Dental Hygiene Practices and Regulations, Exams of Advanced Education

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Professional Issues I Final Exam Review

1. List the four committees of CDHBC. - ANSWER-1. Registration Committee
2. Inquiry Committee
3. Discipline Committee
4. Quality Assurance Committee
5. Special Committee 75 CC credits per _______________ year cycle. - ANSWER-5 years Analytic Cross-Sectional Study - ANSWER-ex. To study a presumed inverse relationship between black tea consumption and cardiovascular disease, investigators randomly selected a sample of 13, 500 subjects, 50 -64 years of age and queried them about tea consumption and current treatment for cardiovascular disease. No significant association as found between. Analytic Ecological Study - ANSWER-o multiple group comparison studies, time trend studies, and mixed studies o groups are defined by geographical areas Analytic Studies - ANSWER-o studies which provide information about association of risk attributes o aimed at helping to establish risks and causality Animal Research - ANSWER-o Testing through animals o Weak because their results are often impossible to generalize to humans Autonomy - ANSWER-• Ability to be self-governing

• Based on the principle of respect for persons.
• Individuals have the right to make their own judgments based on their own evaluations.
• Recognizing autonomy occurs when the DH involves the client in decision making and obtains informed consent. Beneficence - ANSWER-• The principle of promoting what is kind, good, & charitable
• Promotes benefits
• Prevention of harm
• A professional is responsible for contributing to the health and welfare of others. British Columbia Dental Hygiene Association (BCDHA) - ANSWER-• Our provincial association
• Formed in 1964
• Collaborates with government, the provincial dental hygiene regulatory body and clients to effectively serve members and the public

Canadian Dental Hygienist Association (CDHA) - ANSWER-• National

• Where you get liability insurance
• Exists so that its members are able to provide quality preventive and therapeutic oral health care as well as health promotion for the Canadian public Case Control Study - ANSWER-o patients with disease and a group of control without the outcome or disease are selected and then information is obtained on whether the subjects have been exposed or not, to the factor under investigation. o ex. A study was undertaken to test the hypothesis that chewing tobacco increases the risk of stomach cancer. Detailed historical date on chewing tobacco use were collected from 400 subjects with newly diagnosed stomach cancer and 400 subjects without stomach cancer. The results revealed that chewing tobacco was not a significant factor for stomach ulcer. CC Learning Activities fall within which 2 categories? - ANSWER-• Guided Learning Plan
• Self-Directed Learning Plan All activities for the Guided Learning Plan or the Self- Directed Learning Plan fall into one of three categories:

1. Group Learning
2. Self Learning
3. Reflective Learning Child Abuse - ANSWER-• Includes any physical, sexual, or emotional act directed against a child

• Any act that endangers or impairs a child's physical or emotional health and development Code of Ethics - ANSWER-A code of ethics is one of the essential characteristics of a profession •A contract the professional makes with society •First ethical code ~ Hippocratic Oath •First code of ethics for RDH's was in 1927 Cohort Studies - ANSWER-o Cohort Studies:
• provide stronger evidence since both groups in a study do not have the condition of interest
• watch both groups over time to see which one develops condition of interest o Case Control Studies:
• compare patients who already have a condition with a matched group of those who do not

• May provide good info ***but not good enough cause they rely on gathering data RETROSPECTIVELY o Case Report Studies:
• Stronger than editorials BUT provide weak evidence as they rely on reporting findings from one case by one individual and do not control for bias, cannot be generalized, and cannot be statistically analyzed. College of Dental Hygiene British Columbia (CDHBC) - ANSWER-• Our regulatory body
• Focus on the public
• Sets out scope of practice for dental hygienists
• Describes restricted activities and limitations on dental hygiene practice as well as standard of practice expected to be met by all registrants
• Establishes Code of Ethics to be followed
• Govern the operation of the operations of the CDHBC, registration, and licensure of dental hygienists o Provide guidelines for:

1. The election and appointment of the governing board
2. The duties and responsibilities of the board registrar and deputy registrar
3. Qualifications of registrants
4. Standards of practice
5. Code of Ethics Commercial Publisher - ANSWER-o Referred to as "throwaways" o more like "magazines" than journals o often written by professional in-house staff o lots of advertising o usually free o not peer reviewed o poor scientific quality Conditional Registration - ANSWER-• DH's who meet ALL requirements of Full Registration except for L.A. or C.C. ◦ Must satisfy CC requirements in a reasonable length of time ◦ After successful completion of approved L.A. course and CC requirements may apply for Full Registration ◦ May practice DH only under supervision of full registrant with conditions set by Registration Committee Continuous Data - ANSWER-o Numerical o Interval, ratio o Quantitative o ex. temperature, test scores, time, blood pressure

