In-patient physiotherapy for adults on veno-venous extracorporeal membrane oxygenation - United Kingdom ECMO Physiotherapy Network: A consensus agreement for best practice.

Clinical specialist physiotherapists from the five severe respiratory failure centres in England where respiratory extracorporeal membrane oxygenation (ECMO) is practiced have established this consensus agreement for physiotherapy best practice. The severe respiratory failure centres are Wythenshawe Hospital, Manchester; Glenfield Hospital, Leicester; Papworth Hospital, Cambridge; Guy's and St Thomas' Hospital, London and The Royal Brompton Hospital, London. Although research into physiotherapy and ECMO is increasing, there is not a sufficient amount to write evidence-based guidelines; hence the development of a consensus document, using knowledge and experience of the specialist physiotherapists working with patients receiving ECMO. The document outlines safety aspects, practicalities and additional treatment considerations for physiotherapists conducting respiratory care and physical rehabilitation.

Physical therapist practice in the acute care setting: a qualitative study.

BACKGROUND: Physical therapist practice in the acute care setting is not thoroughly understood, and it has been argued that skilled care is not required. OBJECTIVES: The objective of this study was to describe the role of physical therapists, the clinical reasoning processes used by physical therapists, and the context for providing physical therapy services in the acute care setting. DESIGN: A convenience sample of 18 physical therapists working in 3 academic medical centers in the United States was included in this qualitative study with grounded-theory methods. METHODS: Semistructured interviews were conducted. Transcripts were coded, and a constant comparative process of analysis was used to determine common themes. A theoretical model was derived. RESULTS: Eight themes were identified: collection and analysis of medical information, application of specialized physical therapy knowledge, communication to gain information, communication to provide information, continual dynamic assessment, professional responsibility, complex environment, and decision making for patient care. Among the limitations of this study were that the sample and method limited the generalizability of the findings, the participants were not observed in their practices, and researchers' preconceived views may have influenced the interpretation and derivation of themes. CONCLUSIONS: Physical therapists in the acute care setting used clinical reasoning that required the ability to integrate medical information with physical therapy knowledge. Clinical reasoning required continual dynamic assessment of patients in a crowded, complex, fast-paced environment and resulted in rapid decision making. Constant communication with many people was critical to the process. The major concerns for physical therapists in the acute care setting, like physical therapists in other settings, were patients' mobility and safety. The goals were an optimal plan of care and an appropriate discharge setting for each patient. The therapists' roles reflected professional core values applied in ways unique to the acute care setting.

Bosom Buddies: a practical model of expressive disclosure.

BACKGROUND: A writing and theatre workshop, conducted in northern New Hampshire with 8 posttreatment breast cancer survivors, utilized expressive disclosure in a nonscientific environment. METHOD: Through writing, the participants have explored both negative and positive feelings about cancer and its impact on their lives. Through theatre games and rehearsals, the participants have had the opportunity to learn new expressive skills. In performance, they have helped others by telling their own stories. RESULTS: Participants reported a feeling of transformation and a renewed sense of well-being as a result of the workshop, as well as an ongoing desire to positively affect others with their work. CONCLUSIONS: The facilitators and participants agreed that the results of this work have been transformative for all involved. The facilitators are encouraged by the idea of further practical exploration of these methods. This article is a blueprint for this type of work and an exploration of the scientific background that supports this method as a valid tool to aid in emotional recovery.