Clinical Practice in Physiotherapy - Assignment Example

Clinical Practice in Physiotherapy In physiotherapy, the practitioners are obliged to help ill or injured people function and recover movement to their full potential. They provide care directly to the patients. Physiotherapists work in areas that include mental health, paediatrics, men and women health, intensive care and more (Herbert 2011, p. 56).These trained health professionals operate in private hospitals, community health care organizations and National Health Service (NHS) hospitals. In the United Kingdom, the CSP has formulated the quality assurance standards that govern the treatment and management in physiotherapy. All practitioners use different sources to inform clinical practice in order to increase their effectiveness in the delivery of care. Section 8.5 of the QAS in the Chartered Society of Physiotherapy (CSP) requires physiotherapists to identify the best treatment options based on sources such as clinical guidelines and empirical evidence (Chartered Society of Physiotherapy 2012, sec. 8). Other sources include utilizing the highly experienced physiotherapists and the clinical performance instruments and models, which improves delivery of care. These sources are reliable and when used in clinical practice, they enhance professional empowerment, increase the ability to solve problems and increase the quality of care delivered to patients. On another hand, the sources are prone to inadequate reporting, homogeneity and generalization of the research findings. The CSP has also provided standards that govern the reflective practice in physiotherapy. In section 3.1, practitioners are required to reflect and engage in continuing professional development (CPD) process in order to be competent in health practice. One can utilize reflective models to analyse one’s learning experience and achieve the quality assurance standards stipulated in the CSP. The most commonly used models include the Atkins and Murphy model of reflection and John’s model of reflection of 1994. Empirical Research and Evidence and Clinical Practice Over the past decades,emphasis has been put in evaluating the quality of services delivered by physiotherapist whilst in practice. As a result, the practitioners have increasingly utilized empirical research as a source of information, which support decision making.In order to improve decision-making and problem-solving, practitioners have been encouraged to transfer the research findings into the clinical practice.As a result, the evidence based practice has been born. Research shows that evidence based practice requires three components, that is, the physiotherapists, patients and quality evidence from research (Herbert 2011, p. 58). Strengths Empirical evidence is reliable and covers wide areas in clinical practice. In addition, the empirical evidence forms the basis for further research in the current clinical practice. Quality or best evidence is one of the components of evidence based practice and, therefore, it forms the basis of many decisions made during the provision of care.For example, if a physiotherapist was confronted by a patient who needs antibiotics, he/she will use the empirical evidence in making the final decision on whether to deliver the antibiotics or not. Empirical research shows that antibiotics are ineffective in curing a patient and, therefore, a physiotherapist ought not to deliver the drugs if he/she has adopted the evidence-based practice(Porter 2008, p. 123). The empirical research findings provide a wide range source of information. First, the evidence provides the research based knowledge where physiotherapists use the scientific studies. In scientific research, there is observation and experimentation of the data. The research is usually conducted to solve the complex scientific errors that affect the quality of medicine delivered to patients. For example, in drug prescription, a therapist might commit some errors, but, while using the research results, he/she can correct such errors and improve the quality of health care. On another hand, research findings encompass solutions to complex social problems that exist between the physiotherapists and the patients. Research has brought the best strategies for physiotherapists that improve their relationships with the patients. For example, psychotherapists should be empathetic and congruent when dealing with patients in critical conditions according to research, which also provide scales of measurements (Porter 2008, p. 129). Another important knowledge obtained from research results is the traditional knowledge. It refers to the indigenous information that describes the nature of communities. Physiotherapists working from community-based organizations can utilize this knowledge in delivering quality health care services to children, adults and older adults at local level. Practitioners review the trial and error approaches used by the researchers and use them in clinical practice. The data obtained from these approaches is beneficial to physiotherapists because it helps them in decision making as well as increasing their self-confidence