OTH 560 Level IB Fieldwork

Ticket to Class/Fieldwork
Ethical Decision-Making and Adult Rotation Preparation

Student Name: Austin Walker

Date: 06/21/24
Partner Name (optional): Sean Sloppy
Please indicate if you shared responsibility for Part One, Two, or Both by selecting the
corresponding checkboxes below -
Part One
Part Two

Special note – Due to the robust nature of this learning activity, you can choose to complete this
assignment individually or with a partner. You can also decide if you want to share responsibility
for Part One and/or Part Two. For example, you may opt to share Part One with a partner and
then complete Part Two separately if you are in a different practice setting. Everyone must
submit their own document into Moodle for individual grading. Please indicate in the form if you
shared responsibility with a peer.

Part One – Ethical Reasoning

Instructions: Read Ch. 5 & 6 of the Fieldwork Survival Guide and Ch. 5 & 6 in the Doherty &
Purtilo chapters provided on Moodle. Also, refer to your OTH 510 Intro to OT instructional
materials regarding ethics. Respond to the following prompts:

1. Using pp. 120-122 in the FW Survival Guide, select one of the situations and respond to
the questions provided. Indicate which scenario you selected here:

Situation 4: Client reports physical abuse

A. Do you tell anyone knowing that the client will deny the discussion with you?
- I would tell someone of this discussion with the client even though they will deny it.
Washingotn is a mandated report state on physical abuse so I would need to report this.

B. If you talk with someone whom will you go?

- I would talk with my supervisor to double check protocol and company policies when
handling situations like this. I may also need to contact washington department of health
to report this incident. Human resources may be another person within the company I can
talk to.

C. What are the ethical issues?

- The ethical question we're looking at with this scernio is physical abuse right or wrong?
I believe it's wrong. That being said, there is the moral dilemma of different personal
views of physical abuse. There may be different views on how they family member at
home handles the situations. I would want to get further information on this scernio such
as home life look further into the cognition of the reporter. Trauma informed care would
be a great resource to utilize in this scernio.
 D. Are there legal issues as well?
- Yes, as stated above Washington is a mandated report on physical abuse.

2. Review the ethical scenario document provided for Week 5. Use the 6-step ethical
process to problem solve through the ethical issue.

i. Get the Story Straight - Gather Relevant Info: What factors should you consider in
this scenario? What questions would you want to consider to understand more about
the situation? Basically, what do you need to ask and explore to better understand the
situation? List them below –

I would be interested to see how the prosthetic fits on Isaias and if it can be modified
or altered to be more comfortable to wear. I would be curious about their sleep routine
and what factors may be affecting their quality of sleep.
- How close are you with your family?
- How is your relationship with your mothers boyfriend?
- Can you describe the pain further? Is it constant? Any lingering effects?
- There are a lot of stressors on this insidividual, I would ask how they are coping
with all of their responsibilities?
- Are there other medications they are taking?
- Are there any additional supports such as friends, teachers, etc.?
- What are some of their strengths and activities they find meaningful as part of their
daily routine?
- What coping strategies are they currently using to manage the pain?
- What is the prognosis of osteosarcoma?
- What does the home environment look like?
I would need to discuss further with the mother about this scenerio and look into the
state laws for substance use.

ii. Identify the Type of Ethical Problem – Is it moral distress? Ethical dilemma? What’s
the difference between moral or ethical distress and a dilemma?

This scenerio has some multilayering dilemmas. Dr. Horner has her own stance on
marijuana which has an effect as the supervisor over Maureen. There is the moral
distress in attempting to understand that Isaias has a stage III diagnosis how that
impacts daily performance. As a practioner we try to respect their wishes in handling
this chronic condition. I think this is a legal concern more than an ethical dilemma or
moral distress. As practioners we need to follow the law in the state we practice. If
marijuana use is illegal then I believe we should look for some other alternatives to
potentially alleviate the pain and use interventions for pain management. Moral
distress is related to the way an indivudal lives or interprets the ethics of the groups
where they live or work (Napier, 2011). Ethical dillemma is right or wrong, it’s a set
of codes or prinicples by which people live (Napier, 2011). The main difference is
that an ethical dilemma has a right or wrong. There is a more defined definition rather
than a a personal choice or interpretation to moral situations.
iii. Use Ethics Theories or Approaches to Analyze it – Reflect back on #2.1 and expand.
What factors or context should be assessed to analyze this scenario (e.g., legal
implications, facility policy, and medical literature). Go beyond the examples listed in
the parentheses.

