OS746_CW1_21614264 by 21614264

A1. You must listen to patients and respect their individuality, concerns, and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy.

21614264 — 2021-05-18 14:18:44 UTC

https://www.sciencedirect.com/science/article/abs/pii/S1471595311001879

This paper highlights the need and importance of a patient centered approach.

The further use of professional bodies such as the General Osteopathic Council, allow professional boundaries, conduct and communications to be outlined, upheld and adhered to.

A2. You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them

21614264 — 2021-05-18 14:37:53 UTC

I found within clinic it takes skill to navigate the relationship between parent and child, especially when the child is in their teens. I believe to have developed this over my time in fourth year. The evidence below shows feedback on communication and patient partnership.

A3. You must give patients the information they want or need to know in a way they can understand.

21614264 — 2021-05-18 14:49:31 UTC

The below picture shows the type of visual aid, used within clinic, which allows proper patient understanding.

A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

21614264 — 2021-05-18 15:15:24 UTC

The below evidence shows feedback in regard to consent from an exam in my first year. Throughout the different stations it can be seen that the consent process needed development.

A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

21614264 — 2021-05-18 15:28:21 UTC

The document below is an rehabilitation exercise program developed for a patient to take home with them. It allows the patient to support their own recovery and well being. The link below also outlines the benefits of talking therapies as provided by the NHS.
https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/benefits-of-talking-therapies/

A6. You must respect your patients’ dignity and modesty.

21614264 — 2021-05-18 15:45:00 UTC

The below document is a reflection I wrote based from an observation witnessed in my first year, which identified the patient's discomfort the changes put into place by myself and the student practitioner at the time.

A7. You must make sure your beliefs and values do not prejudice your patients’ care.

21614264 — 2021-05-18 15:49:39 UTC

The below is an example of the difference in opinion, beliefs and values, which I ensured did not affect how I treated the patient or their on-going care.

Due to the current circumstances and the global Covid-19 pandemic, I have found a great difference in patient opinions on the matter. A few patients presenting to clinic have outlined their views on how it is a 'scamdemic', the use of masks and PPE is ridiculous. Despite my own personal beliefs about the pandemic I have not made comment, treated or advised my patient any differently to that of a patient with the same opinion as myself. I continue to offer the same professional advice and care to the best of my ability.

B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

21614264 — 2021-05-18 16:11:01 UTC

The link here highlights a useful website, I used to develop my knowledge about Klippel-feil Syndrome which I came across whilst observing in my second year.

https://medlineplus.gov/genetics/condition/klippel-feil-syndrome/

The below is evidence from my second year transcript, allowing progression into 3rd year.

B2. You must recognise and work within the limits of your training and competence.

21614264 — 2021-05-18 16:17:02 UTC

The link below is a set of guidelines developed by the General Medical Council, which like the OPS state we must work within our remit as professionals, but also to refer to another practitioner which fits the patient health needs better.

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/delegation-and-referral/delegation-and-referral

The below document shows an example of an anonymous referral letter based from one I wrote during a clinic session, in which I recognised the patients condition was not of a mechanical nature

B3. You must keep your professional knowledge and skills up to date.

21614264 — 2021-05-18 16:38:49 UTC

Professional knowledge reflects all aspects of our practice from legislation to appropriate treatment techniques. The below link is from the GOSc providing current knowledge and practices on Covid-19 safety regulations.

https://www.osteopathy.org.uk/standards/guidance-for-osteopaths/coronavirus-covid-19/#osteopathicpractices

The following is further evidence and an example for keeping knowledge up to date, via sources such as the National Institute for Health and Care Excellence

https://cks.nice.org.uk/topics/carpal-tunnel-syndrome/

B4. You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

21614264 — 2021-05-18 17:34:02 UTC

The following was verbal feedback provided by a tutor, on my performance with a new patient on the 22-02-21:
1. 'Logical follow up questioning when given a positive response to systemic inquiry'
2.'Thorough case history'
3.'Differentials for presenting complaint were appropriate and testing to demonstrate was also robust'
4.'Identification of red flag was appropriate'
5.'Able to identify risk of neurovascular event and able to differentiate TIA from stroke'
6.'Some guidance was needed to examine for neurological deficit'
7.'Able to identify a referral was indicated an some assistance was needed for formation of referral letter'
8. Ultimately practice safely

The above feedback was really helpful in my reflective process, helping me to identify the areas which I succeeded and the areas in which I needed to develop further.

C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

21614264 — 2021-05-18 18:23:02 UTC

The evidence below shows the results from my mock CCA, the marking criteria (also below) focuses on patient safety in practice, patient handling and the ability to make a sufficient diagnosis.

