Professional Issues
OBJECTIVES
After studying this chapter, the student will be able to:
1. List the criteria of a profession and explain how the profession of imaging technology has evolved to meet these criteria.
2. List the members of the health care team with whom the radiographer may frequently interact and briefly describe the role of each.
3. Discuss the purpose of professional organizations and explain why the radiographer should join the professional organizations in his field.
4. Explain Practice of Standards and professional growth in radiologic technology.
5. Define ethics and discuss ethics as it applies to radiologic technology.
6. Explain the legal obligations that the radiographer has toward patients, peers, and other members of the health care team.
7. Define the terms respondeat superior, res ips loquitur.
8. Define the Patient Care Partnership, and A Patient’s Bill of Rights.
9. Explain the ethical and legal aspects of patients regarding confidentiality and informed consent.
10. Describe the legal responsibilities of the radiographer regarding patient identification, immobilization, and manipulation of electronic data.
11. Explain the need for professional malpractice insurance.
12. Describe the patient’s need for confidentiality and the legal implications for the radiographer.
13. Explain the need for accurate documentation in health care and the radiographer’s obligations in this aspect of health care.
14. List and define the current methods of health care delivery in the United States.
KEY TERMS
Adhere: To stay fixed or firm
Bias: An inclination or temperament based on personal judgment; prejudice
Bioethics: Moral issues dealing with the ethical issues of human life, health care, and death
Common law: Decisions and opinions of courts that are based on local customs and habits of an area within a particular country or state
Continuing education (CE): Professional education received following completion of a training program to maintain skills
Defaming: To attack or injure a person’s reputation
Diagnostic imaging: Modern term for radiography, encompassing all specialties devoted to producing an image of a body part
Ethical: Conforming to the standards of conduct of a given profession or group
Holistic: The view that an organic or integrated whole has a reality independent of and greater than the sum of its parts
Immobilization device: A piece of equipment that ensures restricting patient movement
In-service: Training given to employees in connection with their work or profession to update or maintain knowledge
Liability: Something that a person is obligated to do or an obligation required to be fulfilled by law; usually an obligation of financial nature
Malpractice: Professional negligence that is the cause of injury or harm to a patient
Mentor: A teacher, coach, or advisor of conduct
Practitioner: Any individual practicing in a specific area or discipline
Preceptor: A teacher; directs action or conduct of another individual (a supervisory individual while involved in “on-the-job training”)
Profession: A calling that requires specialized knowledge and intensive academic preparation
Radiographer: A radiologic technologist who uses critical thinking, problem solving, and judgment to perform diagnostic images
Regulatory compliance: Control of a situation or group of laws that supervise a profession
Statutory law: Established law that is enacted by a legislative body and punishable by the court system
Therapeutic: Healing or palliative
Unethical: Not conforming to the standards of conduct of a particular profession or group
A profession is defined as a body of work that meets specific criteria and characteristics. Any profession can be said to
contain a unique body of knowledge;
have relevance to social values;
require long specialized education;
be motivated to serve the needs of the community versus the needs of oneself;
be organized into associations that help guide the profession;
have set performance standards;
maintain a level of public trust and confidence; and
be made up of people who are motivated by a strong service desire and commitment to competence.
Radiologic technology has evolved to meet the criteria of a profession. As in all professions, radiographers are expected to adhere in conduct and behavior to the particular ethical and legal standards of the field. Any persons who do not adhere to this code may lose their license as well as the privileges of the profession.
As a radiographer, one will not work alone in caring for the patient. One will work and interact with members of a health care team whose goal is to improve or restore the patient to good health. The health care team consists of physicians, nurses, therapists, social workers, and others, all of who work within their scope of practice and are accountable for performing their professional responsibilities.
Students who have made the decision to enter the profession of radiologic technology need to understand that they are making the commitment to accept the code of ethics of this profession and must work within the scope of practice. They must also understand they are accountable for how they perform as a radiographer and may be held legally liable for any errors made while caring for patients.
Radiologic technology is a profession oriented toward the diagnosis and treatment of trauma and disease. This means the radiologic technologist (radiographer) will work in intimate contact with people on a daily basis. A technologist must be prepared to work collaboratively with people of all cultures, religions, and socioeconomic backgrounds and to relate to them in an unbiased, nonjudgmental manner.
