MITS5004 Ethical Physiotherapy Practice

Introduction:

Physiotherapy or physical therapy (PT) is a form of treatment focused on functionality and movement and aimed to optimize potential. The treatment attempts to improve quality of life, movement ability in the domains of promotion, prevention, treatment, intervention, habilitation and rehabilitation. A diverse array of physiological conditions requires PT intervention like neuromuscular, musculoskeletal, cardiovascular and respiratory dysfunctions (physio-pedia.com, 2018). The Australian Health Practitioner Regulation Agency (AHPRA) and National Boards implemented the National Registration and Accreditation Scheme under Health Practitioner Regulation National Law that regulate the PT practice (physiotherapyboard.gov.au, 2018).

What was done:

In the given scenario, involving an accident related to the fall of the patient, and the care staff failing to note this incident. The issue came to light when the patient complained of pain and discomfort during the PT session, and showed concern of the possibility of a fracture. However subsequent diagnosis ruled out the possibility of fracture.

A safety assessment of the environment of the patient was conducted, that helped to identify any fall risks. This included improving the lighting to improve visibility, installing double rails on staircases, grab bar, shower chair and hand held showers in the bathroom. These are simple and inexpensive ways to make the environment safer for the patient (ncoa.org, 2018). Additional strategies to reduce the risks of fall included improvement of balance and gait with exercise routines, reduce tipping hazards (keeping the walkways clear of obstacles), avoiding loose mats or rugs, performing an eye checkups and review of medications that can cause dizziness or drowsiness (Cdc.gov, 2018). Assessment of patient’s ability to move due to the fall was also conducted which highlighted pain in the hip, and discomfort in movement. Additionally, the incident was also reported to healthcare authority.

What was learnt:

Several factors can increase the fall risks, especially among older patients, like: balance and gait, vision, medication, environment and chronic conditions. Any attempts to reduce the risks of falling, needs to address one or more of these factors that actively contribute to the chance of falling (ncoa.org, 2018). The event highlighted the necessity to identify the risks that increase the propensity of falling. Lee, Lee and Khang (2013) pointed out that a normal gait needs proper and appropriate functioning of the joints and muscular contractions, as well as the requirements for accurate visual, tactile, and proprioceptive senses. With age, the joints can stiffen, and muscle strength can decrease, and neurologic feedback can be adversely affected. These increase the likelihood of falling. Different intervention strategies can be suggested to address abnormal results from the PT examination, as shown in the figure below:

The event also highlighted the necessity of maintaining accurate and up to date records about the patient, including symptoms or medications and should include any incidents that can jeopardize the well being of the patient. Wagner et al. (2008) pointed out that incident reporting system is important to improve the care process, and that improvement in the existing system of reporting is a necessity.

How the activity affirmed or influenced my practice:

The activity had profound influence on my practice in PT. Firstly; it highlighted the necessity of prompt and accurate reporting of incidents related to the safety and well being of the patients in the care facility. Since the fall of the patient was not reported, it resulted in the PT aggravating the pain or discomfort, although inadvertently. If such event was reported by the care staff the PT would have taken special care while conducting routine checkups and analysis. Moreover, such an overlook could also have cause serious complications, if the fall resulted in any facture. This showed the necessity absolute mindfulness of the care staff, and proper monitoring of the patient.

Additionally, the incident also shows the importance of risk assessment of falling or tripping hazards. Since among the geriatric population, the ability to move gets significantly affected, any factors that can increase the propensity of falling must be analysed and eliminated if possible, apart from providing assistance to avoid the risk.

Conclusion:

In geriatric care, a significant health and security risk is posed due to an increased propensity of falling. Such risks are aggravated by an abnormal gait, caused due to several conditions related to age and degenerative diseases. Interventions that can reduce the risk include a proper risk assessment, as well as involving activities that can improve the gait.

References:

Cdc.gov. (2018). Simple Steps to Reduce Fall Risks. Cdc.gov. Retrieved 7 February 2018, from https://www.cdc.gov/media/matte/2012/07_falls.pdf

Lee, A., Lee, K., & Khang, P. (2013). Preventing Falls in the Geriatric Population. The Permanente Journal, 17(4), 37-39. https://dx.doi.org/10.7812/tpp/12-119

ncoa.org. (2018). 6 Steps for Preventing Falls in the Elderly | NCOA. NCOA. Retrieved 7 February 2018, from https://www.ncoa.org/healthy-aging/falls-prevention/preventing-falls-tips-for-older-adults-and-caregivers/6-steps-to-protect-your-older-loved-one-from-a-fall/

physio-pedia.com. (2018). Physiotherapy / Physical Therapy. Physiopedia. Retrieved 7 February 2018, from https://www.physio-pedia.com/Physiotherapy_/_Physical_Therapy

physiotherapyboard.gov.au. (2018). Physiotherapy Board of Australia – Code of conduct. Physiotherapyboard.gov.au. Retrieved 7 February 2018, from https://www.physiotherapyboard.gov.au/Codes-Guidelines/Code-of-conduct.aspx

Wagner, L., Capezuti, E., Clark, P., Parmelee, P., & Ouslander, J. (2008). Use of a falls incident reporting system to improve care process documentation in nursing homes. Quality And Safety In Health Care, 17(2), 104-108. https://dx.doi.org/10.1136/qshc.2007.022947