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21614264 — 2021-05-18 18:32:49 UTC

C2. You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

21614264 — 2021-05-18 18:40:14 UTC

The video below, was a helpful guide to completing patients notes when initially starting clinic in year 3.

https://www.youtube.com/watch?v=9TZqTtbBVXc

The following link, also provides details and guidelines for record keeping, via the General Medical Council. Usually aimed at Doctors, however, as allied healthcare professionals all notes should be in accordance with such format.

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/protecting-children-and-young-people/keeping-records

C3. You must respond effectively and appropriately to requests for the production of written material and data.

21614264 — 2021-05-18 19:25:20 UTC

The link below outlines the data protection laws as depicted by the Government. Every individual has the right to access their own information, this includes their patient notes.

https://www.gov.uk/data-protection#:~:text=The%20Data%20Protection%20Act%202018,organisations%2C%20businesses%20or%20the%20government.&text=Everyone%20responsible%20for%20using%20personal,used%20fairly%2C%20lawfully%20and%20transparently

C4. You must take action to keep patients from harm.

21614264 — 2021-05-18 19:34:07 UTC

The pictures below are certificates which were provided on completion of a safe guarding and female genital mutilation awareness course.

Recognising how to protect patients and ensure their safety is imperative as primary health care providers.

C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

21614264 — 2021-05-18 20:53:18 UTC

Reflecting in practice, ensuring good hygiene practices within myself and the clinic setting allow a safe environment for my patients, but also for myself as a practitioner. Following health and safety legislation is imperative to uphold standards.

The video below was a useful guideline in the correct way to put on and dispose of PPE within a clinical setting. Which is very important in the current climate and work practice.

https://www.youtube.com/watch?v=-GncQ_ed-9w

The image below, was a very useful aid in the further development of personal hygiene routines.

C6.You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

21614264 — 2021-05-18 21:01:18 UTC

The below is a link to an article regarding the five osteopathic models as discussed in,

The Five Osteopathic Models: Rationale, Application, Integration : from an Evidence-based to a Person-centered Osteopathy (Lunghi & Fusco., 2017). The 5 models of osteopathy highlight the differences in the integrative approach of osteopathy, relating to the entirety of a patient and their well being as a whole individual.

http://files.academyofosteopathy.org/AAOJ/2014/AAOJ_March2014pp12-20.pdf

D1. You must act with honesty and integrity in your professional practice.

21614264 — 2021-05-18 21:28:26 UTC

Reflection on a patient case:
In February 2021, a patient presented to clinic with a loss of range of motion in their glenohumeral joint, progressively getting worse. Testing showed the most likely diagnosis was Frozen Shoulder Contracture Syndrome (FSCS). Due to the nature of the condition and the long term prognosis, it was important for me to discuss this with my patient.

At the time my patient had a lot of questions, apprehension and was in obvious discomfort. However, it was important for her to have all the facts. I provided alternative treatment options such as: Steroid injections, hydrodilation, physiotherapy and acupuncture etc.

The patient seemed happy with the advice she recieved and the treatment and exercises she was given. I felt as though I acted honestly, with integrity, I did not down play the length of time recovery may take or the different stages.

The paper below was an interesting discussion into the different aspects of trust within a professional setting as a physician/ healthcare worker.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495000/

D2. You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

21614264 — 2021-05-18 22:30:23 UTC

The below PDF is a guide to Nurses and professional boundaries for them in practice.

https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf

There is a difficulty in setting boundaries due to the rapport and nature of the relationships which can develop, especially with long term patients, due to getting to know a patient personally. Due to the lack of set guidelines about excepting things such as gifts from patients, it is within the practitioners discretion and professional integrity to set these boundaries and not take advantage of their patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860914/

The link shows a paper written about accepting gifts from patients, the lack of literature around this topic makes it difficult to interpret. As a student practitioner I had a patient buy me a gesture, of hand made soap, after she nearly fainted and could not receive treatment at the clinic. At the time I found accepting a gift from a patient difficult, as I was unsure of the rules. However, from this experience and discussing it with clinic tutors and other healthcare professionals (nurses). I have learnt that patients will feel gratitude, towards you as a practitioner, especially if they are in pain and you help to resolve this. Within nursing, smaller tokens, such as flowers or chocolates are usually deemed acceptable. However, gifts of money or larger gestures e.g. holidays, dinners, drinks etc. cross a boundary between being a professional and exploiting patients.

D3. You must be open and honest with patients, fulfilling your duty of candour.

