Chapter 1 Ethics and Professionalism Nicole Cruz, RDH, BSDH
Email: [email protected] Ethics and Law in Dental Hygiene
Slide 2
Introduction From inception in the early 1900s, the profession
of dental hygiene has been concerned with the public good and with
advocating methods of preserving human teeth. Hygienists are seen
as oral preventive therapists because of their vision of the day
when dental disease could be prevented by following a system of
treatment and cleanliness. ADHA revised and adopted the original
dental hygiene oath in 1979 and it is still in use today. Be
familiar with the oath (pg.4)
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The Dental Hygiene Oath IN MY PRACTICE AS A DENTAL HYGIENIST, I
AFFIRM MY PERSONAL AND PROFESSIONAL COMMITMENT TO IMPROVE THE ORAL
HEALTH OF THE PUBLIC, TO ADVANCE THE ART AND SCIENCE OF DENTAL
HYGIENE, AND TO PROMOTE HIGH STANDARDS OF QUALITY CARE. I PLEDGE
CONTINUALLY TO IMPROVE MY PROFESSIONAL KNOWLEDGE AND SKILLS, TO
RENDER A FULL MEASURE OF SERVICE TO EACH PATIENT ENTRUSTED TO MY
CARE, AND TO UPHOLD THE HIGHEST STANDARDS OF PROFESSIONAL
COMPETENCE AND PERSONAL CONDUCT IN THE INTEREST OF THE DENTAL
HYGIENE PROFESSION AND THE PUBLIC IT SERVES.
Slide 4
Introduction Society recognizes that health care providers, by
virtue of their education and special skills, are appropriately
held to a higher standard than that expressed by legislative
mandate. These higher standards are expressed in professional codes
of ethics and are enforced by those within the profession, this is
known as self- regulating. Self-regulating or self-policing
behavior represents an increased level of trust on the part of the
public.
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Introduction In essence, the public is saying that it is not
qualified nor in a position to evaluate the adequacy of treatment
provided by health care professionals. Therefore, the public TRUSTS
the professions to perform these evaluations. An ethical dental
hygienist will accept the duty of self-regulation, both in judging
their colleagues and in submitting to peer review, to ensure
quality care for the public.
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The Health Care Provider A health care professional: the motive
of a patients welfare is placed above the profit motive. Because of
this SERVICE motive, society has granted to the health care
professional a certain status that carries prestige, power, and the
right to apply special knowledge and skill.
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Health Care Provider *In the delivery of healthcare, trust is
the critical foundation for the relationship that develops between
the person seeking services-the patient or client, and the
healthcare provider-professional.
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The Dental Hygienist A professional oral health care provider,
an individual who has: Completed a required higher-education
accredited program Demonstrated knowledge, skills, and behaviors
required by the college or university for graduation Passed a
written national board examination Successfully performed certain
clinical skills on a state or regional examination.
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The Dental Hygienist BECAUSE of all of those requirements the
state grants you a license to practice dental hygiene because you
are deemed competent. Thus, the board of dentistry or dental
practice act exists, to protect the publics health and safety.
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Old school dental hygiene!
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The Health Care Provider Profession is defined as a limited
group of persons who have acquired some special skill and are able
to perform that function in society better than the average person.
Fig.1-1 states the characteristics of a true profession:
Specialized body of knowledge of great value to society Intensive
academic course of study Set standards of practice External
recognition by society Code of ethics Organized association Service
orientation
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The Dental Hygienist What separates the professional from a
layperson is the specialized knowledge, which is exclusive to a
professional group. True professions are still considered to be
medicine, dentistry, and law because they possess all the
characteristics listed for a true profession. A profession incurs a
professional obligation by virtue of its relationship with society,
something that is affirmed and reaffirmed over time The Hippocratic
oath, dentists pledge, and the dental hygiene oath are examples of
outward signs that reflect acceptance of the professional
obligation.
