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12/11/2017Break Out of Your Silo:Collaborations to AchieveCore CompetenciesKim Levenhagen PT, DPT, WCCSaint Louis UniversitySara Alhajeri MPT, GCSCaitlin Rosentreter, DPTBarnes Jewish Hospital, Saint Louis, MissouriObjectivesBy the end of thiseducational sessionthe participant will: Recall the Core Competencies for EntryLevel Practice in Acute Care PhysicalTherapy, the APTA Core Values andbehaviors identified in the evidence thatreflect acute care practice. Identify methods to integrate acute carepractice behaviors into the didacticcurriculum. Determine methods for various clinicaleducation models to increase numbers ofstudents in the acute care setting. Create a win/win scenario to maximizeexcellence and professional duty amongstudents and physical therapists/physicaltherapists assistants.Minimum Required Skills ofPhysical Therapist Graduates at Entry Level Screening– Systems review for referral– Recognize scope of limitations l RecordsImagingLab ValuesMedicationsHome environmentEach system Integration Evaluation– Clinical reasoning and evidence Diagnosis– Identify and prioritize impairmentsand activity limitations, participationrestrictions Prognosis– Recognizing barriers Plan of Care– Goal setting– Coordination of care– DischargeDOISY COLLEGE OF HEALTH SCIENCES1

12/11/2017Minimum Required Skills ofPhysical Therapist Graduates at Entry Level Interventions––––––Airway clearanceAssistive devicesMovement (gait, functional mobility)SafetyCollaborationCommunication across settings Outcome Assessments Education Practice n and supervisionHIPPA/Patient rights Professionalism Consultation Evidence Based Practice– Patients/families– ColleaguesDOISY COLLEGE OF HEALTH SCIENCESMinimum Required Skills of Physical TherapistAssistant Graduates at Entry Level Plan of Care Review‒ Review of physical therapydocuments‒ Identification of role in patient care‒ Identification of items to becommunicated to the physicaltherapist‒ Identify when the directedintervention are either beyondthe scope of work or personalscope of work of the PTA Provision of ProceduralInterventions Patient Instruction‒‒‒‒Application of principles of learningUse of variety of teaching strategiesClarity in instructionsAssessment of patient response Patient Progression‒ Competent patient progression‒ Communication of patientinformation‒ Clinical problem solvingDOISY COLLEGE OF HEALTH SCIENCESMinimum Required Skills of Physical TherapistAssistant Graduates at Entry Level Data Collection––––––Competent date collectionInterview skillsAccurate and timelyClinical problem solvingAbility to modify techniquesDocumentation and communication Documentation– Select relevant information– Accuracy– Ability to adapt Safety, CPR and EmergencyProcedures Reads and understands thehealthcare literature Educate colleagues and otherhealth care professional aboutthe role, responsibilities andacademic preparation andscope of work of the PTA Ensure ongoingcommunication with thephysical therapist for optimalpatient care.DOISY COLLEGE OF HEALTH SCIENCES2

12/11/2017A Normative Model of Physical TherapistProfessional Education: Version 2004“Consistently define and describe entry-level physicaltherapist professional education that is reflective of acontemporary and forward looking perspective of practice,is responsive to physical therapy practice and the healthcare environment, and that incorporates the elements forthe profession's vision.”– Guide to Physical Therapist Practice– Core competencies for area of practice– Movement SystemDOISY COLLEGE OF HEALTH SCIENCESCore Competencies for Entry Level Practicein Acute Care Physical Therapy (2015) Clinical decision makingCommunicationSafetyPatient managementDischarge planningKristin Greenwood, PT, DPT, EdD,MS, GCS ChairEric Stewart, PT, DPTErin Milton, PT, DPT, NCSMelissa Hake, PT, DScPTLauren Mitchell, PT, DPTBabette Sanders, PT, DPT, MS,FAPTA3

12/11/2017Core Competencies for Entry Level Practice forPhysical Therapist Assistants inAcute Care Settings (2017) Communication Safety Patient Management‒ Medical review and documentation Contributions to discharge recommendationsJeremy Foster, LPTA ChairAmanda Rausch, PTAMichele Biernacki, PTA, ACCEChristina Schiel, PT, DPTHolly Clynch, PT, DPT, MA, GCSDeanna Smith, PTChrissy LaMastus, MPT, BSN, RNMovement System (APTA 2017) PTs provide a unique perspective onpurposeful, precise, and efficientmovement across the lifespan basedupon the synthesis of their distinctiveknowledge of the movement system andexpertise in mobility and locomotion. PTs examine and evaluate themovement system (including diagnosisand prognosis) to provide a customizedand integrated plan of care to achievethe individual's goal-directed outcomes. PTs maximize an individual's ability toengage with and respond to his or herenvironment using movement-relatedinterventions to optimize functionalcapacity and performance.DOISY COLLEGE OF HEALTH SCIENCESWhat do the students say? What I learned in the classroom is not real life– Line management– Ventilators Complex patients on paper not the same as the hospital– Clinical reasoning is not always black/white– Difficult to apply classroom knowledge to patients in the clinic Some clinicals too short Not enough acute care choices– May not have a rotation in level 1 trauma center Some time since my acute care rotation and starting my jobDOISY COLLEGE OF HEALTH SCIENCES4