21614264 — 2021-05-19 13:30:21 UTC

The below leaflet, created by the NHS, outlays the process of candour and conversations with patients within a clinical setting.

https://www.guysandstthomas.nhs.uk/resources/patient-information/all-patients/duty-of-candour-communicating-when-things-go-wrong-webfriendly.pdf

Upon reflection of this OPS, and applying it within my clinical practice, being able to discuss long term prognosis is essential. For example, with conditions such as Frozen Shoulder Contracture Syndrome (FSCS), the patient is looking at prolonged recovery, which may never result in complete full function. I found this discussion very difficult, however, relying on knowledge and patient communication really helped, in the relay of information and answering the patients questions. Allowing an open honest communication is really important in patient management.

D4. You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

21614264 — 2021-05-23 11:57:44 UTC

The link is provided by the General Osteopathic Council (GOsC) which describes the complaint and investigative processes.

https://www.osteopathy.org.uk/standards/complaints/

Within the future I will look to uphold the practice standards and reply and deal with any complaints in an swift appropriate manner.

Upon reflection of this OPS, it is also within our professional duty to report another osteopath if they are in breech of the OPS or safeguarding, or legal views. It may be a difficult task, but one that is in place to protect ourselves, our profession and our patients. Therefore, in reflection to this OPS, it would be my professional duty to report any wrong doings and follow the correct complaints procedure throughout my career.

D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively

21614264 — 2021-05-23 12:50:35 UTC

I have found within practice this can sometimes be difficult when treating multiple members of the same family. I have worked on my ability to protect and respect my patients rights to privacy and confidentiality, I found this was of particular benefit when treating a husband and a wife. The wife would often inquire about her husbands condition, his prognosis and how he was in treatment in general. I discussed with her that despite both of them being under my care I was not allowed to discuss her husbands condition, without him being present or his express consent. She said 'he won't mind, I am his wife, we've been married 34 years.' To which I still had to discuss the rules and professional codes of conduct for our profession. She did seem a little offended but said she understood and respected my professionalism.

The below link is from the General Medical Council which provides information around when personal information can and cannot be shared.

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/confidentiality/using-and-disclosing-patient-information-for-direct-care

D6. You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

21614264 — 2021-05-23 13:07:18 UTC

Reflection of my experience at clinic: Year 3 Term 1, using Gibbs Reflective Cycle

Description: I recieved a file for a cover patient, whose care I was taking over. Within the notes it was written that the patient was HIV positive. I was unsure of the condition, what it entailed and whether it was safe for me to treat without PPE or the use of gloves. I have it very difficult and stressful, I made instant judgements of the patients character before having even met them. I asked the tutor whether I would need gloves or PPE and the tutor was quite dismissive would not answer my question and told me to just look it up. It put me under a lot of pressure in my first two weeks of clinic.

Feelings: This situation made me feel terrible. I felt like a horrible person, I felt very judgmental and unjustly so. I found this very difficult, I judged my patient unfairly and despite the fact it did not impact my patient care, I was disappointed in myself in how I reacted to my patients condition. I was also very angry towards the clinic tutor for his lack of guidance and lack of compassion towards myself as a new student.

Evaluation: The good aspects to come from this was the recognition of my own preconceived ideas and that despite my own personal views I did not allow it to affect my patient care or treatment outcomes and goals. The bad aspects of this experience was my lack of compassion, my lack of understanding about HIV and the attitudes of the tutor on the day.

Analysis: I have found this experience to have helped within my understanding, it has highlighted my lack of knowledge around HIV and highlighted my own lack of experience as a practitioner.

Conclusion: I could have taken the time to take a step back, breath and reassess the situation. I could have asked another tutor in the building to answer my questions before going to see the patient.

Action Plan: In conclusion, I have researched HIV, how it develops as a condition, how well it is treated and the rates of transmission, side effects and the overall, psychological affects of the condition. I have made it a goal throughout my learning and career to treat all patients the same, irrelevant of their past medical history, their values or beliefs. I have made a very conscious effort to not misjudge my patients before knowing them and their condition,

D7. You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace

21614264 — 2021-05-23 13:39:17 UTC

Within osteopathy there is a standard of acceptable behaviour, conducts and proceedings. I have found throughout the four years at the ESO there has been a certain standard that we are accountable for and I believe I have managed to maintain these standards in both my private and practical life.

Unfortunately, I have had to address some unprofessional-ism within my year at university, as asked to do so by the staff. This was a difficult task as it was hard to create boundaries with those in my year I see as friends and colleagues, however, the unprofessional posts such as that on social media needed to be addressed.

The following is an email recieved by a member of staff as a reminder of professional conduct.

Dear All,

I am sending a strong reminder regarding professionalism and confidentiality in relation to health information and the professional code of conduct.

