RESEARCH PROPOSAL
NURSES’ PERCEPTIONS OF PHYSIOTHERAPISTS IN
CRITICAL CARE TEAM
MPT (CARDIO RESPIRATORY DISORDERS INCLUDING ICU)
MS. GUPTE PRANATI PRAVIN
DEPARTMENT OF PHYSIOTHERAPY
FR. MULLER MEDICAL COLLEGE, MANGALORE-575002
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE CANDIDATE MS. GUPTE PRANATI PRAVIN
AND ADDRESS
DEPARTMENT OF PHYSIOTHERAPY
FATHER MULLER MEDICAL COLLEGE
MANGALORE-575002
2.
NAME OF THE
INSTITUTION
3.
COURSE OF THE STUDY
FATHER MULLER MEDICAL COLLEGE
MANGALORE.
MASTER OF PHYSIOTHERAPY IN
CARDIO RESPIRATORY DISORDERS
INCLUDING ICU
4.
DATE OF ADMISSION TO
23.07.2012
THE COURSE
5.
TITLE OF THE TOPIC
NURSES’ PERCEPTIONS OF
PHYSIOTHERAPISTS IN CRITICAL CARE
TEAM
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BRIEF RESUME OF THE INTENDED WORK.
6.1 NEED FOR THE STUDY:
Physiotherapy has been accepted as an integral part of the management of
patients in Intensive Care Unit. The precise role that physiotherapists play varies from
one unit to the other depending upon the country in which the Intensive Care Unit is
located, local traditions, staffing levels, training and expertise1.
The aim of physiotherapy within a critical care setting is optimization of
cardiopulmonary function and the prevention or treatment of the effects of immobility
and recumbency2.
Evidence based targets for Physiotherapy is deconditioning, impaired airway
clearance, atelectasis, re-intubation avoidance and weaning failure. Early physical
activity and mobilization are essential in the prevention and attenuation or reversion of
physical deconditioning related to critical illness3.
Skilled nursing management of a critically ill patient operated on: Improving
patient outcomes, communication and observation. Effective nursing care also includes
pro-active prediction and prevention of complications and prompt and skilled
intervention in the event of sudden deterioration .Also, nurses’ role in patient care is
holistic. They are the key provider of information to patients, relatives and other
members of the Interdisciplinary team. In addition, good observations reduce patient’s
risk of precipitous deterioration and monitor their total dependence on support
equipment4.
In a health system in which patient complexity, outcome indicators and informed
familie are representative of current reality, an Interdisciplinary approach to care is
crucial to successful navigation of a patients experience in ICU and evidence proves
that lack of communication and Interdisciplinary collaboration may be responsible for
as much as 70% of adverse events5.
3
Interdisciplinary practice refers to people with distinct disciplinary training,
working together for a common purpose, as they make different complementary
contributions to patient focussed care5. This team includes physicians, nurses,
respiratory therapists, physical and occupational therapists, speech pathologists and
rehabilitation psychologists6.
Although the importance of understanding each other’s role is recognized, others
have observed differences in role perception and role expectation. There may also be
difference in ideology between professions or negative attitudes between professional
groups that can create barriers to learn functioning7.
Several studies have highlighted some of the attitudes and perceptions that may
underlie interprofessional relationships and their effect on teamwork and effectiveness
of management in Critical care 7. Interpersonal factors are the main causes of stress in
high-dependency areas and poor communication is the chief cause of errors8.
The purpose of this study is to explore, describe and uncover Nurses’ perception
on the role of physiotherapists in Critical care unit and as a part of Interdisciplinary
team and investigate the level of collaboration and communication between nurses’ and
physiotherapists so that the treatment in acute care is patient directed and the
congruency between therapists and Nurses’ is more so as to avoid inconsistencies for
the patient.
Also, in order to achieve optimal outcomes, it remains a necessity that the
members of the interdisciplinary team work together in a consistent, goal-oriented and
collaborative manner so that our focus remains on developing a ‘blame free’ process,
minimize conflicts and gaps and prevent the errors from repeating themselves.
RESEARCH QUESTIONi. Do Nurses’ perceive Physiotherapists as a part of Critical Care Team?
ii. Do Nurses’ feel the need for the inclusion of Physiotherapists in
Interdisciplinary Team in Critical Care?
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HYPOTHESISi.
