In this DB, you will provide a compeling argument of WHY you believe this (your
In this DB, you will provide a compeling argument of WHY you believe this (your selected topic) is the most challeging aspect for the respiratory profession. You will be required to complete a discussion board post that includes the following:
Topic summary including description of your topic AND why you believe it possess the greatest challenge for the respiratory profession.
Statistical data to support your position
Recommendations of how you would attempt to improve the selected topic
Be sure to support your post with a minimum of 2 additional scholarly sources.
Response Post
Respond briefly to each post. In your post provide feedback or additional suggestions for your classmates regarding their selected topic.
Joshua Weisz posted Oct 3, 2023 11:33 AM
Pulmonary Diagnostic Testing in my opinion will become very challenging for Respiratory medicine in the future. I believe there are multiple variables to support this opinion. Pulmonary Diagnostic Testing involves Pulmonary Function Testing, Exercise testing, and nocturnal oxygen qualification. PFT includes a multitude of tests including spirometry, diffusion studies, slow and forced vital capacities, nitrogen wash outs, body plethysmography, and Maximum Voluntary Ventilation (MVV). There are also specific exercise testing and bronchial provocation tests. These are very specific and nuanced tests that involve extra training. Each test is scrutinized and held to a national standard to assure reproducibility and held subject to interpretation from skilled pulmonologists. There are 3 key elements to obtain high quality pulmonary function data: accurate and precise instrumentation, a patient/subject capable of performing acceptable and repeatable measurements, and a motivated technologist to elicit maximum performance from the patient. In the realm of standardization, the technologist has received the least attention. Exercise testing for either oxygen or asthma includes walking/running the patient to achieve a target heart rate based on age and gender and ethnicity. Nocturnal oxygen studies include sensitive recordings whilst a patient sleeps to qualify them for oxygen or perhaps a respiratory assist device. These tests were primarily geared towards the COPD population including, but not limited to smokers, asthma, bronchitis, and obstructive sleep apnea. In 2020, 12.5 million people, or 5.0% of adults, reported a diagnosis of COPD (chronic obstructive pulmonary disease, chronic bronchitis, or emphysema (CDC,2022). I believe due to Covid 19 we will see a big uptick in lung related illness, either with post covid damage or long haul covid, which has already begun to appear. I also think that with a decreased trust in public health will lead to patients not coming to see their doctors or have tests ordered that could potentially catch early-stage lung cancer or pulmonary fibrosis. In 2018, an estimated 8.1 million U.S. adults were current electronic cigarette (e-cigarette) users (Creamer, 2019). This in my opinion, will be the biggest boom to pulmonary disease since cigarette smoking. I believe that we have yet to see the effects of this product. It is particularly harmful and difficult to quantify how bad at this stage, but people are consuming this product without fear. Unaware of the dose of nicotine or even what chemical fillers that are inhaling. As this lies dormant, I believe it is slowly moving towards quite a devastating outcome.
Lastly, I find it alarming how the diagnostic testing RT is slowly fading away. As RT’s increase their clinical knowledge and bedside expertise our field is more geared towards inpatient while our outpatient resources dwindle. As diagnostic techs begin to retire with no one to fill their positions I believe we will hit a critical low of people able to perform these tests. Without these tests to diagnose it makes treatment much more difficult because as we’ve learned in this course different etiologies and pathologies are so very important to treatment. Diagnostic tests help to define and specialize treatment for patients. If demand increases as I have theorized, and supply (RT) decreases we are in for a difficult time.
To improve this impending problem, I think first, and foremost education is critical. We must get the word out that vaping is not a safe alternative to smoking and that it may come with its own issues. We need to get the younger generation of RTs to appreciate different aspects of respiratory care and not just all the action of the ICU and Emergency Departments. I also believe that recognition of this potential problem can help to mitigate some of the strain it could potentially cause.
Chelsey Hannisick posted Oct 3, 2023 12:37 AM
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The field of respiratory medicine faces a complex challenge in protecting its workers from facing potential exposure to airborne transmissible diseases as they encounter patients with severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome (MERS)–CoV, influenza virus, human rhinovirus, and respiratory syncytial virus (RSV). Airborne transmission involves aerosolized suspensions of residue (less than five microns in size, from evaporated aerosol droplets) or particles containing agents that can be transported over time and long distance and still remain infective (Van Seventer et al., 2017). Airborne particles can also be generated from medical equipment during the manipulation of the lung airways. Many of which are performed by or with a respiratory therapist. These include manual ventilation (with a big mask), open endotracheal suctioning, intubation, bronchoscopy, sputum inductions, nebulizer therapy, chest physiotherapy, and no invasive positive pressure ventilation. The use of personal protective equipment is extremely important when it comes from preventing the transmission of airborne disease between patients and protecting the provider from becoming infected. According to the Occupational Safety & Health Administration when PPE is required, training for health care personnel must include the identification of the correct PPE; how to properly put on (don), wear, and remove (doff) equipment; limitations of PPE; and how to appropriately maintain and dispose of PPE (Valdez, 2015). PPE includes a range of items including but not limited to gloves, gowns/aprons, masks and respirators, goggles, face shields, and foot/leg covers. When selecting PPE staff must consider the type of anticipated exposure and be knowledgeable about current standards set forth by the Centers for Disease Control and Prevention (CDC) and organizational policy. Respiratory medicine is challenged by recent research which that despite the ability of PPE to protect health care workers, there are a number of factors, which have been, identified as barriers to PPE use such as discomfort, inconvenience, carelessness, forgetfulness, lack of habit, equipment inadequacy, insufficient quantity, and disbelief in its use acts as barriers to PPE use (Sharma et al., 2022) . If individuals aren’t willing to properly wear equipment, stay educated on requirements, and follow preventive measures at the bedside are not only putting other patients at risk they are putting their self at risk. If policies aren’t enforced by intuitions become at a higher risk of transmission/ outbreaks occurring.
