Navigating Regulatory Documents for Professional Behaviour

Original Editor - Wanda van Niekerk based on the course by Yara Peterko

Top Contributors - Wanda van Niekerk and Jess Bell  

Regulation and Professional Standards

Regulatory systems seek to promote positive outcomes for patients accessing rehabilitation services. Regulation aims to protect the public by establishing standards that minimise potential physical or psychological harm. Regulatory frameworks ensure that rehabilitation professionals are certified and consistently uphold educational, ethical, and professional standards.

Regulatory frameworks for rehabilitation professionals vary depending on the country and the profession. Although the regulatory documents of each country are unique and reflect societal differences, they all have the same purpose.

Rehabilitation professions include physiotherapy, occupational therapy, speech and language therapy (pathology), audiology, prosthetics and orthotics, physical and rehabilitation medicine, rehabilitation nursing and psychology. Each rehabilitation profession has its own international or national frameworks to guide professional standards and standards of practice.

Key Regulatory Documents for Rehabilitation Professionals

There are several key regulatory documents for rehabilitation professionals:

• Code of Ethics
• Code of Conduct
• Standards of Practice
• Scope of Practice

These documents can be created as separate documents or combined into larger documents.

Code of Ethics

A code of ethics is a regulatory document that guides the behaviour or standards of specific professionals. Merriam-Webster defines a code of ethics as “a set of rules about good and bad behaviour.”

The four main ethical principles of healthcare are included in a code of ethics. These principles are:

• autonomy – the right of an individual to make their own choice
• beneficence – the principle of acting in the best interests of another person
• non-maleficence – the principle that “above all, do no harm”, as stated in the Hippocratic oath
• justice – a concept that emphasises fairness and equality among individuals

Organisations often add additional principles to their code of ethics specific to their local circumstances and cultural backgrounds. For example, the World Federation of Occupational Therapists included the four main ethical principles, as well as ten occupational therapy values and beliefs in their Guiding Principles for Ethical Occupational Therapy document. These values and beliefs include occupation focus, collaborative approach, duty of care, human rights and occupational justice, respect for diversity, integrity, confidentiality, competency and lifelong learning, obligations to the profession and responsibility toward local and global societies. The Physiotherapy Board of New Zealand included ethical values such as respect and dignity, responsibility, trustworthiness, integrity and citizenship in their code of ethics. The American Physical Therapy Association (APTA) has eight ethical principles in their Code of Ethics for the Physical Therapist. These principles also reflect the core values of a physiotherapist. Table 1 shows the eight principles and their underlying core values.

Table 1. The Ethical Principles and Core Values of the American Physical Therapy Association's Code of Ethics

Ethical Principle	Core Values
Respect the inherent dignity and rights of all individuals	Compassion and caring, integrity
Be trustworthy and compassionate in addressing the rights and needs of patients and clients	Altruism, collaboration, compassion and caring, duty
Be accountable for making sound professional judgements	Collaboration, duty, excellence, integrity
Demonstrate integrity in their relationships with patients and clients, families, colleagues, students, research participants, other healthcare providers, employers, payers, and the public	Integrity
Fulfill legal and professional obligations	Accountability, duty, social responsibility
Enhance expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviours	Excellence
Promote organisational behaviours and business practices that benefit patients, clients and society	Integrity, accountability
Participate in efforts to meet the health needs of people locally, nationally, or globally	Social responsibility

Code of Conduct

Codes of conduct ensure professional integrity and accountability by providing clearly defined behavioural standards. They provide rehabilitation professionals with a framework that outlines the expected behaviours and values of their profession. These codes also show the public exactly what conduct is expected from a rehabilitation professional, and when their conduct doesn't meet expected standards, they can be held accountable. Furthermore, if legal issues arise, a code of conduct can serve as a benchmark to determine if a rehabilitation professional has acted appropriately (i.e. did they act in a way that a “reasonable professional” would have acted?).

Two main approaches are used to structure a code of conduct: a principle-based approach and a framework-based approach.

The Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct stipulates the professional conduct for each ethical value and is an example of the principle-based approach. Another example is the American Physical Therapy Association's Guide for Professional Conduct. This guide is used to help physiotherapists interpret the Code of Ethics for the Physical Therapist in professional conduct. An example from the APTA Guide for Professional Conduct:

Principle 2A: "Physical therapists shall adhere to the core values of the profession and shall act in the best interests of patients and clients over the interests of the physical therapist." This can be interpreted as saying that the physical therapist's primary ethical obligation is to place patient and client welfare above self-interest. A physiotherapist demonstrates this commitment by consistently striving to act according to the profession's core values throughout all professional activities and interactions. If a conflict situation arises between personal interests and those of patients, the physiotherapist should resolve the conflict in a way that places the patient's needs first. The public's trust in the profession depends on practitioners who consistently demonstrate dedication to those they serve through actions reflecting professional integrity, altruism and compassionate care. A physiotherapist's clinical decisions and professional conduct should be guided by what serves the patient's health needs or interests, rather than what may be convenient, financially advantageous or beneficial to the therapist.

In a framework-based approach, specific frameworks are used in the design of codes of conduct. Some examples of frameworks are the CanMEDS, the Therapeutic Process and the Rehabilitation framework by the World Health Organization (WHO). The roles included in the CanMEDS framework are professional, communicator, collaborator, leader, scholar, medical expert, and health advocate. The WHO Rehabilitation Competency Framework includes competencies and activities across the areas of rehabilitation practice, professionalism, learning and development, management and leadership, and research. Read more about Rehabilitation Frameworks. A good example of a framework-based approach in the development of a regulatory document is the American Occupational Therapy Association's code of ethics.

Standards of Practice

A standards of practice document is a set of guidelines that sets out the expected professional skills and knowledge required in specific situations. It is the "how-to" of a profession, discipline or speciality, describing what is and what isn't considered good and satisfactory practice in a specific profession.

The primary goal of this regulatory document is to promote, guide, direct and regulate professional practice. This document can include clinical policy statements, standard operating procedures, clinical practice protocols and clinical procedures. It covers different aspects, such as administration and business management, communication, community responsibility, documentation, cultural competence, education, ethical behaviour, informed consent, patient management, continuous professional development and research.

The standards of practice described in a regulatory document should be achievable for all qualified professionals. It presents ideal standards that professionals should aim to achieve. However, interpretation of these standards may sometimes be necessary based on the specific setting, situation, available resources and support systems. World Physiotherapy has put together a guideline document for organisations to consult when creating a standards of practice document. In this guideline, the diverse social, political and economic environments in which physiotherapy is practised are recognised. You can read the policy statement on the standards of physiotherapy practice here and the guideline for standards of physical therapy practice here.

If you are interested, you can learn more about Standards of Practice here.

Scope of Practice

“The term scope of practice (SOP) refers to the limits of a health professional’s knowledge, skills and experience and reflects all tasks and activities they undertake within the context of their professional role.”

Many factors influence a health profession's scope of practice. A review by Wiggins et al. identified eight influencing factors across three professions (nursing, pharmacy and physiotherapy). These were: education, competency, professional identity, role confusion, legislation and regulatory policies, organisational structures, financial, professional and personal factors.

It is important to note that there is also a substantial overlap in the scope of practice of many rehabilitation professions (e.g. physiotherapy and occupational therapy). With this overlap, interprofessional collaboration is key to providing the best possible care to patients. For interprofessional collaboration to be successful, health professionals need to clarify their roles and consider how to divide responsibilities. This can help create a mutual understanding of each professional’s role and their goals for rehabilitation. Health professionals need to internalise the need for interprofessional collaboration. This means that they need to create a culture of interprofessional trust by developing an understanding of other health professionals’ level of competence, their management style and their scope of practice.

You can read more on the scope of practice, particularly in disaster and conflict areas here.

Where to Find Regulatory Documents

National or regional regulatory bodies are a good place to look for regulatory documents relevant to your profession and local context.

Your professional association may also have relevant resources. Sometimes these documents are only available in the members-only section of their websites. You might consider contacting your association if these documents are not available online.

If you would like more information, international organisations like World Physiotherapy, the World Federation of Occupational Therapists, the International Society for Prosthetics and Orthotics (ISPO), the European Speech and Language Therapy Association, and the International Society of Audiology provide valuable global resources.

Non-Compliance with Regulations

Adherence to professional standards and regulations is fundamental to rehabilitation practice. If healthcare professionals practice in a way that does not meet accepted professional standards, they may face disciplinary action.

Disciplinary actions can be set in motion for “unsatisfactory professional performance”, “unprofessional conduct” or “professional misconduct”. The regulatory board of the profession will follow a disciplinary process in cases where complaints have been laid against a professional. Consequences of non-compliance with regulations can vary, based on the infractions. Professionals may receive a caution or reprimand, a condition on their registration may be imposed, they may be required to pay a fine to the particular regulatory board, their registration may be suspended for some time, or their registration may be cancelled permanently.