Patient Supervision and Observation During Treatment

Published on 16/03/2015 by admin

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Last modified 16/03/2015

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Patient Supervision and Observation During Treatment

Candy Bahner


Among the many challenges for the physical therapist assistant (PTA) are supervising the patient during selected interventions, solving problems effectively, and making appropriate decisions. The PTA must recognize that interpersonal communication skills, patient supervision methods, data collection skills, effective problem solving, and responsive clinical decision making must be learned, practiced, and demonstrated to function efficiently and effectively.

Initial contact with a patient establishes a framework of rapport and sets the stage for all future interactions with that individual. The PTA has the opportunity to convey confidence, capability, and sensitivity during the initial introductions by the supervising physical therapist (PT). This leads the patient to trust the PTA and minimizes fear and anxiety in the patient.

The PTA is responsible for carrying out prescribed selected interventions, patient supervision, data collection, and appropriate problem solving and clinical decision making. The American Physical Therapy Association’s Department of Education, Accreditation, and Practice developed the “Problem-Solving Algorithm Utilized by PTAs in Patient/Client Intervention,”1 which reflects current policies and positions on the problem-solving processes to be utilized by PTAs in the provision of selected interventions (Fig. 1-1). For proper care to be given, the PTA must monitor the patient’s response to selected interventions and accurately and swiftly report changes to the supervising PT. This involves constant patient interaction, observation, data collection, reassessment of initial data, problem solving, and responsive action to clarify and enhance the effectiveness of prescribed selected interventions. Changes in the patient’s status, both positive and negative, can occur throughout the treatment program, whether during a single visit or over the span of multiple treatments. Some of these changes are subtle and require keen awareness of the initial objective data and acute sensitivity to the patient’s subjective reports. Other changes are profound and sudden. In either situation, the PTA observes the patient and collects appropriate data, such as range of motion, strength, pain, balance, coordination, swelling, endurance, or gait deviations. When reported to the supervising PT, these changes dictate and can significantly affect the course of treatment.

Components of Patient Supervision

Clinical patient supervision can be viewed as a process with the following purposes:

Clearly gathering information from the patient and interpreting those data during the initial evaluation are the responsibility of the PT. However, the PTA may need to assist the PT in helping the patient understand the problem throughout the course of rehabilitation. The PTA must recognize how difficult it is for patients to grasp all the components of the situation well enough to fully appreciate the rationale for the prescribed treatment. Therefore the PTA may be asked, when appropriate, to help the patient understand the disorder being treated, the supervising PT’s plan of care, and the selected interventions to be provided. In so doing, the PTA must be keenly aware of and sensitive to subtle or overt signs of patient apprehension, fear, and anxiety.

Although direct patient supervision is frequently the task of one individual, responsibility for the patient’s care is shared by the entire rehabilitation team. In addition, the patient must be actively involved in the treatment and accept shared responsibility for his or her own care.

While providing selected interventions, the PTA makes observations of the patient, collects relevant data, and develops an objective assessment using appropriate scales of measurement (Box 1-1). Using applicable questioning techniques ensures that the patient is actively involved. This interactive approach to supervision, as well as the skills of the PTA to seek, understand, and accurately relay information related to the patient’s status distinguishes the PTA from an on-the-job trained aide.5

BOX 1-1   General Scales of Measurement


−5/5 Normal: Full resistance against gravity

−4/5 Good: Some resistance against gravity

−3/5 Fair: No resistance against gravity

−2/5 Poor: No movement against gravity

−1/5 Trace: Slight contraction, no movement

−0/5 Zero: No contraction

Patient Supervision by the Rehabilitation Team

The PTA must be aware of the key members of the rehabilitation team. The PT and PTA are involved with direct patient care on a daily basis and may be assisted by supportive personal, such as physical therapy aides or technicians. The occupational therapist and occupational therapy assistant, along with the speech language pathologist, audiologist, rehabilitation counselor, nurse, respiratory therapist, psychologist, and dietitian, play significant roles in daily patient care. These rehabilitation specialists seek to maximize recovery for each patient and always must be regarded as resources to meet specific patient needs as they are identified by any member of the team. Thus the PTA charged with direct patient care and supervision is only one vital member of the team, and he or she can take comfort in knowing that every member of the team is prepared to provide appropriate skills so that the patient can achieve the highest functional gains in recovery. Developing a team mindset helps the PTA to be responsible and accountable to the other members of the team for his or her own contribution and to reach out to others when their expertise is needed.7

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