ABUSE PREVENTION
Abuse Prevention
Preventing abuse is everyone’s responsibility. If you are the subject of, or witness to, abuse you have a professional and ethical duty to report the behaviour. In addition you may wish to consider the following recommendations:
FIRMLY tell the person that their behaviour is not acceptable and ask them to stop. You can ask a supervisor or union member to be with you when you approach the person.
KEEP a factual journal or diary of daily events. Record:
- The date, time and what happened in as much detail as possible
- The names of witnesses
- The outcome of the event
Remember, it is not just the character of the incidents, but the number, frequency, and especially the pattern that can reveal the abuse or harassment.
REPORT the abuse to the person identified in your workplace policy, your supervisor, or a delegated manager. If your concerns are minimized, proceed to the next level of
management. Consider reporting the individual to his/her regulatory College.
CRTO Zero Tolerance Position Statement
The CRTO’s Zero Tolerance position statement, regarding abuse, states:
The College of Respiratory Therapists of Ontario (CRTO) recognizes the seriousness and extent of harm that sexual abuse and other forms of abuse can cause to individuals, their family members, and members of the healthcare team. Therefore, the CRTO has a position of zero tolerance for any form of abuse (sexual, physical, verbal, emotional, financial, or cyber) by its Members.
Through its standards of practice, policies and guidelines, the CRTO strives to educate its Members on the effects and/or impacts of abuse. The CRTO expects the principles of sensitive practice to be an important part of the care our Members provide. It is important for the profession to be aware of the imbalance of power that exists in various relationships.
Please note that abuse in any form is considered to be professional misconduct and allegations will be referred to the Inquiries, Complaints and Reports Committee (ICRC).
Therapeutic & Professional Relationships
Most RTs engage in the following two key relationships when practicing the profession:
Therapeutic Relationships exists between patients/clients, their
family members, substitute decision maker and/or guardians.
Professional Relationships exists between other members of the health care team, such as co-workers, colleagues and students.
Both types of relationships are built on trust, respect, compassion and honesty. RTs must always conduct themselves within these relationships in a manner that is free of all forms of abuse, including sexual abuse. The responsibility falls on the RT to know what meets the legal obligations and professional standards of acceptable conduct. Ignorance of these obligations or standards is not an acceptable defense. Professional standards regarding Professional Boundaries / Therapeutic & Professional Relationships are outlined in the CRTO Standards of Practice – Standard 12. RTs are also expected to adhere to their organizational policies regarding conduct.
Managing Power Imbalances
In both therapeutic and professional relationships, an inherent power imbalance exists that favours the RT (e.g., between RT and patient/client, between staff RT and student, etc.). This power imbalance occurs because the RT has authority, knowledge, access to information and influence. This inequity can increase the potential for abuse and cannot be managed by obtaining consent.14
Therapeutic Relationships
Patients/clients depend on the unique knowledge and skills of RTs to provide them with the care they need. The power imbalance places the patient/client in a dependent position, and it is the responsibility of the RTs to ensure that a proper therapeutic relationship is established and maintained. To do so, RTs must respect the dignity and privacy of the patient/client and their cultural, religious and sexual diversity.
It is the expectation that RTs:
Recognize that an individual remains a patient/client for at least one
year following their last professional interaction;
Not engage in behaviour, conversations, or make comments that cause inappropriate discomfort in the presence of patients/clients;
Not engage in any sexual activity with a patient/client;
Not condone abusive behaviour of others by any means including words, actions, body language or silence;
Understand that patients are frequently in a vulnerable state and may not be able to advocate for themselves; and
Learn about attitudes and behaviours (e.g., cultural, religious, societal) that are appropriate to the patient/client services you provide.
To learn more about providing culturally competent care, please see the CRTO’s A Commitment to Ethical Practice.
Scenario:
A male RT observes a colleague telling an inappropriate joke to a teenage
patient. The RT doesn’t laugh or take part in the joke but he also does not say
anything to the colleague or the colleague’s supervisor.
What do you do?
By his silence, the RT has given his unspoken approval for the colleague’s
behaviour and has done nothing to prevent this type of conduct in the future.
Professional Relationships
RTs often work within an interprofessional team and are required to use a wide range of communication and interpersonal skills to effectively establish and maintain professional relationships. In addition, RTs teach students, manage staff and take part in the administration of their organization. It is essential that the standards for interactions in these professional relationships mirror the standards that apply to therapeutic relationships.
Scenario:
An RT thinks that another health care professional with whom they work is lazy
and argumentative, and doesn’t hesitate to tell this to their peers in the
lunchroom.
What do you do?
The CRTO Standards of Practice requires that RTs “refrain from maligning the reputation of any colleague.” (CRTO Standards of Practice – Standard 12)
Professional Boundaries
Issues related to abuse, sexual abuse, sexual assault and sexual harassment can also
arise for RTs outside of therapeutic relationships with patients/ clients. Just as in
therapeutic relationships, professional relationships are based on trust and respect
for boundaries. As outlined in the CRTO Standards of Practice, the RT is expected to
appropriately manage these professional relationships by:
Collaborating and co-operating with peers and other health professionals in order to serve the best interest of their patients/clients; and
Maintaining clear and appropriate professional boundaries in all professional interactions
Scenario:
An RT sees a particular patient in the Asthma Clinic on a regular basis. They begin to interact on Facebook™ and then the patient/client starts calling the RT at her home seeking advice between visits.
