The Osteopathic Council of New Zealand is required to set standards of competence to be observed by registered osteopaths.
The six core competencies set by the Council relate to:
- Clinical Skills
- Communication
- Cultural Competency
- Legal Requirements
- Ethical Requirements
- Professional Management
This document provides details on each core competency.
1 Clinical Skills
The osteopath must:
1.1 Take a case history and gather evidence of the presenting condition
1.1.1 Patient details must be recorded.
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In every case the name, date of birth, and contact details must be recorded in the case history.
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Other details are to be recorded if relevant (i.e. occupation, sex, name of GP and other relevant health providers, cultural factors relevant to diagnosis and/or treatment, other patient requirements).
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Record must be made if communication has been difficult in any manner (e.g. infant, deaf, blind), and if an interpreter or guardian/parent/friend/family member/support person has been present.
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The practitioner must use effective communication at all times.
1.1.2 Patient's description of presenting symptoms and history of condition must be recorded.
- In every case the case history must include onset, previous onset, factors that affect the problem (aggravating and relieving).
- This includes: how, what, when, where, aggravating factors, relieving factors, previous onset, daily patterns, previous investigation, previous treatment and other symptoms.
- A statement should be made about the patient's general health.
1.1.3 Patient's description of any reported changes in major body systems must be recorded.
- This could include: genito-urinary, cardiovascular, respiratory, neurological, gastro-intestinal, musculo-skeletal, haemopoietic, lympho-reticular endocrine, immune and psycho-social changes.
- Other details are to be recorded if applicable.
1.1.4 All other potentially related factors must be recorded.
- This may include: family history, medications, falls, fractures, hospitalisation, accidents, infections, patient's perception of general health, sleep profile, activity profile and occupation.
- The osteopath must record details relevant to the case, and not omit details that relate to the patient's overall pattern of health and lifestyle.
All case histories must:- demonstrate a logical progression in terms of information gathering
- show an understanding of the process of gathering evidence to arrive at a clinical differential diagnosis
- be able to be clearly understood by peers and other medical professionals
- be legible and accessible to the patient.
Practitioners must keep thorough, detailed and accurate records.
1.2 Examine the patient including the use of osteopathic examination
1.2.1 In every case the osteopath must identify the issues pertinent to the presenting symptoms.
- These issues may include visual and palpatory observation of body type, range of motion, magnitude and character of pain, presence of disability and ease of movement.
1.2.2 In every case the osteopath must conduct examinations relevant to the case and record all results.
- These may include systems examinations such as neurological integrity, vascular integrity, orthopaedic tests including routine examinations associated with primary care.
1.2.3 In every case there must be a record of osteopathic palpatory diagnosis and findings.
- These records may include both positive and negative findings, altered and impaired tissue states, standing and sitting assessment of posture, gait, active and passive range of motion, quality of and barriers to motion and reflex activity.
In every case the osteopath must:
- demonstrate a logical progression in terms of information gathering
- show the process of gathering evidence to progress towards a differential diagnosis
- come to a working or clinical diagnosis.
1.3 Use a logical process of evaluation of the evidence from the case history and the examination to determine a clinical differential diagnosis
1.3.1 In every case the patient notes should clearly show the process by which a diagnosis has been determined.
1.3.2 The osteopath must justify decisions to defer osteopathic manipulative techniques, seek another opinion, conduct further investigations or refer.
1.3.3 The osteopath must be able to recognise when a patient needs to be referred to someone else.
In every case the justification must be in terms of the diagnosis.
1.4 Treat the patient when it is appropriate using osteopathic manipulative techniques or refer when necessary
1.4.1 Treatment must employ appropriate osteopathic manipulative techniques within a Scope of Practice as designated by the Osteopathic Council of New Zealand.
1.4.2 All treatment must be recorded and results noted.
- This may include patient response and consent, patient compliance, natural history of the condition, length of treatment, period of recovery, rate of recovery, degree of recovery, any adverse treatment response, likelihood of recurrence, requirement for further treatment and further investigation.
1.5 Continually re-evaluate the patient's progress
1.5.1 Patient progress is re-evaluated after treatment, treatment plan and prognosis are modified or confirmed.
Communication and informed consent must be demonstrated throughout all stages of consultation and treatment.
2 Communication
The osteopath must:
2.1 Use effective communication at all times
2.1.1 The osteopath must demonstrate the ability to establish rapport through the use of verbal micro skills such as but not limited to; open questions, closed questions, minimal encouragers, paraphrasing, reflection of feeling, summary of information, self disclosure, directives and confrontation.
