Managing Challenging Interpersonal Situations When Providing Patient Care

Recently Updated Updated: December 2009

Previous Updates: September 2006

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Challenging interpersonal situations arise in healthcare due to a variety of factors including the availability of resources, personal expectations and other environmental or contextual factors.

This standard only applies when a patient receiving physiotherapy care is central to the situation.
Most often a challenging situation develops between the patient and the physiotherapist, however,
interpersonal situations between a physiotherapist and another health care provider or between a patient’s partner or a family member may also present challenging situations for registrants.

This standard describes the profession’s and the College’s expectations of registrants when they manage challenging situations that arise during the provision of individual patient care.

Standard Statement

In the event of any inconsistency between this standard and any legislation that governs the practice of physiotherapists, the legislation governs.

Registrants will manage challenging interpersonal situations with a desire to deliver quality care and achieve positive physiotherapy outcomes for their patients. Accordingly, physiotherapists will identify and proactively manage behaviors in situations involving patient care that may interfere with a safe, respectful and professional interaction.

Performance Expectations

A physiotherapist demonstrates the standard by:

1. Conducting an analysis of the severity of the behavior(s) observed, the risks imposed by the behavior(s) and the likelihood of achieving the desired positive physiotherapy outcomes and making a reasonable decision about how they will respond.

2. Identifying behaviors in the situation that are challenging and proactively managing them by:

  • Describing the behavior(s) to the individual involved

  • Providing an explanation about why the behavior(s) presents a challenge

  • Describing the changes that would contribute to a positive outcome

  • Explaining the consequences if the changes are not observed

3. Refraining from labeling the behavior(s) based on assumptions or stereotypes.

4. Critically examining the circumstances in which the behaviour arose to ensure that, where possible, such circumstances are avoided in future.

5. Monitoring the situation for any signs of recurrence of the behavior and instituting immediate appropriate action.

6. Documenting:

  • The behavior(s) that is presenting the challenge in the situation
  • The changes in behavior that are expected to occur
  • The timeframe for the change to be observed
  • The tools or resources, if any, utilized to assist in facilitating the change (e.g. written contract)
  • The consequences that were discussed if the change is not observed including termination of the challenging situation

7. Terminating the situation under the following conditions:

  • A risk of emotional or physical abuse to the physiotherapist or others is present
  • A demonstrated inability to comply with the expected behavioral change exists
  • Lack of cooperation or attendance renders the ability to achieve the positive physiotherapy out- comes impossible
  • The situation is disruptive in the therapeutic environment



See Glossary in the Guide.


Physiotherapy Act

Essential Competency Profile for Physiotherapists

Legislative Reference

Ontario Regulation 388/08 under the Physiotherapy Act
Professional Misconduct: Section 1, paras 1 and 2

Related Laws and Legislation

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