whilst in practice (Partridge 2007, p. 111). Using empirical evidence in clinical practice is very important because it leads to improvement of health care services, increased professional empowerment and high professional confidence. High quality of care is delivered because physiotherapists consider the patients’ values and the evidence when in clinical practice. They also review their skills and experiences using the models of reflection. The enhanced knowledge obtained from the evidence empowers psychotherapists, which make them fit at the workplace and meet the jobs criteria, as well.Empirical evidence enables physiotherapists adopt critical approaches whilst delivering care and this improves the decision making processes(Hack and Gwyer 2013, p. 165). Weaknesses As stated earlier, the evidence obtained from the qualitative research is prone to insufficient data reporting. Although the physiotherapists have benefit from research, they have also committed errors due toineffectiveness of the same research. In some physiotherapy research, there are no follow-ups, which prove that the findings were effective. Also, lack of control groups makes the research results incredible. The patients, physiotherapists and estimators involved in the qualitative research may be biased or irrational when filling the questionnaires. In some research, the researchers do not identify the population and the samples used, which distorts the results obtained. It, therefore, means that, physiotherapists using such evidence in clinical practice might deliver poor services whilst in practice (Partridge 2007, p. 116). The physiotherapy evidence also suffers from homogeneity where many research findings are similar. Additionally, the subjects of the study are usually considered that, they suffer from similar problems and have similar potential in responding to the questions asked by the researcher. In the real sense, the patients cannot have similar problems whether in mental health or neurology. This homogeneity in research findings renders the evidence based practice incredible and ineffective. Lack of comparison of studies, emanates from researchers behaviour that assumes that the samples are homogenous (Partridge 2007, p. 119). There is generalization of studies conducted by the physiotherapy research. After analysis of the research findings, researchers generalize that it can be used in clinical practice even without providing the necessary procedures. In most research conducted, the researchers recommend the results for improvements and use in clinical practice, but, fail to outlay the procedures and scales of measurements of the outcomes. As a result, physiotherapists interpret the findings in their own ways thus reducing the effectiveness in the delivery of care (Partridge 2007, p. 127). Clinical Guidelines in Clinical Practice The clinical guidelines refer to recommendations and statements that are based on the empirical evidence usually intended to increase the health care delivered to patients. In the formulation of the guidelines, the physiotherapist systematically reviews the empirical data in order to identify the best evidence that applies in each area of specialization. These guidelines are informed with the evaluations of the harms and benefits of using alternative care options. The guidelines help physiotherapists in making decisions on which methods of treatment to adopt in clinical practice. The guidelines are used as instruments in managing and improving the health care processes. Physiotherapists mostly deal with patients with mental disorders, stress or disabilities. Using the clinical guidelines is very important in NHS hospitals, for example, in the ICUs where patients need much attention despite the drug treatments. In community based programs, the health providers usually deal with children, women and people with disabilities. Thesignificant difference between the clinical guidelines and empirical evidence is that the guidelines are informed with alternative treatment methods whereas empirical evidence is never informed (Higgs 2008, p. 234). Advantages of Clinical Guidelines Clinical guidelines are usually developed in order to optimize health care and reduce cost of the interventions between the physiotherapists and the patients. The fact that the guidelines are made in relation to the patients’ behaviour and local experience makes them favourable in addressing wide range of problems.Due to the distinctive health care problems that arise in developed and underdeveloped countries across the world, the guidelines, therefore, help in solving such problems since they are not universal. In a UK based hospital, physiotherapists adhere to the clinical guidelines that are compatible with their clinical environment, other than following universally, accepted guidelines. As a result, the rehabilitation processes, intensive care and child care is improved(Higgs 2008, p. 236). These guidelines address the concepts of variability and transparency in clinical practice. These concepts have been omitted in the empirical evidence. These guidelines promote transparency in clinical practice and rule out