Dr Catherine Johnston

Objectives: The aim of this study was to describe physiotherapists' involvement, confidence and training needs in the provision of student clinical education (CE) in Australia. Methods: A valid and reliable cross-sectional online survey instrument was used to collect data from physiotherapists employed in public and private healthcare facilities in Australia. Survey questions included participant personal and professional characteristics, participation in CE-related continuing professional development (CPD) and confidence in components of CE. Results: In all, 170 (34%) physiotherapists (mean age 37 years mean years clinical experience 13 years) completed the survey. Most participants (68%) were currently involved in CE, over half (56%) had completed CE-related CPD and many (56%) reported a need for more CPD. Participants with no previous CE experience were less confident (P = 0.05) in all components of CE. Participants with less clinical experience were less confident in managing challenging students (P = 0.003), multiple students (P = <0.001) and competing workplace and education duties (P = <0.001). Conclusions: Physiotherapists with varying professional characteristics were involved in CE. Although many participants had attended CE-related CPD, many reported that more training was required. Future training for clinical educators should be tailored to participants' level of experience and focus on the components of CE in which they feel least confident. What is known about the topic?: The ability of physiotherapists to confidently assume a clinical educator role may affect their willingness to be clinical educators in the future and the students' perceptions of clinical placement quality. CPD relating to CE may help prepare physiotherapists for the clinical educator role. What does this paper add?: There is a lack of information regarding physiotherapists' involvement in CE, completion of CE-related CPD or perceived levels of confidence in various aspects of the clinical educator role, such as placement organisation, teaching, assessment and the provision of feedback. This study describes the involvement of physiotherapists in CE in Australia, including their demographic and professional characteristics, participation in CE-related CPD and confidence in various components of CE. What are the implications for practitioners?: Several recommendations regarding future CE-related CPD have resulted from this study, including tailoring CPD to the needs of physiotherapists based on their level of clinical or CE experience, focusing CPD on the aspects of CE in which physiotherapists feel least confident and raising the awareness of and improving accessibility to CPD opportunities in this area.

Objective: To describe the geographical distribution of physiotherapy clinical placements and investigate the relationship between geographical setting and clinical placement marks in physiotherapy students. Design: A retrospective cohort design was used for this study. Setting: The University of Newcastle, New South Wales. Participants: Data from entry-level Bachelor of Physiotherapy student clinical placements. Main outcome measure(s): Data from all clinical placements in the Physiotherapy program between 2003 and 2014 were included. For all clinical placements, student assessment mark, year of study, type of placement and placement location were collected. Placement location was then classified using the Modified Monash Model (MMM) categories: one (most metropolitan) to seven (most remote). Results: Over the 12¿year period of the study 3964 placements were completed. Between 2003 and 2005 the average proportion of clinical placements occurring in metropolitan areas (MMM1) was 78% and in rural areas (MMM categories 3¿6) was 22%. In 2014 these proportions had changed to 59% (MMM1) and 40% (MMM3-6). There were significant differences in clinical placement grades between MMM1 and all other categories except MMM2, with lower assessment marks in MMM1 than other categories. Conclusions: The changing distribution of physiotherapy clinical placements may be reflective of increasing student numbers and greater efforts to support students completing rural and remote placements. This change may lead to a positive effect on the rural and remote physiotherapy workforce. Further research is required to determine the specific training and support needs of students and clinical educators in rural and remote settings.

Background Chest physiotherapy techniques, such as percussion, postural drainage, and expiratory vibrations, may be employed in a critical care setting. Physiotherapists are primarily responsible for their provision; however, nurses have also traditionally implemented these treatments. It is unclear whether nurses consider chest physiotherapy to be a part of their role, or how they perceive their knowledge and confidence pertaining to these techniques. Objective To investigate the attitudes of nurses towards traditional chest physiotherapy techniques. Method A total of 1222 members of the Australian College of Critical Care Nurses were invited to participate in an anonymous online survey. Results There were 142 respondents (12%) with the majority (n = 132, 93%) having performed chest physiotherapy techniques in clinical practice. Most of them considered that the provision of chest physiotherapy was a part of nurse's role. Commonly cited factors influencing nurses' use of chest physiotherapy techniques were the availability of physiotherapy services, adequacy of nursing staff training and skill, and perceptions of professional roles. Conclusions Nurses working in critical care commonly utilised traditional chest physiotherapy techniques. Further research is required to investigate the reasons why nursing professionals might assume responsibility for the provision of chest physiotherapy techniques, and if their application of these techniques is consistent with evidence-based recommendations.

