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PSIO3041 Open Module - Preparing for on call

Module Overview

On-call physiotherapy has been defined as the provision of emergency respiratory/cardiorespiratory/cardiothoracic physiotherapy or combinations of respiratory and orthopaedic physiotherapy, out of normal working hours (Standard 9 of the Association of Chartered Physiotherapists in Respiratory Care ACPRC, 1996). It is an essential requirement of a qualified physiotherapist, however, many graduates feel under prepared for this role having not had an acute respiratory placement during their undergraduate training or if they have had an acute respiratory placement, they still feel under confident in their respiratory skills. This module intends to help better prepare you for on-call duties and to improve your-confidence in undertaking core respiratory assessment and treatment skills.

Aims and Objectives

Module Aims

This option module will focus on the issues of working out of hours and independent assessment and management of an acutely unwell respiratory patient that physiotherapists are often called to see in an emergency on-call situation, although not necessarily on a critical care unit as critically ill patients may be anywhere in a hospital. You will explore your own role and the role of other members of the team for the most appropriate management of the patient.

Learning Outcomes

Learning Outcomes

Having successfully completed this module you will be able to:

  • To critically explore the management of different patients from a variety of settings e.g. Critical Care, Surgical; Medical, Orthopaedics that a physiotherapist may be called out to see and the evidence that underpins management.
  • To develop respiratory assessment and advanced clinical physiotherapy skills, to evaluate the knowledge gained and critically apply it to on-call physiotherapy case studies.
  • Evaluate the role of the physiotherapist as part of the Multidisciplinary team in the management of an on-call patient; and reflect on the skills required that will contribute to becoming a lifelong learner.
  • Critically reflect on the application of knowledge gained in a situational context and apply to practice, which will inform future personal and professional practice when undertaking on-call duties.

Syllabus

This option module will draw on the theory of normal respiratory, cardiac and renal physiology and will consider the pathophysiology of certain conditions. The ABCDE resuscitation council (UK) assessment process will be utilised alongside current national early warning scores that are used by Trusts to monitor patients in a variety of ward settings. Sessions will allow the opportunity to explore some of the more advanced intervention strategies such as the cough assist, and nasal intermittent ventilation NIV and commonly used drugs. Part of the module will be to rehearse the assessment of a deteriorating patient via using a computerised mankin SiMMan 3G so as to develop problem solving and communication skills with both the patient and MDT in the context of an on-call scenario. The overall aim of the option is to facilitate your understanding of this important duty of a physiotherapist and reduce any anxiety associated by facilitating the opportunity to rehearse your role and discuss with senior clinical physiotherapists any fears that you may have with undertaking this role. The module will cover different aspects of physiotherapy respiratory management such as: • Understanding the multidimensional nature of physiological deterioration • A-E assessment and physiological measurement using early warning scores • The management of common respiratory presentations: loss of lung volume, sputum retention and increased work of breathing conditions – • The use of adjuncts such as the cough assist, NIV • Management of a ventilated patient, e.g. closed suctioning and care of a tracheostomy

Special Features

Simulation based education using a computerised manikin and an expert simulated patient will play a major part of this module as the subject area must be taught and applied in the context of an on-call situation. To further enhance the simulation experience other members of the MDT will be employed so that students can learn how to take an emergency phone call and how to refer patients back to the appropriate member of staff or escalate the patients care further, using the RSVP method as might happen in an on-call situation.

Learning and Teaching

Teaching and learning methods

This module will use a blended learning approach consisting of lectures, practical sessions for learning advanced clinical skills and simulation to practice the management of an on-call patient with acute respiratory deterioration. You will attend a combination of lectures, practical’s and simulated sessions to develop your knowledge and understanding of how respiratory deterioration presents in both ventilated and self-ventilated adults. You will assess, identify problems and decide if the patient is suitable for respiratory physiotherapy or if the patient needs to be escalated to another member of the MDT. The RSVP Reason, Story, Vital Signs, Plan method will be used for all aspects of communication in the simulated sessions. Principles of assessment of the respiratory; cardiac; renal and neurological systems and how they are monitored will be applied to the management of the critically ill patient that physiotherapists are often called to see in an emergency on-call situation although, not necessarily on a critical care unit as critically ill patients may be anywhere in a hospital. You will explore the underpinning changes in the physiology of the acutely critically ill patient and how these are medically managed by the multidisciplinary team. The module will be informed by real-life case studies of on-call scenarios from local Hospital Trusts and consist of a deteriorating surgical, medical, critical care and orthopaedic patient. The assessment and management of these case studies will be discussed and opportunities where possible to practice the clinical skills wherever possible will be given. The simulated sessions with SimMan (computerised human manikin) will be set up in the clinical skills laboratory as a ward setting for the on-call scenario; to enable you to rehearse what it feels like to be called into a ward/unit to see a patient that you have not previously treated. The simulation will give you an opportunity to practice your assessment and intervention skills. The simulated session will be video recorded and a full debrief session undertaken afterwards to identify any issues they may have encountered and facilitate reflection after action, it will also identify any further teaching that is required.

TypeHours
Independent Study163.5
Teaching24
Total study time187.5

Resources & Reading list

Shannon et al 2015, Differences in delivery of respiratory treatments by on-call physiotherapists in mechanically ventilated children: a randomised crossover trial. Physiotherapy, Vol 101, Issue 4, pages 357-363

Clinical guideline 50. Acutely iIl Patients in Hospital: Recognition of and response to acute illness in adults in hospital. London. NICE.

Edited by Sally A Smith, Ann M. Price A., Dr Alistair Challiner (2009). Ward based Critical Care: A guide for health professionals. 

Shannon et al, 2015, Clinical effects of specialist and on-call respiratory physiotherapy treatments in mechanically ventilated children: A randomised crossover trial. Physiotherapy, Vol 101, Issue 4, pages 349-356

Collins, T (2000) Understanding shock. Nursing standard, 14 (49), 35-41. Garretson S, Malberti S (2007) Understanding hypovolaemic, cardiogenic and septic shock. Nursing Standard. 50, 21, 46-55.

Subbe, C. (2006) Recognition and assessment of critical illness. Anaesthesia and Intensive Care medicine, 8(1), 21-23. Standard 9 of the Association of Chartered Physiotherapists in Respiratory Care ACPRC, 1996)

Assessment

Assessment Strategy

On-call scenario formative & summative Students will be randomly allocated 1 out of 4 scenarios which they will come in to assess as if on-call and identify the patients’ problems and recommend a treatment plan to the nurse looking after the patient . Following this simulation, the students will write a short reflective piece (1,000 words) using Driscol’s reflective model about What happened, So what? And now what? They will also be required to submit short summary (2,000 words) of the evidence on any treatment they would recommend and justify why they have chosen.

Summative

MethodPercentage contribution
Individual written reflection  (1000 words) 40%
Simulation 60%

Repeat Information

Repeat type: Internal & External

Linked modules

Pre-requisite: PSIO2025 - Clinical Management 2 (Neurology & Cardiorespiratory)

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