5.3 Professional Practice & Ethics

CRT/RRT Respiratory Therapist Exam Exam

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1 Introduction: NBRC TMC Exam Overview

NBRC TMC Exam Overview Credential Pathway: CRT to RRT Study Strategies for the TMC Exam Content Domains & Weight Distribution

2 Chapter 1: Patient Data Evaluation

1.1 Patient History & Physical Assessment 1.2 Diagnostic Procedures & ABG Interpretation 1.3 Hemodynamic Monitoring & Waveform Analysis 1.4 Laboratory Values & Diagnostic Data

3 Chapter 2: Airway Management & Oxygen Therapy

2.1 Airway Anatomy & Assessment 2.2 Airway Management Devices & Procedures 2.3 Oxygen Therapy Devices & Delivery 2.4 Humidification & Aerosol Therapy

4 Chapter 3: Mechanical Ventilation

3.1 Ventilation Fundamentals 3.2 Initial Ventilator Settings 3.3 Ventilator Monitoring & Waveform Analysis 3.4 Weaning & Liberation from Mechanical Ventilation

5 Chapter 4: Pharmacology & Equipment

4.1 Respiratory Pharmacology 4.2 Equipment & Troubleshooting 4.3 Specialty Procedures

6 Chapter 5: Infection Control, Ethics & Professional Practice

5.1 Infection Control & Prevention 5.2 Emergency Procedures & Resuscitation 5.3 Professional Practice & Ethics

5.3 Professional Practice & Ethics

Key Takeaways Explain This Topic AI

The AARC Statement of Ethics & Professional Conduct directs RTs to act with competence, integrity, and respect for autonomy

Valid informed consent requires understanding, disclosure of alternatives, voluntariness, and patient competence/capacity

Competent patients may refuse any treatment, including mechanical ventilation, even when refusal may be fatal

Advance directives (living will, healthcare proxy, DNR/DNI, POLST/MOLST) speak for patients who cannot communicate

SOAP documentation: Subjective (patient statements), Objective (measurable data), Assessment (interpretation), Plan (next steps)

HIPAA limits disclosure to the minimum necessary, shared only with authorized personnel who need to know

Evidence-based practice integrates best research evidence, clinical expertise, and patient values

SBAR (Situation, Background, Assessment, Recommendation) is the standard structured handoff and physician-notification format

Last updated: June 2026

Professional Practice & Ethics

The TMC exam threads professional-practice, ethics, legal, documentation, and communication items through its safety objectives. These feel less clinical than ventilator math, but they protect patients and your license.

AARC Statement of Ethics and Professional Conduct

The American Association for Respiratory Care (AARC) publishes the profession's ethics standard. Core duties:

Competence -- maintain and advance skills through continuing education.

Integrity -- act honestly; avoid conflicts of interest and falsified records.

Patient welfare (beneficence/nonmaleficence) -- put the patient's well-being first; do no harm.

Confidentiality -- protect health information (HIPAA).

Justice / non-discrimination -- treat all patients fairly regardless of race, gender, religion, age, or ability to pay.

Respect for autonomy -- honor patient decisions, including refusal of care.

Scope of practice -- stay within state licensure and credentialing limits.

The four classic bioethics principles -- autonomy, beneficence, nonmaleficence, and justice -- are fair game on the exam.

Patient Rights and Legal Concepts

Concept Definition

Informed consent Patient understands the procedure, risks, benefits, and alternatives; agrees voluntarily; is competent

Implied consent Assumed in life-threatening emergencies when the patient cannot consent
Right to refuse A competent adult may refuse any treatment, even life-sustaining therapy
Advance directive Document stating wishes when the patient cannot communicate
Living will Specifies which treatments are wanted or declined
Healthcare proxy / power of attorney Names a surrogate decision-maker
DNR No CPR if arrest occurs
DNI No intubation; non-invasive support may still be offered
POLST / MOLST Portable, actionable physician orders for life-sustaining treatment

Worked scenario: A competent end-stage COPD patient says, "Do not put me on a ventilator." Autonomy governs -- you advocate for a physician-documented DNI order and never coerce or override the patient. Battery/assault language on the TMC describes treating a competent refusing patient without consent.

