Introduction:
Every day we are faced with a moral decision to provide high-quality, reasonable care for our patients. We are entrusted by our profession, colleagues, and other healthcare providers to act professionally and put the interest of our patient first when providing rehabilitation intervention. In this discussion assignment, I will be sharing with you the ethical challenges that I encounter as a physical therapist (PT) in the intensive care unit (ICU) while providing an early mobilization program and also this is a Segway to my project titled “Evidence-based Approach to the Benefits of Early Mobilization in the Intensive Care Unit: An Education In-Service."
The ICU is a highly specialized environment that has a high volume of patients
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As much as possible, I try to focus my rehabilitation efforts on patients with an acute respiratory distress syndrome and post-surgical patients. However, there are some clients that have a chronic medical conditions such as long-term SCI patients with tetraplegia and patients with complex medical conditions that are also amenable to mobilization but due to the chronicity of their medical condition, I did not include them in my early mobilization project rather I choose to provide a conventional PT treatment of range of motion exercises and proper positioning techniques. I do not see any legal issues concerning this treatment practice since a thorough ICU PT evaluation is conducted and appropriate rehabilitation recommendations within the scope of physical therapy practice are communicated to the referring physicians and other members of the multidisciplinary team. According to Partridge (2010, p. 65), physical therapists are not completely independent practitioners; they work as a team to assist using their expertise to arrived at a unified …show more content…
S42) supports the idea of early referral to physical therapy to improve the patient's cardiopulmonary function, improve muscle strength and endurance that may have an impact in optimizing the overall functional capacity of the patient.
Fortunately, physical therapy consult is part of a standing order in the ICU. The ICU physician notifies the patient, and in situations where the patient is not cognitively appropriate, a family member will be notified for rehabilitation intervention. Therefore, no further legal documentation needed such as informed consent.
Since this project does not involve the use of patient’s name or specific identifiers, patient confidentiality and privacy are preserved.
Concerning the formal process to remain ethical and legal, I was able to assist in the creation, and implementation of an acute care and ICU competency skills checklist to warrant PTs including myself working in the ICU, to be competent and skilled. These clinical proficiencies can be made possible by collaborating with nursing educators in providing instructions and training on various tubes and lines. Moreover, the respiratory therapy team leader also provides an in-service regarding the different oxygen delivery systems including the unique ventilator
and the patient. According to the Indiana PT practice act “Physical therapy” includes, but is not limited to, such measures
While most physical therapists will not solely work in a cardiopulmonary rehabilitation position, all settings of physical therapy frequently treat patients suffering from co-morbidities in addition to the condition that they are prescribed for our care.1 Recognizing and understanding these co-morbidities is important to provide the most effective care to the patient while also decreasing the risk of predisposition to other health conditions.2,3 This is especially important when physical therapists are in a position of providing primary care by seeing patients under a direct access model.4 There are also times when multiple co-morbidities occur simultaneously which must be considered in a plan of care.5 It is important that the physical therapist always screens for co-morbidities, but essentially important when there is the presence of one co-morbidity that is commonly associated with another co-morbidity.3 The recognition of multiple conditions is critical because of the potential interaction that can occur between the different conditions. The presence of one or more conditions can also have a profound impact on treatment that they receive both through surgical and rehabilitative interventions. Co-morbidities can fall under multiple areas and body systems that each affect the patient in different ways. Respiratory and cardiovascular systems are particularly interrelated and can play a vital role in guiding the future
I have attached a recent research report published in the Cardiopulmonary Physical Therapy Journal. With our busy schedules at work and home we often have limited time to review journal articles. I proffer this information hoping to stimulate awareness, thought, and discussion among us. I hope to follow up with monthly articles throughout the year.
Providing physical therapy in the early phase of cardiac rehab in the Intensive Care Unit (ICU) is both daunting and gratifying. I had a 76 years old male patient named Phil (not real name) who in day one, status post off the pump coronary artery bypass graft x 4. As part of the early cardiac rehab program, sternal precautions education is being reviewed on open-heart surgery patients to ensure safety during functional mobility task. However, due to the effects of pain medication, the patient's focus and carry over are both diminished
Nurses are subject to a plethora of legal, ethical, and professional duties which can be very challenging on a day to day basis. Some of these duties include respecting a patient 's confidentiality and autonomy, and to recognize the duty of care that is owed to all patients. As nurses our duties are always professional; however there are legal implications if these duties are breached. We also must consider when it is okay as nurses to breach these duties and therefore ethical issues arise. As nurses one of our main priorities is to advocate for our patients, without our own personal feelings on the matter taking over.