Anyone contemplating a career in radiologic technology needs to examine the reasons why this profession was chosen. It would be helpful to ask oneself the following questions before proceeding:
“Am I prepared to accept and practice the profession of radiologic technology and support the American Registry of Radiologic Technologists (ARRT) and American Society of Radiologic Technologist (ASRT) Standards of Ethics?”
“Am I prepared to avoid violations of the law in practicing this profession?”
“Will I be willing and able to learn to relate to my patients in a professional and nonjudgmental manner at all times?”
If these questions cannot be answered positively, this career choice should be reconsidered.
CRITERIA FOR A PROFESSION
Radiologic technology has evolved from an undereducated workforce of x-ray technicians in the early 1900s to the continued advances as a profession in the 21st century (Display 2-1). This progression took place over decades with the efforts and dedication of the persons who worked in this field. These dedicated people, known as practitioners, are united by criteria that identify them as a profession. These criteria were summarized by Chitty (2005) as the following:
1. A vital human service is provided to the society by the profession.
2. Professions possess a special body of knowledge that is continuously enlarged through research.
3. Practitioners are expected to be accountable and responsible.
DISPLAY 2-1 Chronology of Events in the History of the Radiologic Technology Profession
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4. The education of professionals takes place in institutions for higher education.
5. Practitioners have an independent function and control their own practice.
6. Professionals are committed to their work and are motivated by doing well.
7. A code of ethics guides professional decisions and conduct.
8. A professional organization oversees and supports standards of practice.
All professions have a code of ethics and professional organizations that control the educational and practice requirements of its members. The two organizations that assume these roles for radiographers are the ASRT and the ARRT. If applicable, the professional radiographer is registered by ARRT and by state licensure or certification.
Radiologic technology fulfills the basic requirements of a profession and is becoming increasingly autonomous in professional practice. The status of a profession demands certain responsibilities and educational requirements that former “x-ray technicians” did not possess. An individual contemplating radiologic technology as a profession must examine the criteria of a profession listed above to make certain that there is a willingness to uphold the high standards of a professional. These standards include responsibility, accountability, competence, judgment, ethics, professionalism, and lifelong learning. The professional radiographer is expected to demonstrate all these qualities.
DISPLAY 2-2 American Society of Radiologic Technologist—Radiography Practice Standards—June 25, 2017
Radiographer—General Requirements
Radiographers must demonstrate an understanding of human anatomy, physiology, pathology, and medical terminology.
Radiographers must maintain a high degree of accuracy in radiographic positioning and exposure technique. They must possess, apply and maintain knowledge of radiation protection and safety. Radiographers independently perform or assist the licensed practitioner in the completion of radiographic procedures. Radiographers prepare, administer, and document activities related to medications in accordance with state and federal regulations or lawful institutional policy.
Radiographers are the primary liaison between patients, licensed independent practitioners, and other members of the support team. Radiographers must remain sensitive to the needs of the patient through good communication, patient assessment, patient monitoring, and patient care skills. As members of the health care team, radiographers participate in quality improvement possesses and continually assess their professional performance.
Radiographers think critically and use independent, professional, ethical judgment in all aspects of their work. Radiographers engage in continuing education to include their area of practice to to enhance patient care, public education, and technical competence.
Radiographer Scope of Practice
The scope of practice of the medical imaging and radiation therapy professional includes:
Providing optimal patient care.
Receiving, relaying and documenting verbal, written and electronic orders in the patient’s medical record.
Corroborating a patient’s clinical history with procedure and ensuring information is documented and available for use by a licensed practitioner.
Verifying informed consent for applicable procedures.
Assuming responsibility for patient needs during procedures.
Preparing patients for procedures.
Applying principles of ALARA to minimize exposure to patient, self and others.
Performing venipuncture as prescribed by a licensed practitioner.
Starting, maintaining and/or removing intravenous access as prescribed by a licensed practitioner.
Identifying, preparing and/or administering medications as prescribed by a licensed practitioner.
Evaluating images for technical quality, ensuring proper identification is recorded.
Identifying and responding to emergency situations.
Providing education.
Educating and monitoring students and other health care providers.
Performing ongoing quality assurance activities.
Applying the principles of patient safety during all aspects of patient care.
