Section or disabled students (Delforge & Behnke, 1999).

Section One: Athletic
Training-History and Development

     The athletic training profession, which was
first established in the late nineteenth century, developed a way to provide
medical care in colleges and secondary schooling (Prentice, 2014). In 1950, the
profession took a giant leap by founding the, National Athletic Trainers’
Association (NATA), with the purpose to “build and strengthen the profession of
athletic training through the exchange of ideas, knowledge, and methods of
athletic training” (Delforge & Behnke, 1999). Five years later, William E.
Newell was elected to a position in the organization formally known as the
Executive Director (Delforge & Behnke, 1999). Newell would then comprise a
committee with an overall goal of recognition for the profession and to
establish a standard for athletic training (Delforge & Behnke, 1999). One
of the largest footprint that the committee left for the profession dates to
1959. The Committee on Gaining Recognition is responsible for the first
curriculum model, intended to prepare students whose intent it was to study the
athletic training profession along with ability to teach health, physical
education, or disabled students (Delforge & Behnke, 1999). The NATA
suggested that this curriculum aid athletic training students in providing care
to all students, not specifically limited to student-athletes (Delforge &
Behnke, 1999). At the time in 1986, the largest movement in athletic training was
occurring. This movement was brought forth by the NATA Board of Directors,
calling for an approval for undergraduate athletic training programs be offered
as a specific major degree by July of 1986 (Delforge & Behnke, 1999). However,
this movement is being over-shadowed by one taking place currently. The
standards for becoming a certified athletic trainer will now require students,
in the fall term of 2022, to obtain an athletic training degree in a graduate
setting, no longer undergraduate (CAATE, 2017). Strides that the athletic training
profession has made within the last century is unmatched by many other highly acclaimed
healthcare professions.

     As touched on previous, major strides were
made in the name of athletic training. One that would change the profession
forever would come in 1990. June of 1990, the American Medical Association
(AMA) officially and formally acknowledged the profession of athletic training
as an allied healthcare profession (Delforge & Behnke, 1999). The formal
recognition of athletic training transformed the profession and the areas that
they worked in. (Anderson, 2017) depicts how in the past, the common workplace
setting of athletic trainers was in organized sports. Specifically, the high
school, collegiate, and professional settings. However, the recognition by the
AMA has brought athletic trainers into work settings as well as currently,
emerging settings such as performing arts, public safety, military, and
Occupational health (Anderson, 2017) (NATA, 2017). These new opportunities
would not be possible without the expansion of the scope of care that athletic
trainers are now able to provide (Hortz, 2017).

     The NATA was advancing the profession of
athletic training at a fast rate, but they strategized an even better way to
advance the profession as a whole. In 2013 the National Athletic Trainers
Association (NATA) joined forces with the Board of Certification (BOC), the
Commission on Accreditation of Athletic Training Education (CAATE), and the
NATA Research and Education Foundation (NATA Foundation) (NATA, 2017). Although
each of the four pillars perform different tasks, they each have a common goal
in mind, advancing the profession of athletic training (NATA, 2017). The
purpose of the BOC is to focus on certification and consumer and patient
protection (Strategic Alliance, 2017). The BOC accomplishes their purpose by
establishing the standards for the practice of the profession as well the
requirements of the educational component to keep an athletic trainer
certification (BOC, 2017) The NATA prides its organization on the professional
development of athletic training as well as advocating it (Strategic Alliance,
2017). The NATA plans to be globally recognized as vital organization in,
administration and advancement of heath care (NATA, 2017). CAATE focuses on
accrediting athletic training programs and assuring the education that is
offered is of the highest quality (Strategic Alliance, 2017). CAATE revolves
around their mission of, “Defining, measuring, and continually improving
education” (CAATE, 2017) Lastly, the mission of the NATA Research and Education
Foundation is to focus on research and scholarships for students interested in
the profession of athletic training (Strategic Alliance, 2017). The Research
and Education Foundation looks to “optimize the clinical experience and
outcomes within the diverse patient population served by the athletic training
profession” (Research & Education Foundation, 2017).