o Interval: the distance between the values is constant and equal, but the zero point is not meaningful o ex. iq scores o Ratio: has equal intervals between values and a meaningful/natural zero point o ex. height, weight Core values - ANSWER-basic values of a profession Cross-Sectional Survey - ANSWER-o no hypothesis tested o examines the relationship between diseases and other variables of interest as they co exist o the data only describes the distribution of a condition in a population Crossover Design RCT's - ANSWER-o A specialized controlled trial where each study participant has both therapies. o is randomized to treatment A first, at the crossover point they then start treatment B Cultural Blindness - ANSWER-o Systems, agencies and individuals provide services with the philosophy of being unbiased o This group believes color, race, ethnicity and poverty do not matter a all and are inconsequential o People of diverse culture are anticipated to meet the needs and expectations of the dominant group Cultural Competence - ANSWER-Systems, agencies and individuals are characterized by acceptance and respect for differences Cultural Destructiveness - ANSWER-o The most negative end of the continuum o Represented by the attitudes, policies and practices that are destructive to culture, communities and individuals Cultural Incapacity - ANSWER-o Individuals who do not intentionally seek cultural destructiveness but lack the capacity to help diverse backgrounds o Believe in racial superiority and are extremely biased Cultural Pre-competency - ANSWER-o Awareness of some sensitivity but not sure what to do or what is right o Recognizes its weakness in serving clients of diverse culture and attempts to improve Cultural Proficiency - ANSWER-This is the most positive end of the continuum; an advanced cultural competence Define the 365 day rule and what category does this fall under? - ANSWER-Category: Limits or Conditions on Services

The client must be examined by a dentist within the previous 365 days or within a shorter time in order to provide dental hygiene services. UNLESS the RDH has a 365- day exempt status. Define the Health Profession Act and what year was it established? - ANSWER-o Health Profession Act: 1990 o Serves as the umbrella legislation under which health professions will regulate themselves in this province. o Each profession has its own regulation under the Act, setting out the governing framework specific to it, and establishing the profession's college. o Each college develops its own bylaws for approval by the government, setting out the detailed rules governing the profession Dental neglect - ANSWER-willful failure to provide treatment necessary to ensure an adequate level of oral health Deontological Ethics: (Nonconsequentialist Ethics) - ANSWER-• Immanuel Kent, 18th century philosopher

• Decisions are made based on a sense of duty, not the consequences
• Right is right & wrong is wrong Dependent Variable - ANSWER-outcome of the effects of the independent variable Descriptive Studies - ANSWER-o define characteristics of a population o are done when not much is known about a disease o case reports Discipline Committee - ANSWER-conducts hearings into matters referred from the inquiry committee Discrete Data - ANSWER-o Categorical o Nominal, Ordinal o Qualitative o ex. Hair colour, gender, favourite color, total number of DMF teeth present. o Nominal: named categories with no implied order among the categories o one value isn't 'higher' or 'better' than the other o Ordinal: ordered categories where the differences between categories cannot be considered to be equal o ex. ranking, your place in time, pass/ fail Elder Abuse - ANSWER-Any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or serious risk of harm to a vulnerable adult.

Epidemiology - ANSWER-describes and explains disease occurrence in a community/population Ethical Awareness - ANSWER-• How the RDH will respond in certain situations depends on his/her ethical awareness.

• Categories of moral problems:
• Moral weakness
• Moral uncertainty
• Moral dilemma
• Moral distress Ethical Theories - ANSWER-• Theories are a foundation for ethical decision making
• There are three main theories to describe how people direct their actions when faced with a moral dilemma Ethics - ANSWER-• A branch of philosophy which attempts to understand morality
• Used to Distinguish between right & wrong
• In dental hygiene, ethics focuses on moral duties and obligations of the professional to clients, colleagues and society
• Can provide a framework for making ethical decisions Ethnocentrism - ANSWER-The belief that one's culture is superior to all others. Leads to discrimination and ultimately loss of clients. Experimental - ANSWER-o experimental treatment is manipulated and variables measures o provides highest level of evidence of all study designs o randomization is critical Explain the conditions where a fully registered dental hygienist in BC could provide local anaesthetic. - ANSWER-A. In circumstances where a dentist is on the site and immediately available B. In a facility if the anaesthetic has been authorized by a medical practitioner or a dentist, and a person qualified (MD, RN, DDS) to act in a medical emergency is immediately available. Full Registration - ANSWER-• For graduate dental hygienists practicing in BC
• Must meet ALL requirements

1. Graduate of DH program in Schedule I
2. NDHCB certification
3. Graduate of CDHBC approved L.A. course
4. Meet CC requirements
5. Complete BC DH Regulation Assessment in registrants handbook
6. CPR Certification
7. HCP category

8. Professional negligence insurance $1 million/ occurrence
9. Be in good standing where currently or previously registered
10. Be of good character as per the standards of a registrant.
11. Criminal record search
12. Complete Application for Registration form and submit applicable fees Full Registration (365 Day Exempt Status) - ANSWER-• For RDH's working in facilities, education, own practice...

