Code of Ethics and Professional Conduct

Professional Conduct

Physiotherapists respect the kiritaki and their Whānau and families.

Terms and wording used within the Code which are underlined are defined in the Glossary.

The relationship between physiotherapist and kiritaki is one of trust, and as such physiotherapists must:

1. respect the dignity, privacy, bodily integrity, and mental wellbeing of kiritaki.
2. conduct themselves respectfully towards kiritaki as well as their Whānau, family and support persons.
3. practise with due care and respect for kiritaki culture, identity, needs, values, lived experience and beliefs.
4. not impose their own identity, values, and beliefs on kiritaki or their Whānau and family.

Physiotherapists act to promote the health and wellbeing of the kiritaki while acknowledging, respecting, and facilitating kiritaki autonomy.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. consider the health and wellbeing of the kiritaki to be their first priority.
2. respect the autonomy and freedom of choice of kiritaki by involving them in the planning and delivery of care.

Commentary: Physiotherapists must respect the freedom of the kiritaki to choose their physiotherapist (where practicable) or to refuse physiotherapy treatment (even if in doing so that would harm them). The kiritaki is also entitled to seek a second opinion, and physiotherapists should assist this process.

1. establish collaborative and respectful relationships with kiritaki that acknowledge their needs and goals.

Commentary: These relationships may include the kiritaki Whānau and family if that accords with kiritaki needs, values and wishes.

1. clearly and adequately inform kiritaki of the purpose and nature of the physiotherapy service to enable them to make an informed choice, ensuring informed consent is freely given and appropriately documented.

Commentary: The kiritaki is entitled to information about their diagnosis and prognosis, care plan, alternative treatments, risks and benefits associated with treatment, costs associated with treatment, results of any tests, and the name of the physiotherapist providing care and any other relevant information. This information must be provided in form, language and manner that can be understood by kiritaki. The kiritaki must be given the time and opportunity to ask questions and have them answered to their satisfaction. Where necessary and practicable an interpreter must be supplied. The physiotherapist should be guided by the kiritaki in ascertaining whether additional information is required to enable the kiritaki to make an informed choice and give informed consent.

1. act in accordance with the law where the kiritaki has compromised decision‐making capacity or is unable to provide informed consent.

Commentary: There are times when a kiritaki is unable to give or refuse informed consent due to compromised decision‐making capacity. The kiritaki with diminished decision‐making capacity has the right to make informed choices and give informed consent to the level of their understanding. Whether or not a kiritaki can give or refuse consent to treatment depends on whether the person is able to understand the treatment decision that they are being asked to make.

In emergency situations where treatment is necessary to save a kiritaki life, or to prevent harm to the kiritaki, and the kiritaki wishes are not known, the professional is expected to act in the best interests of the kiritaki (which may include, for example, providing resuscitation).

1. seek kiritaki consent if a physiotherapy student (or other person) will be present during the provision of physiotherapy services or providing aspects of care.
2. not exploit any kiritaki physically, sexually, emotionally, or financially. Sexual contact of any kind with kiritaki is unacceptable, and in nearly all instances sexual contact with former kiritaki would be regarded as unethical.

Commentary: It is acknowledged that in some instances the former physiotherapist‐kiritaki professional relationship may have been brief, minor in nature, or in the distant past. In such circumstances and where a sexual relationship has developed from social contact away from the professional environment, impropriety would not necessarily be inferred.

See Professional boundaries standard and Treatment of Whānau, family members and others close to you standard.

1. establish and maintain appropriate professional boundaries with students under their supervision and recognise there is a power imbalance.

Commentary: Physiotherapists must understand that a power imbalance exists with students under their supervision and recognise a sexual or emotional (or otherwise inappropriate) relationship is never acceptable with a student under a physiotherapist’s direct supervision. (Professional boundaries standard).

1. establish and maintain appropriate professional boundaries with kiritaki and their Whānau and families.

Commentary: Society trusts physiotherapists to act in the best interest of kiritaki. A power imbalance exists within the therapeutic relationship that can easily lead to exploitation or abuse if trust is not respected. Professional boundaries describe the limits to the relationship that a physiotherapist should observe when treating kiritaki and their Whānau and family.

1. make provision for continuity of care when closing or relocating a place of practice or otherwise planning to be absent from their place of practice.