The scope of practice of the radiographer also includes:
Performing diagnostic radiographic and noninterpretive fluoroscopic procedures as prescribed by a licensed practitioner.
Optimizing technical exposure factors in accordance with the principles of ALARA.
Assisting the licensed practitioner with fluoroscopic and specialized radiologic procedures.
Radiography Clinical Performance Standards
The clinical performance standards define the activities of the individual responsible for the care of patients and delivery of diagnostic or therapeutic procedures. This section incorporates patient assessment and management with procedural analysis, performance and evaluation.
Standard One—Assessment: The radiographer collects pertinent data about the patient the procedure.
Standard Two—Analysis/Determination: The radiographer analyzes the information obtained during the assessment phase and develops an action plan for completing the procedure.
Standard Three—Education: The radiographer provides information about the procedure and related health issues according to protocol. Standard Four—Performance: The radiographer performs the action plan.
Standard Five—Evaluation: The radiographer determines whether the goals of the action plan have been achieved.
Standard Six—Implementation: The radiographer implements the revised action plan.
Standard Seven—Outcomes Measurement: The radiographer reviews and evaluates the outcome of the procedure.
Standard Eight—Documentation: The radiographer documents information about patient care, the procedure, and the final outcome.
Quality Performance Standards
The quality performance standards define the activities of the individual in the technical areas of performance such as equipment and material assessment, safety standards, and total quality management.
Standard One—Assessment: The radiographer collects pertinent information regarding equipment, the procedures, and the work environment.
Standard Two—Analysis/Determination: The radiographer analyzes information collected during the assessment phase to determine the need for equipment, procedures, or the work environment.
Standard Three—Education: The radiographer informs the patient public, and other health care providers about procedures, equipment, and facilities.
Standard Four—Performance: The radiographer performs quality assurance activities.
Standard Five—Evaluation: The radiographer qualifies assurance results and establishes an appropriate action plan.
Standard Six—Implementation: The radiographer implements the quality assurance action plan for equipment, materials, and processes.
Standard Seven—Outcomes Measurement: The radiographer assesses the outcome of the quality management action plan for equipment, materials, and processes.
Standard Eight—Documentation: The radiographer documents quality assurance activities and results.
Radiography Professional Performance Standards
The professional performance standards define the activities of the individual in the areas of education, interpersonal relationships, self-assessment and ethical behavior.
Standard One—Quality: The radiographer strives to provide optimal patient care.
Standard Two—Self-assessment: The radiographer evaluates personal performance.
Standard Three—Education: The radiographer acquires and maintains current knowledge in clinical practice.
Standard Four—Collaboration and Collegiality: The radiographer promotes a positive and collaborative practice atmosphere with other members of the health care team.
Standard Five—Ethics: The radiographer adheres to the profession’s accepted ethical standards.
Standard Six—Research and Innovation: The radiographer participates in the acquisition, dissemination of knowledge, and the advancement of the profession.
PRACTICE STANDARDS AND PROFESSIONAL GROWTH IN RADIOGRAPHY
The ASRT Practice Standards for Medical Imaging and Radiation Therapy is a guide for the appropriate practice, assists in developing job descriptions, and promotes role definition for practitioners. The Practice Standards define the practice and establish general criteria to determine compliance (Display 2-2). Practice Standards are authoritative statements established by the profession for judging the quality of practice, service, and education. It includes expected and achievable levels of performance against which actual performance can be assessed. Radiographers are the primary liaison between patients, licensed independent practitioners, and other members of the health care team. Radiographers must remain sensitive to the
physical and emotional needs of the patient through effective communication, patient assessment, monitoring, education, documentation, and patient safety and care skills. Radiographers use independent, professional, ethical judgment and critical thinking. Quality improvement and customer service allow the radiographer to be a responsible member of the health care team by continually assessing professional performance (ASRT, 2016). Radiographers engage in continuing education (CE) to enhance patient care, public education, knowledge, and technical competence while embracing lifelong learning. In addition, the radiographer must include professional values in effective oral and written communication skills, critical thinking and problem-solving skills, and a broad knowledge base in developing technology.
physical and emotional needs of the patient through effective communication, patient assessment, monitoring, education, documentation, and patient safety and care skills. Radiographers use independent, professional, ethical judgment and critical thinking. Quality improvement and customer service allow the radiographer to be a responsible member of the health care team by continually assessing professional performance (ASRT, 2016). Radiographers engage in continuing education (CE) to enhance patient care, public education, knowledge, and technical competence while embracing lifelong learning. In addition, the radiographer must include professional values in effective oral and written communication skills, critical thinking and problem-solving skills, and a broad knowledge base in developing technology.