variability. When practitioners become transparent in delivering health care services, many physical therapy care units benefit from the same, thus, achieving high quality of patient care across the world(Higgs 2008, p. 239). Another advantage of the clinical guidelines is that the recommendations are based on the examination of the problems faced by the physiotherapists on the daily basis. In guideline development, the problem analysis is included in the formulation of the clinical questionnaires. In this way, the challenges facing practitioners are accounted for in the guidelines, unlike the empirical evidence. Unlike the traditional physiotherapy field, the clinical guidelines encompass diagnosis, treatment and improvement of the body functioning statuses of the injured or disabled patients.The process of formulating the patient-relevant outcomes when developing the guidelines is very important because it accounts for the patients’ values. These values are important in evidence based practice(Partridge 2007, p. 123). Disadvantages of Clinical Guidelines Clinical guidelines have been published worldwide over the past decade. This has created problems in the local health care providers in adopting the universal guidelines in clinical practice. Therefore, the application of the guidelines is not achieved in many areas. The guidelines also lack enough evidence that can guide the clinical practice in a more appropriate way. The variability of the processes involved in guideline development also reduces the effectiveness of the outcomes in achieving high quality patient care. These guidelines are based on evidence that is not definitive in the sense that it fails to account for the previous research findings based on physiotherapy. Instead, the guidelines cover only the practitioner’s experience as a source of data in formulating the recommendations(Higgs 2008, p. 245). In many countries, the health organizations cannot develop their own guidelines due to the challenging processes and methods involved in formulating the statements and recommendations. It may be because the countries have inadequate evidence and resources required in guideline development. These countries end up using the international guidelines, which are hard apply in the local context(Higgs 2008, p. 249). In clinical practice, application of the guidelines in physiotherapy management becomes hard because patient population exceeds that of the physiotherapists; there are inadequate facilities and equipment as well as the short hospital patient stays. Due to the cultural differences, the guidelines might not be effective at local levels. Physical therapists in patient care organizations might be performing different tasks that are not included in the clinical guidelines and thus the effectiveness in the delivery of care(Hack and Gwyer 2013, p. 171). Reflective Clinical Practice Reflective Practice in physiotherapy refers to the process of thinking about one’s own practice, analysing one’s decision making processes and developing appropriate techniques in order to improve that practice. In this practice, physiotherapists rethinks on their experience and existing knowledge and develop new ideas aimed towards achieving positive change in diagnosis, treatments and the overall behaviour(Taylor and Ghaye 2010, p. 321). In the CSP quality assurance standards, section 3, addresses on the matters concerning learning and development in physical therapy. Particularly, Standard 3.1 states that physiotherapists should reflect and engage in continuing professional development (CPD)processes in order to be competent. CPD ensures practitioners engage in an evolving practice whereby there are changes and creation of new ideas and knowledge. With CPD, organizations can ensure that there is satisfaction of each physiotherapist’s learning needs and provision of health care through client-centred therapy. Additionally, health care organizations would make the practitioners take the responsibility of delegating tasks. Fully supported CPD improves the governance of health care organizations (Chartered Society of Physiotherapy 2012, sec. 3). Through critical analysis on my clinical practices, I identified a learning experience that hindered my abilities in delivering high quality patient care. As a member of the CSP, I thought that CPD was only meant for other’s learning development. I did not know that CPD was a learning tool for CPD members as well as a professional requirement (Chartered Society of Physiotherapy 2012, sec. 3). When teaching students and the junior staff, I identified that I was not only unable to deliver the right information, but also, to learn on my own. This was a learning experience that triggered my performance in delivering care to patients suffering from psychological disorders after recovering from stroke. Whenmassaging the patients I was uncomfortable and guilty of how I was becoming unethical in clinical practice. In person-centred therapy sessions, I was anxious and full of fear while dealing with the patients. The numerous guidelines stipulated in the CPD were tedious and inconsiderable of my capabilities. During the