Background Practice education is a compulsory component of health programs with practice educators playing a critical role in the education of students. Practice educator characteristics may positively or negatively affect student learning in practice settings. This study aimed to identify characteristics of the ideal practice educator that lead to successful practical experiences as perceived by current practice educators working in the Australian context of diagnostic radiography, nuclear medicine, nutrition and dietetics, occupational therapy, physiotherapy and radiation therapy. Methods All practice educators (n = 1063) on the University of Newcastle Practice Educator Database were invited to participate in this prospective, cross-sectional, descriptive study via online link or paper format. Results There was a 52% response rate. The five most valued characteristics were feedback skills, non-judgemental, professionalism, clarity and listening skills. The five least valued characteristics were scholarly activity, respect for students' autonomy, well-prepared, availability and being a role model. Comparisons between disciplines, genders, ages, years in practice and levels of supervisory experience indicated some statistically significant differences, though actual differences were small. Discussion Overall there was a high degree of agreement within and between disciplines on the characteristics of the ideal practice educator. The top five skills could be classed as generic skills and not specific clinical and practice skills, thus formal training and certification schemes may enhance practice educator competence.

Objective: Pulmonary rehabilitation is recommended for people with chronic lung disease however access remains limited in rural and remote settings. The aim of this project was to explore the perspectives of rural and remote health care professionals regarding the establishment and delivery of pulmonary rehabilitation. Setting: Rural (NSW) and remote (NT) Australian healthcare settings. Participants: Health care professionals (n=25) who attended a training program focussing on the delivery of pulmonary rehabilitation. Main outcome measure(s): Surveys with open written questions were completed by participants following the training program. Key informants also participated in face-to-face interviews. Thematic analysis was undertaken of data collected on participant opinions, attitudes and concerns regarding the establishment and delivery of pulmonary rehabilitation in their individual situation. Results: Participating health care professionals (predominantly nurses and physiotherapists) identified a number of issues relating to establishing and delivering pulmonary rehabilitation; including staffing, time and case load constraints, patient and community attitudes, lack of professional knowledge and confidence and inability to ensure sustainability. The practicalities of delivering pulmonary rehabilitation, particularly exercise prescription and training, were also important concerns raised. Conclusions: Lack of health care professional staffing, knowledge and confidence were reported to be factors impacting the establishment and delivery of pulmonary rehabilitation. This study has facilitated a greater understanding of the issues surrounding the establishment and delivery of pulmonary rehabilitation in rural and remote settings. Further research is required to investigate the contribution of health professional training and associated factors to improving the availability and delivery of pulmonary rehabilitation in rural and remote settings.

Background Practice education is a core component of undergraduate health programs, with the characteristics of the practice educator reported to have an influence on student experience during practical. This study analyses Australian student perceptions from six allied health professional undergraduate programs, to identify the characteristics of the ideal practice educator leading to successful placement experiences. Methods An existing survey developed for medical students was modified to incorporate both quantitative and qualitative responses. Participants included all students enrolled in six undergraduate health professions in the School of Health Sciences at the University of Newcastle, Australia (n = 1485). Students were invited to complete the survey via hard copy or online. Results There was a 54% response rate. The most valued characteristics were non-judgemental, clarity and feedback. The three least valued characteristics were scholarly activity, role model and practices evidence base practice. Students identified the importance of their relationship (respectful, inspirational and supportive) with the practice educator as being fundamental to a productive placement. Conclusion The characteristics identified by respondents were common to all six professions, with little differences between gender, year of program or number of placements completed. This study suggests that the attitude of the practice educator towards the student is one of the key factors that underpin the success of practice experience across allied health professions.

Background. People who have had a prolonged admission to an intensive care unit (ICU) commonly have profound debilitation and weakness. For the delivery of effective exercise training, an accurate assessment of exercise capacity is essential. Objective. The study objectives were to investigate how much ground-based walking is undertaken by inpatients recovering from critical illness within 1 week of discharge from an ICU and to evaluate the feasibility and safety of the Six-Minute Walk Test (6MWT) for this population. Design. This was an observational study. Methods. Within 1 week of discharge from the ICU, functional exercise capacity was measured with the 6MWT. The maximum distance ambulated on the ward in a single session as part of usual clinical management was extracted from the medical notes. The distance achieved during the 6MWT and the maximum distance ambulated on the ward were compared. Results. The participants (N=23) were survivors of a critical illness; their mean age was 57 years (SD = 11). The median length of ICU stay was 11 days (interquartile range [IQR]=7). The mean 6-minute walk distance (6MWD) was 179 m (SD = 101), and the maximum distance ambulated on the ward was 30 m (IQR=65). There was a moderate association between the distance participants ambulated on the ward and the 6MWD (r=.54). The maximum distance ambulated on the ward, expressed as a percentage of the 6MWD, was 29% (IQR=34%). Five participants (22%) experienced oxygen desaturation (oxygen saturation of <85%) and recovered within 1 minute of resting. Limitations. The maximum distance ambulated on the ward was estimated with premeasured distances. Conclusions. Most participants ambulated at a low percentage of their measured exercise capacity. The 6MWT appears to be a safe and useful test for inpatients recently discharged from the ICU.