Scope of Practice

RTs work under medical direction , bounded by state licensure law, facility policy, physician orders/protocols, and NBRC credentials (CRT, RRT, and specialties such as ACCS or NPS). Never perform a task outside your scope, even at a physician's request, unless your state permits it and you are trained and credentialed.

Documentation -- SOAP

Section Content Example
S -- Subjective What the patient reports "My chest feels tight."
O -- Objective Measurable data RR 28, SpO2 91% on 2 LPM NC, bilateral wheezes, peak flow 180 L/min
A -- Assessment Clinical interpretation Moderate acute asthma exacerbation
P -- Plan Next steps Albuterol 2.5 mg via nebulizer; reassess in 30 minutes; notify physician

Documentation rules: record objective facts, not opinions; chart in real time; use only approved abbreviations; if it is not documented it was not done; never alter a record -- add a dated, signed addendum; always note the patient's response to therapy. Charting "patient seems to be faking" is a subjective judgment that is legally hazardous and unprofessional.

Communication -- SBAR

Component Content Example
S -- Situation What is happening now "Mr. Jones in 412 dropped to SpO2 85% on 4 LPM."
B -- Background Relevant context "Admitted yesterday with pneumonia, on antibiotics."
A -- Assessment Your read "I think the pneumonia is worsening; accessory-muscle use."
R -- Recommendation Your request "Recommend a non-rebreather, an ABG, and consider BiPAP."

Use SBAR for physician notification and handoffs; SOAP is for the chart, while SAMPLE and OPQRST are history-taking tools.

Evidence-Based Practice and the Evidence Hierarchy

Evidence-based practice integrates best research evidence + clinical expertise + patient values . From strongest to weakest: (1) systematic reviews and meta-analyses of randomized controlled trials, (2) randomized controlled trials, (3) cohort and case-control studies, (4) case series/reports, (5) expert opinion.

Quality, Safety, and Event Classification

Term Description
Sentinel event Unexpected death or serious harm; triggers immediate investigation
Near miss Error caught before harm reaches the patient
Never event A serious, wholly preventable event that should never occur
Root cause analysis Structured search for the underlying cause
Time-out Pre-procedure verification of patient, procedure, and site

The Joint Commission National Patient Safety Goals stress two-identifier patient identification, accurate communication, and medication safety -- frequently tested professional-practice content.

Patient Identification and Medication Safety

The TMC reinforces using two patient identifiers (typically full name and date of birth, never the room number) before any treatment or medication. Before a respiratory medication, verify the five rights : right patient, right drug, right dose, right route, and right time. A common exam trap is administering a nebulizer based on a room-number match alone or skipping verification because the unit is busy -- both are unsafe.

Cultural Competence, Disclosure, and the Impaired Colleague

Professional practice extends to cultural competence (using a qualified medical interpreter rather than a family member for non-English speakers), truthful disclosure of errors to patients and supervisors, and mandatory reporting . If you observe a colleague who appears impaired by drugs or alcohol, the ethical and legal duty is to report it through the chain of command to protect patients -- not to cover for the coworker. Falsifying a record, practicing beyond your license, or abandoning a patient assignment are all reportable to the state licensing board and can cost your credential.

Delegation and Supervision

Under the NBRC credential structure, an RRT may supervise students, technicians, and aides, but delegation never transfers accountability. The supervising therapist remains responsible for ensuring the task is within the delegatee's training and scope and that the patient outcome is verified.

Situation Correct RT action
Physician orders a treatment outside RT scope Decline; clarify with the physician and reference policy
Patient refuses a documented treatment Honor refusal; document and notify the physician
Suspected medication error reached the patient Assess the patient, report, and complete an incident report
Family asks for the chart in the hallway Disclose only per HIPAA and facility release policy

These professional-judgment scenarios are exactly how the TMC frames ethics: a short patient vignette with one defensible, patient-centered, legally sound choice.