Respiratory Therapy Essay, Research Paper

The field I wish to pursue is that of respiratory therapy. When I was a child was when my first interest in respiratory therapy was aroused. As a child I was sick a great deal with various lung ailments that required frequent hospitalizations. I would always revel in the fact that how intelligent and courtesy the respiratory therapist were that took care of me. They were so good at what they did and they always made me ?feel better.? I wanted to be like them. That thought had never deviated since I decided that was what I wanted to do.

(1)Respiratory therapy is a result of specialization trends of the late 60?s in health care. At first referred to as ?inhalation therapy?, respiratory practitioners did very little. They were initially one the job trainees, trained by nurses, who did medial chores that nurses didn?t have time or didn?t want to do. This consisted of a lot of the time consuming activities such as setting up oxygen, delivering IPPB?s, ultrasonic nebulizers, chest physiotherapy and setting up machinery such as croup tents and ventilators. These technical chores involved no interpretation of the reasoning behind these mechanisms but only how to ?monkey? the steps involved in performing them. This ?early? practitioner had absolutely no autonomy as they had only technical skills and other employees such as nursing normally surpassed those skills.

(2)The field of respiratory care has since evolved a great deal. Beginning in the seventies formal respiratory programs were initiated. This formalized training would not only teach an individual the technical aspects of the field but also a moderate amount of the theory behind them. As in most fields, this increase in education was shortly followed by credentialing exams to ?certify? the respiratory practitioners. These exams were used to ?prove? the skills and information that the practitioners actually have learned. Two separate exams could be taken dependent on level of skill and/or education. The CRTT, which labeled the individual a certified respiratory therapy technician, this was the entry-level exam. When a practitioner became certified a certain amount of prestige was achieved. These credentials showed that these technician demonstrated more competence that those who did not have these credentials. The RRT or registered respiratory therapist indicated a higher level of understanding of reparatory skills and typically involved an increase in pay scale. At that time only a minimal amount of autonomy was present with this certification, however the prestige was greater in that typically only supervisors and directors were ?registered?.

(1)As the implementation of formalized training began many of the number of technical schools teaching these skills began to arise. More importantly for the profession many colleges began associate degree programs in the area of respiratory care. These programs were focused directly on the treatment of respiratory patients. These programs had many of the same requirements such as nursing degrees at the time but had also respiratory specific classes. The individuals were required to take Chemistry, Physics, Anatomy and Physiology, Microbiology, Pharmacology, and more. As these new ?educated? therapist began to arise the responsibilities and tasks of the therapist began to increase. The therapist was now not only involved in physically treating the sick individual but now knowing what and why to treat on a sick individual. As more and more formally educated practitioners were put into the work force the on the job trainee began to lose their positions to better-trained individuals. This was initially hospital policies or departmental preference but soon became to be the law with the advent of state licensing. With the increase knowledge base of practitioners came a state licensure. The state licensures typically stopped all hiring of OJT?s and often times limited the scope of the practicing OJT technicans. Other states required the OJT?s to pass the standardized CRTT exam to work. This CRTT exam quickly became the benchmark of the profession. If you did not pass the test you did not work. This left many OJT?s that had been in the field for years that were technically sound without at a job. These individuals typically were forced into ?non-skilled? arenas of hospital work, such as housekeeping and laundry, in order to keep their jobs, insurance, and their diligently worked for retirement. These licensure laws also assured competence in the therapists by other methods. The licensure requires continuing education credit. This is when the practitioner, certified or registered, have to receive ?x? number of hours of education annually in the changing field of respiratory care. Many conferences and seminars are given yearly in all states to help inform practitioners of the changes in not only respiratory care, but in health care specifically. This licensure also has a supervisory aspect in which each individuals work is subject to review. If inappropriate procedures and/or techniques are performed the licensure board has the legal right to discipline the practitioner accordingly. This could be as simple as cease and desist or as complicated as revoking the your licensees and preventing the practitioner to work in respiratory again.

With the implementation of the college degree gave the opportunity to gain a higher degree. Many bachelorate programs began to arise to ready the practitioner to a management position. Most of the degrees were focused in the area of management or education with the emphasis on the field of respiratory care. These programs have been tailored to help a practitioner achieve graduate degrees in such fields as health service administration, management, and education.

(4)As the years passed technology in healthcare has greatly increased. The new ?superior? trained therapist was taught the recent highly evolving equipment such as ventilators, IPV machines, BI-level ventilation, ECMO perfusion, etc.. in which nursing were not trained. Many nursing schools began to look at respiratory therapy as invaluable and began not to emphasize on teaching what the respiratory practitioners already did. Hence many of the nurse no longer knew how to use these ?specialized? equipment. Therapists were being taught the new functions and in led to the scenario of the pupil that had surpassed the teacher.(4) Many ?tenured? nurses still have a problem swallowing this, but it is very much the case.