The preparatory education for the radiographer has evolved from a hospital-based preceptor training to formal educational programs. Hospital-based programs, as well as college- or university-based programs of study, are now available. To become a registered radiographer, one must successfully complete an accredited educational program.
Programmatic accreditation by the Joint Review Committee on Education in Radiologic Technology (JRCERT) ensures that the program will provide the knowledge and skills for quality patient care in compliance with the JRCERT accreditation standards. Currently, approved and accredited programs operate under six standards, effective January 1, 2014. Included in the six standards are 53 objectives that educational programs must clearly present documentation ensuring compliance. The initial accreditation process for a program takes about 18 to 21 months from the receipt of the application/self-study reports. The accreditation process has several steps, which include a site visit, report of team findings, response to report of findings, and program notification of accreditation. Initial accreditation is for 3 years. Eight years is the maximum number of years awarded to established programs; thereafter, accredited programs provide
periodic self-studies and interim reports. Site visits of the educational programs are conducted by JRCERT.
periodic self-studies and interim reports. Site visits of the educational programs are conducted by JRCERT.
The formal educational programs include the didactic and clinical competency requirements. Two-year certificate, associate degree, and 4-year baccalaureate degree programs are available in the United States. Upon successful completion of a recognized, accredited formal educational program in radiologic technology, candidates are eligible to participate in the ARRT national certification examinations.
Radiography program curriculum includes an extensive set of courses for the production of diagnostic images for interpretation by a radiologist. The course work includes anatomy, patient positioning, exposure techniques, equipment protocols, radiation safety, radiation protection, and basic patient care. Entry-level radiographer’s general requirements include the following skills and abilities:
1. Apply modern principles of radiation exposure, radiation physics, radiation protection, and radiobiology to produce diagnostic images.
2. Demonstrate knowledge of medical terminology, pathology, anatomy (cross-sectional and topographic), and physiology.
3. Maintain a high degree of accuracy in radiographic positioning.
4. Provide direct patient care.
5. Evaluate recognized equipment malfunctions.
6. Evaluate radiographic images.
7. Correctly document as required.
8. Effectively communicate with other members of the health care team.
9. Provide patient and family education.
10. Demonstrate knowledge of the use of contrast media and drug administration.
In addition, the entry-level radiographer must possess the following qualities: an ability to think in a critical manner; a willingness to participate in lifelong learning (including becoming an active member of professional organizations); ethical behavior (from a holistic caregiver perspective); a broad computer knowledge base; problem-solving skills; and the ability to communicate effectively orally and in writing.
As one becomes more experienced, the radiographer will possess all of the qualities and abilities listed above. With continued experience and training, radiographers may also obtain the abilities to
supervise, evaluate, and counsel staff;
plan, organize, and administer professional development activities;
utilize superior decision-making and problem-solving skills to assess situations and identify solutions for standard outcomes;
promote a positive, collaborative atmosphere in all aspects of radiography;
act as a mentor; and
provide knowledge in areas of in-service and/or CE, and regulatory compliance.
The knowledge to become a competent and independent radiographer is gained as the student nears the end of the educational process. Another guide is available to help the radiographer determine what is professional and what should be done in the work force. This document is called the ASRT Radiographer Scope of Practice (Display 2-3). It is closely related to the Standards of Practice. If there is any question as to the course of action that a radiographer should take, this document is a good guide.
As a health care professional, one must acquire and maintain current knowledge to preserve a high level of expertise. CE will provide educational activities to enhance knowledge, skills, performance, and awareness of changes and advances in the field of radiologic technology. CE supports professionalism, which fosters quality patient care.