Objective Access to pulmonary rehabilitation (PR), an effective management strategy for people with chronic respiratory disease, is often limited particularly in rural and remote regions. Difficulties with establishment and maintenance of PR have been reported. Reasons may include a lack of adequately trained staff. There have been no published reports evaluating the impact of training programs on PR provision. The aim of this project was to evaluate the impact of an interactive training and support program for healthcare professionals (the Breathe Easy, Walk Easy (BEWE) program) on the delivery of PR in rural and remote regions. Methods The study was a quasi-experimental before-after design. Data were collected regarding the provision of PR services before and after delivery of the BEWE program and patient outcomes before and after PR. Results The BEWE program was delivered in one rural and one remote region. Neither region had active PR before the BEWE program delivery. At 12-month follow-up, three locally-run PR programs had been established. Audit and patient outcomes indicated that the PR programs established broadly met Australian practice recommendations and were being delivered effectively. In both regions PR was established with strong healthcare organisational support but without significant external funding, relying instead on the diversion of internal funding and/or in-kind support. Conclusions The BEWE program enabled the successful establishment of PR and improved patient outcomes in rural and remote regions. However, given the funding models used, the sustainability of these programs in the long term is unknown. Further research into the factors contributing to the ability of rural and remote sites to provide ongoing delivery of PR is required. What is known about the topic? PR including exercise training, education, and psychosocial support, is an effective and well evidenced management strategy for people with chronic obstructive pulmonary disease (COPD) that improves exercise capacity and quality of life, and reduces hospital admissions and length of stay. Despite the fact that participation in PR is seen as an essential component in the management of COPD, access remains limited, particularly in rural and remote regions. Difficulties with establishing and maintaining PR have been attributed to lack of physical and financial resources and adequately trained and skilled staff. There have been no published reports evaluating the impact of training programs for healthcare professionals in the provision of PR. What does this paper add? This paper is the first to demonstrate that the delivery of a well supported, interactive healthcare professional training program may facilitate the establishment of PR in rural and remote regions. Following delivery of the BEWE program, PR which broadly met the Australian recommendations for practice in terms of program content and structure, was established. Factors influencing the establishment of PR were related to the characteristics of the healthcare setting, such as remoteness, and to issues around staff retention. The settings where PR was not established were in less well-staffed, community-based, more remote settings. People with COPD who participated in these programs showed significant improvements in exercise capacity and quality of life. What are the implications for practitioners? One of the factors limiting the delivery of PR may be a lack of appropriately trained and skilled staff. Healthcare professionals' participation in locally provided education and training programs targeted at developing skills for providing PR may enable effective PR programs to be established and maintained in rural and remote regions. © AHHA 2014.

Background and Objective: There is a paucity of information related to teaching palliative care to entry-level physical therapy students. The aim of this study was to evaluate the impact of an undergraduate course in palliative care on the preparedness of entry-level physical therapy students to practice within the palliative care setting. Methods: Participants were all entry-level undergraduate students enrolled in the third year of a 4-year undergraduate degree. All students enrolled in the course, "Physiotherapy Through Lifestages" took part in the learning modules relating to the care of patients undergoing palliative care. A survey instrument was used in the study, a modified version of an existing unpublished written questionnaire previously used to evaluate palliative care education in other allied health professions. Results and Conclusions: Participation in the course resulted in an increase in self-rated knowledge and confidence for working in the palliative care setting for entry-level physical therapy students and is considered to provide a useful ongoing resource for the presentation of this topic material. Although the impact of the delivery of this education module may be considered successful in this regard, it would appear that some of the underlying attitudes and emotional responses to this area of physiotherapy practice were less easily influenced. Further research is required to understand the influences on emotional preparedness of students to undertake this area of study and practice and to determine the optimal stage of study for delivery of this content. © Copyright 2014, Mary Ann Liebert, Inc.