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Privacy

Consent

Telehealth

Interprofessional Practice

Effective Listening

Therapeutic Relationships

Compassionate Care

Resources

Equity, Diversity, &

Social Inclusion

Professional Practice and its Relationship to Telehealth

By: Claire Gora, Emma Van Lieshout, Evan Dhaliwal, Hana Marmura, Mikayla Strukoff, Nadya Shamji, and Rachel Goldenberg

Consent

Permission for something to happen, or agreement to do something.

9 Requirements: autonomous, voluntary, informed, capacity, treatment specific, provider specific, format, documented, right to refuse

Challenges

Solutions

  • Provide Client with an e document checklist

  • Check client's understanding and answer questions

  • Record the session

Assessments and interventions were not all designed to be used online

Need to ensure we are actually assessing what we are asking the client to consent to

Privacy

The health care provider is a custodian of the patient’s personal health information and must make efforts to safeguard it. This is key to maintaining a trusting therapeutic relationship. This can be challenging over the internet and when it is harder to control who is in the room.

Challenges:

*Who is in the room?

*Protecting electronic information.

*Secure sessions.

Solutions:

*Private room settings.

*Offer to show room to client.

*Encrypt documents.

*Use initials or pseudonyms

rather than patients’ names.

*Delete files and recordings

in a secure manner.

Therapeutic Relationships

Therapeutic Relationship: the professional relationship between a regulated health professional and a patient, goal of the therapeutic relationship is to foster trust and respect to help better provide successful treatment, and to increase patient satisfaction

Suggested Solutions to Strengthening Therapeutic Relationship over Telehealth:

Patients’ Perception of Therapeutic Relationships While Using Telehealth

  • Heightened interpersonal and communication skills

  • Adjusting therapeutic presence to a virtual environment

  • Keeping the virtual environment consistent and professional

Effective Listening

1) Receptive Listening = being present, providing careful attention

2) Exploratory Listening = active dialogue, gain info, clarification

3) Consensus- & Action- Oriented Listening = brainstorming, shared goals, plan

Challenge:

Lack of physical presence leading to feelings of disconnectedness and increased distractions.

Solution:

Utilize the 3 types of effective listening with the 3 S's

Silence

Summarize

Shared decision-making

Interprofessional Practice

Interprofessional practice: collaboration of health professionals from multiple disciplines working together to provide high quality client centered care.

4 Key Competencies:

  • Mutual respect
  • Clear roles
  • Effective communication
  • Teamwork

Barriers in Telehealth:

  • Not knowing about other professions
  • Communication breakdowns
  • Clinician hesitancy

Solutions:

  • Understand roles of each profession
  • Open and frequent communication
  • Technology training

Equity, Diversity & Social Inclusion

Diversity: attending to human differences that have been deemed to matter

Social Inclusion: when different groups of people feel valued and respected within a society

Barriers

Solutions

Telehealth

Offering telehealth can promote equity oriented care. It does have barriers, but can also be one solution.

  • Some groups are systemically underprivileged
  • Socioeconomic determinants
  • Decreased access to resources
  • Geographical location/rural areas
  • Prioritize equity-oriented care
  • Be responsive to socioeconomic status of client
  • Use trauma informed care approach
  • Advocate need to recognize multiple world views
  • Engage in continuous learning working with those unlike ourselves

You can reach a vast population of patients that may not otherwise be able to access that service or specialty.

Compassion Care

Compassion is a "virtuous and intentional response to know a person, to discern their words and ameliorate their suffering through relational understanding and action.”

Challenge:

  • Absence of a client's body language
  • Barrier between communication

Solution:

  • Eye contact and observation
  • The "how much do you want to know" approach

Resources

  • Elliott, T., Tong, I., Sheridan, A., & Lown, B. A. (2020). Beyond Convenience: Patients’ Perceptions of Physician Interactional Skills and Compassion via Telemedicine. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 4(3), 305–314. https://doi.org/10.1016/j.mayocpiqo.2020.04.009
  • King et al. (2017). Effective Listening and Interactive Communication Scale (ELICS). https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119102991.ch22
  • Geller, S. (2020). Cultivating online therapeutic presence: strengthening therapeutic relationships in teletherapy sessions. Counselling Psychology Quarterly . https://doi.org/10.1080/09515070.2020.1787348
  • Henry, B.W., Block, D.E., Ciesla, J.R., McGowan, B.A., & Vozeniley, J.A. (2017). Clinician behaviours in telehealth care delivery: a systematic review. Advances in Health Sciences Education 22, 869-888.
  • James (2020). Best Practices for Patient Engagement with Telehealth. https://postgraduateeducation.hms.harvard.edu/trends-medicine/best-practices-patient-engagement-telehealth
  • Johnson, K. F. & Mahan, L. B. (2020). Interprofessional collaboration and telehealth: useful strategies for family counselors in rural and underserved areas. The Family Journal: Counseling and Therapy for Couples and Families, 28(3), 215-224.
  • Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Interprofessional Education Collaborative.
  • Nemetz1, E. T. A., Urbach2, D. R., Devon2, K. M., Medicine, 1F. of, & Devon, C. A. K. M. (n.d.). The art of surgery: Balancing compassionate with virtual care. Journal of Medical Internet Research. Retrieved November 26, 2021, from https://www.jmir.org/2020/8/e22417/.
  • Nittari, G., Khuman, R., Baldoni, S., Pallotta, G., Battineni, G., Sirignano, A., . . . Ricci, G. (2020). Telemedicine Practice: Review of the Current Ethical and Legal Challenges. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757597/
  • https://caslpo.com/sites/default/uploads/files/PS_EN_Standards_Virtual_Care.pdf
  • https://www.asha.org/practice-portal/professional-issues/telepractice/?fbclid=IwAR0xV2WEdFuNWa95sYXI6cYZkegu6y0Mn6aL0cLODvgkt6hUb0ihpqwPl1M#collapse_1
  • https://www.physiotherapyalberta.ca/physiotherapists/resources_to_help_you_meet_practice_standards/consent#the_nine_underlying_principles_of_consent
  • https://www.coto.org/docs/default-source/prep-modules/2014-prep-privacyand-confidentiality.pdf?sfvrsn=2

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