• Full registration requirements PLUS:
• Minimum 3500 hours clinical RDH practice within the last 5 years
• Successful assessment of additional knowledge and skills.
• Bachelor's degree in Dental Hygiene or equivalent Grey Literature - ANSWER-o not published commercially, nor controlled by commercial publishers o not peer reviewed o this category of material lies between the published material and indexed works such as journals, texts, and flyers o Is significant for research and development but requires much scrutiny How long is a term for a committee member? - ANSWER-No more than 2 years in a term How long is the first term of office for a registrant board member? How long are subsequent terms? - ANSWER-o First term - 3 years o Subsequent terms - 2 years How many committee members must be elected? - ANSWER-Each committee consists of 6 members: 1 public, 1 appointed, 1 elected, 3 registrants How many members compose the Board in the CDHBC? - ANSWER-Nine: 6 elected registrants and 3 public representatives How to determine which type of (qualitative/quantitative) study is required? - ANSWER-

1. What was the aim of the study? A. To simply describe a population = QUALITATIVE B. To quantify the relationship between factors (PICO) = QUANTITATIVE Hypothesis Testing - ANSWER-o If the null hypothesis is rejected = STATISTICALLY o significant means unlikely to have been caused by sampling error Ideas, Editorials and Opinions - ANSWER-o Not related to scientific studies/info provided may not be founded on good research o EDBM does take professional experience and judgement into consideration

In Vitro (test tube) Research - ANSWER-o Lowest level of pyramid o Test the efficacy and or safety of products and treatments prior to testing in humans Independent Variable - ANSWER-treatment, age and life style Initial/Student Registration - ANSWER-◦ Currently enrolled in a board approved DH education program ◦ Head of DH program recommends student for specific procedures and dates ◦ Only under direct supervision of a Full Registrant Inquiry Committee - ANSWER-investigates complaints, dismiss the matter, recommend mediations, request the registrant to agree: not to repeat the conduct, accept a reprimand, take upgrading or do other remedial activities, refer to discipline committee Jeopardy Question #1) ______________________ surveys gather data over a period of time. The researcher may then analyze changes in the population and attempt to describe and/or explain them. The 3 main types of ______________________ surveys are trend studies, cohort studies, & panel studies. - ANSWER-Longitudinal Jeopardy Question #10) What is the dental hygiene process of care (5 steps). - ANSWER-1. Assessment

2. Diagnosis
3. Planning
4. Implementation
5. Evaluation Jeopardy Question #11) When were DH self-regulated in the province of B.C.? - ANSWER-March 1st, 1995 Jeopardy Question #12) List 4 determinants of health. - ANSWER-● Income ● social support ● education & literacy ● employment & working conditions ● social environments ● physical environments ● person health practice & coping skills ● healthy child development, biology & genetic endowment ● health services ● Gender ● Culture Jeopardy Question #13) List the three structures of the office of the CDHBC. - ANSWER-Board, registrar/CEO & support staff

Jeopardy Question #14) List the 6 various registration categories. - ANSWER-1. Full Registration

2. Full Registration, 365 Day Exempt Status
3. Conditional Registration
4. Non-practicing Registration
5. Temporary Registration
6. Student Registration
7. Added now: Dental Hygiene Practitioner (DHP) instead of 365 Jeopardy Question #15) Define the 365-day rule. - ANSWER-Category: Limits or Conditions on Services The client must be examined by a dentist within the previous 365 days or within such shorter time in order to provide dental hygiene services. UNLESS the RDH has a 365- day exempt status. Jeopardy Question #16) Matching: The null hypothesis is not rejected, when in fact it is false. A. type I error (also called alpha) B. nominal C. statistically significant D. type II error (also called beta) E. ordinal - ANSWER-D - Type II error (also called beta) Jeopardy Question #17) Matching: A scale that lists condition in some order of severity. A. type I error B. nominal C. statistically significant D. type II error (also called beta) E. ordinal - ANSWER-E - Ordinal Jeopardy Question #18) Matching: The efficacy of the tested product or regiment was not a result of chance. A. type I error B. nominal C. statistically significant D. type II error (also called beta) E. ordinal - ANSWER-C - statistically significant Jeopardy Question #19) Matching: A scale that simply gives names to different conditions. A. type I error

B. nominal C. statistically significant D. type II error (also called beta) E. ordinal - ANSWER-B - nominal Jeopardy Question #2) ______________________ variables answer the question "What do I change?" A. Dependent B. Controlled C. Independent - ANSWER-C - Independent Jeopardy Question #20) ___________________________________ ensures that members of the same group are less likely to have higher than usual rates of other potentially cofounding characteristics in common. - ANSWER-Randomization Jeopardy Question #21) Sampling = a subset/portion of the population. What are five types of sampling? - ANSWER-● Random: everyone has an equal chance = best* most external/internal validity ● Stratified: subdivisions of a population with similar characteristics ● Systematic: including every 9th person, not a true random sample - biased ● Purposive/Judgmental: chosen on personal judgement that the subject would be most representative of the population - biased ● Convenience: subject that are most readily available - biased Jeopardy Question #22) True or False: According to the HPA, dental hygienists must not, under any circumstances, provide dental care to spouses, partners, or anyone they've had sexual relations with. - ANSWER-False Jeopardy Question #23) What are the four normative ethical principles that govern health care? - ANSWER-● Autonomy ● Non-maleficence ● Beneficence ● Justice Jeopardy Question #24) Matching: An RDH dealing with a non-compliant period client. A. Non-maleficence B. Moral weakness C. Moral uncertainty D. Moral Dilemma - ANSWER-C - Moral Uncertainty Jeopardy Question #25) Matching: An RDH who forgoes providing a client with self-care instruction because they would like to go to lunch early. A. Non-maleficence

