Home Health: "Breaking into the ICE Arena"
Purpose: As acute care admission days have decreased, patients often receive home health physical therapy earlier in their recovery process. Due to the decreased length of stay on the inpatient side, medical complexity of the home care client has increased. This shift requires physical therapists in home health to be critical thinkers and strong communicators who constantly synthesize all medical, pharmacological and physical information to make autonomous decisions quickly regarding medical status and referral. Home health physical therapists serve an important role in the continuum of care as primary care providers focusing on chronic disease management and health promotion in diverse home environments. Students need experience with medically complex patients and home health is where they reside, yet it has been an underutilized setting for clinical education due to potential challenges. The purpose of this project is to describe the implementation of an Integrated Clinical Education (ICE) experience in home health. Methods/Description: Creation of ICE experiences requires coordination, collaboration and communication. Initial meetings were held with primary clinical instructor (CI), Site Coordinator of Clinical Education (SCCE) and Director of Clinical Education (DCE) to identify key objectives that were critical for students to achieve in this setting and potential challenges to the provision of patient care. There was careful selection of CIs to ensure high quality experiences. It was determined that a 1:1 model would be the most effective for all stakeholders occurring during the second year of the Doctor of Physical Therapy program (DPT2). The DCE met with all students during an initial seminar meeting to explain home health and the expectations. The SCCE met with CIs to review the established student objectives. Clinical instructors were able to communicate with each other to ensure that each student would receive similar experiences and that there would be consistent performance expectations for both CIs and students. Students met their CIs at the office to discuss an overview of home care including responsibilities, interdisciplinary aspects, documentation and patient information. They then traveled with that CI to clients’ homes in a 1:1 model. Students were able to apply clinical skills in a “non-clinic” setting experiencing firsthand the unexpected challenges in home health. Travel time facilitated critical thinking through discussion and thoughtful questioning. Students were required to write a reflection on the course web site following their experience and complete a written assignment that synthesized their knowledge of coursework in relation to their unique patient experience. Deliverables allowed the DCE to assess critical thinking, perceptions, cultural competence and professional behavior in addition to feedback from the CIs. Results/Outcomes: Students during their DPT 2 year completed two, four-hour sessions in home health as ICE experiences. In addition to typical planning for a new ICE experience, home health required consideration of vulnerability for all constituents - patients, students and CIs - due to the setting and level of care provided. Based on student feedback and reflections, support from the academic institution was essential to work with students to value the experience and recognize relevance of this experience to patient care in every setting. Anecdotally the second experience seemed to be reflected upon more positively which may be due to repeated exposure and a shift in perspective.This environment required students to be critical thinkers who are open-minded, flexible and adaptable. They benefited from mentorship and modeling of clinical integration from their CIs. Conclusions/Relevance to the conference theme: Home health is a unique setting lending itself to medically complex patients in potentially challenging and diverse environments that often push students outside of their comfort zone. This unique environment contributes to student preparation for full-time clinical experiences while addressing future needs of this population and the profession. This is one model of an ICE experience in home health that could be transferable to other institutions.