scholarly journals Constrained Physical Therapist Practice: An Ethical Case Analysis of Recommending Discharge Placement From the Acute Care Setting

2010 ◽  
Vol 90 (6) ◽  
pp. 939-952 ◽  
Author(s):  
Ernest Nalette
Keyword(s):  
Clinical Practice ◽  
Acute Care ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Moral Agent ◽  
Moral Dilemma ◽  
Case Analysis ◽  
Ethical Practice ◽  
Best Interest ◽  
Systematic Analysis

Background and PurposeConstrained practice is routinely encountered by physical therapists and may limit the physical therapist's primary moral responsibility—which is to help the patient to become well again. Ethical practice under such conditions requires a certain moral character of the practitioner. The purposes of this article are: (1) to provide an ethical analysis of a typical patient case of constrained clinical practice, (2) to discuss the moral implications of constrained clinical practice, and (3) to identify key moral principles and virtues fostering ethical physical therapist practice.CaseThe case represents a common scenario of discharge planning in acute care health facilities in the northeastern United States.MethodsAn applied ethics approach was used for case analysis.ResultsThe decision following analysis of the dilemma was to provide the needed care to the patient as required by compassion, professional ethical standards, and organizational mission.Discussion and ConclusionsConstrained clinical practice creates a moral dilemma for physical therapists. Being responsive to the patient's needs moves the physical therapist's practice toward the professional ideal of helping vulnerable patients become well again. Meeting the patient's needs is a professional requirement of the physical therapist as moral agent. Acting otherwise requires an alternative position be ethically justified based on systematic analysis of a particular case. Skepticism of status quo practices is required to modify conventional individual, organizational, and societal practices toward meeting the patient's best interest.

scholarly journals Creating an Interface Between the International Classification of Functioning, Disability and Health and Physical Therapist Practice

2010 ◽  
Vol 90 (7) ◽  
pp. 1053-1063 ◽  
Author(s):  
Reuben Escorpizo ◽  
Gerold Stucki ◽  
Alarcos Cieza ◽  
Kandace Davis ◽  
Teri Stumbo ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Physical Therapists ◽  
Physical Therapist ◽  
International Classification ◽  
International Classification Of Functioning ◽  
Clinical Documentation ◽  
Disability And Health ◽  
Comprehensive Classification ◽  
American Physical

The American Physical Therapy Association (APTA) has endorsed the International Classification of Functioning, Disability and Health (ICF) as a framework to be integrated into physical therapist practice. The ICF is a universal and inclusive platform for the understanding of health and disability and a comprehensive classification system for describing functioning. The APTA's Guide to Physical Therapist Practice was designed to guide patient management, given the different settings and health conditions that physical therapists encounter in their daily clinical practice. However, physical therapists may be unclear as to how to concretely apply the ICF in their clinical practice and to translate the application in a way that is meaningful to them and to their patients. This perspective article proposes ways to integrate the ICF and the Guide to Physical Therapist Practice to facilitate clinical documentation by physical therapists.

scholarly journals Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series

2020 ◽  
Author(s):  
Sabrina Eggmann ◽  
Angela Kindler ◽  
Andrea Perren ◽  
Natalie Ott ◽  
Frauke Johannes ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Critically Ill ◽  
Acute Care ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Treatment Strategies ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Potential Treatment ◽  
Prone Positioning