Ethical issues in nursing will always be an ongoing learning process. Nurses are taught in nursing school what should be done and how. Scenarios are given on tests with one right answer. However, there are situations that nurses may encounter that may have multiple answers and it is hard to choose one. “Ethical directives are not always clearly evident and people sometimes disagree about what is right and wrong” (Butts & Rich, 2016). When an ethical decision is made by a nurse, there must be a logical justification and not just emotions.
It is critical as a future physical therapist I recognize the body’s full potential to set the standard for recovery. I will evaluate the individual’s lifestyle and generate the best practice techniques in diagnosing and measuring the most advantageous outcome.
There are quite a bit of barrier implementing a treatment program in the cardiac ICU but the most common hurdle is the nursing staff, and this is because of the variability in their clinical experience. The cardiac ICU that I work at has more new nurses vs. “seasoned” nurses. As you know, the newer nurse seems to be more “conservative” maybe because they are still not content with their newly obtained skills. Therefore, aggressive physical therapy sometimes gets some resistance from this group of providers, in contrast with the seasoned nurses, they are the ones that advocate for assertive treatment.
Having the knowledge that Physical therapists should have to be able to practice autonomously in their profession will equip these professionals to cope with the ever changing medical practice. PTs are slowly working on “Vision 2020” of APTA (2016), wherein we are going to be DPTs, practicing autonomously with direct access, using evidence-based practice, showing professionalism all the time, to be the preferred providers (practitioner of choice) for most patients.
Financial status, geographic location, insurance acceptance are all major contributors to seeing if a patient is eligible for physical therapy. All of this information has importance in this progress just as much as the actually therapy itself. Therapy is intended to help individuals with the treatment of chronic disease, pain or pain management. Of course without payment or insurance acceptance this can’t be achieved. When applying this to the field I want to study the article lays all details out and shows just what a patient is going to experience in his/her physical therapy program. Mainly with the older population this is a problem or occurrence I would see on a daily basis as I would try to provide health care to the
To “optimize movement” for a diverse and changing society, it is vital that I approach each examination, diagnosis and intervention ready to address a wide range of character traits. For instance, based on my knowledge of the human body and best practices of physical therapy, I may conclude that aquatic therapy is necessary for an elderly patient’s optimal recovery from a knee surgery. However, if that patient has a phobia of water, trying to force him or her into the water will remove any initial trust between the patient and myself. While I would still highly recommend water therapy, other alternatives will need to be considered. Eventually, personal care for that patient may even build their trust up enough to allow them to overcome their
My undergraduate education in Kinesiology has provided me with an in-depth insight regarding the physiotherapy profession and has supplied me with sufficient knowledge to form the foundation of human anatomical and physiological science. A physiotherapist is a part of the healthcare system and holds an extensive role in providing quality healthcare services. The primary responsibility is to treat patients with physical complications due to injury, illness, surgery or aging. The goal of a physiotherapist is to rehabilitate the patient to help him/her return to normal level of function. They attempt to restore body systems such as neuromuscular, musculoskeletal, cardiovascular and respiratory systems by using a variety of treatment methods. The
Physical therapists, or PTs, create rehabilitation programs for people with injuries or chronic illnesses to improve their physical function and quality of life. PTs are responsible for knowing a patient's medical history and reviewing any referral from other healthcare professionals before they begin to diagnose a patient's movements through observation. Once they have diagnosed their patients they must develop an individualized care plan to meet the goals of each individual. These treatment plans may combine exercises, stretches, therapy and other equipment to minimize pain and increase movement in a patient. Physical therapists need to track progress and modify treatment if needed. This shows the growth or decline in the care plan. They
Treatment plans that are most common to physical therapists are exercise for patients who are currently immobilized and lack flexibility, strength, or endurance (Asenjo). The main goal of the physical therapist is helping patients achieve goals and use encouragement to improve flexibility, range of motion, strength, balance, coordination, and endurance. The overall job goal is to promote function. Treatments that are commonly used in physical treatments include electrical therapy treatments, physical treatments, therapeutic exercises, and manual therapy. Physical treatments help make muscles and joints more flexible and decrease pain and swelling. Deep heating, or ultrasound and diathermy, cold packs and ice massages, whirlpools and water therapy,
Ethic in nursing form the basis between which sound and moral decisions are derived. They form the backbone of all the trust that is laid on nurses dealing with Moral Question. Acceptable cultures and actions are gauged by nursing ethics that are derived from nursing values. Nurses are supposed to ensure that they adhere to the highest standards as well as maintaining the trust they have from the public. All nurses are bound to exercise the highest standard of ethics though the performance of their functions.