Commentary: A written record of the transfer of care together with any notes on the kiritaki ongoing care and treatment should be provided to the replacing physiotherapist or other healthcare provider in a timely manner.

1. where there are concerns that kiritaki or others may be subject to abuse, consider their legal and ethical obligations.

Commentary: Children, the elderly and the disabled may be particularly vulnerable to physical, sexual or emotional abuse. Where a physiotherapist suspects that a kiritaki is being abused, they should be guided by relevant policies and procedures of their employer. In the absence of such guidance, the physiotherapist should seek advice from health providers with expertise in dealing with abuse.

1. be alert to the needs and special concerns of vulnerable kiritaki and groups within the context of physiotherapy services.

Physiotherapists should:

1. consider and, where practicable, advocate for the health needs of the community within which they practise.

Commentary: Physiotherapists may become aware of health needs that go beyond the individual kiritaki and may affect the wider community and require a broader‐based intervention.

Physiotherapists protect confidentiality, privacy, and security of kiritaki information.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. protect kiritaki information, hold it in confidence, and not disclose identifiable personal or health information without their recorded permission, or if legally required or permitted.

Commentary: Trust is important in the physiotherapy‐kiritaki relationship, and maintaining confidentiality is central to that trust. It is expected that physiotherapists respect the confidentiality, privacy, and security of kiritaki information. However, the duty of confidentiality is subject to exceptions outlined below:

Privacy Act 2020

Health information Privacy Code  

1. ensure that all kiritaki information, records and images are stored securely.

Commentary: Kiritaki records must be retained and disposed of in accordance with the law. If photographs or other images of the kiritaki were taken for clinical reasons, specific consent must be sought if those photographs or images are to be used for advertising, promotion or academic purposes.

1. only access kiritaki information, records, and/or images when the physiotherapist has a lawful reason to do so.

Commentary: Only those people authorised to do so should access kiritaki records, and access must only be made when necessary for providing care. This must be in keeping with the Privacy Act 2020 and the Health Information Privacy Code 2020.

Physiotherapists treat people fairly.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. not discriminate or facilitate or enable discrimination based on race, gender, age, religion, ethnicity, disability, sexual orientation, political affiliation, economic, social or health status or any other legally prohibited grounds of discrimination.
2. not bully or harass or facilitate or enable bullying or harassment in a workplace or workplace related setting.
3. use a coherent, robust, and transparent rationale when allocating resources, taking into account the resource environment.

Commentary: As responsible stewards of healthcare resources, it is important for physiotherapists, within their role and capacity, to use a rationale that is reasonable and acceptable when making decisions around allocation of resources including kiritaki care and training for staff. For example, prioritising one person over another on the basis of personal friendship or because one person is considered to be a ‘better’ person is not acceptable.

1. only feel able to refuse to treat kiritaki if they have sound reasons. The kiritaki should be informed of the reasons, alternative options of care, and where appropriate to refer to another healthcare provider.

Commentary: Reasons for refusing treatment might include: where the physiotherapist feels unsafe, where the physiotherapist believes the treatment requested will provide no clinical benefit; where the physiotherapist has a conflict of interest; where the physiotherapist feels they cannot provide safe care; where the kiritaki poses or has posed a risk of harm to the physiotherapist, their Whānau, family, or their employees; or if they are under the influence of alcohol or other drugs.

Physiotherapists should:

1. advise managers or funders, and kiritaki and their Whānau and families where appropriate when the resource environments are insufficient to allow adequate care.
2. advocate to promote health equity and improve access to services.

Commentary: Occasionally policy or changes to policy such as transport and health service may negatively impact on the health and wellbeing of particular kiritaki groups. Where such disparities are identified, physiotherapists may choose to take an advocacy role to speak for those kiritaki affected by such policy. Any physiotherapist who takes on an advocacy role in their professional capacity should remember that they represent the profession and should carry out such advocacy within their scope of practice. Physiotherapists who take on such a role should seek guidance from their professional organisation.

1. identify, and work to reduce organisational, institutional, and individual discriminatory behaviour in the physiotherapy context.

Physiotherapists practise in a safe, competent, and accountable manner.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. base physiotherapy interventions on the best available evidence.
2. make sound professional judgements within their scope of practice and level of expertise and be accountable for their professional practice.
3. provide physiotherapy services that are justifiable and appropriate.
4. practise according to the current Physiotherapy Practice Thresholds in Australia & Aotearoa New Zealand.
5. incorporate safety and risk management strategies within physiotherapy practice to ensure the safety of kiritaki, colleagues and staff.
6. provide appropriate direction and support for colleagues and staff.

