{"id":16179,"date":"2021-05-01T01:01:26","date_gmt":"2021-05-01T00:01:26","guid":{"rendered":"https:\/\/bant.org.uk\/?page_id=16179"},"modified":"2024-08-20T18:32:23","modified_gmt":"2024-08-20T17:32:23","slug":"online-working","status":"publish","type":"page","link":"https:\/\/bant.org.uk\/bant-professional-practice-handbook\/online-working\/","title":{"rendered":"ONLINE WORKING"},"content":{"rendered":"

[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern” el_id=”top-section” z_index=”” css=”.vc_custom_1619334407087{padding-bottom: 45px !important;}”][vc_column][vc_column_text]As well as traditional face-to face consultations, many Registered Nutritional Therapy Practitioners (NTs) now also offer online consultations. Talks, webinars and group programmes may also be conducted online, and this section provides guidelines for safe practice and advice on what to take into consideration when working online.[\/vc_column_text][vc_raw_html]JTVCcHJpbnRmcmllbmRseSU1RA==[\/vc_raw_html][\/vc_column][\/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern” z_index=”” anchor=”main_anchor1″][vc_column]\n\n\t\n\t Conducting Online Nutritional Therapy Consultations<\/span><\/i><\/span>\t<\/a>\n\n[vc_separator type=”transparent” thickness=”5″ up=”2″ down=”2″]\n\n\t\n\t Considerations for Online Working<\/span><\/i><\/span>\t<\/a>\n\n[vc_separator type=”transparent” thickness=”5″ up=”2″ down=”2″]\n\n\t\n\t Guidelines for Recording Online Consultations<\/span><\/i><\/span>\t<\/a>\n\n[vc_separator type=”transparent” thickness=”5″ up=”2″ down=”2″]\n\n\t\n\t Online Workshops\/Programmes<\/span><\/i><\/span>\t<\/a>\n\n[vc_separator type=”transparent” thickness=”5″ up=”2″ down=”2″]\n\n\t\n\t Guidelines for Webinars and Webinar Recording<\/span><\/i><\/span>\t<\/a>\n\n[vc_separator type=”transparent” thickness=”5″ up=”2″ down=”2″]\n\n\t\n\t Online Consent and eSignatures<\/span><\/i><\/span>\t<\/a>\n\n[vc_separator type=”transparent” thickness=”30″][vc_row_inner row_type=”row” type=”full_width” text_align=”left” css_animation=”” anchor=”conducting-online-nutritional-therapy-consultations” el_class=”anchordiv”][vc_column_inner el_class=”anchor_col” css=”.vc_custom_1618397491357{padding-top: 30px !important;padding-right: 30px !important;padding-bottom: 30px !important;padding-left: 30px !important;}”][vc_column_text]<\/p>\n

Conducting Online Nutritional Therapy Consultations:<\/i> Top<\/span><\/a><\/h3>\n

There are several reasons why it might be appropriate for Registered Nutritional Therapy Practitioners (NTs) to conduct consultations online using video conferencing software. These include convenience, availability, a client\u2019s immobility or ill-health, or the distance to an NT, particularly one who has an interest in a specific health condition or a particular area of expertise.<\/p>\n

Online consultations are now an acceptable alternative to face-to-face, but there are many aspects to consider when assessing whether an online consultation is appropriate.\u00a0 Where possible, the NT can have a conversation with potential clients before they are booked in to assess whether the consultation will be held face-to-face or remotely. Most healthcare professionals agree that meeting a client face-to-face at least once in the therapeutic relationship facilitates interaction. This is mainly due to the almost subliminal interactions that take place when in the presence of another person: building rapport, viewing physical symptoms, picking up on visual cues e.g., body language that demonstrates that the client is or is not in agreement with any recommendations, see Considerations for Online Working<\/a>. A client must understand the potential limitations of an online consultation and this must be noted in the client file.<\/p>\n

