FREE ESSAY ON RESPIRATORY THERAPY

RESPIRATORY THERAPY

The field I wish to pursue is that of respiratory therapy. When I was a child was when my
first interest in respiratory therapy was aroused. As a child I was sick a great deal
with various lung ailments that required frequent hospitalizations. I would always revel
in the fact that how intelligent and courtesy the respiratory therapist were that took
care of me. They were so good at what they did and they always made me "feel better." I
wanted to be like them. That thought had never deviated since I decided that was what I
wanted to do. 
(1)Respiratory therapy is a result of specialization trends of the late 60's in health
care. At first referred to as "inhalation therapy", respiratory practitioners did very
little. They were initially one the job trainees, trained by nurses, who did medial
chores that nurses didn't have time or didn't want to do. This consisted of a lot of the
time consuming activities such as setting up oxygen, delivering IPPB's, ultrasonic
nebulizers, chest physiotherapy and setting up machinery such as croup tents and
ventilators. These technical chores involved no interpretation of the reasoning behind
these mechanisms but only how to "monkey" the steps involved in performing them. This
"early" practitioner had absolutely no autonomy as they had only technical skills and
other employees such as nursing normally surpassed those skills.
(2)The field of respiratory care has since evolved a great deal. Beginning in the
seventies formal respiratory programs were initiated. This formalized training would not
only teach an individual the technical aspects of the field but also a moderate amount of
the theory behind them. As in most fields, this increase in education was shortly
followed by credentialing exams to "certify" the respiratory practitioners. These exams
were used to "prove" the skills and information that the practitioners actually have
learned. Two separate exams could be taken dependent on level of skill and/or education.
The CRTT, which labeled the individual a certified respiratory therapy technician, this
was the entry-level exam. When a practitioner became certified a certain amount of
prestige was achieved. These credentials showed that these technician demonstrated more
competence that those who did not have these credentials. The RRT or registered
respiratory therapist indicated a higher level of understanding of reparatory skills and
typically involved an increase in pay scale. At that time only a minimal amount of
autonomy was present with this certification, however the prestige was greater in that
typically only supervisors and directors were "registered".
(1)As the implementation of formalized training began many of the number of technical
schools teaching these skills began to arise. More importantly for the profession many
colleges began associate degree programs in the area of respiratory care. These programs
were focused directly on the treatment of respiratory patients. These programs had many
of the same requirements such as nursing degrees at the time but had also respiratory
specific classes. The individuals were required to take Chemistry, Physics, Anatomy and
Physiology, Microbiology, Pharmacology, and more. As these new "educated" therapist began
to arise the responsibilities and tasks of the therapist began to increase. The therapist
was now not only involved in physically treating the sick individual but now knowing what
and why to treat on a sick individual. As more and more formally educated practitioners
were put into the work force the on the job trainee began to lose their positions to
better-trained individuals. This was initially hospital policies or departmental
preference but soon became to be the law with the advent of state licensing. With the
increase knowledge base of practitioners came a state licensure. The state licensures
typically stopped all hiring of OJT's and often times limited the scope of the practicing
OJT technicans. Other states required the OJT's to pass the standardized CRTT exam to
work. This CRTT exam quickly became the benchmark of the profession. If you did not pass
the test you did not work. This left many OJT's that had been in the field for years that
were technically sound without at a job. These individuals typically were forced into
"non-skilled" arenas of hospital work, such as housekeeping and laundry, in order to keep
their jobs, insurance, and their diligently worked for retirement. These licensure laws
also assured competence in the therapists by other methods. The licensure requires
continuing education credit. This is when the practitioner, certified or registered, have
to receive "x" number of hours of education annually in the changing field of respiratory
care. Many conferences and seminars are given yearly in all states to help inform
practitioners of the changes in not only respiratory care, but in health care
specifically. This licensure also has a supervisory aspect in which each individuals work
is subject to review. If inappropriate procedures and/or techniques are performed the
licensure board has the legal right to discipline the practitioner accordingly. This
could be as simple as cease and desist or as complicated as revoking the your licensees
and preventing the practitioner to work in respiratory again.
With the implementation of the college degree gave the opportunity to gain a higher
degree. Many bachelorate programs began to arise to ready the practitioner to a
management position. Most of the degrees were focused in the area of management or
education with the emphasis on the field of respiratory care. These programs have been
tailored to help a practitioner achieve graduate degrees in such fields as health service
administration, management, and education. 
(4)As the years passed technology in healthcare has greatly increased. The new "superior"
trained therapist was taught the recent highly evolving equipment such as ventilators,
IPV machines, BI-level ventilation, ECMO perfusion, etc.. in which nursing were not
trained. Many nursing schools began to look at respiratory therapy as invaluable and
began not to emphasize on teaching what the respiratory practitioners already did. Hence
many of the nurse no longer knew how to use these "specialized" equipment. Therapists
were being taught the new functions and in led to the scenario of the pupil that had
surpassed the teacher.(4) Many "tenured" nurses still have a problem swallowing this, but
it is very much the case. 
As the field continues to grow the therapist's role will continually change with it.
