Tidy's Physiotherapy, 15e (Physiotherapy Essentials)

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For students and clinical professionals who are learning to better themselves in the field of their study. This book is the latest in its release and is a trademark of . Written by carefully selected global experts, practicing physicians, and educators in the various sub-disciplines of medicine and surgery. A must read for everyone. Exercising autonomy Autonomy, or 'personal freedom' (Concise Oxford Dictionary, 7th edn), is a key characteristic of being a professional. It allows independence, but is mirrored by a responsibility and accountability for action. Central to the practice of professional autonomy is clinical reasoning, described as the 'thinking and decision-making processes associated with clinical practice' (Higgs and Jones 2000). Clinical reasoning requires the ability to think critically about practice, to learn from experience and apply that learning to future situations. It is the relationship between the physiotherapist's knowledge, his or her ability to collect, analyse and synthesise relevant information (cognition), and personal awareness, self-monitoring and reflective processes, or metacognition (Jones et al. 2000). Online resources via Evolve Learning with video clips, image bank, crosswords and MCQs! Log on and register at http://evolve.elsevier.com/Porter/Tidy Introduction 2 Characteristics of Being a Professional 2 Responsibilities of Being a Professional 5 Becoming an Autonomous Profession 6 Clinical Governance 7 Evidence-Based Practice 8 Clinical Effectiveness 10 Applying National Standards and Guidelines Locally 11 Evaluating Services 12 Continuing Professional Development and Life-long Learning Having the Right Workforce (and using it appropriately) 14 Monitoring Clinical Governance 15 The Future 16 Sources of Critical Appraisal Tools 17 References 18 Responsibility to colleagues and the profession A profession has legitimate expectations of its members to conduct themselves in a way that does not bring the profession into disrepute, but rather enhances public perceptions. Physiotherapists have a duty to inform themselves of what is expected of them. Indeed, Rules of Professional Conduct states that knowledge and adherence to the Rules are part of the contract of membership of the CSP. Standards of Physiotherapy Practice makes it clear there is an expectation that all physiotherapists should be able to achieve all the core standards (CSP 2000). Where they do not, programmes of professional development should be put in place to facilitate full compliance, as part of the individual's professional responsibility. Physiotherapists should not be critical of each other except in extreme circumstances. However, they do