Commentary: Physiotherapists have responsibilities to those they work with and lead, including those new to physiotherapy practice in Aotearoa New Zealand and physiotherapy assistants.

1. keep comprehensive, up‐to‐date, accurate, accessible, and comprehensible kiritaki records.

Commentary: Making sure that kiritaki health records are comprehensive, up‐to‐date, accurate and legible is of utmost importance. In particular:

• Kiritaki health records are a vital source of communication between health professionals providing care to kiritaki. The records must, therefore, provide clear details on investigations and diagnosis using recognised terminology, information provided by and given to the kiritaki, consent given by kiritaki, and treatment carried out.
• Physiotherapists should be mindful that treatment records may be accessed by kiritaki and so all entries must be respectful.

1. have an appropriate level of understanding of and comply with the laws and regulations that govern and impact on the practise of physiotherapy in Aotearoa New Zealand.
2. not undermine kiritaki safety, when teaching physiotherapy skills to others.

Commentary: There are times when it may be appropriate to teach physiotherapy skills to others including Whānau of kiritaki. Physiotherapists must consider the potential harm that could eventuate from teaching physiotherapy skills to people who do not have the requisite knowledge or skill base.

Physiotherapists teaching undergraduate or postgraduate physiotherapy students must also ensure that kiritaki safety is not jeopardised, by maintaining appropriate supervision.

Physiotherapists act with integrity in all professional activities.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. provide truthful, accurate and relevant information, and must not knowingly make misleading representations.
2. disclose any interests, including financial interests, held in products and services recommended to their kiritaki and relevant others.
3. act with honesty and integrity in all areas of professional practice (including when interacting with funders, employers, employees, insurers).
4. ensure that their professional obligations and standards are not jeopardised by employment or contractual arrangements, relationships with industry, or other arrangements.
5. consider and only accept gifts, and/or koha and/or incentives that do not influence or give the appearance of influencing the physiotherapist’s professional judgement.

Commentary: When offered a gift and/or koha from a kiritaki (or their family member), or where other incentives are offered from industry or others, physiotherapists must respond in a manner appropriate to the context, and the intent of the giver. Physiotherapists must take care not to allow any gift, koha and/or incentive to influence their clinical decision‐making, compromise the standard of care provided to any kiritaki, or affect their cooperation with other healthcare providers. The physiotherapist must not encourage a kiritaki to give, lend or bequeath money or gifts and/or koha that will benefit a physiotherapist directly or indirectly. Physiotherapists are advised to keep a register of any gifts, and/or koha and/or incentives received.

1. be alert to potential or apparent conflicts of interests, (including financial arrangements) and take appropriate steps to declare and manage them.

Commentary: Physiotherapists may find themselves in a conflict‐of‐interest position where their obligations to the kiritaki conflict with their financial, professional or personal interests. In such situations, the physiotherapist must declare their conflict and take steps to avoid or minimise the conflict.

1. be open and honest when something has gone wrong with the provision of care, treatment, or other services.

Commentary: Seek timely advice from experienced colleagues. Inform the kiritaki or, where appropriate, their carers when something has gone wrong. Acknowledge that something has gone wrong, apologise and take action to put matters right if possible. Provide a prompt explanation of what has happened and why, including any likely effects and document this. An analysis should be undertaken to help prevent reoccurrence of a similar incident.

1. provide information about the avenues for raising concerns or complaints about the care, treatment, or other services kiritaki have received.

Physiotherapists strive for continual improvement in the practice of physiotherapy.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. undertake continual learning and the maintenance and development of contemporary physiotherapy skills, knowledge and practise.

Commentary: As part of the Recertification Programme, physiotherapists are required to engage in continuing professional development including peer review.

Relevant resources: Physiotherapy Board recertification programme.

1. ensure research in which they are involved has appropriate ethics approval.
2. declare to research participants and proposed publishers where research funding, support or equipment have been received from industry or any other person or organisation.
3. ensure that any remuneration for participating as a research investigator does not influence clinical judgement or commitment to kiritaki welfare.

Physiotherapists should:

1. when developing innovative approaches, ensure they are formally evaluated and reviewed for the safety of kiritaki.