B. Moral weakness C. Moral uncertainty D. Moral Dilemma - ANSWER-B - Moral weakness Jeopardy Question #26) Matching: Exists when obligations or responsibilities are in conflict. A. Non-maleficence B. Moral weakness C. Moral uncertainty D. Moral Dilemma - ANSWER-D - Moral dilemma Jeopardy Question #27) Matching: If you were asked to perform a procedure on a client for which you are not qualified, what ethical principle would you be violating? A. Non-maleficence B. Moral weakness C. Moral uncertainty D. Moral Dilemma - ANSWER-A - Non-maleficence Jeopardy Question #28) ______________________________ is a measure of reliability among two or more evaluators over time. - ANSWER-Inter-rater reliability Jeopardy Question #29) The margin of error ____________________ as sample size ___________________________. - ANSWER-decreases; increases Jeopardy Question #3) __________________________ variables answer the question "What do I observe?" A. Dependent B. Controlled C. Independent - ANSWER-A - Dependent Jeopardy Question #30) What are the exceptions to adhering to the principle of confidentiality? - ANSWER-There are exceptions: reporting child abuse, reporting diseases that may have an effect on the public. With minors, if child is at risk, you must tell the patient. A clients right to confidentiality has to be weighed against the rights of other individuals. Jeopardy Question #31) True or False: Gingival curettage is within the dental hygiene scope of practice in BC? - ANSWER-False Jeopardy Question #32) Can an RDH in BC prescribe chemotherapeutic agents to their clients? - ANSWER-No. We can deliver them into periodontal pockets & use oral rinses in the office but cannot prescribe agents for home use without a prescription.

Jeopardy Question #4) __________________________ variables answer the question "What do I keep the same?" A. Dependent B. Controlled C. Independent - ANSWER-B - Controlled Jeopardy Question #5) The mission of the BCDHA includes all of the following except:

1. Promote the professional growth of its members
2. Advocate for the profession of DH
3. Position the DH in alternative practice settings
4. Support its members in improving the health of the public through oral health promotion - ANSWER-3 - Position the DH in alternative practice settings Jeopardy Question #6) You have submitted your continuing competency credits to the college and they are asking you for further clarification on the hours claimed for a particular course. Which type of review is this? - ANSWER-CC Credit form review Jeopardy Question #7) True or False: Local anesthesia course is eligible for CC credit if required for full registration. - ANSWER-False Jeopardy Question #8) Define ethnocentrism. - ANSWER-The belief that one's culture is superior to all others. Leads to discrimination & ultimately loss of clients. Jeopardy Question #9) List 5 professional roles within the DH scope of practice - ANSWER-1. Clinician
5. Advocator
6. Administrator
7. Researcher
8. Educator Justice - ANSWER-• Relies on fairness and equality

• All clients should be treated equally, without discrimination
• Providing access to care for underprivileged Learned Society - ANSWER-o Focus is to promote research findings o Best and most important research papers o Learned society would contain the best research out of the 4 categories of sponsorship o Little to no advertising o Peer-reviewed o Expensive o Strong editorial board o Very Scientific

List 4 factors that must be considered when implementing evidence-based decision making in dental hygiene practice. - ANSWER-1. Scientific evidence

2. Experience and judgement
3. Clinical Patient circumstances
4. Patient Preferences or values List examples of professional misconduct. - ANSWER-1. Conduct that is relevant to suitability to practice
5. Committed acts founded by another regulatory body to be Professional Misconduct
6. Sexual misconduct
7. Breaches a term, condition or limitation of registration
8. Breach of Practice Standards or Code of Ethics
9. Practiced DH while impaired in some capacity
10. Discontinued required treatment of a client
11. Providing personal information without consent
12. Falsified records List some examples of Parental Attitude: Warning Signs of Abuse. - ANSWER-• Overly critical, belittling

• Lack of interest in dental treatment for the child
• Never available for consultation
• Extremely isolated families
• Provides inconsistent information regarding signs of trauma List the 4 Acts of Adult Guardianship. - ANSWER-1. Representation Agreement Act

2. Health Care (Consent) and Care Facility (Admission) Act;
3. Adult Guardianship Act;
4. Public Guardian and Trustee Act List the 4 Conceptual Models and briefly describe each one. - ANSWER-1. The Occupational Model: views the concept of dental hygiene actions as technically based
5. The Professional Model: views dental hygiene actions as knowledge based
6. The Collaborative Practice Model: assumes that dentists and dental hygienists work together as colleagues
7. The Human Needs Conceptual Model: defines dental hygiene actions in terms of the human needs theory List the 5 electoral districts of the board members in BC? How many board members are elected from which districts? - ANSWER-• 2 in Lower Mainland