Abstract Objective The aim of this case series was to describe the experience of Swiss physical therapists in the treatment of patients with COVID-19 during their acute care hospital stay and to discuss challenges and potential strategies in the clinical management of these patients. Methods We report 11 cases of patients with COVID-19 from five Swiss hospitals that illustrate the various indications for physical therapy, clinical challenges, potential treatment methods and short-term response to treatment. Results Physical therapists actively treated patients with COVID-19 on wards and in the ICU. Interventions ranged from patient education, to prone positioning, to early mobilization and respiratory therapy. Patients were often unstable with quick exacerbation of symptoms and a slow and fluctuant recovery. Additionally, many patients who are critically ill developed severe weakness, post-extubation dysphagia, weaning failure or presented with anxiety or delirium. In this setting, physical therapy was challenging and required specialized and individualized therapeutic strategies. Most patients adopted the proposed treatment strategies and lung function and physical strength improved over time. Conclusion Physical therapists clearly have a role in the COVID-19 pandemic. Based on our experience in Switzerland, we recommend that physical therapists routinely screen and assess patients for respiratory symptoms and exercise tolerance on acute wards. Treatment of patients who are critically ill should start as soon as possible to limit further sequelae. More research is needed for awake prone positioning, early breathing exercises as well as post-COVID rehabilitation. Impact To date there are few data on the physical therapist management of patients with COVID-19. This article is among the first to describe the role of physical therapists in the complex pandemic environment and to describe the potential treatment strategies for countering the various challenges in the treatment of these patients.

scholarly journals Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline

2016 ◽  
Vol 96 (2) ◽  
pp. 143-166 ◽  
Author(s):  
Ellen Hillegass ◽  
Michael Puthoff ◽  
Ethel M. Frese ◽  
Mary Thigpen ◽  
Dennis C. Sobush ◽  
...  
Keyword(s):  
Decision Making ◽  
At Risk ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Patients At Risk

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT.

Video-Based Motion Analysis Use: A National Survey of Orthopedic Physical Therapists

2020 ◽  
Vol 100 (10) ◽  
pp. 1759-1770
Author(s):  
Craig P Hensley ◽  
Devyn Millican ◽  
Nida Hamilton ◽  
Amy Yang ◽  
Jungwha Lee ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Treatment Outcomes ◽  
Motion Analysis ◽  
Online Survey ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Reliability And Validity ◽  
The United States ◽  
Future Research

Abstract Objectives Motion analysis is performed by physical therapists to assess and improve movement. Two-dimensional video-based motion analysis (VBMA) is available for smartphones/tablets and requires little to no equipment or cost. Research on VBMA use in clinical practice is limited. The purpose of this study was to examine the current use of VBMA in orthopedic physical therapist practice. Methods Members of the Academy of Orthopaedic Physical Therapy completed an online survey. Questions examined frequency of VBMA use, reasons for use, facilitators/barriers, device/apps used, practice patterns, other certificates/degrees, and demographic information. Results Among the final analysis sample of 477 respondents, 228 (47.8%) use VBMA. Of 228 VBMA users, 91.2% reported using it for ≤25% of their caseload, and 57.9% reported using their personal device to capture movement. Reasons for using VBMA included visual feedback for patient education (91.7%), analysis of movement (91.2%), and assessment of progress (51.8%). Barriers to use included lack of device/equipment (48.8%), lack of space (48.6%), and time restraint (32.1%). Those with ≤20 years of clinical experience (odds ratio [OR] = 1.83, 95% CI = 1.21–2.76), residency training (OR = 2.49, 95% CI = 1.14–5.43), and fellowship training (OR = 2.97, 95% CI = 1.32–6.66), and those from the West region of the United States (OR = 1.66, 95% CI = 1.07–2.56) were more likely to use VBMA. Conclusions More than 50% of surveyed orthopedic physical therapists do not use VBMA in clinical practice. Future research should be directed toward assessing reliability and validity of VBMA use by smartphones, tablets, and apps and examining whether VBMA use enhances treatment outcomes. Data security, patient confidentiality, and integration into the electronic medical record should be addressed. Impact This study is the first to our knowledge to describe the use of VBMA in orthopedic physical therapist practice in the United States. It is the first step in understanding how VBMA is used and might be used to enhance clinical assessment and treatment outcomes.

scholarly journals The First Two Years of Practice: A Longitudinal Perspective on the Learning and Professional Development of Promising Novice Physical Therapists

