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reflective practice using johns model of reflection

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Physiotherapy in contemporary practice: a critical evaluation of two different physiotherapy context, demonstrating the diversity of scope of practice. Physiotherapists can only practice to the extent that they have established, maintained and developed their ability to work safely and competently (CSP 2002). Each individual physiotherapist has their own scope of practice, within the physiotherapy scope of practice. This essay will demonstrate the diversity of scope of practice and critically evaluate the two different physiotherapy context of palliative care (hospice) and private practice (PP) (musculoskeletal). Palliative care is care given to improve the quality of life of patients who have a serious or life-threatening disease (Zimmermann 1986). Physiotherapists work in palliative care to provide treatment that relieves symptoms, such as pain, but they are not expected to cure the disease. The main purpose is to improve the patient's quality of life (Zimmermann 1986). Many physiotherapists set up in private practice in a variety of specialist areas. The aim of musculoskeletal physiotherapy is to treat muscles, bones and joints in order to restore proper functioning to the body (Refshauge and Gass 2004). Both in private practice and palliative care, physiotherapists have three core skills which include manual therapy, therapeutic exercise and the application of electrophysical modalities and it is a way in which physiotherapists can ensure they are working within their scope of practice (CSP 2002). ...read more.


The physiotherapist must be able to deal with a patient who is suffering from stress and anxiety as the majority of patients I observed had some form of anxiety. In pp, I did not observe the physiotherapist deal with any patients with anxiety or stress as the patient is paying for treatment, and time is money. Although psychological issues can also arise in pp. Going through a thorough assessment is a part of any physiotherapists practice. In PP I observed that the physiotherapist will go through a thorough assessment with the patient and work with them to design a treatment plan. In palliative care I observed that they did not go through a long thorough assessment but they did very basic movements with them and observed more functional things such as walking, sitting and getting out of bed. The reason for the difference between PP and palliative care assessments is due to the abilities of the patients (mobility) and their lack of understanding (end stages) due to the nature of the illnesses in palliative care. In addition to, the aims of their treatments are different so their assessments would be different. In pp they are trying the find the underlying pathological condition of the patient so a thorough assessment is vital. ...read more.


In terms of confidentiality in private practice, from my experiences I believe that it is not as confidential as the palliative care setting. This is due to the high number of phone calls being made and messages being left with somebody other than the patient. This breaches the confidentiality rule if consent to leave information with others is not obtained. However, in a palliative care setting, I observed that confidentiality is maintained well. The duty of the physiotherapist, as part of the scope of practice is to make sure they keep records regarding the care of their patients (CSP 2002). They types of records that are kept can vary from different physiotherapy settings. In palliative care, there are MDT folders where records are kept. The reason for this is that everyone treating the individual patient can see what is happening with the patient in terms of treatment. The physiotherapists also keep separate records for the patients they have seen. In pp, the physiotherapist keeps their own records as there is no MDT. To conclude physiotherapists in pp and palliative care have diverse scopes of practice, but both settings working within their scopes of practice. Physiotherapists in palliative care have to accept that the course of their patients is one of deterioration, rather than that of rehabilitation and improvement that is seen in pp. ...read more.

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