Definition Clinical effectiveness was defined by the Department of Health in 1996 as 'the extent to which specific clinical interventions, when deployed in the field for a particular patient or population, do what they are intended to do - that is, maintain and improve health and secure the greatest possible health gain from the available resources' (NHS Executive 1996). • Is the practitioner sufficiently skilled to apply the intervention safely and effectively? • Was the practitioner an effective communicator? • Did the practitioner give the patient an opportunity to fully describe the symptoms and the impact of the problem on the person's life, and to ask questions? • Did the patient have enough information to be able to give informed consent? • Were other options discussed, that may have been more acceptable to the patient, even if less effective? • Would treatment in a hospital setting mean a long, exhausting and expensive journey for the patient? • Would the patient feel intimidated by a hospital environment? • Would treatment have been more effective if it had been provided closer to home, for example in the GP's surgery or health centre? • Would treatment have been more relevant if it had been given in a patient's own home, to be able to develop a programme tailored to the person's lifestyle and environmental needs? • Wherever treated, did the patient have adequate privacy, warmth and comfort? • How long did the patient have to wait for treatment - will delay affect the effectiveness of the interventions? The answer to each of these questions can have an impact on the patient's ability to benefit from an intervention, however effective the research evidence might suggest an intervention is. This also illustrates the complexity of the clinical reasoning process, where highly skilled judgements have to be made based on a consideration of the whole person, physically, emotionally and within society, as well as the environment, practitioner skills and resources available, in order to provide truly effective treatment. So while evidence-based practice is a key component of clinical effectiveness, clinical effectiveness also takes account of a range of other influences that could Responsibility to patients This chapter has already discussed the importance of the individual physiotherapist as well as the profession as a whole maintaining the attributes of professionals. Trust is perhaps the most essential characteristic with which to develop a sense of partnership with patients that, in turn, will optimise the benefits of intervention. For physiotherapy, many of the other hallmarks for building and securing trust are set out in the profession's Rules and Standards; for example • to provide safe and effective interventions (safety of application as well as safe and effective) - Rule 1 and Core Standards 4, 8, 16 • to treat patients with dignity and respect - Rule 2 and Core Standard 1 • to provide patients with information about their options for treatment/interventions - Rule 2 and Core Standard 2 • to involve patients in decisions about their treatment (informed consent) - Rule 2 and Core Standard 2. Is clinical governance something new? Yes and no. Its component parts are all familiar activities, but there is also an underpinning philosophy in clinical governance, to reduce risks for patients, a new and more focused emphasis that was not previously articulated. It can be argued that clinical governance is, at least in part, a response to a loss of public confidence in the NHS discussed earlier, which has undermined public perceptions of the NHS as an organisation they can rely on to 'doDefinition EVALUATING SERVICES How do you know whether you are being effective? Knowing whether you are or not is part of your professional responsibility as a physiotherapist. Rule 1 of Rules of Professional Conduct (CSP 2002a) describes the responsibility a physiotherapist has to ensure that any intervention offered to a patient is intended to be of benefit. Several of the CSP's standards of physiotherapy practice include criteria that relate to evaluation, including: • As part of the assessment process, physiotherapists consider and critically evaluate information about effective interventions relating to the patient's condition (Core Standard 4.1). • A published, standardised, valid, reliable and responsive outcome measure is used to evaluate the change in the patient's health status (Core Standard 6). • All physiotherapists participate in a regular and systematic programme of clinical audit (Service Standard 3.2). • Physiotherapists use the results of audit to assess their learning needs (Core Standard 19.1) and/or as a means to achieve their personal learning objectives (Core Standard 20.3h). All evaluation is about learning which leads to improvements in the quality and effectiveness of practice. It should be carried out, and the results used, in the context of CPD and reflective practice, to improve an individual practitioner's personal practice and/or the delivery of a whole service. Set out below are four means by which physiotherapists can evaluate their practice. They are not mutually exclusive. Mead 1998, with permission.) Figure 1.2Whatdowemeanby'evidence'?(AdaptedfromBuryandMead1998,withpermission.)

Maintaining competence to practise So an individual's scope of practice and competence are constantly evolving, based on professional and life experiences, learning from reading, from evaluating practice, from reflecting on practice, or more formal ways of learning. It includes undertaking programmes of structured CPD. Clinical reasoning skills are continually refined and further developed throughout a career through evaluative and reflective practice, leading to the ability to deal with increasingly complex and unpredictable situations. Physiotherapists have a duty to keep up to date with new knowledge generated by research, with what their peers are thinking and doing, and by formally evaluating the outcome of their practice. The responsibility for this is reflected in Standards of Physiotherapy Practice (CSP 2000). In particular, Core Standards 19-22 are concerned with a requirement that individuals assess their learning needs, then plan, implementCLINICAL GOVERNANCE So far, this chapter has explored the responsibilities of being a physiotherapist from a professional perspective. The focus has been on the individual's personal responsibility as a professional. This section will put all that in the context of a professional's responsibilities to their employer organisation, whether it be in the public or independent sector. In the NHS, responsibility for the clinical safety of patients and the quality and effectiveness of services is through a system of clinical governance. It seems probable this will apply equally to the independent sector in the near future. But even though clinical governance is the responsibility of NHS trusts, its foundation is based on 'the principle that health professionals must be responsible and accountable for their own practice' (Secretary of State for Health 1998). So the individual's professional responsibility is still paramount. Lecturer in Physiotherapy School of Health Care Professions University of Salford Manchester UK Honorary Research Fellow Wrightington Wigan and Leigh NHS Trust Wigan Lancashire UK Evaluating the outcomes of care This will determine the impact of the process of care on the patient's life by using specific measures before and after treatment. The use of a test, scale or questionnaire which records what it aims to record (is valid and responsive) and is sufficiently well described to ensure that ev Myotomes 524 Biomechanics: background maths and questions 525 Respiratory Anatomy and Physiology 532 Index