2013 ◽  
Vol 93 (3) ◽  
pp. 369-383 ◽  
Author(s):  
Lorna M. Hayward ◽  
Lisa L. Black ◽  
Elizabeth Mostrom ◽  
Gail M. Jensen ◽  
Pamela D. Ritzline ◽  
...  
Keyword(s):  
Professional Development ◽  
Clinical Practice ◽  
Professional Competence ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Practical Knowledge ◽  
Participant Observation ◽  
Health Care Systems ◽  
Professional Role ◽  
Second Year

Background Physical therapists work in complex health care systems requiring professional competence in clinical reasoning and confidence in decision-making skills. For novice physical therapists, the initial practice years are a time for developing professional identity and practical knowledge. Objectives The study purpose was to extend previous research describing the experiences, learning, and professional development of 11 promising novice therapists during their first year of practice. The present study examined the continued development of the same therapists during their second year of clinical practice. Design Seven researchers from 4 physical therapist educational programs in the eastern and midwestern United States used a longitudinal, qualitative, multiple case study approach. Methods Eleven physical therapist graduates identified as “promising novices” were recruited using purposive sampling. Participants ranged in age from 24 to 29 years and entered varied practice settings. Data were collected for 2 years using semistructured interviews, reflective journals, and participant observation. Results A conceptual model describing the participants' ongoing development during the second year of practice emerged. The 3 themes were formal and informal learning, increasing confidence and expansion of skills, and engagement in an environment characterized by collaborative exchange and opportunities for teaching. The second year represented consolidation and elaboration of practice-based learning and skills. The expansion of confidence, skills, and responsibilities and the externalization of learning the participants experienced promoted professional role formation. Learning previously directed inward and self-focused turned outward, fueled by growing self-confidence. Conclusions Research illuminating the professional role formation experienced during early clinical practice is not widely available. The current study and further research into the learning and development of novice practitioners may assist educators in the design of pedagogical strategies and learning environments that enhance the professional development of physical therapists.

scholarly journals Determining Current Physical Therapist Management of Hip Fracture in an Acute Care Hospital and Physical Therapists' Rationale for This Management

2011 ◽  
Vol 91 (10) ◽  
pp. 1490-1502 ◽  
Author(s):  
Susie Thomas ◽  
Shylie Mackintosh ◽  
Julie Halbert
Keyword(s):  
Hip Fracture ◽  
Physical Therapy ◽  
Acute Care ◽  
Best Practice ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Acute Care Hospital ◽  
Early Mobilization ◽  
Care Hospital ◽  
Retrospective Case

Background Physical therapy has an important role in hip fracture rehabilitation to address issues of mobility and function, yet current best practice guidelines fail to make recommendations for specific physical therapy interventions beyond the first 24 hours postsurgery. Objectives The aims of this study were: (1) to gain an understanding of current physical therapist practice in an Australian acute care setting and (2) to determine what physical therapists consider to be best practice physical therapist management and their rationale for their assessment and treatment techniques. Design and Methods Three focus group interviews were conducted with physical therapists and physical therapist students, as well as a retrospective case note audit of 51 patients who had undergone surgery for hip fracture. Results Beyond early mobilization and a thorough day 1 postoperative assessment, great variability in what was considered to be best practice management was displayed. Senior physical therapists considered previous clinical experience to be more important than available research evidence, and junior physical therapists modeled their behavior on that of senior physical therapists. The amount of therapy provided to patients during their acute inpatient stay varied considerably, and none of the patients audited were seen on every day of their admission. Conclusions Current physical therapist management in the acute setting for patients following hip fracture varies and is driven by system pressures as opposed to evidence-based practice.

scholarly journals Meaning of Caring to 7 Novice Physical Therapists During Their First Year of Clinical Practice