Previously voluntary for radiographers, CE became a mandate in 1995 for all who are licensed by ARRT. The radiologic technologist is required to earn 24 CE credits. These credits must be accepted by ARRT and are to be earned every 2 years. The licensing body must verify these credits before license renewal. CE credits, such as seminars, conferences, lectures, departmental in-service education, directed readings, home study, and college courses, may be achieved by participating in educational activities that meet the criteria set forth by ARRT and approved by the ASRT. By participating in CE activities, professional knowledge and professional performance are enhanced, which ensures a higher standard of patient safety and care. Twenty-four credits may also be earned by taking an entry-level examination in another eligible discipline that was not previously passed. The entry-level examinations are in radiography, nuclear medicine, or radiation therapy. Another way to earn 24 credits is by passing an advanced-level examination in the field after proving eligibility. The advanced-level examinations are in mammography, cardiovascular-interventional technology, magnetic resonance, computed tomography, quality management, bone densitometry, and sonography.
In January 2018, the ARRT implemented the Continuing Qualification Requirements (CQR) for all technologists that were certified in 2011 and after. The ARRT stresses that this is not a test but a structured self assessment that evaluates the abilities and knowledge of the radiographer based on the examination content of that current year.
The candidate has three years to complete the requirements. While the continuing education requirements remain, most of the prescribed CQR until will serve as the required biennium CE.
DISPLAY 2-3 ASRT Radiographer Scope of Practice: Clinical Scope of Practice (Revised September 2017)
Obtains relevant information from all available resources and the release of information as needed.
Verifies patient identification and the procedure requested or prescribed.
Verifies that the patient has consented to the procedure.
Reviews all available patient medical record information to verify the appropriateness of the procedure requested or prescribed.
Verifies the patient’s pregnancy status.
Assesses factors that may negatively affect the procedure, such as medications, patient history, insufficient patient preparation, or artifact-producing objects.
Recognizes signs and symptoms of an emergency.
Selects the most appropriate and efficient action plan after reviewing all pertinent data and assessing the patient’s abilities and condition.
Employs professional judgment to adapt imaging and therapeutic procedures to improve diagnostic quality and therapeutic outcomes.
Consults appropriate medical personnel to determine a modified action plan.
Determines the need for and selects supplies, accessory equipment, shielding, positioning, and immobilization devices.
Determines the course of action for an emergent situation.
Determines that all procedural requirements are in place to achieve a quality diagnostic or therapeutic procedure.
Provides an accurate explanation and instructions at an appropriate time and at a level the patient and their care providers can understand. Addresses questions and concerns regarding the procedure.
Refers questions about diagnosis, treatment, or prognosis to a licensed independent practitioner.
Provides patient education.
Explains effects and potential side effects of medications.
PROFESSIONAL ORGANIZATIONS IN RADIOLOGIC TECHNOLOGY
Participation in professional organizations is the responsibility of all practicing professionals, regardless of their field. Membership in professional organizations provides a pathway to continued successful professional development. It also provides comprehensive opportunities to remain current in a constantly changing technologic career. Professional organizations provide pathways for technical growth and the development of leadership skills as well as an arena for professional interaction and problem solving, especially in career issues. The mission statement for ASRT is “to advance the medical imaging and radiation therapy profession and to enhance the quality of patient care.” ASRT offers many program and member services, including CE opportunities, publications, career information and resources, events, meeting, conferences and seminars, government relations and legislative monitoring and advocacy, group professional liability insurance, and other member benefits and services. In addition, ASRT works with professional certification bodies and accreditation agencies for radiographers. Ultimately, membership in professional organizations enables the radiographer to continue providing quality patient health care in accordance with the standards of the profession.
The radiographer must understand that there are professional societies, certification and licensing boards, and accreditation organizations. The differences might seem obscure; however, it is important to know the difference if one is to be a professional. As an example, a radiographer cannot “belong” to the ARRT because it is not a society, but rather it is the certification board that determines if an individual is qualified to practice the profession of radiography. The different organizations and certification boards are listed below. Although this is not an exhaustive list, it will give the student radiographer an idea of the many different acronyms that one will hear while involved in the field.
American College of Radiology (ACR) is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States.
American Hospital of Radiology Administrators (AHRA) is the professional organization representing management at all levels of hospital imaging.
American Medical Association (AMA) is a voluntary association of physicians, which sets standards for the medical profession and advocates on behalf of the physician and the patient.
American Registry of Diagnostic Medical Sonographers (ARDMS) is an independent organization that administers examinations and awards to qualified ultrasound professionals.
American Registry of Radiologic Technologists (ARRT) is the largest credentialing organization that seeks to ensure the highest quality patient care in radiologic technology.
