions. Their levels of satisfaction and the power and influence they had in their positions were high. However, the time spent on faculty recruitment and mentoring, given the lack of seniority of their faculty, and the small percentage of time they devoted to their own professional development may be concerns. Long-range planning and accreditation duties take up most of the time of PT chairpersons. This information may be helpful to people who seek, or who are recruited for, chairperson positions. It provides a foundational database for longitudinal studies of PT chairpersons.     

A working around "it": the experience of occupational therapy students with a disability

The purpose of this qualitative study was to gain an understanding of the experiences of students with disabilities in occupational therapy (OT) programs. Telephone and email interviews were conducted with five students from different universities who volunteered to participate in the study. Interviews were transcribed, and researchers used the constant comparison method for data analysis. Trustworthiness was assured by using an audit trail, triangulation of data analysis, and member checking. Results revealed that students with disabilities (1) have a strong desire to "work around it," (2) desire support and understanding both within and outside the academic environment, (3) understand that disability is an essential part of who they are as people, and (4) believe that having a disability will enhance their own practice. The discussion includes ways to optimize the experience of being an OT student with a disability.     

Ethics and community-based education: balancing respect for the community with professional preparation

Community-based education and service learning are becoming increasingly common in health and human services education. As students enter the community, several ethical dilemmas arise regarding the university's interaction with the community. This article explores clinical, agency, and community placements in terms of the relationships they engender between the university and the community. The article then outlines some ethical obligations of universities and faculty members and ethical dilemmas that arise in different placements. Finally, a fundamental ethical framework that may guide universities and faculty members in planning community-based educational experiences is proposed.     

Developing a Strategic Marketing Plan for Physical and Occupational Therapy Services: A Collaborative Project Between a Critical Access Hospital and a Graduate Program in Health Care Management

The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program.     

Occupational therapy, professional development, and ethics

The aim of this article is to reflect on and contribute to developing occupational therapy as a profession. The author proposes an ethical interpretation of health and helping professions in general and occupational therapy in particular. According to this ethical interpretation, the essential function and mission of classical health and helping professions are defined by certain ethical values: the basic elements of a good human life. The author argues that the central concepts of occupational therapy, activity and participation, can plausibly be understood in this light. However, this seems to imply a rather substantial conception of well-being which the author tries to spell out. In addition, the basic principles of biomedical ethics are specified in the context of occupational therapy according to an ethical interpretation. In conclusion, four advantages of the ethical interpretation are highlighted: it adds precision and content to ethical principles and guidelines; it contributes to building up and preserving a shared professional identity; it puts emphasis on a client-centred perspective on professional work; and it provides a constructive framework for inter-professional cooperation.     

Service Learning in an Occupation-Based Curriculum: Student Commentary

Recent trends toward occupation-based practice and the move toward masters-level occupational therapy (OT) education has forced OT educators to reevaluate their programs to meet the needs of the contemporary health care environment. Service learning is one way to bridge the gap between theory and practice. The Master of Occupational Therapy (MOT) Program at Cleveland State University (CSU), in keeping with its focus on occupation, incorporates three service-learning components into its curriculum. This paper, written by a second-year MOT student at CSU, discusses two of these experiences in depth. The first, which took place at a homeless shelter, included both a didactic and “clinical” component, with an emphasis on community-based mental health OT services. The second, which included a training component and a structured program, involved co-leading after-school social-emotional learning groups for low-income urban youth. Both experiences served to expand the clinical skills and reasoning of the MOT students while introducing both the students and agencies to the role of OT in non-traditional community settings. Based on these experiences, the author highly recommends that all masters-level OT programs should, if they have not done so already, institute service learning as a core component of their curricula, in order to prepare their students for contemporary OT practice.