• 1 in Kootenays
• I in Cariboo North
• 1 in Okanagan
• 1 Vancouver Island/Coast

List the 6 Cultural Competency Continuum (from lowest to highest). - ANSWER-1. Cultural Destructiveness

2. Cultural Incapacity
3. Cultural Blindness
4. Cultural Pre-competency
5. Cultural Competence
6. Cultural Proficiency List the 7 Characteristics of a True Profession. - ANSWER-1. Specialized body of knowledge & skill of great value to society
7. Intensive academic course of study
8. Standard of practice determined & regulated by the group
9. External recognition by society
10. Code of Ethics
11. Organized association
12. Service orientation List the 8 unmet human needs. - ANSWER-1. Protection from Health Risks: Premedication required, HBP uncontrolled, uncontrolled illness (anything that can risk a Medical Emergency)
13. Freedom from Stress: bad experiences in the past, anxiety, fear of treatment, fear of needles
14. Wholesome Facial Image: facial disfigurement, yellow teeth, wearing Dentures, facial changes with age (can affect self-worth)
15. Skin and Mucous Membrane Integrity of Head and Neck: periodontal disease, gingival disease (focus here is evidence of inflammation) intraoral/extraoral lesions caused by? E.g. Nutritional deficiencies, medications or poor OH?
16. Biologically Sound Dentition: anything to do with the dentition (lacking) condition. Broken restorations, ill-fitting partial dentures or crown and bridge, caries, calculus, plaque and extrinsic stain
17. Conceptualization and Problem Solving: Client lacks understanding of processes, this could be ADPIE or how caries occur, how disease occurs.....the clients level of knowledge of the subject is low
18. Freedom from Head and Neck Pain: pain during instrumentation (needs anesthetic), jaw pain (maybe has limited opening or TMJ issues...
19. Responsibility for Oral Health: If client has poor OSC, no dental exam within 2 years, poor parental supervision for child's OSC, client is performing inadequate OSC on a daily basis List the CDHA 8 Step Ethical Decision Making Model. - ANSWER-1. Identify the problem:

• Briefly summarize the problem
• Identify, the nature of the challenge or problem

2. Gather information:

• Gather information to make an informed decision
• including factual information, sequence of events; applicable policies, laws, and regulations and the views of stakeholders

3. Clarify the Problem:

• Clarify and elaborate on the problem, based on the additional information obtained

4. Identify Options:

• Identify the various options for action
• Brainstorm as many options as possible

5. Assess Options:

• Often the best decision is not the first one that comes to mind
• This step forces us to look at other possible solutions. Look at all angles

6. Choose a Course of Action:

• focus on ethical principles & support with values and concepts

7. Implement the Action:

• Implement one's decision as thoughtfully and sensitively as possible

8. Evaluate Outcomes:

• Assess the consequence of your decision and evaluate the outcomes.
• Evaluate the process used:
• Did things turn out a expected? Would you do the same thing again? What went right? What went wrong? List the CDHA Code of Ethics: 5 Principles - ANSWER-• Principle I: Beneficence - the principles of promoting what is kind, good and charitable
• Principle II: Autonomy - ability to be self-governing
• Principle III: Integrity - the quality of being honest and having strong moral principles
• Principle IV: Accountability - pertains to taking responsibility for one's actions
• Principle V: Confidentiality - the duty to hold secret any information acquired in the professional relationship List the CDHBC Code of Ethics: 12 statements - ANSWER-1. Hold paramount the health and welfare of those served professionally.

2. Provide competent and appropriate care to clients.
3. Practice the principle of confidentiality
4. Treat clients with respect for their individual needs and values.
5. Regard the clients' rights to control their own care.
6. Inform clients of the dental hygiene care available to them, clearly advise them of probable consequences of not following recommended action, but respect the client's right of informed choice.
7. Recognize the expertise and contribution of colleagues and other disciplines as essential to excellent client care.

8. Uphold the principle that the public should have fair and equitable access to dental hygiene services.
9. Maintain a high level of skill by participating in programs of continued study to update and advance their body of knowledge.
10. Report to their licensing body or other appropriate agencies any illegal or unethical professional decisions or practices by dental hygienists, or others.
11. Avoid a conflict of interest in carrying out professional duties, but where such conflict arises, fully disclose the circumstances without delay to the client or appropriate agency.
12. Represent the values and ethics of dental hygiene before others, and maintain the public trust in dental hygienists and their profession. List the Determinants of Health. - ANSWER-1. Income
13. Social support
14. Education and literacy
15. Employment and working conditions
16. Social environments
17. Physical environments
18. Personal health practices and coping skills
19. Healthy child development, biology and genetic endowment
20. Health services
21. Gender
22. Culture List the five aspects that must be considered when integrating cross-cultural dental hygiene into the process of care. - ANSWER-1. Social
23. Political
24. Ethnic
25. Religious
26. Economic List the four central concepts in the paradigm for the discipline of dental hygiene. - ANSWER-1. Client
27. Environment
28. Health/Oral health
29. Dental hygiene actions List the four Ethical Principles that govern Health Care. - ANSWER-· Autonomy · Beneficence · Nonmaleficence · Justice List the Intervention Techniques for RDH. - ANSWER-1. Assure clients of confidentiality to the extent allowed under the provincial's mandatory reporting laws. CDHBC handbook: code of ethics, interpretation guidelines and BC Adult guardianship act (part 3).