American Society of Radiologic Technologists (ASRT) is the professional organization for radiologic science professionals.
Association of Collegiate Educators in Radiologic Technology (ACERT) is a society in which membership is voluntary (like the ASRT). This organization was founded to improve the quality of education in radiologic technology. It is one of several societies that have a focus on education. The annual conference normally has three educational tracks: one for the didactic educator, one for the clinical educator, and one for the student radiographer.
Association of Educators in Imaging and Radiologic Sciences (AEIRS) is another society that was founded to meet the needs of the educator.
International Society of Radiology (ISR) is a voluntary society with the mission to facilitate the global endeavors of the member organizations to improve patient care and population health through medical imaging. Joint Commission (aka the Commission [TJC]) accredits and certifies health care organizations and institutions in the United States.
JRCERT is the accrediting board that recognizes the quality of education in radiology. Students graduating from a JRCERT-approved program will be allowed to sit for the qualifying certification exam.
Nuclear Medicine Technology Certification Board (NMTCB) is a certification board that was formed for the purpose of creating and maintaining examinations in nuclear medicine. Once an individual successfully completes this examination, he or she will be given the right to have the initials NMT (nuclear medicine technologist) after his or her name.
THE HEALTH CARE TEAM
The radiographer will interact on a daily basis with peers in diagnostic imaging and with other members of the health care team. The list that follows is not exhaustive but will give the student a short list of some of the individuals that will be part of daily interactions (Display 2-4).
PROFESSIONAL ETHICS
Ethics may be defined as a set of moral principles that govern one’s course of action. Moral principles are a set of standards that establish what is right or good. All individuals have a personal code of ethics that evolves on the basis of their cultural and environmental background—the same background that has taught us to place values on behaviors, as well as on objects in our environment, that is, to assign a judgment of either good or bad to an action, behavior, or object.
Ethics is a combination of the attributes of honesty, integrity, fairness, caring, respect, fidelity, citizenship, competence, and accountability. The terms “ethics,” “principles,” and “values” are closely linked and may be used interchangeably from time to time.
Bioethics is a branch of ethics that was established because of the advanced technical methods of prolonging life. Bioethics blends philosophy, law, history, and theology with medicine. When coined in 1971, it referred to biology and bioscience with knowledge. Now, it refers to much more complex and controversial choices that range from difficult decisions to prolong life or honor a “do not resuscitate” order, to stem cell research. An individual in the field of radiology may not be called upon to act upon these “bioethical decisions” that are found in health care; however, the radiographer’s exposure to these ideas in the medical field may influence one’s own beliefs and ethics.
The student entering the profession of radiologic technology brings a personal code of ethics, moral principles, and personal values. All professionals have a set of professional values, and all professionals have a set of ethical principles or a code of ethics that governs professional behavior. This is true of radiologic technology.
The Standard of Ethics is made up of two parts: the Code of Ethics and the Rules of Ethics. The Code of Ethics was developed, revised, and adopted by ASRT and ARRT on September 1, 2017. It serves as a guide in maintaining ethical conduct in all aspects of the radiologic sciences. Considered to be mandatory and enforced by ARRT, the 20 Rules of Ethics are designed to promote protection, safety, and comfort of the patient (Display 2-5).
Together, these documents represent the application of moral principles and moral values to the practice of the profession and are considered to be the minimum acceptable
standards of conduct. They are concerned with the duties and responsibilities that the radiographer must have toward self, patients, and professional peers and associates. These responsibilities deal with rights and correlated responsibilities and are discussed in the following section.
standards of conduct. They are concerned with the duties and responsibilities that the radiographer must have toward self, patients, and professional peers and associates. These responsibilities deal with rights and correlated responsibilities and are discussed in the following section.
DISPLAY 2-4 The Health Care Team
Members of other health care professions with whom the radiographer will interact are:
Physicians: A doctor of medicine or osteopathy. They often specialize in a specific area of practice and, following licensing, are able to prescribe and supervise the medical care of the patient.
Registered nurses: Provide patient care, which is often required 24 hours a day. They also provide home health care and case management, educate, act as a patient advocate, administer medications and treatments as ordered by physicians, monitor the patient’s health status, and coordinate and facilitate all patient care when the patient is hospitalized. Advance practice nurses work as clinical nurse specialists and nurse practitioners.