2008 ◽  
Vol 88 (10) ◽  
pp. 1154-1166 ◽  
Author(s):  
Bruce H Greenfield ◽  
Adam Anderson ◽  
Brittany Cox ◽  
Michelle Coryell Tanner
Keyword(s):  
Clinical Practice ◽  
Time Management ◽  
Physical Therapists ◽  
Physical Therapist ◽  
First Year ◽  
Moral Orientation ◽  
Difficult Patient ◽  
Caring Behaviors ◽  
Personal Lives ◽  
Core Value

Background and Purpose Caring has been identified as a rules-based approach to good patient care, as a core value in physical therapist professional behavior, as a part of experienced and expert practice, as a virtue, and as a moral orientation. Previous research showed that experienced and expert female physical therapists value compassion and caring in clinical practice. However, little is known about how novice physical therapists care for their patients. The purpose of this study was to explore the meaning of caring from the perspectives of novice physical therapists. Subjects Seven novice physical therapists (with less than 1 year of clinical experience) working in either an outpatient or an inpatient facility were recruited. Methods A qualitative method (phenomenology) was used, with data being obtained from retrospective interviews of the novice physical therapists regarding their experiences in the clinic. Results Three common themes relating to the nature of caring emerged: learning to care (with the following subthemes: barriers to caring, the “difficult” patient, finding a balance, and time constraints), patients as subjects, and the culture of the clinic. Discussion and Conclusion The novice physical therapists in this study expressed difficulty in dealing with difficult patients, with time management, and with balancing their professional and personal lives. However, despite the barriers to caring, many of these participants viewed caring not just as a rules-based approach but as a core value and, in some cases, a moral orientation that guided their first year of clinical practice. The findings suggest that caring requires certain skills and attitudes that accrue over time and that physical therapist education programs should integrate learning experiences (including clinical experiences) throughout the curriculum that foster caring behaviors in order to prepare students for the first-year transition in the clinic. In addition, experienced clinicians should appreciate how their clinic's culture and their behaviors can help model caring attitudes in novice physical therapists.

scholarly journals Clinical Update for Physical Therapists: Coagulopathy and COVID-19

2020 ◽  
Vol 100 (12) ◽  
pp. 2127-2133
Author(s):  
Kathleen Lukaszewicz ◽  
Ellen Hillegass ◽  
Michael L Puthoff ◽  
A Kate MacPhedran
Keyword(s):  
Physical Activity ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Signs And Symptoms ◽  
Early Mobility ◽  
Unique Role

Abstract Physical therapists have a unique role in both prevention of venous thromboembolism (VTE) through the promotion of early mobility and physical activity and diagnosis through discovery of signs and symptoms of VTE. This Perspective updates clinicians on the latest information regarding pathophysiology of coagulopathy associated with COVID-19 and applies VTE clinical practice guidelines to COVID-19 in order to provide guidance on physical therapist management.

scholarly journals Paradigm shift, metamorphosis of medical ethics, and the rise of bioethics

1999 ◽  
Vol 15 (suppl 1) ◽  
pp. S15-S25 ◽  
Author(s):  
José Luiz Telles de Almeida ◽  
Fermin Roland Schramm
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Medical Practice ◽  
Paradigm Shift ◽  
Medical Technology ◽  
Moral Dilemma ◽  
Ethical Practice ◽  
Ethical Theories ◽  
Philosophical Debate ◽  
The 1960S

Both the increasing incorporation of medical technology and new social demands (including those for health care) beginning in the 1960s have brought about significant changes in medical practice. This situation has in turn sparked a growth in the philosophical debate over problems pertaining to ethical practice. These issues no longer find answers in the Hippocratic ethical model. The authors believe that the crisis in Hippocratic ethics could be described as a period of paradigm shift in which a new set of values appears to be emerging. Beginning with the bioethics movement, the authors expound on the different ethical theories applied to medical practice and conclude that principlism is the most appropriate approach for solving the new moral dilemma imposed on clinical practice.

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