2. Listen to the client and sit down when talking to client.
3. Respond to client's feelings.
4. Acknowledge that disclosure is scary.
5. Assure client s/he did the right thing in telling you.
6. Provide clients with options and resources.
7. Document the information on the client's chart.
8. File mandatory reports.
9. Schedule a follow-up visit! List the Levels of Clinical Evidence from highest to lowest. - ANSWER-1. Meta-analysis systematic reviews
10. Randomized Controlled Trials
11. Cohort Studies
12. Case Reports
13. Ideas, Editorials and Opinions
14. Animal Research
15. In Vitro (test tube) research List the Possible Ethical Dilemmas. - ANSWER-1. Substandard care
16. Over treatment
17. Scope of practice
18. Fraud
19. Confidentiality
20. Impaired professional
21. Sexual harassment
22. Abuse List the Professional Traits for the Dental Hygienist. - ANSWER-1. Clinical Competence
23. Communication skills = foundation of trust, make sure the client is let to speak and make sure you listen and hear them
24. Ethical and legal understanding
25. Critical thinking ability = sound judgment for every client: technical, scientific, ethical dimensions
26. Honesty & Integrity = trust
27. Caring & Compassion = empathy
28. Reliability & Responsibility = performing services to the best standard of care, sound judgment, maintaining current knowledge, CE
29. Maturity & Self-Analysis = improving or changing skills when necessary
30. Respect For Self = maintain your own physical and mental health
31. Loyalty = protecting and promoting the interests of a person, group or organization. Promises made are carefully made and kept.
32. Tolerance For Others = treat all clients without discrimination List the RDH responsibilities for reporting abuse. - ANSWER-1. Observing and examining any suspicious evidence that can be ascertained in the office.

2. Recording any evidence that may be helpful in the case including physical evidence and any comments from questioning or interviewing.
3. Treating any dental or orofacial injuries within the treatment expertise and referring more extensive treatment needs to a hospital or dental/medical specialist.
4. Establishing/maintaining a professional therapeutic relationship with the client.
5. Be familiar with the perioral, extraoral and intraoral signs of Intimate Partner Violence (IPV) and Elder Abuse (EA) List the steps (in order) for the dental hygiene process of care. - ANSWER-1. Assessment
6. Diagnosis
7. Planning
8. Implementation
9. Evaluation List the three structures of the office of the CDHBC. - ANSWER-1. Board
10. Registrar/CEO
11. Staff List the values and concepts supporting the four Normative Ethical Principles. - ANSWER-• Veracity - truthfulness & honesty

• Fidelity - loyalty & faithfulness
• Confidentiality - critical aspect of trust
• Paternalism - closely related to the principles of nonmaleficence and beneficence
• Informed Consent - RDH provides the client with all relevant information needed to make a decision & allows the client to make the decision based on the information provided
• Societal Trust - Ethical duty to ensure public trust is maintained List the various registration categories. - ANSWER-1. Full Registration

2. Full Registration, 365 Day Exempt Status
3. Conditional Registration
4. Non-practicing Registration
5. Temporary Registration
6. Student Registration Margin of Error - ANSWER-as the sample size increases the margin of error decreases Meta-analysis and Systematic Reviews - ANSWER-o Systematic Reviews: assess quality of numerous RCTS that were answering specific clinical questions, limits bias and improves the reliability and accuracy o Meta- Analysis: a special form of systematic review. o A statistical analysis of a collections of SRs' from individual studies to provide an overall quantitative summary of the effect of interest.

Moral Dilemmas - ANSWER-Exists when obligations or responsibilities are in conflict Moral Distress - ANSWER-• Situations when RDH may be frustrated due to feeling powerless when a perceived wrong is occurring but is unable to act

• Leads to: distress, emotional toll, anger, guilt and depression Moral Uncertainty - ANSWER-• Defined as the question of whether a moral obligation exists and its scope
• E.g. An RDH dealing with a non-compliant perio client could raise issues of moral uncertainty Moral Weakness - ANSWER-• Moral responsibilities point in one direction and personal inclinations in another direction
• E.g. An RDH who foregoes providing a client with self care instruction because he/she would like to go to lunch early. Morals - ANSWER-a principle with respect to right or wrong behavior; acceptable standards of conduct Non-Practicing Registration - ANSWER-◦ For RDH's who do not wish to practice ◦ Meets requirements of Full Registration with the exception of:
• L.A., C.C., CPR, and Malpractice insurance ◦ May return to practising registration by completing all requirements Nonmaleficence - ANSWER-• "Do No Harm"
• An RDH seeks to never harm a client ~ minimizes unavoidable pain
• Prevent or remove harm
• As an example, being asked to perform a procedure on a client for which they are not qualified. Observational Study - ANSWER-The research ONLY observes the participants behaviors actions, or other exposures to disease related factors in relation to the presence of disease. Primary Literature - ANSWER-o resourced directly from its original source o original study or experiment o examples: original finding, current findings, or new experiments Principles - ANSWER-express the broad ideas to which dental hygienists aspire and guide them in their practice Professional Organization - ANSWER-o Peer Reviewed o Can have some bias compared to journals from a learned society due to the organization's views o Fair amount of advertising therefore there is a moderate bias o Wide distribution to members