As the field continues to grow the therapist?s role will continually change with it. Currently the field is focusing on disease management and further diversifying into all areas related to the respiratory genre.(7) The therapist already can do arterial punctures but are beginning to perform venous punctures (which are less risky and most of the time easier anyway), sleep studies, bronchoscopy, Hemodynamic monitoring, Cardiac monitoring, protocols, and much more. All of these skills are currently being taught in the ?average? college level respiratory degree program on various levels. The actual act of doing these ?new? procedures rely on the insight of the hospital and the aggressiveness in get them implemented by the department directors. The level of autonomy is directly related to this as well. The facility determines what an individual can do. Even though most of the time the practitioner knows how to manage their patients effectively many hospital pollicies won?t allow them too. Typically the therapists still have no autonomy. Many times they can work on their own and change therapies as see fit. This is done only under pre-laid plans by physicians that have already set plans of what should be done. The beuacracy of healthcare is a tangled one in that on one wants to let go of any control. Doctors are taught to think they are the end all and say all in healthcare and quite frankly are wrong a lot of times in the respiratory management of their patients. (4)Nurses are at times the same way. The internal workings of health care show a lot of back stabbing and fighting for respect. Every field wants to be the most highly regarded. Thus nurses many times will not concede that therapist know more than they know due to sheer ego.

(4)The interpersonal skills are related to this very struggle. The therapist must temper their relations in dealing with each specific individual. Many physicians want to think they are deities, such you approach them in a manner that isn?t offensive but still will enable you to speak with them regarding concerns of a specific patient. Nurses are varying greatly in the way you deal with them as well. Most ?old? nurses have a chip on their shoulders and remember the time when inhalation therapist knew nothing. Even though times have changed, ignorance hasn?t. These nurses often time search for reasons not to work well with therapist in hopes to gain the upper hand in the hospital hierarchy. On the other hand, more recently trained nurses are taught to understand what respiratory therapy is and what it is that they do. They respect the knowledge and opinion of the therapist and when this is accomplished the teamwork approach is at its best. The patient is taken care of by the best of all of our abilities and a better prognosis for treatment is definitely achievable.

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n certain other areas of respiratory therapy such as that in nursing homes quite a bit of autonomy can be expected. In this environment the respiratory practitioner will be expected to not only to deliver the treatment but also to evaluate and order the therapy as well. Of course these individuals are not acutely sick so there isn?t a huge amount of responsibility applied to treating the patient. This is a scenario actual autonomy is present but in all reality has no huge effect on that of treating the patient.

In all respiratory therapy is a ?technical? field, not professional. Professional in that autonomy is a must. A certain amount of autonomy may be present but that is normally reserved for those who want it. For the ?average? therapist is would be perfectly acceptable to go about day to day taking orders form physicians. These therapists typically have no initiative or drive and in my opinion have no real interest in patient care. I say this because in certain instances where the therapist only took orders without question would differ when if it were their family member. Physicians and nurses often times overlook things and it should be the therapist?s job to correct them. This is definitely ethically true and often times legally as well. This often times causes interpersonal struggles as alluded to earlier. No body likes to admit they?re wrong,

especially physicians. The therapist must be able to communicate concisely and clearly why something should be done. If done in the proper context and tone there shouldn?t be a problem. However, as long as a heiracle system is present there will always be instances of debate and ridicule when addressing your ?superiors?.

Bibliography:

1)Parkman, Anna MBA, RRT. Personal interview. 2/28/00

2) Fisher, Jean MBA,MHRA,RRT. Personal interview 2/28/00

3) Wildt, Jay RRT, RPFT. Personal interview2/26/00

4) French, William, MA RRT. ?How to Cement Working Relationships with Nurses?.

5) Coile, Russel C. ?Future Trends Impacting Healthcare and Respiratory Care?. AARC Times 7/97 pg. 34-36

6) Bunch, Debbie. ? Health Care Delivery Update: Lessons Learned in Reingeneering 101? AARC Times 7/97 pg. 37-39

7) Bunch, Debbie. RC Clinicians- and Not Just Managers- Need to Understand Managed Care?. AARC Times 1/98 pg. 30-32

8) Dunne Patrick J. ?The Emerging Health Care Delivery System?. AARC Times 1/98 pg. 25-28

9) Milligan, Shrake, et al. ?Lewin report? http://aarc/org/members_area/lewin_report/chapter_two.html pg. 1-30

10) Baker, Chris PHD. Lecture notes and various related teachings. 7/97-12/99`

11) Richards, Joe BS. Lecture notes and various related teachings. 7/97-12/99

1)Parkman, Anna MBA, RRT. Personal interview. 2/28/00

2) Fisher, Jean MBA,MHRA,RRT. Personal interview 2/28/00

3) Wildt, Jay RRT, RPFT. Personal interview2/26/00

4) French, William, MA RRT. ?How to Cement Working Relationships with Nurses?.

5) Coile, Russel C. ?Future Trends Impacting Healthcare and Respiratory Care?. AARC Times 7/97 pg. 34-36

6) Bunch, Debbie. ? Health Care Delivery Update: Lessons Learned in Reingeneering 101? AARC Times 7/97 pg. 37-39

7) Bunch, Debbie. RC Clinicians- and Not Just Managers- Need to Understand Managed Care?. AARC Times 1/98 pg. 30-32

8) Dunne Patrick J. ?The Emerging Health Care Delivery System?. AARC Times 1/98 pg. 25-28

9) Milligan, Shrake, et al. ?Lewin report? http://aarc/org/members_area/lewin_report/chapter_two.html pg. 1-30

10) Baker, Chris PHD. Lecture notes and various related teachings. 7/97-12/99`

11) Richards, Joe BS. Lecture notes and various related teachings. 7/97-12/99