Commentary: Physiotherapists regularly develop innovative approaches, including therapies, to respond to particular kiritaki needs.

Physiotherapists communicate effectively and collaborate with colleagues, other health professionals, and agencies, for the benefit of their kiritaki and the wider community.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. engage in effective communication and collaborate with colleagues, other health professionals, and agencies to achieve optimal outcomes for the kiritaki.
2. refer kiritaki in a timely fashion when required.

Commentary: There are many different reasons why a physiotherapist may need to refer kiritaki to another provider including:

• when kiritaki needs fall outside the physiotherapist’s scope of practice or skill level
• breakdown of the professional relationship
• kiritaki request
• location or timing issues

Referral to others must be in a timely manner.

1. collaborate with other service providers for the benefit of the kiritaki, keeping referring colleagues informed of the outcomes of assessment and treatment.
2. behave respectfully in all media and communication to and about kiritaki, colleagues or other health professionals and agencies (including when using electronic communication and social media).

Physiotherapists take responsibility for maintaining their own health and wellbeing.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. engage in activities that encourage self‐awareness and reflective practice.

Commentary: These activities may include reflective writing, reflective group work, professional supervision or mentoring, or individual forms of reflection.

1. not practise while their judgement or skill may be affected by any alcohol or drugs or psychoactive substances.

Physiotherapists should:

1. recognise when fatigue, stress, physical or mental illness or any other condition may affect their professional practice and take appropriate steps.

Commentary: Some life events including marriage difficulties, bereavement, loneliness, substance abuse, financial difficulties, or other forms of stress may make physiotherapists more vulnerable, and at these times the quality of clinical practice may suffer, and professional standards may slip. It is important that physiotherapists are self‐aware and engage in reflective practice activities and seek guidance and professional support.

1. Reflect on the need for appropriate support when practising in challenging areas of practice.  

Physiotherapists accept responsibility for upholding the integrity of the profession.

Terms and wording used within the Code which are underlined are defined in the Glossary.

Physiotherapists must:

1. report to the appropriate authority any matter they have witnessed, observed, or been made aware of in the practice setting that could endanger a kiritaki or others.

Commentary: Reflect and consider the strength and credibility of the evidence related to the situation. Raise any concerns with colleagues or other members of the team if they are contributing to those concerns. If they are unsure, they should seek advice from a senior colleague or professional organisation. Formally raise the concerns with their manager or a senior person within their employment situation. Escalate any concerns to a higher level within employing organisations if the issue is not resolved. If efforts to resolve the situation within the workplace continue to be unsatisfactory, escalate concerns to another appropriate body, for example, the Physiotherapy Board, Ministry of Health, the Health and Disability Commissioner, or any other health professional regulatory authority

Under section 34 Health Practitioners Competence Assurance Act 2003 (HPCAA), you may notify the relevant health regulatory authority if you believe that a health practitioner (a physiotherapist or other health practitioner) may pose a risk of harm to the public by practising below the required standard of competence.

1. bring unsafe or unethical behaviour by another physiotherapist or other health professional to the attention of the appropriate authority.

Commentary: Section 45 HPCAA provides that: If a physiotherapist has reason to believe that another health practitioner (another physiotherapist or other health practitioner) is unable to perform the functions required for the practice of his or her profession because of some mental or physical condition, the physiotherapist must promptly give the Registrar of the authority with which the health practitioner is registered written notice of all the circumstances.

Section 34 HPCAA provides that: If a physiotherapist has reason to believe that another health practitioner (another physiotherapist or other health practitioner) may pose a risk of harm to the public by practising below the required standard of competence, the physiotherapist may give the Registrar of the health practitioner’s registration authority written notice of the belief and the reasons on which that belief is based. A physiotherapist who has acted in good faith would be protected from civil or disciplinary proceedings.

Section 34 HPCAA provides that: Whenever a physiotherapist resigns or is dismissed from his or her employment for reasons relating to competence, the person who employed the physiotherapist immediately before that resignation or dismissal must promptly give the Physiotherapy Board’s Registrar written notice of the reasons for that resignation or dismissal.

Physiotherapists should:

1. support the education of physiotherapy students and colleagues.

Commentary: Teaching, supervising and mentoring students and colleagues is of benefit to future kiritaki, the individual receiving guidance, and the profession. It also adds value to the supervisor’s practice through engagement with the person being supervised and their learning needs. Physiotherapists should support colleagues in their endeavours to provide care for kiritaki.