Slide 13
Hippocratic Oath Hippocratic-of or relating to Hippocrates or
the school of medicine that took his name; medical practitioner who
is regarded as the father of medicine; author of the Hippocratic
oath (circa 460-377 BC) (Video Hippocratic Oath)
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The Hippocratic Oath https://youtu.be/RSXLucXoI54?t=33s
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Principles of Professionalism Excellence Humanism
Accountability Altruism
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Professionalism Public expectations regarding healthcare have
changed over the years. People have become more knowledgeable,
involved, and active in their own health care decisions. This is
very different from the traditional relationship between
practitioner and patient. David Ozar described this evolution by
developing three models of professionalism: the commercial model,
the guild model, and the interactive model.
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Professionalism: Commercial Model The commercial model
describes a relationship in which dentistry is a commodity, a
simple buying and selling of services. The patient is the consumer
and the dentist is the producer. Dental needs are not as important
as what the patient is willing to pay for. In this model, all
dentists are in competition, selling the same commodity to the
public for the best price. There is no obligation between the
dentist, the patient, other dentists, or the community.
Slide 18
The Commercial Model
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Professionalism: Guild Model The guild model presents dentistry
as an all-knowing profession. The patient has dental needs and the
dentist, as a member of the profession, provides care to meet the
needs of that patient, who is uninformed and passive in the
process. The obligation to provide care comes from the dentists
membership in his or her chosen profession.
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The Guild Model
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Professionalism: Interactive Model The interactive model has
the patient and the dentist as equals, with roles of equal moral
status in the process of dental care delivery. Patients determine
their needs and health care choices based on personal values and
priorities, but seek the care of the dentist because of the
knowledge and skill possessed by the dental professional. The
obligation for care in this relationship holds both parties as
equals because neither can achieve these values without the other.
The fundamental obligation in this model is for the dentist to
treat each patient well and to support the profession. Most
preferable model because patient and provider work as
partners.
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The Interactive Model
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Competency in Dental Hygiene Competencies are essential skills,
requiring knowledge, skill, and ability, that are performed by a
health care provider. For dental hygienists, competencies are
skills used regularly in real practice settings to meet the oral
health needs of the patients. The Commission on Dental
Accreditation (CODA), is the authorized agency that accredits all
dental hygiene education programs in the U.S., publishes standards
and competencies that all dental hygiene programs must meet or
exceed in their educational programs. (fig.1-2) Accreditation has
been developed to protect the public welfare and provide standards
for the evaluation of educational programs and schools.
Slide 24
Competency in Dental Hygiene CODA (Commission On Dental
Accreditation) is the specialized accrediting agency recognized by
the U.S. Department of Education to accredit programs that provide
basic preparation for licensure in dentistry, dental hygiene, and
all related dental disciplines. Patient care competencies or
graduation competencies, are the standards that must be met by
graduates of any educational program accredited by CODA. In states
where mastery of an additional skill is mandated by the dental
practice act, accredited programs offer additional training
opportunities in those competencies. EX: administration of local
anesthesia or nitrous oxide analgesia.
Slide 25
Competency in Dental Hygiene Educational theory categorizes the
process of skill performance into five stages of competency, also
called the expert learning continuum (Figure 1-1 pg. 13). The five
stages are novice, advanced beginner, competency, proficiency, and
expertise. When you begin pre-clinic and progress to caring for
clinical patients under the supervision of the faculty is the
novice or advanced beginner stage. At or even before graduation,
you (the student) will have achieved competency, or the ability to
perform skills without faculty supervision and with
confidence.
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Competency in Dental Hygiene After graduation, you work towards
proficiency and continue to work throughout your professional life
towards being an expert. Becoming an expert is not an end point, it
is something you strive for constantly in practice. Professionals
constantly seek to perform at increasingly higher levels,
perfecting the art and science of dental hygiene for every patient
treated.