Vocational nurses: Work with patients under the supervision of a registered nurse. The training is the same for these licenses. The term “vocational” nursing is used in the states of Texas and California, whereas the term “practical” nursing is used in the rest of the United States.
Occupational and physical therapists: Members of a profession who work in the rehabilitative area of health care.
Pharmacist: Prepares and dispenses medications and oversees the patient’s drug therapy.
Respiratory therapist: Maintains or improves the patient’s respiratory status.
Laboratory technologist: Analyzes laboratory specimens for pathologic conditions.
Social workers: Counsel patients and refer them for assistance to appropriate agencies.
There are also many unlicensed assistive personnel including nursing assistants, ward clerks, pharmacy technicians, ECG technicians, and many more.
Unfortunately, as the world of health care becomes increasingly complex and the ability to prolong life expands, there are more difficult choices to be made. This leads to a growing number of ethical conflicts and dilemmas. The radiographer will not be immune to these. Professional standards of ethics must be adhered to at all times, even though doing so may, at times, present difficult problems to be resolved.
Ethical Philosophies
There are three basic ethical philosophies from which ethical principles are derived. These are utilitarianism, deontology, and virtue. Utilitarianism is often called consequentialism and advocates that actions are morally correct or right when the largest number of persons is benefited by the decision made. For example, a large accident occurs and a number of persons are critically injured. The triage team assigns a higher priority to the less injured patients and, since the chance of survival is less for the most severely injured, attends last to those who are critically injured. This is an acceptable philosophy if one benefits from the decision. In this example, the important element is the result of the action. This is based on the principle known as teleological theory (meaning end or completion). In other words, it is based on consequences with the highest good with the greatest happiness for the largest number of people.
Deontology upholds the philosophy that rules are to be followed at all times by all individuals. Deontology comes from a Greek word meaning “duty”; therefore, deontology requires that one judge an action by deciding if it is an obligation. When making decisions using this school of thought, one generally does not take consequences into consideration even if it proves to be beneficial to the patient. Following the rules at all times may be too restrictive, especially when specific circumstances surrounding a situation do not fit in a set of rules. An example of deontology is illustrated by the accident portrayed earlier. Because the health care provider has the duty to “do no harm,” assigning a low priority number to the most critical patients would be wrong. Deontology and utilitarianism being more or less opposite, the more critically injured patients would get the highest priority and the most likely to survive would be attended to last, with the assumption that they would survive longest without care.
Virtue is a philosophical belief that focuses on using wisdom rather than emotional and intellectual problem
solving. With the popularity of holistic medicine, virtue ethics incorporates certain principles of both utilitarianism and deontology to provide a broader view of issues. Analysis, review of consequences, and societal rules are essential to forming decisions using virtue. Again, using the accident example to illustrate, with virtue ethics, the triage of the patients would take into account the significance of each individual. How the family and friends of the victims would be affected by the triage decisions would be the deciding factor in who gets first treatment.
solving. With the popularity of holistic medicine, virtue ethics incorporates certain principles of both utilitarianism and deontology to provide a broader view of issues. Analysis, review of consequences, and societal rules are essential to forming decisions using virtue. Again, using the accident example to illustrate, with virtue ethics, the triage of the patients would take into account the significance of each individual. How the family and friends of the victims would be affected by the triage decisions would be the deciding factor in who gets first treatment.
DISPLAY 2-5 American Registry of Radiologic Technologist—Standards of Ethics
Last revised: September 1, 2017
Published: September 1, 2017
Preamble
The Standards of Ethics of the American Registry of Radiologic Technologists shall apply solely to persons holding certificates from ARRT that are either currently registered by ARRT or that were formerly registered by ARRT (collectively, Certificate Holders), and to persons applying for examination and certification by ARRT in order to become Certificate Holders (“Candidates”). Radiologic Technology is an umbrella term that is inclusive of the disciplines of radiography, nuclear medicine technology, radiation therapy, cardiovascular-interventional radiography, mammography, computed tomography, magnetic resonance imaging, quality management, sonography, bone densitometry, vascular sonography, cardiac-interventional radiography, vascular-interventional radiography, breast sonography, and radiologist assistant. The Standards of Ethics are intended to be consistent with the Mission Statement of ARRT, and to promote the goals set forth in the Mission Statement.
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