In 2011 it was estimated that nearly 48,000 people in Ireland live with dementia and that this figure is projected to rise to 150,000 by the year 2046 (O'Shea et al 2014).
Since the prevalence of dementia rises concurrently with age, it is not surprising that the greatest rise is predicted to be in those over the age of 65 years. As Ireland's age profile grows (Central Statistics Office 2017), older adults are estimated to be amongst the most frequent of the health service users in coming years (Department of Health 2018).
The health service and those who work within it therefore have a responsibility to shape services in line with the needs of its service users. The National Audit of Dementia Care in Acute Hospitals was therefore conducted in 2013 across 35 acute public hospitals. The global aim of the audit was to assess current practice in relation to dementia care and assist in the development of a National Strategy for Dementia Care in Ireland.
The audit concluded that:
- 94% of hospitals had no dementia care pathway in place
- Only 21% of hospitals were identified as having a training framework that supported skill development for those working with people with dementia.
- Only 6% of hospitals included "dementia awareness training" in their staff induction
- Allied health professionals, including physiotherapists, were amongst those that received the least amount of training.
Physiotherapists working in acute care treat a variety of conditions including, but not limited to, falls, immobility, hospital associated deconditioning, fractures, frailty, balance and gait impairment, progressive neurological disease, cardiorespiratory disease and stroke. Since the prevalence of such conditions is greatest in older adults, acute care physiotherapists will inevitably work with older adults regardless of their chosen clinical area of expertise. It is therefore imperative that physiotherapists have access to dementia training which specifically addresses their learning needs and enables them to work towards the optimal standards of care as specified in the National Dementia Strategy.
Furthermore, acute care physiotherapists are in a unique position to influence ward culture surrounding mobility and independence. The National Audit of Dementia Care in Ireland highlighted the challenges faced by those with dementia when navigating the acute hospital environment and identified the need to adapt ward environments to reduce distress for service users with dementia. Dementia training which empowers acute care physiotherapists to develop a culture of movement and positive risk taking may also assist in meeting these objectives.
Learning outcomes to be achieved upon completion of "Practise Context and Professional Role Development" module:
Learning Outcomes NS5011. On successful completion of this module the learner will be able to:
- LO1: Discuss the impact of contemporary healthcare developments, policies and debates on local service ideology and practice
- LO2: Analyse constructions of professional identity and role and factors that influence role performance and function
- LO3: Examine ways in which professional knowledge and expertise are developed in healthcare practice contexts
- LO4: Evaluate their own professional role in practice using relevant framework
- LO5: Appraise professional and practice development that incorporates evidence based approaches and collaboration with relevant individuals/teams/services/users
For full module descriptor click here
Practice objectives to meet your learning outcomes
LO4: Evaluate their own professional role in practice using relevant framework.
The framework I will use to evaluate my professional role is the Therapy Project's Office Competencies Framework. I am currently employed as a Senior Physiotherapist in the clinical area of Care of The Older Person in Connolly Hospital. The core competencies pertaining to the role of a senior physiotherapist in Ireland are listed below. A number of additional competencies are identified as being unique to the role of clinical specialist physiotherapist. Throughout this portfolio, I will examine my role of senior physiotherapist and identify the areas in need of development in order to achieve competency to the level of clinical specialist. In particular, I will analyse my role as an educator in an area of specialised expertise (dementia care) and also as a clinical resource to other staff members wishing to advance their knowledge and practice in this area.
Physiotherapy Core Competencies Frameowork
Three core competencies underpin the role of a senior physiotherapist. These include;
A) Professional Practice
- Caseload Management
- Communicating Effectively with Others
B) Caseload management
- Planning and Maintaining a Quality Service
- Leadership and Service Development
- Managing People
C) Education and Development
- Acting as a Clinical Resource
- Continuing Professional Development
See detailed explanation of competencies here
The core competencies for a senior physiotherapist that surround education include:
- Recognising the need to provide training for team, and other relevant stakeholders.
- Planning, delivering and evaluating education, training and health promotion activities to meet service needs within the department and MDT.
- Identifying and availing of formal and / or informal learning opportunities within Physiotherapy and multidisciplinary contexts.
- Ensuring there is a balance between staff education and service delivery.
- Managing, participating and playing a key role in the practice education of student therapists (in collaboration with practice education teams).
To achieve competence in education to the level required for a clinical specialist post one must also ensure that they are;
- Participating in the practice education of post graduate therapists (in collaboration with practice education teams).
- Delivering effective education training and support to ensure the successful implementation of new initiatives.
- Participates in education at a national level and international level.
Additionally, a clinical specialist physiotherapist may also be involved in:
- Providing education in a specific field of clinical expertise nationally and internationally by lecturing or through publishing research in professional journals.
Dementia Delirium Care Bundle
In response to the publication of the National Audit of Dementia Care in Ireland, Connolly Hospital has developed a multidisciplinary "Dementia/Delirium Care Bundle" with the aim of enhancing person-centred care for people with dementia. Results from a pilot study support the use of the care bundle (see here and image below).
The Care Bundle in Action
The role of staff education within the wider context of quality improvement
Summary plan of how I will achieve my objectives
Physiotherapists working with acute care will treat older adults and specifically, older adults with dementia. Therefore, there is a need to educate physiotherapists in the area of dementia care and also empower them to work within the best practise guidelines identified in the care bundle. This need to advance professional knowledge and practise is further underpinned by the professional codes of practice.
The education of physiotherapists not only facilitates the objectives I have identified above but also meets my own professional requirement to participate in activities that advance my professional learning and practise. I will reflect on my role as an educator and clinical resource within the department and aim to meet the core competencies of clinical specialist in this area.
Specifically, I will aim to meet the following core competencies:
- Delivering effective education training and support to ensure the successful implementation of new initiatives
26 March 2019, 15:10
[Updated: 26 March 2019, 15:10]
Comments following supervision meeting on 25th February 2019
Claire has clearly identified the learning objectives that she aims to meet on completion of this module. She has also included a well-structured plan that illustrates the steps she will take towards achieving these objectives. A clear framework exists that Claire can use to evaluate her current practice. She has identified the core competencies required to achieve clinical specialist status and these are included in the portfolio. There is also evidence of initial literature review and that can be extended in subsequent cycles.
08 April 2019, 11:39
In focusing on this, Claire has also reflected the other learning outcomes as she looks at professional identity, knowledge, experience and how physiotherapists in acute care work in the current healthcare environment. Claire has used literature and current health policy documents to support her learning objectives. She is on track and committed to her learning.