Nurses’ perception of Physiotherapists as a part of Critical Care Team is good.
ii. Nurses agree the need of inclusion of physiotherapists in Interdisciplinary Team in
Critical Care.
OPERATIONAL DEFINITIONS:
Physical therapist: Physical therapist is a rehabilitation professional who promotes
optimal health and functional independence through the application of scientific
principles to prevent, identify, assess, correct or alleviate acute or chronic movement
dysfunction, physical disability or pain.
Nurse: A licensed health care professional who practices independently or is supervised
by physician or surgeon and who is skilled in promoting and maintaining health.
Intensive Care Unit: A specialized section of a hospital containing the equipment,
medical and nursing staff, and monitoring devices necessary to provide intensive care.
Interdisciplinary practice: Interdisciplinary practice refers to people with distinct
disciplinary training, working together for a common purpose, as they make different
complementary contributions to patient focussed care5.
6.2 REVIEW OF LITERATURE:
A systematic review on ‘Physiotherapy led early rehabilitation of the patient with
critical illness’ by Thomas analysed definitions of physiotherapy led rehabilitations in
critical care, effects of rehabilitation compared to limited or no rehabilitation, early
compared to later rehabilitation, standard physiotherapy management compared to
management including a specific rehabilitation intervention and acute physiological
rehabilitation interventions in critically ill patients. This study suggested that early
initiation of rehabilitation in patients with critical illness had a significant impact on
physical and functional outcomes and decreased length of ICU stay2.
Another study on ‘The level of teamwork as an Index of Quality in ICU
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performance’ wherein all the ICU personnel, were included, adopted a questionnaire
and results were obtained from 196/250 individuals .This study suggested that
teamwork was crucial for performance in ICU. Finally they concluded that to develop a
culture of collaboration and coordination in health care required a commitment to
engage in shared learning and dialogue and this dialogue had the potential to encourage
collegial learning, change thinking, support new working relationships and improve
patient care5.
Rozeboom and colleagues in their study ‘Rehabilitation starts in ICU’ suggested
that ICU is the first place where rehabilitation should begin. This review article
concluded with the thought of how interdisciplinary team approach was the best
practice that aimed at preventing complications and achieving good outcomes in
challenging spinal cord injury patients. They discussed how Interdisciplinary team in
collaboration made a successful SCI team where each one of them played their part in 3
different stages and the patient thereby moved towards his/her ultimate goal of
increased independence. Thus highlighting the management strategies used in
neuroscience ICU at Harborview medical centre6.
Dalley and Sim in their study on “Nurses’ perceptions of physiotherapists as
rehabilitation team members” conducted Semi-structured interviews among eighteen
qualified nurses. They concluded that the Nurses valued the role and contribution of
physiotherapists, but identified areas in which barriers existed to effective
interprofessional working particularly in relation to organizational factors and
interpersonal relationships7.
Another study done by Atwal and Caldwell on Nurses’ perceptions of
multidisciplinary teamwork in acute healthcare concluded that multidisciplinary
teamwork was one of the key processes through which acute health care was managed
in their setting yet was the most problematic. They interviewed nineteen nurses using
critical incident approach and finally identified three barriers that hindered teamwork
which were as follows: differing perceptions of teamwork, different levels of skill
acquisitions to function as a team member and dominance of medical power that
influenced interaction within the teams8.
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A study done on ‘Multidisciplinary perceptions of the role of nurses and health
assistant’s in rehabilitation of older adults in acute health care’ where in twenty four
semi structured interviews were conducted and audio-taped about health care
professionals’ understanding of rehabilitation and the type of skills needed and their
perceptions. This study suggested that the therapists relied on nurses and health care
assistants for therapy carryover and healthcare assistants were perceived as the
professional group who could deliver therapy carryover. The main highlight of this
study was that there was a need for different professional bodies to discuss regarding
the role of therapists, nurses and healthcare assistants in older adult acute rehabilitation
services9.
6.3
OBJECTIVES OF THE STUDY:
To find out Nurses’ perceptions of role of Physiotherapists in Critical Care Team
i.
in Medical Intensive Care Units of Tertiary care hospitals in Mangalore.
To investigate whether Nurses’ perceive Physiotherapists as a part of
ii.
Interdisciplinary team in Critical Care.
MATERIALS AND METHODS:
7.1
SOURCE OF DATA :
Nurses working in Critical Care Units of selected hospitals in and around
Mangalore.