o Expense: moderate Professional sexual misconduct - ANSWER-intentional or unintentional actions or comments of a sexual nature, or sexual innuendo, perceived by the client and made by a dental hygienist in the course of their professional work that a reasonable person would know are unwanted or would create discomfort Prospective Cohort Study - ANSWER-o Being followed over time to determine casualty o start with no disease or outcome.. to see if they get it and how Qualitative Study VS. Quantitative Study - ANSWER-Qualitative: used to DEVELOP hypothesis o ex. Who gets the disease and where and when does the disease occur? o narrative Quantitative: used to TEST hypotheseses o How many people get the disease? OR how much treatment (cause and effect) Quality Assurance Committee - ANSWER-responsible for CC, practice standards, code of ethics and other QA issues Randomized Control Trials - ANSWER-Best evidence as most can be controlled and causality can be determined Randomized Controlled Trial (RCT) - ANSWER-o experimental comparison study o Random assignment o 2 samples: control/placebo and treatment/ intervention Registrant - ANSWER-In respect of a designated health profession, a person who is granted registration as a member of its college. Registration Committee - ANSWER-responsible for all aspects of registration, including exams Reputable Scientific Publisher - ANSWER-o Rigorously peer reviewed o Similar to learned society in presenting the best and most important research papers Retrospective Cohort Study - ANSWER-o represents a historical group o subjects are classified according to exposure status during the past time frame the cohort existed and followed up to the present Risk - ANSWER-the probability that a specified event will occur Secondary Literature - ANSWER-o resourced from information that was documented somewhere else (eg a source referring to a primary resource)

o involves generalization, analysis, synthesis, interpretation or evaluation of the original info o examples: narrative reviews and systematic reviews Special Committee - ANSWER-may be appointed by the board as necessary for special projects or ongoing activities Standards - ANSWER-• provide more specific direction for conduct

• more precise and prescriptive than a principle Statistic Errors - ANSWER-o Type 1 Alpha error: the null hypothesis is rejected, when in fact it is actually true o Type 2 Beta error: the null hypothesis is NOT rejected, when in fact it is false Stereotyping - ANSWER-The erroneous assumption that a person possesses certain characteristics just because he or she is a member of a particular group. Temporary Registration - ANSWER-◦ For DH's from another jurisdiction to conduct or participate in an educational program approved by the Registration Committee. ◦ Example: Research Activity, Degree Completion Tertiary Literature - ANSWER-o combines both primary and secondary in their publications o information that tries to "sum" up what most believe or what most research has demonstrated o this type of information lacks current updated information o examples: encyclopedia and a textbook True or False - No action for damages may be brought against you for reporting information. - ANSWER-False - No action for damages may be brought against you for reporting information UNLESS:

1. You knowingly report false information.
2. The report was not made in good faith. True or False: As an RDH professional, you have an obligation by law to report suspected child abuse. - ANSWER-True - Report to the Ministry for Children and Families when he/she believes on reasonable grounds that a child is or may be in need of protection. The duty to report applies even if the information is privileged or confidential. True or false: Dental professionals are most likely of all clinicians to suspect and intervene in Intimate Partner Violence. - ANSWER-False - Dental professionals are the least likely of all clinicians to suspect and intervene in IPV.

• WHY?

1. Presence of a partner or a child in examination room.
2. Concerns about offending the client.
3. Embarrassment about bringing up the topic.

• This is unfortunate, as at least 60% of such cases involve injuries to the head and neck. True or False: Failing to promptly report suspected abuse or neglect to a child welfare worker is a serious offence under the Child, Family and Community Service Act. - ANSWER-True - Both offences carry a maximum penalty of $10,000 fine, six months in jail, or both. True or False: If permission from the parent of a child client is not appropriately obtained, the dental providers could be accused of technical assault or technical battery. - ANSWER-True True or False: It is the dentist's responsibility to ensure that the documentation of a dental hygienist's care meets these practice standard policies and that the legal criteria.
• ANSWER-False - It is the dental hygienist's own responsibility to ensure that the documentation of their own care meets these practice standard policies and that the legal criteria. True or False: The Jurisprudence Education Module (JEM) must be completed at some point during the 7 year cycle. - ANSWER-False - The Jurisprudence Education Module (JEM) must be completed at some point during the 5 year cycle. Utilitarian Ethics: (Consequentialist Ethics) - ANSWER-• John Stewart Mill, 19th century philosopher and economist
• Rightness or wrongness is produced by the act, not the act itself
• Considers all of the potential outcomes before making a decision
• An action should be judged on its ability to produce the greatest amount of good for the largest number of people
• Example: fluoridated community water Validity - ANSWER-actually measures what it says it measures Values - ANSWER-beliefs and attitudes; from family, friends, peers, professional expectations, customs, life events Variables - ANSWER-is something that is measured or observed Virtue Ethics - ANSWER-• Advocated by Aristotle and Plato
• Emphasis is on excellence of character
• Focuses on the person....not the action
• Individuals make choices based on virtue & character

