1) You are working with an individual who experienced a left CVA resulting in right-sided movement problems.

This individual
requires a lot of assistance at home with all basic daily activities, but they have good potential to benefit from occupational therapy
services to become more independent. This client’s insurance only covers the first 30 minutes of their therapy sessions. Meaning, if
120 minutes of therapy are provided, only 30 minutes of them will be reimbursed. Due to this client’s clinical presentation, they need
more than 30 minutes of treatment per session. However, because of their insurance’s poor reimbursement structure, your employer
tells you to keep all treatments with this individual to 30 minutes.
a. What is one core value that is at stake and why?
One core value that is at stake for me is equality because in this situation, the client is only receiving 30 minutes of
therapy that is covered by insurance. Equality is being stripped from this patient because equality is having all persons
receive the same opportunities, no matter if insurance is being covered or not.
b. When attempting to understand and navigate this situation, what principle will best assist you with making sound ethical decisions
and why?
I would say the principle that will assist me with making sound ethical decisions is fidelity because as a healthcare
provider I made a commitment with my client to provide the best healthcare, even if it is for 30 minutes. I would create a
plan that has supervised and more rigorous tasks to be done in the 30-minute session and educate the client with
activities that are safe for them to do at home. In this situation, the OT has to be able to adapt to different situations fo r the
patient to reach their goals.

c. What standards of conduct may be involved in this situation and why?

The standards of conduct that may be involved in this situation would be service delivery because of the time restraints
you have with your client. Explain to the client what is going to be done and have a clear intervention plan to ensure you
and the client are using the 30 minutes effectively. Also, providing proper education and training, so the client can do
certain exercises outside of the 30 minutes.

2) You are working in a privately-owned neurological rehabilitation center with an interprofessional team composed of occupational,
physical, and speech therapists, education specialists, athletic trainers, behavior analysts, case managers, and physicians. There
are also aides who assist with the daily treatments of the clients; clients are typically complex in their presentation (i.e., they have a
lot of physical, behavioral, and cognitive health problems). All professionals wear identification badges that have their ICA 3: Ethics
2 PNWU SOT/OTH510IntroToOccupationAndOccupationalTherapy/F2023 names but not their profession identified. The aides on
the other hand, are identified as Neurological Rehabilitation Specialists.

a. What is one core value that is at stake and why?

• Justice indicates that OT’s provide OT services for all persons in need of those services and maintain a goal-
directed and objective relationship with recipients of service. In this situation, we are not identifying ourselves to
patients and that will cause confusion about where or who to go to.
b. When attempting to understand and navigate this situation, what principle will best assist you with making sound ethical
decisions and why?
• I would say Fidelity because we as a provider made a commitment to the client to do our job. When we as
healthcare providers do not identify who we are (like our badges) the client will not know who to turn to when a
problem or situation arises.
c. What standards of conduct may be involved in this situation and why?
 • The standards of conduct that are involved in this situation are 5. professional competence, education,
supervision, and training. Occupational therapy personnel maintain credentials, degrees, licenses, and other
certifications to demonstrate their commitment to develop and maintain competent, evidence -based practice.

3) You are working with an older adult in an inpatient facility who has a terminal health condition. This client has low energy,
depression, and is generally deconditioned due to lack of activity. In addition, they often refuse therapy because of feelings of
depression, poor timing of therapy visits, and lack of interest in the therapeutic activities the other therapists are offering. Many of
the therapists do not pay much attention to this client or put much energy into trying to engage them in therapy because of the
frequent refusals.
a. What is one core value that is at stake and why?
One core value in this situation that is at stake is freedom because the patient is not motivated and not interested in
therapy. Allowing the patient to exercise their autonomy can be very detrimental to his overall health. Also, it can put you
and the other providers in legal trouble.
b. When attempting to understand and navigate this situation, what principle will best assist you with making sound ethical decisions
and why?
The best principle to assist me in this situation would be nonmaleficene because due to the factors that hinder the clients
progress, we will still talk to the patient and find things that could motivate them to do the therapeutic activities. I thin k this
could create negative impacts on the client but will help their health in the long term.
c. What standards of conduct may be involved in this situation and why?
I would say service delivery because as an occupational therapist we can provide a variety of occupational services,
education, training. We also can provide different resources to the client that may aid in the factors that are not allowing
him to participate in therapy. Lastly, we can refer the client to another provider that could find alternative measures to help
motivate the client to participate in therapeutic exercises.

You are working with a young adult client in a skilled nursing facility. This client has been working with the occupational therapy
assistant for several days. When you, the supervising occupational therapist, check in with the client to see how therapy has been
going, they tell you that the assistant spends about 20 minutes with them before leaving and uses that time to chat about daily
events and do a few upper body resistance band exercises while seated. As the supervising therapist who wrote this client’s plan of
care and reviews the assistant’s daily notes, you have concerns about what the client has told you, especially because the assistant
is billing for 60 minutes of treatment time. a. Use the 6-step process for ethical reasoning to navigate this situation. For steps 1-5,
use the “Considerations” column to inform the process. For step 6, write a personal reflection addressing the following:
i. How did it make you feel knowing that the situation described above is a true story? How does it make you feel knowing that some
therapists and assistants bill for services that were never provided? This situation is very frustrating and disappointing because
the client sounds like they are motivated to reach their goals, but the OTA is not upholding their promises as a healthcare
provider. I would like to know more information about the situation. I would like to know if other healthcare providers are
also doing similar acts as the OTA. I would also like to observe this OTA from afar and see if this is also happening with
other patients. The situation is very heartbreaking knowing that patients are dealing with this behavior, which could create
a bigger threat to the client's health. Along with the client having to pay for sessions that are not being monitored or
directed by the OTA. The OTA is also violating ethical standards and the trust of other OT’s, OTA’s, along with myself.
ii. What strengths do you possess that would support your ability to effectively navigate ethical dilemmas? I would say empathy
because being able to place myself in the patient's shoes and understand the potential harm this has physically, mentally,
emotionally, and financially for the client. Another example is being ethically aware of the situation and how th e OTA is
mishandling patient care. I would also say advocacy because we are witnessing malpractice and being able to be that
voice and advocate for our client to receive proper care. Lastly, I would say justice because the patient is not being
respected for their time, efforts, and finances. As healthcare providers we need to uphold proper justice for the patients to
ensure we are sticking to the promises we have made as healthcare workers.

iii. What weaknesses do you possess that would hinder your ability to effectively navigate ethical dilemmas?
1. A large weakness I would say I have is lack of experience. I would not know who to turn to in this situation to
help advocate for the patient.
2. Another weakness I have is communication under pressure. I think that in high pressure situations, I get too
emotionally riled up and cannot articulate my words.
3. Lastly, critically think in high pressure situations because I tend to let my emotions get the best of me.
What could you do to improve in these areas?
4. I would say educate myself on different resources to find appropriate help.
5. Putting myself in uncomfortable situations to help me grow and allow for better communication
6. I would say letting myself calm down before confronting the situation and going levelheaded.