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Van Aswegen H.1, Patman S.2, Plani N.3, Hanekom S.4
1University of the Witwatersrand, Physiotherapy Department, Faculty of Health Sciences, Johannesburg, South Africa, 2University of Notre Dame Australia, School of Physiotherapy, Perth, Australia, 3Sklaar, Laidler & Associate Physiotherapists, Johannesburg, South Africa, 4Stellenbosch University, Physiotherapy Division, Department of Interdisciplinary Health Sciences Faculty of Health Sciences, Stellenbosch, South Africa
Background: Physiotherapists are integral to the interprofessional team caring for critically-ill patients. Clinicians working in ICU are often dependant on their own experience when making decisions regarding individual patient management, thus resulting in variation in clinical practice. This may negatively impact patient outcome. Expansion of the conventional ICU physiotherapy role may require additional education and acquisition of specific task-related and diagnostic skills (Berney et al 2012). For effective, efficient and safe physiotherapy in ICU, a competency framework should be established that is endorsed and utilized throughout South Africa.
Purpose: No formalized clinical practice guidelines or standards exist for the educational profile or scope of practice requirements for ICU physiotherapy. This study aimed to explore the perceptions of physiotherapists on minimum clinical standards that physiotherapists working in ICU should adhere to for delivering safe, effective physiotherapy services to critically-ill patients.
Methods: Qualitative design. Experienced physiotherapists (clinicians and academics) offering a service to South African ICUs were purposively sampled to participate in focus groups. Eligibility required qualification for five years or longer and a) three years working experience in ICU, or b) two years experience working in a senior role in ICU or c) publication of a minimum of five papers in critical care.
Three focus group sessions were held in different parts of the country to ensure national participation. Each was audio-recorded. The stimulus question posed was: What is the minimum standard of clinical practice needed by physiotherapists to ensure safe and independent practice in South African ICUs? To inform the formulation of minimum standards three domains were explored, namely knowledge, skill and attributes. Specific categories and sub-themes were developed for each domain, using the codes identified. An inductive approach to data analysis was used to perform conventional content analysis (Thomas 2006).
Results: Twenty-five physiotherapists (21 females) consented to participate in one of the three focus group sessions. Mean years of ICU experience was 10.8 years (±7.0; range 3-33). Nineteen sub-themes arose across the three domains of knowledge, skills and attributes. Eighteen of the sub-themes fell in the knowledge, 11 in the skills and five in the attributes domains. Only four sub-themes namely communication, continuous professional development, cultural sensitivity and multi-disciplinary teamwork emerged across each of the three domains. Eight sub-themes emerged under only one domain. Seven of these emerged under knowledge and included knowledge of technology; pharmacology; anatomy and physiology; pathology and handling skills. Surprising was that handling skills and ethics only emerged within the knowledge domain.
Conclusion(s): This is the first study to explore the perceptions of clinicians on the knowledge, skills, and attributes needed to provide a safe effective physiotherapy service in South African ICUs. The information will be used to inform the development of a list of standards which can be presented to the wider national physiotherapy and ICU communities for further consensus-building activities.
Implications: This study provides a foundation for the ultimate goal to seek consensus on the minimum standards for ICU physiotherapists in South Africa. Whether minimum standards will result in standardisation of treatment and improved patient outcome will warrant investigation.
Funding acknowledgements: National Research Foundation (KIC)
Topic: Critical care
Ethics approval: Ethical approval for the study was obtained from the Health Research Ethics Committee of Stellenbosch University (N13/08/120)
All authors, affiliations and abstracts have been published as submitted.
