5.3 Professional Practice & Ethics
Key Takeaways
- The AARC Statement of Ethics & Professional Conduct directs RTs to act with competence, integrity, and respect for autonomy
- Valid informed consent requires understanding, disclosure of alternatives, voluntariness, and patient competence/capacity
- Competent patients may refuse any treatment, including mechanical ventilation, even when refusal may be fatal
- Advance directives (living will, healthcare proxy, DNR/DNI, POLST/MOLST) speak for patients who cannot communicate
- SOAP documentation: Subjective (patient statements), Objective (measurable data), Assessment (interpretation), Plan (next steps)
- HIPAA limits disclosure to the minimum necessary, shared only with authorized personnel who need to know
- Evidence-based practice integrates best research evidence, clinical expertise, and patient values
- SBAR (Situation, Background, Assessment, Recommendation) is the standard structured handoff and physician-notification format
Professional Practice & Ethics
The TMC exam threads professional-practice, ethics, legal, documentation, and communication items through its safety objectives. These feel less clinical than ventilator math, but they protect patients and your license.
AARC Statement of Ethics and Professional Conduct
The American Association for Respiratory Care (AARC) publishes the profession's ethics standard. Core duties:
- Competence -- maintain and advance skills through continuing education.
- Integrity -- act honestly; avoid conflicts of interest and falsified records.
- Patient welfare (beneficence/nonmaleficence) -- put the patient's well-being first; do no harm.
- Confidentiality -- protect health information (HIPAA).
- Justice / non-discrimination -- treat all patients fairly regardless of race, gender, religion, age, or ability to pay.
- Respect for autonomy -- honor patient decisions, including refusal of care.
- Scope of practice -- stay within state licensure and credentialing limits.
The four classic bioethics principles -- autonomy, beneficence, nonmaleficence, and justice -- are fair game on the exam.
Patient Rights and Legal Concepts
| Concept | Definition |
|---|---|
| Informed consent | Patient understands the procedure, risks, benefits, and alternatives; agrees voluntarily; is competent |
| Implied consent | Assumed in life-threatening emergencies when the patient cannot consent |
| Right to refuse | A competent adult may refuse any treatment, even life-sustaining therapy |
| Advance directive | Document stating wishes when the patient cannot communicate |
| Living will | Specifies which treatments are wanted or declined |
| Healthcare proxy / power of attorney | Names a surrogate decision-maker |
| DNR | No CPR if arrest occurs |
| DNI | No intubation; non-invasive support may still be offered |
| POLST / MOLST | Portable, actionable physician orders for life-sustaining treatment |
Worked scenario: A competent end-stage COPD patient says, "Do not put me on a ventilator." Autonomy governs -- you advocate for a physician-documented DNI order and never coerce or override the patient. Battery/assault language on the TMC describes treating a competent refusing patient without consent.
Scope of Practice
RTs work under medical direction, bounded by state licensure law, facility policy, physician orders/protocols, and NBRC credentials (CRT, RRT, and specialties such as ACCS or NPS). Never perform a task outside your scope, even at a physician's request, unless your state permits it and you are trained and credentialed.
Documentation -- SOAP
| Section | Content | Example |
|---|---|---|
| S -- Subjective | What the patient reports | "My chest feels tight." |
| O -- Objective | Measurable data | RR 28, SpO2 91% on 2 LPM NC, bilateral wheezes, peak flow 180 L/min |
| A -- Assessment | Clinical interpretation | Moderate acute asthma exacerbation |
| P -- Plan | Next steps | Albuterol 2.5 mg via nebulizer; reassess in 30 minutes; notify physician |
Documentation rules: record objective facts, not opinions; chart in real time; use only approved abbreviations; if it is not documented it was not done; never alter a record -- add a dated, signed addendum; always note the patient's response to therapy. Charting "patient seems to be faking" is a subjective judgment that is legally hazardous and unprofessional.
Communication -- SBAR
| Component | Content | Example |
|---|---|---|
| S -- Situation | What is happening now | "Mr. Jones in 412 dropped to SpO2 85% on 4 LPM." |
| B -- Background | Relevant context | "Admitted yesterday with pneumonia, on antibiotics." |
| A -- Assessment | Your read | "I think the pneumonia is worsening; accessory-muscle use." |
| R -- Recommendation | Your request | "Recommend a non-rebreather, an ABG, and consider BiPAP." |
Use SBAR for physician notification and handoffs; SOAP is for the chart, while SAMPLE and OPQRST are history-taking tools.
Evidence-Based Practice and the Evidence Hierarchy
Evidence-based practice integrates best research evidence + clinical expertise + patient values. From strongest to weakest: (1) systematic reviews and meta-analyses of randomized controlled trials, (2) randomized controlled trials, (3) cohort and case-control studies, (4) case series/reports, (5) expert opinion.
Quality, Safety, and Event Classification
| Term | Description |
|---|---|
| Sentinel event | Unexpected death or serious harm; triggers immediate investigation |
| Near miss | Error caught before harm reaches the patient |
| Never event | A serious, wholly preventable event that should never occur |
| Root cause analysis | Structured search for the underlying cause |
| Time-out | Pre-procedure verification of patient, procedure, and site |
The Joint Commission National Patient Safety Goals stress two-identifier patient identification, accurate communication, and medication safety -- frequently tested professional-practice content.
Patient Identification and Medication Safety
The TMC reinforces using two patient identifiers (typically full name and date of birth, never the room number) before any treatment or medication. Before a respiratory medication, verify the five rights: right patient, right drug, right dose, right route, and right time. A common exam trap is administering a nebulizer based on a room-number match alone or skipping verification because the unit is busy -- both are unsafe.
Cultural Competence, Disclosure, and the Impaired Colleague
Professional practice extends to cultural competence (using a qualified medical interpreter rather than a family member for non-English speakers), truthful disclosure of errors to patients and supervisors, and mandatory reporting. If you observe a colleague who appears impaired by drugs or alcohol, the ethical and legal duty is to report it through the chain of command to protect patients -- not to cover for the coworker. Falsifying a record, practicing beyond your license, or abandoning a patient assignment are all reportable to the state licensing board and can cost your credential.
Delegation and Supervision
Under the NBRC credential structure, an RRT may supervise students, technicians, and aides, but delegation never transfers accountability. The supervising therapist remains responsible for ensuring the task is within the delegatee's training and scope and that the patient outcome is verified.
| Situation | Correct RT action |
|---|---|
| Physician orders a treatment outside RT scope | Decline; clarify with the physician and reference policy |
| Patient refuses a documented treatment | Honor refusal; document and notify the physician |
| Suspected medication error reached the patient | Assess the patient, report, and complete an incident report |
| Family asks for the chart in the hallway | Disclose only per HIPAA and facility release policy |
These professional-judgment scenarios are exactly how the TMC frames ethics: a short patient vignette with one defensible, patient-centered, legally sound choice.
A competent adult with end-stage COPD says, "I do not want to be intubated if I stop breathing." The RT should:
Which framework should an RT use when calling a physician about a deteriorating patient?
In a SOAP note, "SpO2 92% on 3 LPM NC, bilateral expiratory wheezes, RR 26" belongs in which section?
Which represents the strongest level of evidence in evidence-based practice?
Which elements are required for valid informed consent? (Select all that apply)
Select all that apply
An RT prepares the wrong medication but catches the error before it reaches the patient. This is classified as a:
An unconscious patient in anaphylaxis arrives in the emergency department. What consent applies?
HIPAA requires respiratory therapists to:
An RT charts "Patient seems to be faking symptoms." This is inappropriate because it:
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