Respiratory care clinics of North America最新文献

Different blends of knowledge, decision making, problem solving,professional behaviors, values, and technical skills are necessary in the changing health care environments in which respiratory therapists practice. Frequently, novice students are expected to perform quickly and efficiently,and it may be forgotten that students are still learning and mastering the foundation pieces of practice. Clinical educators take on the responsibility of student development in addition to overseeing patient care. Normally,these volunteer instructors are role models for respiratory therapy students. The characteristic of initiative when demonstrated by a beginning student is attractive to the clinical instructor, promotes sharing of experiences, and may evolve into a mentor-protege relationship. Some clinical instructors may be underprepared to teach and are uncomfortable with student evaluation. Respiratory therapy facilities in conjunction with academic institutions may consider sponsoring ongoing programs for clinical teachers. Teaching and learning in the clinical environment is more than demonstration of skills and knowledge. Furthermore, it can be debated whether the memorization of facts or of the steps of a skill is more valuable than competency in problem solving, clinical reasoning, or information retrieval. New knowledge is built within a context and is further integrated when grounded by experience. Development of "prediction in practice" or the anticipation of the next necessary actions may be worth integrating into the instructional toolbox. Intuition has been defined as an "understanding without a rationale". This definition separates intuition from rational decision making and presents intuition as a type of innate ability. Reflection when guided by clinical instructors can help deepen critical thinking, as will Socratic questioning on a regular basis. Most clinical staff can agree on the performance of an incompetent student, but discrimination of the levels of competence is more challenging. Observations allow the assessor to obtain the data necessary to evaluate performance, followed by assessment, which denotes a judgment made on the basis of an observation of events. Performance assessment should have stability and consistency, measure what is intended to be measured, and truly determine competence. In contrast, reflective analysis has been shown to be successful for clinical evaluation, thus departing from strict competency and product-based assessment. Students yearn to become clinically knowledgeable, and their enthusiasm should be fostered. An interest in clinical practice is the primary reason individuals enroll in respiratory therapy education programs. Educators,managers, and staff should assure that students experience an appropriate, rich, and diverse clinical curriculum that with practice develops clinical judgment, reasoning, and reflection on practice.

The capacity to perform critical thinking in respiratory care may be enhanced through awareness and education to improve skills, abilities, and opportunities. The essential skills for critical thinking in respiratory care include prioritizing, anticipating, troubleshooting, communicating, negotiating, decision making, and reflecting. In addition to these skills, critical thinkers exhibit certain characteristics such as critical evaluation, judgment,insight, motivation, and lifelong learning. The teaching of critical thinking may be accomplished though problem-based learning using an evidenced-based approach to solve clinical problems similar to those encountered in professional practice. Other traditional strategies such as discussion, debate, case study, and case presentations can be used. Web-based curriculum and technologic advances have created opportunities such as bulletin boards, real-time chats, and interactive media tools that can incorporate critical thinking. Many concerns and controversies surround the assessment of critical thinking, and individuals who administer critical thinking tests must be aware of the strengths and limitations of these assessment tools, as well as their relevance to the workplace. The foundational works reported in this article summarize the current status of assessment of critical thinking and can stimulate further investigation and application of the skills, characteristics, educational strategies, and measurement of critical thinking in respiratory care.

Therapists with bachelor's degrees in respiratory therapy have become the new advanced clinicians of the twenty-first century. Although the opportunity has increased in recent years, earning a baccalaureate degree in respiratory therapy remains a limited option. The "2-year preprofessional plus 2-year respiratory therapy" is the most popular curriculum design, but several other notable designs also fulfill the definition of a bachelor's degree in respiratory therapy. Two landmark documents issued in 2003 make strong arguments for expanding opportunities for baccalaureate education in respiratory therapy. Recognizing the "need to increase the number of respiratory therapists with advanced levels of training and education to meet the demands of providing services requiring complex cognitive abilities and patient management skills," the American Association for Respiratory Therapy has strongly encouraged the continuing development of baccalaureate education. Strategies for expanding baccalaureate opportunities include increasing the number and capacities of traditional programs, creating more articulation and bridge agreements between community and junior colleges with 4-year colleges and universities, and offering baccalaureate respiratory therapy through distance education. For the profession of respiratory therapy to require a baccalaureate at entry level, expansion of baccalaureate education will be necessary, and educators, managers, practitioners, and professional leaders will need to pursue all viable strategies. As an interim phase in the evolution of the profession, Becker suggests a strategy of"reprofessionalism" aimed at assisting therapists currently in the workforce to complete their degrees. Through a combination of strategies, a bachelor's degree in respiratory therapy will inevitably become the standard for clinicians in the decades to come.

Successful outcomes are vital for respiratory care education programs. These outcomes rely heavily on student recruitment and selection. Future graduates practicing respiratory care must have a basic understanding of respiratory care and possess the advanced skills that enable them to problem solve, communicate effectively, and become active leaders in the health care team. It is the responsibility of respiratory care educators to produce the respiratory therapists of the future. It is crucial for the faculty of respiratory care education programs to recruit and select candidates who will complete the educational program and develop the technical and critical-thinking skills needed to pass the advanced level credentialing examinations and succeed in the respiratory care profession.

