Ethics and Law in Dental Hygiene Chapter 1 Ethics and Professionalism Nicole Cruz, RDH, BSDH Email: ncruz@concorde.edu

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)

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.

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.

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.

The Health Care Provider A health care professional: the motive of a patient’s 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.

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.

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.

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 public’s health and safety.

Old school dental hygiene!

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

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, dentist’s pledge, and the dental hygiene oath are examples of outward signs that reflect acceptance of the professional obligation.

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)

The Hippocratic Oath https://youtu.be/RSXLucXoI54?t=33s

Principles of Professionalism Excellence Humanism Accountability Altruism

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.

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.

The Commercial Model

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 dentist’s membership in his or her chosen profession.

The Guild Model

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.

The Interactive Model

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.

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.

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.

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.

Standards for clinical Dental Hygiene practice (Pg 15, Box 1-3) Assessment: collection, analysis, and documentation of patient’s 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.

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 one’s own interest and concerns.

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

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.

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 patient’s needs remain the primary focus. (not under the influence of drugs or alcohol, lack of sleep, or emotional disturbance)

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.

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.

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.

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.

Let’s get Ethical !!!

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