Newstead C.1,2, Johnston C.1, Seaton J.1
1The University of Newcastle, School of Health Sciences, Callaghan, Australia, 2Charles Sturt University, School of Community Health, Orange, Australia
Background: Chest physiotherapy techniques, such as percussion, postural drainage and expiratory vibrations, may be employed in the critical care setting in the management of people with respiratory dysfunction. Critically ill intubated and mechanically ventilated patients are at high risk of developing respiratory complications, including ventilator-associated pneumonia. Historically, chest physiotherapy techniques have been performed routinely as a prophylactic measure in the management of critically ill patients regardless of their underlying pathophysiologic condition. However, this is no longer recognised as best practice. Today, physiotherapy professionals adopt a problem-based framework allowing for individualised and targeted treatment selection, potentially contributing to optimised patient outcomes and more effective resource utilisation in critical care. Physiotherapists are primarily responsible for the provision of chest physiotherapy techniques, however nurses have also traditionally implemented these treatment modalities. This may be due to the prior education and training nursing professionals have received in their original entry-level qualification. Alternatively, this could be due to limitations in physiotherapy service availability in the critical care setting. It is unclear whether nursing professionals continue to use traditional chest physiotherapy techniques as part of their role in critical care, or how they perceive their knowledge and confidence pertaining to these techniques.
Purpose: To investigate the use of, and attitudes towards, the utilisation of traditional chest physiotherapy techniques by nursing professionals in critical care.
Methods: Current members of the Australian College of Critical Care Nurses (n = 1222) were invited to participate in an anonymous online survey. The survey instrument was custom designed and consisted of 28 questions divided into five sections. Sections covered: participant characteristics and workplace information, previous training and clinical use, and knowledge, confidence and understanding of chest physiotherapy techniques. Questions were largely closed categorical in form with several open-ended questions to allow participants to provide additional comments. All data were analysed descriptively and simple content analysis was undertaken for written responses.
Results: There were 142 respondents (12%) with the majority (n = 132, 93%) having performed chest physiotherapy techniques in clinical nursing practice. Most considered the provision of chest physiotherapy techniques to be part of a nurses role. Commonly cited factors influencing nurses use of chest physiotherapy techniques were the availability of physiotherapy services, adequacy of nursing staff training and skill, and perceptions of professional roles.
Conclusion(s): Most nursing professionals working in critical care continued to utilise traditional chest physiotherapy techniques in their clinical practice and the majority viewed the provision of chest physiotherapy techniques as part of a nursing role. Nursing professionals were confident with their clinical application of chest physiotherapy techniques and possessed a high level of perceived knowledge and clinical skill regarding the provision of chest physiotherapy techniques.
Implications: This study has provided insight into the utilisation of traditional chest physiotherapy techniques by nursing professionals in Australian critical care settings. Further research is required to investigate the reasons why nursing professionals might assume responsibility for the provision of chest physiotherapy techniques and whether their application is consistent with evidence-based recommendations.
Funding acknowledgements: No financial or material support of any kind was received for the work described in this article.
Topic: Cardiorespiratory
Ethics approval: Approval for the study was granted by The University of Newcastle, Human Research Ethics Committee.
All authors, affiliations and abstracts have been published as submitted.