2.1.2 The osteopath must demonstrate an understanding of the potential impact of non-verbal communication such as but not limited to; facial expressions, gestures, voice, body posture, eye contact.
2.2 Be aware of barriers that impact on communication and act appropriately
2.2.1 Demonstrate an awareness of the importance of personal presentation especially as a form of sub-conscious, non-verbal communication that may influence the credibility and meaning of what is being said.
2.2.2 Demonstrate an awareness of the role of office environment, temperature, layout, cleanliness and general atmosphere in encouraging a welcoming setting.
2.3 Develop an environment in which consumer rights are observed and informed consent is practised
2.3.1 Visibly locate all relevant information that indicates his or her academic qualifications and current Annual Practising Certificate issued by the Osteopathic Council of New Zealand.
2.3.2 Visibly locate all relevant information on consumer rights, the process of informed consent, health and disability information and culturally preferred services that may be available.
3 Cultural Competency
Cultural competence refers to the acquisition of skills to better understand members of other cultures in order to achieve the best health outcome (Mason Durie 2001). It is important to recognise that culture includes, but is not restricted to:
- age
- sex
- sexual orientation
- occupation
- socio-economic status
- ethnic origin or migrant experience
- religious or spiritual belief
- disability.
The osteopath must:
3.1 Demonstrate cultural sensitivity
3.1.1 Show understanding and respect for patients' cultural beliefs, values and practices.
3.1.2 Understand the Treaty of Waitangi and its relevance to the health of Māori in Aotearoa/New Zealand.
3.1.3 Demonstrate knowledge of the differing health and socio-economic status of Māori and non-Māori.
3.1.4 Recognise his or her own beliefs, values and prejudices that may arise in relation to a client's ethnicity, age, culture, beliefs, gender, sexual orientation or disability.
3.2 Practise in a manner that follows culturally appropriate assessment
3.2.1 Practise in a manner that follows culturally appropriate assessment and demonstrates an understanding of cultural competency.
3.2.2 Recognise the impact of the patient's culture on his or her wellbeing.
3.3 Continue professional development in terms of cultural competency
3.4.1 Update knowledge related to cultural competency in terms of assessment and application.
3.4.2 Contribute to collegial sharing of information about cultural competency.
Treat all patients, colleagues and other health professionals equally regardless of age, sex, gender, cultural background and ability.
4 Legal Requirements
The osteopath must:
4.1 Practise lawfully in regard to all relevant legislation.
This includes the Health and Disability Commissioner Act 1994, Human Rights Act 1993, Privacy Act 1993, Care of Children Act 2004, Smoke Free Environment Act 1990, Consumer Guarantees Act 1993, Fair Trading Act 1986, Injury Prevention, Rehabilitation and Compensation Act 2001, Health and Safety in Employment Act 1992, and all regulations made under these Acts.
4.2 Communicate appropriately with the patient in compliance with the Code of Health and Disability Consumers' Rights
For the consumer, these rights include the right to:
- be treated with respect
- freedom from discrimination, coercion, harassment, and exploitation
- dignity and independence
- services of an appropriate standard
- effective communication
- be fully informed
- make an informed choice and give informed consent
- support in respect of teaching or research
- complain.
3.Work within the scope of practice as defined by the Osteopathic Council of New Zealand
Registered osteopaths are primary healthcare practitioners who facilitate healing through osteopathic assessment, clinical differential diagnosis and treatment of dysfunctions of the whole person. Osteopaths use various recognised techniques to work with the body's ability to heal itself, thereby promoting health and wellbeing. These osteopathic manipulative techniques are taught in the core curricula of accredited courses in osteopathy. The ultimate responsibility for recognition of practice lies with the Osteopathic Council.
5 Ethical Requirements
The osteopath must:
5.1 Abide by the code of ethics as defined by the Osteopathic Council of New Zealand. The Osteopathic Council code of ethics is attached.
6 Professional Management
The osteopath must:
6.1 Conduct his or her business in a professional and lawful manner. This includes treating business associates, employees and all other professionals with respect.
6.2 At all times conduct himself or herself in an honourable and professional manner in relations with their patients, the public and with other members of their profession and other professions
Professional management should include personal hygiene, general appearance and consultation room's style/cleanliness/décor. Premises must be safe in accordance with the Occupational Safety and Health legislation.
At all times, a patient's modesty, privacy and dignity must be respected.
3.Hold a current first aid certificate.
