Basic skills of patient care have served as the initial clinical course for untold numbers of physical therapy students over the years. In our teaching of this course, we have come to see a great opportunity, not only to teach students the techniques of caring for patients, but also to facilitate their growth as professionals in a world that will demand the highest levels of critical thinking and professional judgment. Our goal in creating this textbook has been to help shift the traditional mind-set of technique-driven patient care skills to an approach that is grounded in evidence, true to clinical reality, and easily accessible to students.
Patient care skills, from positioning and vital signs to transfers and ambulation with assistive devices, share a common theme of mobility. Mere mobility techniques, however, are not sufficient for the education of today's and tomorrow's health care providers. Mobility efforts need to occur in a broader context, one that encompasses cultural awareness, biomechanical and motor learning principles, patient-centered care, and changing health care realities.
Within this contextual framework, we have identified foundational principles and recurring themes that guide our clinical judgment. We have made them explicit through the use of thematic features such as “Thinking It Through” boxes, the biome-chanics icon, and multiple clinical cases. We have also structured the material to reflect underlying principles, infusing evidence throughout the content, providing theoretical foundations followed by clinical applications, and organizing mobility tasks by underlying objectives.
One of the greatest challenges for educators is to engage students in critical thinking. We encourage students to begin their decision making by identifying the ultimate objective of the task. Although this may seem simplistic, clinical choices such as whether to use a mechanical lift or to perform a manual transfer can often be resolved with this basic question.
Decision-making principles, such as having the patient do as much as possible as normally as possible (AMAP/ANAP), controlling a patient's movement centrally, and directing a patient's movement with more distal cues (CCDD) are referred to throughout the text. Simple “Try This” boxes encourage active experimentation. The “Thinking It Through” boxes feature decision trees and open-ended clinical questions to promote problem solving. We believe that early introduction of patient situations involving common health conditions is important in providing a clinical context for their learning. The use of “Pathology” boxes allows us to prepare students for such decision making in more complex clinical contexts. Students come away with basic “how to” skills, but they also develop critical decision-making skills that will serve them in any number of clinical situations they may encounter in the future.
Several continua exist in the patient care arena: progression from passive to active movements, from dependence to independence, from simple to complex, and from stability to mobility. These continua are woven throughout the text, some implicitly in the structuring and ordering of content material, and some explicitly in the illustrations and thematic features. For example, we ask students to examine the trade-offs between stability and mobility when selecting assistive devices or wheelchair designs.
Learning how and when to progress a patient can be challenging for a novice student. To nurture habits of thinking that view a patient's status not as a static condition but as a moment in a more fluid condition, a single patient case, “Thelma,” is continued in each chapter of the book, providing a clinical illustration of each content area, as well as of patient progression and regression.
Another difficulty students often have with patient care skills arises when they enter the clinic: many times what they see in practice does not exactly match what they learned in the classroom, either because clinicians have developed expertise that allows them to modify techniques or because of the lag that tends to occur between dissemination of new knowledge and actual clinical practice. The “Clinical Reality Check” boxes help prepare students for variations and unexpected occurrences they may encounter in the clinic. “Keeping Current” equips them with relevant recent evidence regarding best practices.
Patient and therapist safety are, of course, essential to good patient care. Safety, however, goes beyond hygiene, infection control, and body mechanics. This text highlights the importance of mindfulness in everyday clinical activities. Furthermore, habits of critical thinking can prevent acceptance of inappropriate or unsafe activities.
This textbook is designed to elevate patient care skills instruction to the level of the rest of the physical therapy curriculum through its basis in evidence and its ability to challenge students' thinking. Presented with foundational concepts initially and encountering those same principles and themes throughout the book, students are not only able to master patient care skills but also to develop problem solving abilities, preparing them to work safely and effectively in new and unexpected patient situations. Mobility in Context is intended to be a textbook that goes beyond “textbook” situations to facilitate the critical thinking skills essential to quality care and to the advancement of health care professions.
Using these teaching principles, we believe we have witnessed a shift in our students. The guiding principles are being carried over into later courses, decision-making skills are improved, and students are starting to think like professionals much earlier in their educational process.
You work hard, and your work is vital. We hope this textbook supports your efforts and empowers you to achieve even greater outcomes.