     To become acknowledged as a certified
athletic trainer, the profession has created necessary guidlines. The first
step is for the prospective AT to complete an undergraduate or graduate
athletic training program that has been formally recognized by CAATE (Anderson,
2017). Following receiving a degree, students must complete and successfully
pass the national certification test known as the BOC exam (BOC, 2017). The credentials
received by passing the BOC exam is acknowledged by 48 states and included by
the District of Columbia, along with an agreement for areas in Canada and Ireland
(NATA, 2017) (BOC, 2017). The third step in becoming a full-fledged practicing
athletic trainer is to receive state specific credentials (BOC, 2017).
Reasoning behind receiving specific state credentials is to protect practicing
AT’s and those who they provide healthcare too (BOC, 2017). Each state has
created regulations as to the scope of practice that practicing athletic
trainers can or cannot perform. State regulations include three different
levels, licensure which is the strictest form of state credentials concerning
protecting the public. State regulation also includes certification and
registration (Anderson, 2017). However, the only state that does not regulate
the practicing of athletic training and to exempt the ATC credential is California
(BOC, 2017). Once an AT has completed the BOC exam, he or she is responsible to
engage in 50 continuing education units within each two-year period as well as
continually showing proof of an emergency cardiac care certification (BOC,
2017).

     The profession of athletic training has
expanded over the last 100 years and can now be seen in a variety of settings.
The most common is the traditional settings of secondary schooling, collegiate,
and professional sports (Anderson, 2017). The uncommon settings that are now
gaining popularity are: clinical settings, industrial/occupational settings,
physician practice settings, military settings, performing arts settings, and
law enforcement settings (Anderson, 2017). The profession of athletic training
is based upon critical abilities of prevention of injuries, clinical evaluation
of athletes, diagnosis based on signs and symptoms, immediate and emergency
care of patient populations, rehabilitation, and the organization and
professional health and well-being (NATA, 2017). Athletic trainers treat a wide
variety of patients including pediatrics which is patients from ages zero to
eighteen years of age, middle-age which is ages of 18-65, and finally
geriatrics whose age range is 65 and up. Within these populations treated, the
emerging settings such as performing arts, public safety, military, and
occupational health accounts for two percent of ATs (NATA, 2017). The clinic
and hospital settings has quickly increased over the last couple years
registering at 17 percent of all AT’s (NATA, 2017).

     The role of an athletic trainer can vary
based on the level that they practice at, however many of the responsibilities
remain the same. An athletic trainer manages and responds to on-site
emergences, tapes and braces as a method of injury prevention, holds the
authority to hold an individual out of participation or to clear them to
return, along with the responsibility of creating rehabilitation programs for
those who have been injured and are attempting to return to play (Anderson, 2017).
AT’s are also responsible for conducting Pre-Participation Exams (PPE) with
hopes that any red flags seen during the exam will prevent injury during the
season. A large part of providing the best possible care is the close
association that an AT has with other healthcare providers (Anderson, 2017).
Athletic trainers specifically work under a team physician who ultimately has
the final say in deciding the mental and physical fitness of the individual
(Anderson, 2017). Another vital relationship that an AT should possess is that
of Emergency Medical Treatment (EMT) professionals, it is the AT’s
responsibility as the primary responder to make the decision if EMT’s are to be
called (Anderson, 2017). Close association with physical therapists is also
necessary for the ability of an AT to refer their patients to a physical
therapist who will take the individual through a rigorous rehabilitation
programs with the hopes of returning to play.

Section two: Professional
Practice

     In the 2011 revision of the “Athletic
Training Education Competencies” the NATA identifies seven areas of
foundational behaviors of professional practice (NATA, 2011). The seven areas
of foundational behaviors of professional practice are required by CAATE to be
taught and assed on throughout the educational program of the student athletic
trainer (NATA, 2011). These educational requirements are put forth because they
are skills crucial to the professionalism of the occupation (NATA, 2006). The
first behavior touched upon is “Primacy of the Patient”, this behavior focuses
on putting the patient and their personal information as the upmost priority.
The NATA describes this as “Advocate for the needs of the patient”, and “Know
and apply the commonly accepted standards for patient confidentiality” (NATA,
2011). The next foundational behavior focused on is the “Team Approach to
Practice” (NATA, 2011) This term is highly advocated for students to value the
inter-professional connections that the healthcare field uses (NATA, 2011). The
“Team approach” that is depicted refers to athletic trainers working with other
healthcare professionals such as EMT’s, nurses, doctors, and others whose scope
of practice may differ from that of the AT but have the same goal in mind, to
treat the patient (NATA, 2011). Once again patient protection is touched upon
within this behavior: “Include the patient (and Family, where appropriate) in
the decision-making process” (NATA, 2011). The third and fourth foundational
behaviors are instructed to be taught due to legal and ethical conflicts that
may arise during the practice of athletic training (NATA, 2011). The legal
aspect focuses on conforming to the laws that over-look the profession to
protect the AT from breaking laws and facing legal consequences for violating
them (NATA, 2011). The ethical side of the foundational behaviors instructs
AT’s to practice in accordance of the “NATA Code of Ethics and the BOC’s
Standards of Professional Practice” (NATA, 2011). Athletic trainers are also
advised to follow any other ethics codes that they encounter, as following
these codes will ensure that the AT is not at risk of legal and ethicalAM1  lawsuits. The filth behavior is one that is
accordance with the BOC certification and the needs to meet the requirements of
continuing education. This behavior is termed, “Advancing knowledge”, this
revolves around the continuation of increasing the knowledge possessed by the
AT by using “evidence-based practice as a foundation for the delivery of care”
(NATA, 2011). The next behavior is one that if not complete understood by the
athletic trainer, could cause major controversy between patient and healthcare
provider. This behavior is labeled “Cultural Competence”, AT’s should be
instructed on proper ways to approach treatment of patients who have different
beliefs or have cultural barriers that stop the patient from receiving specific
types of care. Athletic trainers should be able to “Work respectively and effect
with diverse populations and in diverse work environment” (NATA, 2011). The
seventh and final foundational behavior is one that is taught upon for the AT’s
own well-being in the profession. “Professionalism” is the term used to trust
AT’s to advocate for the profession, show honesty and integrity in their work, demonstrate
exceptional communication skills and to exercise the use of compassion and
empathy in situations that require it (NATA, 2011).