As osteopathic students you are expected to uphold the osteopathic practice standards in relation to both your professional and personal lives. At times you may be in receipt of health information, which should be treated with the same care and standards whether it is obtained from a patient or a colleague.

I will take this opportunity to remind you of all of the guidance for osteopathic professional behaviours, which also has case examples:

https://www.osteopathy.org.uk/training-and-registering/becoming-an-osteopath/guidance-osteopathic-pre-registration-education/

If there is any evidence that professional behaviours are in question then this will be followed up using the relevant ESO policies and procedures.

If you are experiencing any concerns in regards to your health then you can find support by contacting the Student Welfare Officer directly or via Academic Registry academicregistry@eso.ac.uk if there is an immediate impact on your studies.

Yours sincerely,
XYZ

The below picture, is further evidence of professional conduct in a non-osteopathic setting. It is a review from a sports therapy client.

D8. You must be honest and trustworthy in your professional and personal financial dealings.

21614264 — 2021-05-23 16:33:50 UTC

This OPS has been particularly relevant for myself, due to self-funding this course and receiving no aid from student finance. Within my first year at the ESO, I believed to have secured enough money via a loan for my first two years of study, however, in the October the funding was pulled and no longer accessible.

I was incredibly devastated and thought I might have to leave the course, I was disheartened, depressed and really struggled to come to terms with the loss of my funding. However, I took it one step at a time, I spoke to the administrations team and was completely honest about my financial situation.

They helped me through the initial period and so far I have continued to work throughout my four years to support myself, sending regular updates to staff and keeping the university fully disclosed in my payments and process of funding my degree.

It has been the hardest the four years of my life and working along side studying, in excess of 70 hours per week. This experience has taught a lot about trusting other people, seeking help and advice and that honesty and transparency is the best way to approach difficult situations. I am thoroughly proud from all that I have achieved and will continue to be honest in my financial endeavors both professional and personal.

The following is an email sent to a member of staff about arranging a meeting to help deal with my financial circumstances.

Hi XXX,

I was wondering if it would be possible to come and have a discussion with you regarding my self funding finances. I spoke to XXX yesterday and she said that you may have some more advice and knowledge on different aspects which may help me through funding this course.

Are you at Boxley any time in the next few weeks so I can come in and talk to you?

Thank you for your time and help.

Kind Regards,

XXX XXX

D9. You must support colleagues and cooperate with them to enhance patient care.

21614264 — 2021-05-23 17:50:23 UTC

Co-operation and communication are key fundamentals throughout the osteopathic profession. I have cooperated, communicated, addressed and supported my colleagues in a number of ways, as my time as a student representative. Utilising co-operation and communication are key aspects in all areas of osteopathy. I have found that when students felt listened to they responded well, this allows for students to focus properly and treat patients without other factors clouding their judgement.

The below is an example of communications, sent to Academic Registry, following the dissertations. It was a difficult day for all Year 4 students, as the feedback was released two weeks before final grades. Some students also recieved their feedback whilst at clinic, affecting their ability to provide the best patient care, due to worry, confusion and apprehension.

Throughout, my four years, I feel that this area is something in which I have excelled. I pride myself on my communicative abilities.

Dear Academic Registry,

Following the delivery of the dissertation feedback on Friday the 26th of March, Ashley and I as student reps, have received multiple concerns and queries from our year group about this. We thought it best to gather a few examples to explain the year groups issues with this process.

Firstly, we would like to highlight that feedback without grades at this time is particularly stressful and seemingly have made things more difficult for individuals to process and caused an awful lot of distress. Feedback can be interpreted in many ways and especially with some of the feedback given, has disheartened many and caused a real upset. The main concern being that without a mark the feedback has no context.

Secondly, the type of feedback and comments that have been given is quite frankly unprofessional, demeaning, contradictory and insulting to many students. As I said before we have asked the year for a few examples, things such as: 'LOL - I think this in not accurate!' ; 'Pretty dire'; 'Somewhat of a disaster'; 'Abysmal' and so on have been used and commented. I appreciate some individuals may not have met the criteria to gain the necessary marks, however, the above comments do not reflect this. They are seemingly personal comments on a person's work.

Thirdly, there seems to be a contradiction between markers and feedback given, again examples from the year - one individual had comments about being marked down for not including a discussion section within the abstract and others receiving comments saying they did not need to include this. This has been addressed again between markers and supervisors - details which were checked prior to starting with supervisors were regarded poorly in the feedback and classed as 'conflicting' despite the student seeking guidance and advice in advance.