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Standards for clinical Dental Hygiene practice (Pg 15, Box 1-3)
Assessment: collection, analysis, and documentation of patients
health status and needs. Dental Hygiene Diagnosis: identifying
existing potential oral health problems. Planning: plan of care
based on assessments. Implementation: delivery of hygiene services
Evaluation: reviewing and documenting the outcomes of dental
hygiene care. Documentation: accurate recording of data, treatment
plan and patient care.
Slide 28
Professional Traits Laurence McCullough, an ethicist, states
that there are 2 virtues required in a professional person. 1.
Self-effacement, meaning putting aside all notions of self as
better educated, socially superior, or more economically well off
and focusing on the patients needs. 2. Self-sacrifice, or putting
aside or giving up ones own interest and concerns.
Slide 29
Professional Traits of the Dental Hygienist Honesty and
integrity Caring and compassion Reliability and responsibility
Maturity and self-analysis Loyalty Interpersonal communication
Respect for others Respect for self
Slide 30
Professional Traits for the Dental Hygienist Honesty/integrity-
the patient must feel confident that information given in written
or verbal form is held in confidence and handled appropriately.
Caring/compassion- you must demonstrate the empathy necessary to
comfort and guide the patient in the health promotion process.
Reliability/responsibility- you must perform all services to the
best standard of care. Sound judgment must be used in every patient
encounter, you must stay current on the knowledge and theory of
dental hygiene technique. (CE) requirements Maturity/self-analysis-
you must work efficiently and effectively towards the goals of
attaining and maintaining oral health for each patient. You must
also self analyze to see what skills need change or
improvement.
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Professional Traits for the Dental Hygienist Loyalty- all
professional decisions must be unencumbered by conflicting personal
interests. Promises should be carefully made and kept.
Interpersonal communication- you must listen to the patient to
develop a relationship and build trust. Patients expect that
personal, intimate facts and impressions about them will be kept in
confidence by the dental hygienist. Tolerance for others- you must
treat all patients without discrimination of any kind (race, color,
creed, age, sex, disability, occupation, financial status,
personality, or oral condition). Basic ethical and legal
requirement. Respect for self- you must maintain your own physical
and mental health so that the patients needs remain the primary
focus. (not under the influence of drugs or alcohol, lack of sleep,
or emotional disturbance)
Slide 32
Legal Requirements for the Dental Hygienist Once your license
is granted it is your responsibility to know and uphold all of the
statutes of the law. State dental practice act or the code of
dental practice. Licensure is designed to enforce practice codes,
establish standards, and sanction incompetent practitioners, all
for the purpose of protecting the health and safety of the public.
Scope of practice of a dental hygienist was first established by
law in Connecticut in 1915 at the urging of Dr. Alfred C. Fones.
(The father of dental hygiene). These legal statutes change over
time in response to many factors (to protect the public and to
advance the interests of the health professions) Connecticut was
the first state to license dental hygienists. Texas was the last
state in the US to grant dental hygiene licensure.
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Legal Requirements for the Dental Hygienist Some factors that
influence legislative changes in a state are: Need and demand for
dental care Distribution of dental health care providers Federal
health legislation Goals of organized dental and dental hygiene
associations advocacy groups.
Slide 34
Legal Requirements for the Dental Hygienist Increases in the
scope of practice for hygienists have occurred over the years, but
have been accompanied by controversy. Some states have expanded
functions, but each state has specific hygiene duties in their
dental statutes that dictate the level of supervision or lack
thereof.
Slide 35
Legal Requirements for the Dental Hygienist Only duties or
functions allowed in a particular state may be performed by the
licensed dental hygienist, even if that individual is trained and
licensed in another state where they can perform more procedures.
Attaining and maintaining competency in dental hygiene are among
the obligations that dental hygienist accepts in completing a
formal education program and passing the state licensure
examination. Placing the needs of the patient first and aiming to
provide the best care to every patient as well as society at large.
Colorado was the first state to pass legislation permitting
unsupervised dental hygiene practices and expanded functions.