What do you do?
In all patient/client – RT interactions, the RT is responsible for identifying and maintaining clear professional boundaries. It makes no difference if the patient/client agrees or even initiates the interactions.
Please Note
The Professional Misconduct regulation (s.29) states that it is an act of professional misconduct for an RT to be:
“Engaging in conduct or performing an act, relevant to the practice of the profession that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.”
Students
Student RTs (as well as other students that an RT may be teaching) are dependent on the RT for their training and for an unbiased evaluation. As a result, a power imbalance exists in both the school setting (RT professor to student) and in the clinical care setting (staff RT to student). It is important to understand that the relationship an RT has in these situations is purely to assist the student in gaining the knowledge, skills and abilities necessary to become a competent professional. Students also must understand that
abuse of any form by an RT should not be tolerated. If a student feels they are being abused by an RT, the student should follow the process of their educational facility and contact the CRTO.
“Sexual harassment is a form of sex discrimination and is therefore prohibited
in educational settings”
(Ontario Human Rights Code, 2013)
Scenario:
A staff RT is responsible for supervising an RT student and over a number of shifts they develop a friendly rapport. They begin following each other on Twitter and commenting on each other’s Tweets initially in a good natured manner. After a few weeks, however, the RT’s tweets become increasingly personal and full of innuendo. The student RT feels very uncomfortable with these interactions, but is afraid to speak up or “unfollow” the RT for fear of offending him and jeopardizing her clinical rotation.
What do you do?
The person favored by the power imbalance, in this case, the staff RT, bears the
responsibility for managing the professional relationship. Students are vulnerable
because they are dependent on the RT for an unbiased evaluation that may not
only impact their clinical rotation but also their future job prospects. Students are
also at a disadvantage and are often hesitant to speak up because they are unsure
of the cultural norms and expectations. The staff RT, in this scenario, is accountable
for the relationship they have with the student.
Dating
Dating Dating and other forms of affectionate behavior between an RT and their
patient/client may constitute sexual abuse as defined by the RHPA. As discussed
earlier in this document, the relationship between an RT and their patient/client has
an inherent power imbalance.
There can be no sexual contact between an RT and their patient/client for a oneyear period following the termination of the professional relationship. In some
instances, it will never be appropriate to date a former patient (such as when the
patient/client was particularly vulnerable). Once a patient/client is discharged from
the hospital or permanently transferred to another RT, the waiting period is a
minimum of one year before the patient/client and RT can enter into a sexual
relationship. Waiting less than one year constitutes sexual abuse of a patient/client.
In addition to a power imbalance existing between an RT and a patient/client, a
similar inequity exists between an RT and a Student Respiratory Therapist (SRT)
where the RT is directly or indirectly supervising the student. As a result of the RT’s
status and influence over the SRT (being educated by the CRTO Member), an RT
may not have a personal relationship with the SRT. Such a personal relationship is
unprofessional conduct and may be considered sexual misconduct resulting in a
public discipline hearing and onerous sanctions against the RT.
In general, RTs are advised to avoid personal relationships with anyone over whom
they may be perceived to have professional influence (e.g., family members of
patients/clients) for a minimum of one year following the end of professional
practice interactions
Scenario:
An RT works at the paediatric hospital and frequently speaks with the single father of a child she cares for in the Cystic Fibrosis (CF) Clinic. At one point, the father asks the RT if she would like to go for coffee sometime.
What do you do?
In this scenario, the father is not a patient/client of the RT. However, there is still a power imbalance because the father is dependent upon the RT for the care she provides to his child. The RT must refrain from developing a social relationship with the father until his child has been formally discharged from the CF Clinic.
ADDITIONAL RESOURCES
- CRTO A Commitment to Ethical Practice
- CRTO Funding for Supportive Measures (Non-Patient/Client) Policy
- CRTO Funding for Supportive Measures (Patient/Client) Policy
- CRTO Mandatory Reporting by Member Fact Sheet
- Pause Before You Post: Social Media Awareness for Regulated Healthcare Professionals
eLearning module - CRTO Standards of Practice
- Zero Tolerance of Sexual Abuse and Other Forms of Abuse Position Statement
REFERENCES
- Child and Family Services Act
- Criminal Code of Canada
- Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of
Childhood Sexual Abuse. In Public Health Agency of Canada (Eds.),. Ottawa: Public Health Agency
of Canada - McPhedran, M., & Sutton, W. (2004). Preventing Sexual Abuse of Patients: A Legal Guide for Health
Care Professionals. Toronto, ON, Canada: LexisNexis Butterworths. - Ontario Human Rights Commission (2013). Policy on Preventing Sexual and Gender-Based
Harassment. - Regulated Health Professions Act
- Statistics Canada. (2011). Violent victimization of Aboriginal women in the Canadian provinces,
2009. - Statistics Canada. (2012). Family violence in Canada: A statistical profile, 2010
- Statistics Canada. (2013). Measuring violence against women: Statistical trends
FOOTNOTES
14. McPhedran, M., & Sutton, W. (2004). Preventing Sexual Abuse of Patients: A Legal Guide for Health Care Professionals. Toronto, ON, Canada: LexisNexis Butterworths.