7.2 METHOD OF DATA COLLECTION :
STUDY DESIGN

Cross sectional study
SAMPLE SIZE AND SAMPLING TECHNIQUE

35 nurses working in Critical Care Units of selected hospitals in Mangalore will
be recruited after their consent.
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
Inclusion Criteria:- Nurses working in Critical care unit with at least 1 year of experience.

Exclusion Criteria:-Work Experience less than 1 year.
-Nurses not willing to participate in the study.
Semi-structured interviews will be conducted among Nurses’ working in Intensive
Care Units of Tertiary Care Hospitals in the city of Mangalore. Nurses fulfilling the
inclusion criteria will be contacted by the physiotherapist taking their interview.
Interview questions will be developed from review of literature and from discussions
with experienced physiotherapists. The interview will take place for 20-30 minutes and
will be tape-recorded and transcribed. During the course of the interview, questions
like their demographic data, whether they have a physiotherapist in their team, the role
of physiotherapy in ICU, when is the requirement of physiotherapist in the ICU and in
what conditions will be asked in order to know their perceptions. When the interview is
over, notes will be prepared on how the interview went, where did the interview take
place, any other feelings about the interview and the setting.
STATISTICAL ANALYSIS
Collected data will be analysed by descriptive analysis.
7.3 Does the study require any investigation or intervention to be conducted on
patients or animals?
No
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
The study was approved by the Ethical Committee of Father Muller Charitable
Institutions.
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LIST OF REFERENCES:
1. Stiller K. Physiotherapy in Intensive Care: Towards an Evidence-Based practice.
Chest 2000;118:1801-1813
2. Thomas A. Physiotherapy led early rehabilitation of patient with critical illness.
Physical Therapy Reviews 2011;16(1):46-57
3. Gosselink R, Clerckx B, Robbeets C, Vanhullebusch T, Vanpee G, Segers J.
Physiotherapy in Intensive Care Unit. Neth J Crit Care April 2011;15(2):66-75
4. Galley J, O’Riordan B. Guidance for nursing staffing in Critical Care: Royal
college of nursing: Feb 2003
5. Kydona Ch K, Malamis G, Giasnetsova T, Tsiora V, Gritsi-Gerogianni N. The
level of teamwork as an index of quality in ICU performance. Hippokratia
2010;14(2):94-97
6. Rozeboom N, Parenteau K, Carratturo D. Rehabilitation starts in the Intensive
Care Unit. Crit Care Nurs Q September 2012;35(3):234-240
7. Dalley J, Sim J. Nurses’ perceptions of physiotherapists as rehabilitation team.
Clinical Rehabilitation 2011;15:380-389
8. Atwal A, Caldwell K. Nurses’ perceptions of multidisciplinary team work in
Acute health care. International Journal of Nursing Practice December
2006;12(6):359-365
9. Atwal A, Tattersall K, Caldwell K & Craik C. Multidisciplinary perceptions of
the role of nurses and healthcare assistants in rehabilitation of older adults in
acute health care. Journal of Clinical Nursing 2005; 15:1418-1425
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SIGNATURE OF THE
CANDIDATE
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REMARKS OF THE GUIDE
11.
11.1 NAME AND
DESIGNATION OF GUIDE
MR. NARASIMMAN S.
PROFESSOR
DEPT. OF PHYSIOTHERAPY
(F.M.M.C)
11.2 SIGNATURE
11.3 HEAD OF THE
DEPARTMENT
MR. NARASIMMAN S.
PROFESSOR
DEPT. OF PHYSIOTHERAPY
(F.M.M.C)
11.4 SIGNATURE
12.
12.1 REMARKS OF THE
CHAIRMAN & PRINCIPAL
12.2 SIGNATURE
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APPENDIX-I
INFORMED CONSET
I___________________________________________ hereby agree to provide my fullest consent
and co-operation as a subject for the dissertation work of Ms. Gupte Pranati Pravin titled “Nurses’
perceptions of physiotherapists in Critical Care Team” as a part of her post graduation in
physiotherapy.
The possible benefits as well as the procedure of the study have been explained to me. The
question and queries I have posed have been answered to my satisfaction and I am aware that my
identity will be kept confidential. I am also aware that I can discontinue the study at any time I
wish to do.
Date:
Signature
Place:
11
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