12/11/2017Student Feedback Regarding Preparedness I did not feel under‐prepared for this experience in the sense that wehad not learned certain material yet. However, I did have to look a fewthings up that we had already learned just for a quick refresher! Finding different motivation techniques to encourage patients toparticipate in therapy when they refuse. One suggestion would be to team up with the OT program for a lab andco‐treat a patient so students can learn how to work together efficiently,while also playing a balancing act seeing how both therapies overlap yetdo not cross boundaries. I felt unprepared for ventilator management, IV/leads management,walking patients with multiple medical devices (IV poles, etc.),pharmacology and its implications for PT, discharge disposition.DOISY COLLEGE OF HEALTH SCIENCESReviewing the Evidence(Baybar 2003) Case studypresentation Group discussion Patients in class Patients in clinic Problem solvingvideotapeReviewing the EvidenceJette 2007Masley 2011 Continual Dynamic Assessment ComplexKnowledgeClinical skillsSafetyClinical decision makingSelf directed learningInterpersonal communicationProfessional demeanor– Communication to gain information– Collection and analysis of medicalinformation– Communication to provideinformation– Application of specialized physicaltherapy knowledgeDOISY COLLEGE OF HEALTH SCIENCES5

12/11/2017Foundational SciencesClinical diagnostic proceduresNationwide AcuteCare PhysicalTherapist PracticeAnalysis IdentifiesKnowledge, Skillsand Behaviorsthat Reflect AcuteCare Practice(Gorman 2010)LeadershipRisk managementProfessional developmentSocial nosisInterventionOutcomesBridging the Gap Weaving inpatient care into the curriculum– Pathology clinical examples– Basic Procedure– Multisystem Management Labs Integrative clinical experiences SeminarsDOISY COLLEGE OF HEALTH SCIENCESAcute Care Threaded ThroughoutCurriculumPY 2PY 1Survey of Disease,Lab Studies/Imaging, BasicProcedures,Pharmacology Integrative Project Patients in lab Assist , PatientManagement,Communication Patients in labICEIntegrative ProjectSim LabCollaboration withnursingPY 3Seminars, essionalTeam Seminar,Clinicals Complex evaluationin clinic Cases w/ IPtherapists Collaboration w/PTA Program Interprofessionalinteractions6

12/11/2017Project: Surveyof Disease,Pharmacologyand LabStudies/ImagingExample of Lab: Integrative Clinical Experience Chart Review Subjective Interview Objective Examination–––––––CognitionGross muscle screenDermatome/Light touchVital signsBalance (sitting/standing)Outcome measuresMovement assessment (bed mobility, sit to stand to sit, ambulation)DOISY COLLEGE OF HEALTH SCIENCESExample of Lab: Integrative Clinical Experience Assessment Identify impairments and activity limitation and participationrestrictions. State why patient requires skilled physical therapy. Describe intervention or education provided during this treatmentsession. Plan Determine frequency for therapy sessions during hospital stay. Document 3 short term goals for the patient (met by discharge). Establish a discharge plan.DOISY COLLEGE OF HEALTH SCIENCES7

12/11/2017Example of Lab Integrative Clinical ExperienceDiscuss 3 relevant findings from the chart review with anticipatedpresentation (signs and symptoms and implications with examination.At least one must include an abnormal lab value.Given the patient’s findings today,name 2 interventions and 2 follow‐up examinations you want toperform on the next visit.Explain yourclinical reasoningfor your dischargerecommendation.Include clinical implications for 3pharmacological agents the patient iscurrently taking in the hospital.Discuss how CIadapted theexaminationsecondary tocurrent and pastmedical history.CollaborativeLearning inNursing SimLab“This was a good learning experience for me because I now knowthat I need to make my SBAR statement more clear and concise inAn interprofessional experiencethe future. I especially want to improve upon my "assessmentthrough structured communicationportion" of the SBAR in establishing why the patient might betools such as SBAR provide contextexperiencing various symptoms.”for application in an acute care“It was good to have nursing there and interact with them as well but Ienvironment.found it difficult to cut off my interview and quickly gather my thoughtsto give the SBAR to the nurse in front of the patient.”A HFHS patient scenario withemerging data provided a safeenvironment for learning.“Overall, I liked to experience and I have a better idea of what kindsof communication skills and inpatient skills I can improve upon in thefuture. The experience was unique and not one that we usually get toreceive in school so I really liked to opportunity to see my strengthsand weaknesses in that situation.”“This was a great experience. It was very helpful to be able tocollaborate with the nurse following the interview. It was a good wayto get out first time jitters with experiences like this. I was preparedwith a lot of questions to complete a full interview but due to thesignificant changes in BP and heart rate and presents of redness,swelling, and tenderness in her L calf I had to stop short.”DOISY COLLEGE OF HEALTH SCIENCES8

12/11/2017WHAT IS YOUR PRIMARYCLINICAL EDUCATIONCHALLENGE?Capacity vs QualityCapacity or QualityOUR SSING QUALITY:FROM THE CLINICAL SITEPERSPECTIVEORIENTATION & COMMUNICATION9

12/11/2017HOW DO WE MANAGEALL OF THIS ORIENTATION?IT TAKES A VILLAGE32Structuresimilar toemployeeorientationComponentsof Our StudentOrientationProgram10