Useful references

Physiotherapy Standards Framework

Relevant law includes

• Accident Compensation Act 2001
• Children, Young Persons and their Families Act 1989
• Consumer Guarantees Act 1993
• Crimes Act 1961
• Fair Trading Act 1986
• Health Act 1956
• The Health and Disability Commissioner (Code of Health and Disability Services Consumers’ Rights) Regulations 1996
• Health Information Privacy Code 2020
• Health (Retention of Health Information) Regulations 1996
• Health Practitioners Competence Assurance Act 2003
• Human Rights Act 1993
• New Zealand Bill of Rights Act 1990
• Oranga Tamariki Act 1989
• Privacy Act 2020
• Protected Disclosures (Protection of Whistleblowers) Act 2022
• Protection of Personal and Property Rights Act 1988
• The Health and Safety at Work Act 2015
• Vulnerable Children Act 2014

Glossary of terms

Accountability: taking responsibility for decisions made and actions taken (or not taken).

Advocacy: activity that focuses on priority issues that optimise the health outcomes for New Zealanders. Advocacy raises awareness of the issue, gives people a voice, builds evidence, creates positive change and influences decision makers. (Credit to Youth Advocacy.)

Bullying: repeated and unreasonable behaviour directed towards a person or people that is likely to lead to physical or psychological harm.

Carer: someone who assists/supports kiritaki.

Clinical reasoning: the thought processes associated with a physiotherapist’s examination and management of a kiritaki and is influenced by the therapist (e.g. values and beliefs, knowledge, and cognitive, interpersonal and technical skills), the kiritaki (e.g. needs and goals, values and beliefs, individual physical, psychological, social and cultural presentation), and the environment (e.g. resources, time, funding, and any externally imposed requirements).

Competent physiotherapist: a physiotherapist who consistently integrates and applies knowledge, skills, attitudes, and values in an independent, timely manner to the standard required by the Physiotherapy Board.

Competent kiritaki: the decision‐making capacity of that kiritaki(see decision‐making capacity).

Decision‐making capacity: the ability to make a reasoned decision.

Discrimination: when a person is treated differently and unfairly compared to others because of a personal characteristic such as your race, sex, age, or a prohibited ground.

Evidence‐based practice: is the integration of clinical expertise, kiritaki values, and the best research evidence into the decision‐making process for kiritaki care.

Exploit: involves any activity in which a physiotherapist takes advantage of a person or situation through the use of manipulation, intimidation, threats, or coercion.

Family: those persons whom the kiritaki identifies as being a family member.

Harassment: intimidating, threatening or degrading behaviour directed towards a person or group that is likely to have a harmful effect on the recipient and includes repeated behaviour but may be a serious single incident.

Kiritaki: patient/client/consumer.

Kiritaki hauora: person who uses health care services.

Patient: includes client, kiritaki hauora, as well as others who physiotherapists engage with in their practice (regardless of the setting or location or whether the interaction is clinical or non‐clinical). This also includes members of sports teams, cultural and social groups (such as kapa haka, dance, or choir) and any other group of people seeking or receiving physiotherapy services, regardless of whether or not they personally receive the physiotherapy services.

Refer: to send a kiritaki to another provider.

Reflective practice: the activity in which a person reflects on the process and outcomes of a situation with the aim of improving or affirming their professional practice.

Student: a physiotherapy student enrolled in an accredited physiotherapy programme, an international physiotherapy student on clinical placement in Aotearoa New Zealand.

Support person: trusted individuals such as a Whānau, family member, friend, or advocate who accompany kiritaki to consultations to provide emotional support, help them understand information, and ensure their rights are respected

Te Ao Māori: translates to ‘the Māori world’. Te Ao Māori includes te reo (the language and dialects), tikanga (the processes and practices), marae (the community focal point), wāhi taonga and wāhi tapu (treasures and sites of importance) and access to Whānau, hapū and iwi.

Whānau: This is generally described as a collective of people connected through a common ancestor (whakapapa) or as the result of a common purpose (kaupapa).Whakapapa and kaupapa are not mutually exclusive. Whakapapa Whānau will regularly pursue kaupapa or goals. Whereas kaupapa Whānau may or may not have whakapapa connections. Whakapapa Whānau and kaupapa Whānau are social constructs and as such can be located along a continuum depending on the function and intent.