The legal obligations would need to be researched further, along with communicating
with the supervisors to make a plan moving forward. I would be interested in
discussing more about the supervisors stance or potential bias towards marijuana use.
I would do further research about dealing with this chronic condition for potential
alternatives for managing this diagnosis. I would communicate with the
teachers/counselors at the school to potentially gain further information about the
family and student dynamic. I would like to understand the mothers previous history
and talk with her further about this situation. There also seems to be fragmented care
among the professional settings so this may also play a factor in optimal care that
should be considered.

iv. Explore Practical Alternatives – What are the different courses of action Maureen
could take in this scenario?

Maureen could take the legal action against the mother and contact child protective
services. I would want to get further information before this occurred depending on
state laws and mandated reporting. Pull the team together to discuss the whole
scenerio and get different prespectives from the team and compare it to company
policies and best practice decision making. I'm not sure Maureen's thoughts about
marijuana use, but another alternative could be keeping that information to herself
and allowing Isaias to continue coping with this condition. I don't agree with this
option but it is an option. Maureen could refer this patient to another occupational
therapist.

v. Complete the Action—What consensus do you think the ECHC team should reach?
What action should they take in this scenario?

I think the team should follow their legal obligations. Bring the mother in and discuss
the incident reported internally. I would want to gather all the information together
and discuss the teams responsibilites and the patients desired outcomes. Transparent
communication and respect will need to be used to address this sensitive topic. I
would want to continue care with a clear understanding of expectations moving
forward. The team will collaborate with the family on safety concerns, legal
responsibilites and a plan moving forward. If the team can not reach a consensus then
referring or discharging the patient to another facility may be the conlcuding option.

vi. Evaluate the Process and Outcome—Once you’ve made the decision for the ECHC
team, consider the completed action and discuss the potential outcome for the client,
the family, and the team.
 This scenerio would be a good learning experience to either apply new protocol or
update existing similar protocols in the company. Due to the potential severity of any
legal actions taken, the rapport between the team, Maureen, the clients (Mom/teen)
will change or stop entirely. The client may stop getting care, the families preception
of the medical team may change and impact their own desire to seek routine medical
attention.

Part Two - Adult and Older Adult Rotation Preparation

Instructions: Watch the assigned videos and/or simulations. If in Simucase or ClinEdWeb, watch
the videos in interactive mode and simulations in learning mode when available.

Respond to the following prompts –

1. Describe one new thing you learned in this video. It can be something that surprised you,
aha moments, or a new concept.

We learned that clonus was a muscular spasm that occurs when testing the Achilles
tendon in dorsiflexion. The Babinski test for sensation on the bottom of the foot we are
looking for a response in the toes. We have never heard either of these terms or seen them
performed. They seem to be relatively simple and easy to administer, but provide
valuable information. It was intersting to see how the asssessments and tests performed at
the inpatient facility could translate to the home evaluation.

2. Describe how can you apply this information to your fieldwork experience. What are you
going to do with the information?

We can apply this inform at Landmark to by practicing all MMT's prior to leaving on
fieldwork. We will communictae with our fieldwork educator about these types of
assessments. Get their opinion about them and how frequently they are used at
Landmark. It would be interesting to see if they do home analysis like in the video or if
it's mainly inpatient work.

3. Describe how the information from your videos can be applied to inter or intra-
professional collaboration. Don’t forget to include the most important people in the
collaborative efforts (the client and support networks).

From the video, the OOB was an eval and treat by both the OT and the PT. The
information about grip strength, sensory and ROM can be compared and shared with the
PT's assessment information. So intercollaboration is going to play a huge part to identify
roles, responsibilities and effectively implementing the clients program and goals. A huge
collaboration with the client, not only to keep a client centered focus but to gain the
required information to assist with the intervention, create appropriate goals, and assist in
the home evaluation analysis. This same information is applicable to our experience at
landmark.
4. Describe any health literacy approaches noted in your videos. Hint – health literacy has
been covered in Professional Dev. Seminar I, Intro to Occupation/OT, and a big emphasis
this Summer in your health promotion courses.

The therapist used "lay language" while addressing the client. She made sure her
terminolgy was clear and understood by the client. The therapist asked open ended
questions throughout the process. It was interesting to see that the questions the therpist
asked were clearing up any confusion while simultaneously checking health literacy. She
was clear in her directions and summarized the information given from the clients
responses. The threapist educated the client on new techniques for safety and particpation
in ADL's.