We appreciate the technical difficulties for the delay in our grades but as stated above without context, feedback (being critical in nature) can be incredibly disheartening and distressing. There also appears to be a lack of consistency and professionalism in regard to the tone and feedback provided.

As reps we thought it would be best to raise this as a whole year issue and draw your attention to the current dilemmas many students are facing.

If you require any further details, please feel free to contact us.

Kind Regards,

XXX and XXX

D10. You must consider the contributions of other health and care professionals, to optimise patient care.

21614264 — 2021-05-23 18:04:31 UTC

The document, is a reflective writing piece we had to complete as part of our assessments in second year. It highlights in section D: Professionalism a reflection I completed when a current third year student disregarded my opinion as a first year observer.

D11. You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

21614264 — 2021-05-23 18:15:01 UTC

The link below is the registration process for the General Osteopathic Council, in which to register you need a 'health reference' this is provided by your GP to prove you are fit to practice.

Reflecting upon this I find this practice as healthcare professionals to be unusual. Due to our level of qualification, our knowledge and the diagnostic abilities, I feel as though we are capable practitioners to determine our own fitness to work. However, I know that from current GOsC communications, they are wishing to change the registration process, based on the for mentioned points.

https://www.osteopathy.org.uk/training-and-registering/how-to-register-with-the-gosc/i-trained-in-the-uk/

D12. You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements.

21614264 — 2021-05-23 18:29:03 UTC

The link below shows the government web page for the DBS checks.

https://www.gov.uk/government/collections/dbs-checking-service-guidance--2

As graduating osteopaths we are required to attain an advanced DBS to be allowed to practice.

In further reflection, keeping our professional body informed of any issues with conduct or competence will reflect better in the long term and allow the GOsC to aid our case.

A.

21614264 — 2021-05-25 15:06:41 UTC

Chadwick.A., 2012. A dignified approach to improving the patient experience. Nurse Education in Practice. 12(4). pp 187-191

Google Images. 2019. Muscle Anatomy Poster; The Muscular System. [online] Available at:

National Health Service (NHS).,2018. Benefits of Talking Therapies. [online] Available at: Accessed: 27th April 2021

C.

21614264 — 2021-05-25 15:13:43 UTC

General Medical Council (GMC)., 2021. Keeping Records. [online] Available at: Accessed on: 19th May 2021

Government UK., 2018. Data Protection Act Gov.UK., [online] Available at: Accessed: 19th May 2021

Hendryx.J.T., 2014. The Bioenergetic Model in Osteopathic Diagnosis and Treatment. The American Academy of Osteopathic Medicine. 24(1). pp 13 - 20.

Youtube Video., 2020. Public Health England. Covid-19: Donning and Doffing. [online] Available at: Accessed: 19th May 2021

Youtube Video., 2015. SOAP Notes. [online] Available at: Accessed: 24th May 2021

B.

21614264 — 2021-05-25 15:22:32 UTC

General Medical Council., 2021. Delegation and Referral. [online] Available at: Accessed on: 29th April 2021

General Osteopathic Council (GOsC)., 2020. Coronavirus (COVID-19). [online] Available at: Accessed on: 28th April 2021

MedLine Plus., 2015. Klippel-Feil Syndrome. US National Library of Medicine. [online] Available at:< https://medlineplus.gov/genetics/condition/klippel-feil-syndrome/> Accessed on: 30th April 2021

National Institute for Health and Care Excellence (NICE)., 2020. Carpal Tunnel Syndrome. [online] Available at: Accessed on: 15th May 2021.

D.

21614264 — 2021-05-25 15:36:33 UTC

Caddell.A., Hazelton.L., 2013. Accepting gifts from patients. The college of family physicians in Canada. 59(12). pp 1259-1260

General Medical Council (GMC)., 2021. Using and Disclosing Patient Information for Direct Care. [online] Available at: Accessed on: 4th May 2021

General Osteopathic Council (GOsC)., 2021. Complaints. [online] Available at:

General Osteopathic Council (GOsC)., 2021. Training and Registration. I trained in the UK. [online] Available at: Accessed: 23rd May 2021

Goold.S.D., 2002. Trust, Distrust and Trustworthiness. Journal of General Internal Medicine. 17(1). pp 79-81

Gov.uk., 2013. Disclosure and Barring Services (DBS). [online] Available at:< https://www.gov.uk/government/collections/dbs-checking-service-guidance--2> Accessed on: 17th May 2021

National Council of State Boards Nursing (NCSBN)., 2018. Professional Boundaries in Nursing. [PDF] Available at:

National Health Service (NHS)., 2019. The Duty of Candour. [Leaflet] Available at: Accessed: 3rd May 2021