Atlas · Plate XVIII · Clinical Services
Ethics and Professional Responsibility
Professional responsibility covers the ethical and legal side of practice: the principles behind the ADHA Code of Ethics, informed consent and accurate records, patient privacy under HIPAA, the state practice act that sets a hygienist's scope and supervision, liability for negligence, and the duty to report suspected abuse.
These rules show up in ordinary moments, from a patient who declines treatment to a chart entry that needs correcting. On the NBDHE they are tested through short scenarios in which you name the principle at stake, the type of consent, the element of negligence or the correct legal step, and the revised exam adds documentation and risk management.
Blueprint Provision of Clinical Dental Hygiene Services · Professional responsibility · 40 facts
In this plate, we cover
01 · 7 facts
Ethical principles
Core principles include autonomy (the patient's right to decide), beneficence (doing good), nonmaleficence (doing no harm), justice, veracity and confidentiality. Deciding for a competent patient for their own good is paternalism and violates autonomy. A true dilemma has two defensible choices, and a decision model walks from defining the problem to acting and evaluating.
- Autonomy: the patient's right to decide (self-determination); informed consent follows from it.S55
- Beneficence: do good; nonmaleficence: do no harm.S55
- Justice: fair distribution of care and resources.S55
- Veracity: truthfulness; fidelity: keeping promises; confidentiality: protecting patient information.S55
02 · 8 facts
Consent and records
Informed consent means explaining the condition, the proposed treatment, its risks, benefits and alternatives, and what happens without treatment. Opening the mouth is implied consent, and a refusal must be documented with the risks explained. Minors need a parent or guardian. Fix chart errors with a single line, the date and initials, never erasing or altering.
- Informed consent elements: the condition, the proposed treatment, its risks, benefits, alternatives (including no treatment) and the prognosis without treatment.T2
- Implied consent: actions show agreement (e.g., opening the mouth); express consent is stated orally or in writing.T2
- Informed refusal must be documented, including the risks explained.T2
- Consent for minors comes from a parent or legal guardian, except for emancipated minors or where state law allows.T2
03 · 6 facts
HIPAA and confidentiality
HIPAA protects identifiable health information. Offices give a Notice of Privacy Practices, use the minimum necessary information, and may share it for treatment, payment and operations without separate authorization. Patients can get copies of their records, generally within 30 days, and a breach must be reported to them within 60 days of discovery.
- HIPAA Privacy Rule compliance began in 2003; it protects individually identifiable protected health information (PHI).S56
- Covered entities must give a Notice of Privacy Practices and use the minimum necessary information.S56
- PHI can be shared for treatment, payment and health care operations without separate authorization.S56
- Patients have the right to see and get a copy of their records, generally within 30 days of a request.S56
04 · 8 facts
Law and liability
Malpractice requires four elements: duty, breach of duty, direct cause and damages. Treating without consent is battery, ending care without notice or a referral is abandonment, and under respondeat superior the employer answers for employees' acts. The standard of care is what a reasonably prudent, similarly trained practitioner would do in the same situation.
- Malpractice (professional negligence) needs 4 elements: duty, breach of duty (dereliction), direct cause, damages.T2
- Battery is touching or treating without consent; assault is making a person fear harmful contact.T2
- Respondeat superior: the employer is liable for the acts of employees within the scope of employment.T2
- Res ipsa loquitur: "the thing speaks for itself" (e.g., an instrument left in a wound).T2
05 · 7 facts
Licensure and practice acts
Each state's dental practice act defines what hygienists may do and under what supervision, and the state board enforces it. Supervision ranges from general (the dentist need not be present) to indirect, direct and personal. Licensure usually requires a CODA-accredited program, the NBDHE, a clinical exam and a jurisprudence exam, with continuing education to renew.
- Each state's dental practice act defines hygiene scope and supervision; the state board of dentistry enforces it.T2
- Supervision levels: general (dentist authorizes, need not be present), indirect (dentist in the office), direct (dentist in the office and checks the work), personal (dentist working on the same patient).T2
- Many states allow some form of direct access, where hygienists can start treatment without a prior dentist exam.T2
- Licensure usually requires an accredited (CODA) education, the NBDHE, a clinical exam and a state jurisprudence exam.S1
06 · 4 facts
Reporting and the workplace
Dental professionals must report suspected child abuse and neglect in every state, and many states add elder abuse; suspicion is enough and proof is not required. Warning signs include injuries in different stages of healing, bruises on the face or neck and explanations that do not fit. Workplace harassment includes quid pro quo and hostile work environment.
- Dental professionals are mandated reporters of suspected child abuse and neglect in every state; report suspicion, not proof.T2
- Many states also mandate reporting of elder or vulnerable-adult abuse.T2
- Signs of abuse: injuries in different healing stages, bruises on the face or neck, torn labial frenum in an infant, explanations that do not fit the injury.T2
- Sexual harassment types: quid pro quo (job benefits for sexual favors) and hostile work environment.T2