period of one month, I was unable to fully attend all my patients due the stated inconveniences. However, after conducting researchon the best methods involved in reflective practice I found a set of guidelinesthat allows one to rethink on the best methods of clinical practice. Writing down the day-to-day experiences is very first step in reflexive practice. Then, working with colleagues and mentoring student is the next step. The final step involves using the supporting tools in order to be competent in clinical practice(Taylor and Ghaye 2010, p. 325). However, the steps stated in reflective practice were unsuccessful, which made me utilize the Atkins and Murphy’s model of reflection in assessing my learning experience. The model was developed in 1994.The model involves description of the events that have occurred whilst in practice. These events form the basis of the learning outcome delivered at the end of the processes. Atkins and Murphy Reflective Model The model has a number of steps that deliver change in the clinical practice. First, one must be aware of the new feelings and thoughts. In this case, I was aware of my nervousness and anxiety in delivering care. The next step involves full description of the situation including feelings and thoughts. Identification of the noticeable events and key features is also necessary at this stage. I was thinking of clinical practices that are free of the CPD since it was tedious to implement. Analysing knowledge and feelings relevant to that situation is the next step. The knowledge behind my situation relates to the inabilities to accept new methods of learning, particularly the CPD.The alternatives to my situation include consulting my colleagues and keeping a diary of my day-to-day experiences(Atkins and Murphy 1994, p. 67). The next stage involves evaluating the relevance of knowledge in solving problems. There is assessment of the extent of utilization of the knowledge. In my case, the fact that I am irresponsive to new learning tools confirms why I had a problem in learning through CPD, as well as, mentoring. Finally, there is identification of the learning achieved. The final step in the model improved my approach to the learning tool, CPD (Atkins and Murphy 1994, p. 69). In my progress towards achieving competency in the quality assurance standard 3.1, I have focused on boosting my self-confidence, consulting my colleagues and keeping a record of events. The best measures in increasing my self-esteem includegetting involved in lots of discussions and conducting research on the ethical practices required in physiotherapy. For the last few weeks, I have consistently shared my experiences on the use of the CPD in clinical practice. My take in sharing feelings and thoughts have improved my ability in being empathetic and congruent during person-centred therapy sessions.Through keeping a record of daily events, I have reflected on my experience and as a result, I have improved in my overall behaviour in clinical practice(Hack and Gwyer 2013, p. 178). In conclusion, empirical evidence and clinical guidelines are the most reliable sources of information for decision making in clinical practice. Empirical research provides results that are reliable in physiotherapy. However, the research findings are prone to insufficient data reporting and generalization. The clinical guidelines can be used by physiotherapists in clinical practice because they rely on evidence that is obtained from the practitioner’s experience. On another hand, the guidelines are hard to formulate and implement at local levels. In reflective clinical practice, physiotherapists ought to rethink on their practices and develop their ideas and knowledge in order to be competent in maintaining the standards stipulated in the Charted Society of Physiotherapy (CSP). My learning experience related to the concept of continuing development professional development (CPD) involves how I perceive new learning tools in clinical practice. Some of the measures I have put in place include sharing my thoughts and feelings with my colleagues and keeping a record of events in order to be competent in clinical practice. References List Atkins, S. and Murphy, K. (1994). Reflective Practice. Nursing Standard 8(39), 49-56. Chartered Society of Physiotherapy (2012). Quality Assurance Standards. London, Chartered Society of Physiotherapy. Hack, L. M. and Gwyer, J. (2013). Evidence into practice integrating judgment, values, and research. Philadelphia, F.A. Davis Co. Herbert, R. (2011). Practical evidence-based physiotherapy, Elsevier/Churchill Livingstone, Edinburgh. Higgs, J. (2008). Clinical reasoning in the health professions [Online]. Accessed 11 may 2014 From: http://www.csp.org.uk/professional-union/professionalism/csp-expectations-members/quality-assurance-standards Partridge, C. J. (2007). Recent advances in physiotherapy, John Wiley & Sons, Chichester, England. Porter, S. B. & Tidy, N. M. (2008). Tidys physiotherapy. Edinburgh, Livingstone/Elsevier. Taylor, B. J. & Ghaye, T. (2010). Reflective practice for healthcare professionals: a practical guide. Maidenhead, Open University Press. Read More