Community physiotherapy service: an evidence based proposal to identify and manage community dwelling adults with or at risk of developing impaired cough

Brown, Lorna (2017) Community physiotherapy service: an evidence based proposal to identify and manage community dwelling adults with or at risk of developing impaired cough. Masters thesis, University of Cumbria. Item availability may be restricted.

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Abstract

This proposal centres on the identification and management of patients with impaired cough, identified by measurement of Peak Cough Flow (PCF), aiming to improve morbidity and mortality, optimising local services and the use of specialist centres. It is accepted that patients with an impaired cough will retain secretions, develop micro atelectasis and be at increased risk of developing respiratory failure during a simple respiratory infection. The aim is to identify patients at risk and intervene as appropriate with education and treatment, assisting self-management. These goals will be achieved through the implementation of a cohesive evidence based plan designed to enable maintenance of good respiratory health. The basis of this will be the jointly published British Thoracic Society (BTS) and Association of Chartered Physiotherapists in Respiratory Care “Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient”. Clinically, this proposal will maximise the care and support provided locally through enhancing skills available, and also identify patients that require specialist assessment or provision of equipment such as mechanical in and exsufflation devices, thereby facilitating referral onwards.

The service this proposal will be implemented by is the South Cumbria Domiciliary Physiotherapy team; this is a service that provides home based physiotherapy for patients with clinical need. A large proportion of these patients are those with reduced mobility and/or life limiting conditions. Due to the nature of the caseload this service is ideally positioned to deliver and develop this proposal. Physiotherapists are skilled at respiratory assessment and with education will be able to easily administer this change in practice of assessment and treatment. In order to implement this plan there will be a need to change practice, any process that requires change evokes multiple and complex concerns as well as emotions in those involved. Change is a process that requires managing and leadership, the practical application of this change will be discussed using the framework of Lewin’s Model of Change. Any service development requires a process of evaluation; the outcome of said evaluation should demonstrate the effectiveness of the process and clearly show how the new service is adding value. As the landscape of health provision evolves and moves towards the outline of the five year forward view, there is a necessity to demonstrate how services and professionals can support service users to reduce reliance on healthcare, especially unplanned contacts. The evaluation planned will be completed internally, be a formative process allowing for review and generate both quantitative and qualitative data.

Item Type: Thesis (Masters)
Departments: Faculty of Health and Science > Nursing, Health and Professional Practice
Additional Information: Dissertation submitted in part fulfilment for the MSc Advanced Practice (Clinical).
Depositing User: Anna Lupton
Date Deposited: 13 Oct 2017 10:00
Last Modified: 14 Oct 2017 17:56
URI: http://insight.cumbria.ac.uk/id/eprint/3296

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