If online consultations are being conducted with clients living outside the UK, then NTs must check with their insurer that they are covered to do this. If an NT is working overseas and wants to conduct online consultations with clients living in the UK, they need to follow BANT guidelines for Overseas Practitioners<\/a>.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator type=”transparent” thickness=”30″][vc_row_inner row_type=”row” type=”full_width” text_align=”left” css_animation=”” anchor=”considerations-for-online-working” el_class=”anchordiv”][vc_column_inner el_class=”anchor_col” css=”.vc_custom_1618397536613{padding-top: 30px !important;padding-right: 30px !important;padding-bottom: 30px !important;padding-left: 30px !important;}”][vc_column_text]<\/p>\n

Considerations for Online Working:<\/i> Top<\/span><\/a><\/h3>\n

What to consider and prepare for before starting online working:<\/p>\n

Technology<\/strong><\/p>\n

An NT must review the available online options (Skype, Facetime, GotoMeeting, Zoom etc.) and choose the system most suited to their purposes. The software chosen must be encrypted to ensure UK GDPR compliance. Technology changes rapidly and a practitioner must regularly review updates to the system being used to ensure that it remains the best one.<\/p>\n

A client may not be familiar with the technology being used and\/or they may not be confident or experienced in video calling. Extra time must be built into an initial consultation to allow for set-up issues. If a prospective client is very uncomfortable with the idea of video conferencing, they must be referred to the BANT website to search for a practitioner<\/a> they can consult with face to face.<\/p>\n

When relying on internet providers at both ends of a video call, there is scope for things to go wrong: Wi-Fi dropping out, picture freezing, background noise, automatic updates at the time of a call, microphone not working, etc. It is essential to have a plan for what to do if the call has to be abandoned due to technological issues. This reduces stress for both the client and the NT and manages a client\u2019s expectations.<\/p>\n

Pre-Consultation Paperwork<\/strong><\/p>\n

Consultation paperwork such as Terms of Engagement Agreement<\/a> and Commercial Agreements must be completed before the first online consultation. Online signatures<\/a> or even tick-boxes agreeing to terms and conditions are acceptable and members must ensure that all paperwork is completed and stored safely, regardless of the type of consultation. As part of the pre-consultation paperwork, the NT must include \u2018Remote Consultation Guidelines\u2019 to discuss with the client at the time of booking.\u00a0 \u00a0For example, if there is some background noise, such as a neighbour\u2019s dog barking, the mute button can be used when required; if the call has to be abandoned, what happens with the consultation? if a Wi-Fi signal is weak, can the call be continued with voice only? (this uses less bandwidth), etc. \u00a0\u00a0These guidelines can be included in the Terms of Engagement or Commercial Agreement and BANT recommend obtaining a client signature.<\/p>\n

Privacy\/Confidentiality<\/strong><\/p>\n

One advantage of remote consultations is that both parties can be anywhere, but privacy and client confidentiality remain paramount. The NT must ensure that the location each party is using is UK GDPR compliant: a client may not realise that a caf\u00e9, for example, is not an appropriate location.<\/p>\n

If there is a risk that the consultation may be overheard, even if an NT is in a closed room away from others, a headset must be used so that only the practitioner can hear the client\u2019s conversation. Regarding a client, it is possible that there may be someone else in the room with them, even if the practitioner cannot see them. This must be checked with a client at the start of an online consultation and if another party is present, a note made in the consultation paperwork to record this.<\/p>\n

Background<\/strong><\/p>\n

In remote consultations the NT is only visible from the shoulders up, unless they get up during the consultation, so the same professional attire is required as if a client were in the room. The view behind the practitioner must also be considered and present a tidy, professional, neutral aspect. What artwork\/books\/files\/furniture are visible? How does the light fall in the room? Can the client see the practitioner clearly? If a NT is at home with pets and children, it\u2019s essential to make sure that they can\u2019t get into the office during a client call. If a door is visible in the background, it must be closed. A practice call with a friend or family member is recommended to ensure the environment is right.<\/p>\n