Because of the increasing demand for program effectiveness, program outcomes have become important for quality assessment in respiratory care education. Respiratory care programs and their institutions must ensure that programs in which they invest their time, energy, and money have there sources necessary to provide quality preparation of program graduates. To determine how well an educational program achieves its goal in producing competent respiratory therapists, respiratory therapy programs must be assessed through key personnel, teaching, clinical education, and enrollment management. The processes such as developing faculty,improving instruction and enhancing students' learning, and strengthening the structure of the respiratory therapy program with competent personnel and effective enrollment management practices determine the direction and rate of success of the respiratory care program at GSU.

After years of discussion, debate, and study, the respiratory care curriculum has evolved to a minimum of an associate degree for entry into practice. Although programs are at liberty to offer the entry-level or advanced level associate degree, most are at the advanced level. The most popular site for sponsorship of the associate degree in respiratory care is the community college. The basis for community college sponsorship seems to be its comprehensive curriculum, which focuses on a strong academic foundation in writing, communication, and the basic sciences as well as supporting a career-directed focus in respiratory care. Issues facing the community college are tied to literacy, outcomes, assessment, placement,cooperation with the community, partnerships with industry, and articulation arrangements with granting institutions granting baccalaureate degrees. Community colleges must produce a literate graduate capable of thriving in an information-saturated society. Assessment and placement will intensify as the laissez-faire attitudes toward attendance and allowing students to select courses without any accountability and evaluation of outcome become less acceptable. Students will be required to demonstrate steady progress toward established outcomes. Maintaining relations and cooperation with the local community and the health care industry will continue to be a prominent role for the community college. The challenge facing associate degree education in respiratory care at the community college level is the ability to continue to meet the needs of an expanding professional scope of practice and to provide a strong liberal arts or general education core curriculum. The needs for a more demanding and expanding respiratory care curriculum and for a rich general education core curriculum have led to increased interest in baccalaureate and graduate degree education. The value of associate degree education at the community college level is well established. It is affordable, accessible, and responsive to the local health care industry it serves. It is likely to enjoy acceptance and popularity until its curricular limitations and time constraints no longer allow it to meet the needs of the respiratory care profession.

This study would not have been possible without the valuable insight of program directors across the country who were willing to share their experience. Although not conclusive, the results of the survey of program directors indicate that online education is being used in a small number of respiratory care education programs. The benefits and difficulties related by these program directors are similar to those found in the larger body of literature in higher education. The authors agree with most survey respondents that online education is a critical long-term strategy for programs of respiratory care education. Further investigation and better understanding of the various issues affecting online learning for respiratory care students are needed, however.

Problem-based learning has been used in respiratory therapy education for a relatively short time. The purpose of PBL is to produce a graduate who has improved critical thinking and life-long learning skills. On a practical note, another goal is to help the graduate pass the NBRC Clinical Simulation examination. PBL is the use of cases to provide a stimulus for the specification of learning issues, or objectives, which the students research and discuss. The heart of the PBL process is the tutorial group, composed ofa group of five to seven students and a faculty facilitator. Students work through the case, listing facts, testing hypotheses, learning pharmacology,and studying the learning issues of the case. Information is learned in thecontext of the patient case, rather than in isolated classes. Cases are presented in the progressive-disclosure model. Student evaluation consists of written examinations, self- and peer evaluation, and with an independent case study process. Program evaluation has shown that students enjoy the process and think that they are performing clinically better than their non-PBL peers. Pass rates for the Clinical Simulation examination are above the national average. A more in-depth study of program outcomes is indicated.

Respiratory care is indeed at a crossroads. The profession will continue to develop by advancing the education and credentialing needed to function as physician extenders-true cardiopulmonary physician's assistants. As such, the respiratory therapist of the future will focus on patient assessment,care plan development, protocol administration, disease management and rehabilitation, and patient and family education, including tobacco education and smoking cessation. Respiratory therapists, through primary, secondary, and tertiary prevention activities, can positively affect peoples'quality of life. This advanced level professional will work in the intensive-and acute-care settings, applying sophisticated cardiopulmonary technologies, as well in clinics, physician offices, home care, long-term and rehabilitation facilities, industry, educational institutions, and research facilities. The alternative to this advanced practice is for the profession to remain a task-oriented technical field, focused on procedures and the technical aspects of oxygen and aerosol therapy, mechanical ventilatory support, and related diagnostic and monitoring techniques. Although there is a dignified and important role for the provision of the technical aspects of respiratory care, the authors believe that the future role of the respiratory specialist is that of physician extender. Higher-order performance will result in higher-order contributions to health care. This role will require increased numbers of baccalaureate and graduate degree programs in respiratory care and increased numbers of respiratory therapists who hold higher degrees,including the master's degree in respiratory care and doctoral degrees in related fields. Community colleges, 4-year colleges, and universities should be encouraged to develop effective articulation agreements and mechanisms to offer the bachelor of science degree in respiratory care to the community college student. Professional associations and accrediting agencies should promote the development of additional baccalaureate and master's degree programs in respiratory care. Education is best defined as positive behavior change. Amplified education can only improve the ability of respiratory therapists to contribute to the cardiopulmonary health of people worldwide.