The recent COVID 19 pandemic put into perspective of how unprepared our government was for such an outbreak which caused a burden of issues for hospitals and health care workers. Given the vital role of therapists in providing care to COVID‐19 patients, they were pushed to use PPE for long hours with unsafe staffing patterns. The CDC recommends that health care providers have adequate time to properly don and doff equipment before engaging in patient care. A study on respirator tolerance in health care providers found that a significant portion of the study participants were unable to tolerate wearing a respirator for an 8-hour shift, even with break periods (Valdez, 2015). When health care providers are wearing full-body coverage especially when they are engaged in complex patient care activities, the period in PPE that is tolerable may be even shorter. The lack of proper planning and adequate staffing also made it difficult for the field of respiratory medicine to properly adhere to protecting workers from exposure. When workers are burnt-out, don’t have adequate time to properly rest without equipment on, and have unsafe patient ratios the risk of poor monitoring and care being neglected can result in a decreased quality of care being provided.
Another consideration to look at in regard to the field of respiratory medicine and protecting its workers from transmission was the PPE shortage that occurred during the pandemic. This was reflected in survey data on PPE usage and in data on COVID-19 morbidity and mortality which concluded that “As of May 2020, 87% of nurses reported having to reuse a single-use disposable mask or N95 respirator, and 27% of nurses reported they had been exposed to confirmed COVID-19 patients without wearing appropriate PPE (Cohen & Rodgers, 2020). The CDC (2023) also aggregated national data of 172,844 cases among healthcare personnel and 743 deaths. With advancements in technology and modern medicine the government should’ve been more adequately prepared to handle a pandemic. Though this could be considered more of a governmental challenge, the field of respiratory medicine had to deal with the repercussions of the outbreak while at the front lines. This can also be burdensome for the respiratory field when thinking of ways to prevent future outbreaks and ensuring staff safety. It basically comes down to proper equipment being available, if its not then the therapist has no choice but expose their self to airborne diseases.
All of the listed topics that we could choose from face some sort of challenge for the field of respiratory medicine. But the COVID 19 pandemic has created a huge limitation when it comes to protecting health care works from airborne transmission. While there are many types of coronaviruses and infectious diseases, COVID‐19 has created worldwide uncertainty due to its novel profile and lack of immunity or vaccination. The pandemic-imposed challenges associated with learning new skills and adapting to new care models for the treatment modalities that are still being researched today. Though some of it can be associated with an individual’s choice to not adhere to preventative measures (recommended by the CDC), other challenges were created due to unsafe working conditions and lack of equipment.
A few recommendations I have are reevaluating not only the respiratory department but the entire workplace with a hazard assessment. This would ensure and identify that all PPE is safeguarded and working properly. It’s also important to select, maintain, store and care for the PPE. Departments need to ensure that proper equipment fits all employees and comes in all sizes. Proper fit testing needs to be enforced not just based on what the individual says what size they are. The biggest recommendation I have is proper training and testing for all employees to demonstrate that they are not only able to properly don, doff, adjust, maintain, care for, store and dispose of PPE, also be educated and knowledgeable on what infectious diseases require special precautions. According to Valdez (2015) workers also need to know the limitations of their P. “Employees may think a certain glove or dust mask may be sufficient to address a hazard, but there are limitations for each PPE, and you must communicate the limitations, to make sure they understand they’re not protected from all hazards”. In addition to understanding how to properly select and use PPE healthcare providers need to have practice in using PPE in realistic emergency patient care situations. The use of PPE can affect clinical performance by causing discomfort for the user, limiting manual dexterity, and impairing hearing and communication. Completing annual competencies in realistic simulation scenarios may help decrease the risk of transmission and the wrongful use of PPE. Though this could put a bigger burden on patient ratio staffing issues, having some sort of disciplinary write up that goes on their review if they fail to follow sanitation and safety protocols.