Presentation<\/strong><\/p>\n

When using video, looking at the image of the client on the screen provides the most natural effect. Looking directly into the camera may seem like staring into a client\u2019s eyes. Additionally, some apps make an adjustment, so looking into the camera may seem like looking away. If preferred, most software has a \u2018Hide Self View\u2019 option that may be used if the practitioner finds their own image distracting.<\/p>\n

The quality of the NT\u2019s microphone should be checked with a practice session before using with clients. If the quality is poor, investing in a separate microphone may be considered.<\/p>\n

Other apps, email alerts, etc., must be shut down before an online consultation and phones silenced to avoid interruptions.<\/p>\n

Physical Symptoms<\/strong><\/p>\n

Visualising physical symptoms via video link is not ideal but may be supported with a request for photos of any specific symptoms e.g., eczema flares, prior to the consultation. All symptoms requiring a diagnosis must be referred to a GP. Asking clients to describe their physical symptoms in detail can be supported by showing a problem area via video, when appropriate.\u00a0 However, other general symptoms such as nail conditions, eye colour etc. may be missed. Detailed use of a \u2018Body Scan\u2019 tool that asks questions relating to symptoms per body area, as part of the intake questionnaire, is key for picking up symptoms that may not be clear over a video screen.<\/p>\n

Assessments such as weigh-ins, measurements and blood-pressure analysis clearly cannot be undertaken online. Weigh-ins and tape-measure measurements can be undertaken by the client themselves and self-reported for the record but bear in mind that a client may be \u2018looking to please\u2019 so there is a risk of inaccurate reporting.<\/p>\n

Rapport and Non-Verbal Cues<\/strong><\/p>\n

When working online, a slightly different approach to building rapport and spotting non-verbal cues must be considered. Whilst all NTs are trained to explore fully what clients mean when they describe something, online consultations mean that this form of questioning becomes even more important. Ensuring understanding, and therefore lowering the risk of complaints, is paramount, particularly as non-verbal cues, made off-screen, will be missed. Rapport may be harder to build in an online consultation.<\/p>\n

Online consultations are more intense than face-to-face interactions so consider short breaks in a long consultation or reducing the overall time of the appointment.<\/p>\n

Post-Consultation Paperwork and Client Notes<\/strong><\/p>\n

As with any consultation, all paperwork and client notes, including text messages, instant messages, emails etc., must comply with the UK legislation relating to GDPR<\/a>. Information shared via text and instant message must be kept to a minimum e.g., the confirmation of consultation times, as it is difficult to record this in a client file and may be used against a practitioner in the event of a complaint.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_separator type=”transparent” thickness=”30″][vc_row_inner row_type=”row” type=”full_width” text_align=”left” css_animation=”” anchor=”guidelines-for-recording-online-consultations” el_class=”anchordiv”][vc_column_inner el_class=”anchor_col” css=”.vc_custom_1618397548620{padding-top: 30px !important;padding-right: 30px !important;padding-bottom: 30px !important;padding-left: 30px !important;}”][vc_column_text]<\/p>\n

Guidelines for Recording Online Consultations:<\/i> Top<\/span><\/a><\/h3>\n

With the increasing use of video-conferencing apps for consultations, recording features are widely available across different video platforms. The recording of consultations is discouraged but if recorded, guidelines must be followed with regard to consent, storage and duration of storage.\u00a0 These guidelines apply to both audio and video recording of consultations using any software or recording device.<\/p>\n

BANT recommend using the GDPR guidelines<\/a> to evaluate the appropriateness of recording consultations.<\/p>\n

Ensure any default settings in the app chosen, which allow video recording to take place, are disabled.\u00a0 They can then be switched on when appropriate agreements are in place and with the full awareness of both parties.<\/p>\n

Consent<\/strong><\/p>\n

The most important point to remember is that neither the NT nor the client can record the consultation without reciprocal consent.<\/p>\n