This second edition reflects several ongoing changes in healthcare practices and terminologies with updated content and references. Chapter 1, Establishing the Therapeutic Alliance, expands the discussion of healthcare bias to include immigrant bias and provides suggestions for providing culturally competent care for transgender patients. The revised chapter also addresses issues of inappropriate patient sexual behavior and compassion fatigue.
In response to the large and growing body of evidence regarding the effectiveness of early mobility in intensive care, we expanded the coverage of this area in Chapter 3, Special Environments. A sample mobility rating scale and team protocol for patients in intensive care and specific guidelines for approaching the complexity of the environment in a systematic way are among the chapter additions.
In Chapter 4, Keeping It Clean, improved diagrams and illustrations serve to clarify donning and doffing procedures for personal protective equipment and enteric precautions, frequently being used in healthcare facilities, in the coverage of transmission-based precautions.
Terminology has been updated where indicated in the new edition. For example, in April 2016, the National Pressure Ulcer Advisory Panel changed the term pressure ulcer to pressure injury and made several changes to the staging system for pressure injuries, which are now reflected in Chapter 7, Positioning Your Patient for Mobility.
Chapter 8, which previously addressed dependent transfers through manual and mechanical means, has been revised to more closely match the classroom reality. Although both of these transfer techniques represent similar levels of patient participation, teaching manual dependent transfers in conjunction with maximum-, moderate-, and minimal-assistance transfers is more efficient and follows a natural motor learning progression. The manual dependent transfer portion of Chapter 8, therefore, was moved to Chapter 11.
In an effort to make lengthy Chapter 14 less cumbersome, and to emphasize both the basic principles of assisted ambulation and the decision-making process of selecting, using, and progressing gait assistive devices, we divided its content. Chapter 14, Navigating the Challenges of Ambulating, now covers the fundamentals of gait, an introduction to assistive devices, principles of guarding during ambulation, and functional tasks such as walking over uneven surfaces and opening doors. The new Chapter 15, Implementing Device-Specific Gait, addresses the selection, fitting, and therapeutic use of each device, along with instruction on other aspects such as guarding, turning, and recognizing when patients are in need of a more stable device or are ready to progress to a more mobile one.
Other, more global enhancements throughout this edition include new and revised photographic illustrations of principles and techniques and the broadening of tasks and language to be more inclusive of patient-care skills provided by occupational therapists and occupational therapy assistants. Clinical decision-making has been further emphasized through the addition of review questions at the end of each chapter applying new concepts to clinical scenarios.