What are 3 (Moral) Models of Professionalism and which model does dental hygiene practice follow to deliver care? - ANSWER-1. Commercial Model

2. Guild Model
3. Interactive Model: Dental Hygiene practice follows this one What are 5 roles a professional dental hygienist can perform? - ANSWER-1. Clinician
4. Administrator
5. Advocator
6. Researcher
7. Educator What are some roles a dental hygienist could do in order to alleviate disparities and develop effective oral healthcare systems? - ANSWER-1. Volunteer at dental health fairs
8. Educate clients regarding the importance of public programs and practitioners
9. Support research on oral health disparities
10. Advocate for increased scope of practice regulations that would allow dental hygienists to provide more care to the underserved, in a variety of settings.
11. Collaborating among many stakeholders and advocating the need for increased access to oral-health care. What are the application of the principles of Professionalism? - ANSWER-1. Excellence
12. Humanism
13. Accountability 4.Altruism What are the Current CC requirements for the different types of registrants? - ANSWER-• New Registrants: five-year cycle begins January 1st of the year FOLLOWING their registration

• Full/Conditional: five-year cycle is January 1st to December 31st for renewal by March 1st
• Non-Practicing: not required unless converting to a practicing class
• Full-time students: CC cycle waived and new cycle will begin January 1st of the year FOLLOWING completion of program What are the Four A's for addressing moral distress? - ANSWER-1. Ask - Become aware of the problem. Is this affecting you emotionally?

2. Affirm - Commit to taking care of yourself. Affirm the professional obligation to act
3. Assess - Identify sources of distress and determine severity. Analyze risks and benefits
4. Act - Prepare personally and professionally to take action

What are the objectives of QAP? - ANSWER-• Establish and maintain a QAP to promote high practice standards among registrants

• Establish, monitor and enforce standards of practice to enhance the quality of practice and reduce incompetent, impaired or unethical practice among registrants
• Establish, monitor and enforce standards of professional ethics among registrants
• Promote and enhance the ability of registrants to respond and adapt to changes in practice environments, advances in technology and other emerging issues What are the three categories of Ethical Challenges? - ANSWER-1. Ethical violations:
• Fail to meet or neglect specific ethical responsibilities - Ex: recommends unnecessary tx to achieve personal gain

2. Ethical dilemmas:

• One or more ethical principles conflict with another ethical principle(s) and no obvious action will satisfy both sides
• Ex: client who refuses ore-medication prior to invasive dental tx when they need it - autonomy conflicts with beneficence

3. Ethical distress"

• RDH experiences constraints or limitations where they feel powerless and compromise their ability to practice in accordance with standards
• Ex: RDH who's boss expects them to complete tx in an amount of time that is not long enough to provide quality care or acceptable levels of infection control What are the three main ethical theories? - ANSWER-• Consequentialist
• Nonconsequentialist
• Virtue ethics What are the three most common Ethical Issues in Clinical Practice? - ANSWER-1. Observation of behavior in conflict with standard infection control procedures

2. Failure to refer clients to a specialist
3. Non-diagnosis of dental disease What are the types of consent? - ANSWER-Expressed consent: client verbally agrees to procedures or nods their head Written: client signs a statement authorizing the procedure; RDH must document that consent was given What are the types of sampling? - ANSWER-● Random: everyone has an equal chance = best* most external/internal validity

● Stratified: subdivisions of a population with similar characteristics ● Systematic: including every 9th person, not a true random sample - biased ● Purposive/Judgmental: chosen on personal judgement that the subject would be most representative of the population - biased ● Convenience: subject that are most readily available - biased What are the warning signs of abuse? - ANSWER-Behavioural:

• Withdrawal
• Inappropriate behaviour for a child
• Act differently in the presence of the parent
• Social development delays Overall Appearance:
• Malnutrition
• Poor hygiene What are two ways that a dental hygienist could advocate at a political level? - ANSWER-1. Engage your elected official by writing a letter

2. Meet with politicians What does CONSORT stand for, what is its goal? - ANSWER-o Consolidated standards of Reporting Trials o Provides Evidence based, minimum set of recommendation for reporting random controlled test o GOAL: to achieve homogeneity in reporting o Consort Format for RCTs
3. Title and abstract
4. Introduction
5. Methods
6. Results
7. Discussion
8. "Other info" What does EBD stand for? - ANSWER-Evidence Based Dentistry usually triggered by client experiences which generate questions about: o effects of therapy o utility of diagnostic tests o prognosis of diseases o Aetiology of disorders What does PICO stand for? - ANSWER-Patient, Intervention, Comparison, Outcome What is our RDH scope of practice broadly defined as? - ANSWER-Subject to the bylaws, a registrant may assess the status of teeth and adjacent tissues & provide preventative & therapeutic dental hygiene care for teeth and adjacent tissues.