     As an athletic trainer, a commitment is
made toward every patient, to provide what is termed, “patient centered care”.
Patient centered care is “providing care that is respectful of and responsive
to individual patient preferences, needs, and values, ensuring that patient
values guide all clinical decisions” (NATA, 2016). The Institute of Medicine
separates patient centered care into eight subcategories: respect, coordination
of care, emotional support, physical comfort, involvement of the family,
continuity and transition and access to care (NATA, 2016). The relationship
created with the patient is important in providing the best healthcare
possible, this is best done by considering religion, sex, and race of the
patient (NATA, 2016).

     When it comes to the privacy of the
patient, an athletic trainer is both professionally and legally accountable for
the personal information that they are privy to. In 1996, the United States
Congress passed The Health Insurance Portability and Accountability Act
(HIPAA), this act set national standards in regard to disclosure of an
individuals health information (US Department of Health and Human Services,
2017). HIPPA states that an information regarding a patient’s medical care is
not to be shared with without written consent of the individual (US Department
of Health and Human Services, 2017). This protects any “Individually identifiable
health information” such as name, address, date of birth, social security
number or even past and present demographic data (US Department of Health and
Human Services, 2017). If personally identifying information is removed from a
statement, an AT is permitted to share the information as long as the
information provided does not allow the recipient to identify the patient
without consent (US Department of Health and Human Services, 2017). Athletic
trainers are also legally obligated to follow, “The Family Rights and Privacy
Act (FERPA), if they are in a setting that allows them access to educational
records. FERPA is a federal law that protects the privacy of educational
records of students, stating that this information is not to be shared without
the written consent of the student’s parent or legal guardian (US Department of
Education, 2017). Educational systems group together a student’s educational
records with all known medical records provided to the school or those created
by the school, with these together, sharing of a student’s official file
without the consent of a parent or legal guardian violates both HIPAA and FERPA
and could lead to major lawsuits and consequences.

     Athletic trainers who are legally
practicing the profession are legally responsible to carry out a “Standard of
Care”. “Standard of Care is measured by what another minimally competent
individual educated and practicing in the profession would have done in the
same circumstance” (Anderson, 2017). Along with these standards of care, the AT
must also adhere to their specific states scope of practice. Failing to meet
either the scope of practice or standard of care puts the athletic training
liable for failing to meet their duty in said profession if a patient in the
care of the AT suffers further injury or other damages.

     Athletic trainers are held highly
accountable for their actions or in some cases the lack their off. The act of
an AT providing care that harms the individual is termed commission, the act of
an AT not acting on a situation is omission. Both fall under the umbrella of
“Negligence”. Different categories of negligence are as follows: The act of an
AT to perform a task that they are not legally allowed to perform is termed
Malfeasance (Anderson, 2017). The act of an athletic trainer to perform a task
that is in their scope of practice, however is completed incorrectly causing
harm to the patient is Misfeasance (Anderson, 2017). Negligence of any action
not taken by an AT who was responsible is termed nonfeasance (Anderson, 2017).
Malpractice is the act an individual commits incorrectly while providing care
(Anderson, 2017). Finally, total disregard for the safety and well-being of
others while incorrectly practicing is labeled, gross negligence (Anderson,
2017). For an AT to be found liable under any of the categories of negligence,
the patient must prove that there was a duty of care by the AT, that there was
a breach of duty, there was further harm caused by the athletic trainer, and
finally that the harm on the patient was directly caused by the breach of duty
(Anderson, 2017).

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