Maintaining Professional Standards in Disasters and Conflicts

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Original Editors - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Jess Bell, Lilian Ashraf, Aminat Abolade and Rishika Babburu      

Introduction

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Regulation and Professional Standards

Regulation of rehabilitation professionals aims to protect the public and reduces the risks posed by rehabilitation professionals to cause physical or psychological harm to patients. Regulation also reduces the risks of causing adverse consequences as a result of interacting with health services. Regulatory systems, promote professionalism and harm prevention, and ensure rehabilitation professionals have been certified as meeting and continuing to meet educational, ethical and professional practice standards, therefore, protecting the health and safety of the public. Regulation of rehabilitation professionals varies significantly around the world, depending on both the country and the specific profession (i.e physiotherapy, occupational therapy etc.). If working in disaster and conflict settings outside of your own country of practice, rehabilitation professionals have a responsibility to register with the National Regulatory Authority, where it exists and work within existing legislative and regulatory frameworks in that country and always ensure have valid professional liability/indemnity insurance for the work they are undertaking. If travelling as part of an emergency medical team for shorter term deployments, rehabilitation professionals may often be required to follow regulation by both their own regulatory body and that of the country they are travelling to work in, and should ensure they meet whichever regulation is tighter.

Despite facing overwhelming needs within humanitarian settings, it is vital that rehabilitation professionals maintain appropriate levels of practice.All rehabilitation professionals require profession-specific clinical knowledge to assess patients who need or would benefit from rehabilitation services. All professionals share the same requirement of having the knowledge, skills and ability to implement evidence-based intervention and management programs that are patient-centred while also monitoring, adapting, and redesigning intervention plans based on the patient’s needs and response to care. Rehabilitation professionals have a responsibility to follow the professional standards and standards of practice around competence, knowledge, skills and personal, social and methodological abilities and the standards of professional conduct as defined by the relevant regulatory authority to ensure clinical practice is safe and effective. Eight core professions offer rehabilitation services: audiology, occupational therapy, psychology, physical and rehabilitation medicine, physiotherapy, prosthetics and orthotics, rehabilitation nursing and speech-language pathology. Each rehabilitation profession has developed its own international and/or national frameworks to guide professional standards and standards of practice. These frameworks or guidelines communicate professional standards, support education, guide curriculum planning and development and help to establish individual and service-wide development priorities. Rehabilitation professionals should also include wider humanitarian-specific professional standards, such as humanitarian principles as outlined above, and the The Minimum Technical Standards and Recommendations for Rehabilitation - Emergency Medical Teams to ensure their practice meets the professional and ethical standards required when working in humanitarian settings.

The Minimum Technical Standards and Recommendations for Rehabilitation - Emergency Medical Teams outline the following standards and recommendations in relation to regulation and professionals standards in emergencies.

• Recommendations for Optimal Care;
  • All rehabilitation professionals should comply with the same requirements for practice as in their home country (such as professional registration and licensing) and should work within their scope of practice. Those from countries in which there is no professional certification may practice under the direction and authority of their EMT clinical lead with approval of the Ministry of Health of the Host Country.

Scope of Practice

Scope of practice pertains to the full spectrum of roles, functions, responsibilities, activities and decision-making capacity that individuals within their specific rehabilitation profession are educated, competent and authorised to perform. While this can be broad for each profession, each individual will need to consider their own individual scope of practice, which will be unique to each individual and is influenced by your career, experience and development. Working in humanitarian settings such as disaster and conflicts can be very challenging with rehabilitation professionals often pushed towards the boundaries of their individual scope of practice. Despite these challenges it is vital that all rehabilitation professionals have a responsibility to work within their own individual scope of practice at all times, and should only practice within areas where they have the skills and competency to safely work. Some additional tasks advanced or extended scope practitioners are involved in following further specialised training may be outside of what would normally be considered within scope of practice for a particular profession. Rehabilitation professionals who have an extended scope of practice or advanced practice, have an obligation to only work within the scope of practice for your profession as defined by the regulatory body within the country you are working in if there is one present, and only participate in their advanced practice if allowed within the setting in which you are working and where your insurance covers you. Rehabilitation professionals may have a role to play in working with national staff to support them in developing further skills and competencies, within the scope of practice as defined in the country in which they are working.

The Minimum Technical Standards and Recommendations for Rehabilitation - Emergency Medical Teams outline the following recommendations in relation to scope of practice and knowledge exchange in emergencies.

• Recommendations for Optimal Care;
  • Rehabilitation professionals should maximize opportunities to exchange rehabilitation knowledge and competencies with local personnel ensuring that training of local rehabilitation workers should be consistent with local practice; and acknowledge local rehabilitation standards.

Ethical Practice

Ethics in health care and rehabilitation can be defined as the moral code of conduct that defines the relationship between the rehabilitation professional and their patient, and the therapist and other healthcare professionals based on mutual respect and trust. Ethical issues emerging in disasters have been identified as tensions between the respect for local customs and values imposed by external responders; different understandings of health, illness and diseases; external factors that hinder to providing adequate care such as scarce resources; questions of a “moral identity” for health workers; and trust and distrust between humanitarian workforce and local communities. Professionals’ roles and interactions are influenced by historical, political, social and commercial structures, aid agency policies and agendas that can contribute to ethically challenging situations. Ethical issues can also arise on the level of the patient-healthcare professional relationship.

You can read more about Ethics in Disasters and Conflicts.

Medical Records

The Minimum Technical Standards and Recommendations for Rehabilitation - Emergency Medical Teams outline the following recommendations in relation to medical records and documentation in emergencies.

• Recommendations for Optimal Care;
  • Notes on rehabilitation, including interventions, assessments and assistive devices, should be incorporated into the patient’s main health record, which should remain with the patient when they are referred or discharged (in accordance with the minimum standards for EMTs.

The Classification and Minimum Standards for Emergency Medical Teams outline the following minimum technical standards in relation to medical records and documentation in emergencies during triage, referrals and transfers and in ward management;

• Minimum Technical Standard
  • Triage
    • A unique identifier system should be in place that takes into account patient follow-up care and protection issues.
  • Referral and Transfer
    • Establish a standardized form and system for patient referral and transfer including formal handover between the transferring and receiving EMT/health facility.
    • Share information in a written document on patient's clinical condition, current treatment, intention to transfer, mode and timeline of transfer.
  • Ward Management
    • Provide documented discharge planning and follow-up care
    • Hand out a discharge document/copy of patient record to the patient.

Research

The Minimum Technical Standards and Recommendations for Rehabilitation - Emergency Medical Teams outline the following standards and recommendations for research in emergencies.

• Minimal Technical Standard;
  • Ethical standards for research with human participants should be maintained in emergency response, especially in regards to permission and confidentiality

• Recommendations for Optimal Care;
  • Clinical care should take priority over research, which itself should be focused on improving the delivery and outcomes of rehabilitation.
  • People conducting research should collaborate with local academic institutions and undertake to build national capacity.
  • When local partners are involved, they should share the leadership of the project and ownership of the data.

Resources

Regulatory Bodies

National Regulatory Bodies, World Physiotherapy

Reciprocity - Mutual Recognition, World Physiotherapy

National Regulatory Bodies, World Federation of Occupational Therapists

Professional Standards

Standards of Practice, World Physiotherapy

Ethical Practice

Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies, World Physiotherapy

Code of Ethics, World Federation of Occupational Therapists

Medical Records

Physical Therapy Records Management: Record Keeping, Storage, Retrieval and Disposal, World Physiotherapy

Informed Consent

Informed Consent, World Physiotherapy

Research

Research, World Physiotherapy