Currently the field is focusing on disease management and further diversifying into all
areas related to the respiratory genre.(7) The therapist already can do arterial
punctures but are beginning to perform venous punctures (which are less risky and most of
the time easier anyway), sleep studies, bronchoscopy, Hemodynamic monitoring, Cardiac
monitoring, protocols, and much more. All of these skills are currently being taught in
the "average" college level respiratory degree program on various levels. The actual act
of doing these "new" procedures rely on the insight of the hospital and the
aggressiveness in get them implemented by the department directors. The level of autonomy
is directly related to this as well. The facility determines what an individual can do.
Even though most of the time the practitioner knows how to manage their patients
effectively many hospital pollicies won't allow them too. Typically the therapists still
have no autonomy. Many times they can work on their own and change therapies as see fit.
This is done only under pre-laid plans by physicians that have already set plans of what
should be done. The beuacracy of healthcare is a tangled one in that on one wants to let
go of any control. Doctors are taught to think they are the end all and say all in
healthcare and quite frankly are wrong a lot of times in the respiratory management of
their patients. (4)Nurses are at times the same way. The internal workings of health care
show a lot of back stabbing and fighting for respect. Every field wants to be the most
highly regarded. Thus nurses many times will not concede that therapist know more than
they know due to sheer ego.
(4)The interpersonal skills are related to this very struggle. The therapist must temper
their relations in dealing with each specific individual. Many physicians want to think
they are deities, such you approach them in a manner that isn't offensive but still will
enable you to speak with them regarding concerns of a specific patient. Nurses are
varying greatly in the way you deal with them as well. Most "old" nurses have a chip on
their shoulders and remember the time when inhalation therapist knew nothing. Even though
times have changed, ignorance hasn't. These nurses often time search for reasons not to
work well with therapist in hopes to gain the upper hand in the hospital hierarchy. On
the other hand, more recently trained nurses are taught to understand what respiratory
therapy is and what it is that they do. They respect the knowledge and opinion of the
therapist and when this is accomplished the teamwork approach is at its best. The patient
is taken care of by the best of all of our abilities and a better prognosis for treatment
is definitely achievable. 
I
n certain other areas of respiratory therapy such as that in nursing homes quite a bit of
autonomy can be expected. In this environment the respiratory practitioner will be
expected to not only to deliver the treatment but also to evaluate and order the therapy
as well. Of course these individuals are not acutely sick so there isn't a huge amount of
responsibility applied to treating the patient. This is a scenario actual autonomy is
present but in all reality has no huge effect on that of treating the patient.
In all respiratory therapy is a "technical" field, not professional. Professional in that
autonomy is a must. A certain amount of autonomy may be present but that is normally
reserved for those who want it. For the "average" therapist is would be perfectly
acceptable to go about day to day taking orders form physicians. These therapists
typically have no initiative or drive and in my opinion have no real interest in patient
care. I say this because in certain instances where the therapist only took orders
without question would differ when if it were their family member. Physicians and nurses
often times overlook things and it should be the therapist's job to correct them. This is
definitely ethically true and often times legally as well. This often times causes
interpersonal struggles as alluded to earlier. No body likes to admit they're wrong, 
especially physicians. The therapist must be able to communicate concisely and clearly
why something should be done. If done in the proper context and tone there shouldn't be a
problem. However, as long as a heiracle system is present there will always be instances
of debate and ridicule when addressing your "superiors".
Bibliography:
1)Parkman, Anna MBA, RRT. Personal interview. 2/28/00
2) Fisher, Jean MBA,MHRA,RRT. Personal interview 2/28/00
3) Wildt, Jay RRT, RPFT. Personal interview2/26/00 
4) French, William, MA RRT. "How to Cement Working Relationships with Nurses". 
5) Coile, Russel C. "Future Trends Impacting Healthcare and Respiratory Care". AARC Times
7/97 pg. 34-36
6) Bunch, Debbie. " Health Care Delivery Update: Lessons Learned in Reingeneering 101"
AARC Times 7/97 pg. 37-39
7) Bunch, Debbie. RC Clinicians- and Not Just Managers- Need to Understand Managed Care".
AARC Times 1/98 pg. 30-32
8) Dunne Patrick J. "The Emerging Health Care Delivery System". AARC Times 1/98 pg.
25-28
9) Milligan, Shrake, et al. "Lewin report"
http://aarc/org/members_area/lewin_report/chapter_two.html pg. 1-30
10) Baker, Chris PHD. Lecture notes and various related teachings. 7/97-12/99`
11) Richards, Joe BS. Lecture notes and various related teachings. 7/97-12/99
Bibliography
Bibliography:
1)Parkman, Anna MBA, RRT. Personal interview. 2/28/00
2) Fisher, Jean MBA,MHRA,RRT. Personal interview 2/28/00
3) Wildt, Jay RRT, RPFT. Personal interview2/26/00 
4) French, William, MA RRT. "How to Cement Working Relationships with Nurses". 
5) Coile, Russel C. "Future Trends Impacting Healthcare and Respiratory Care". AARC Times
7/97 pg. 34-36
6) Bunch, Debbie. " Health Care Delivery Update: Lessons Learned in Reingeneering 101"
AARC Times 7/97 pg. 37-39
7) Bunch, Debbie. RC Clinicians- and Not Just Managers- Need to Understand Managed Care".
AARC Times 1/98 pg. 30-32
8) Dunne Patrick J. "The Emerging Health Care Delivery System". AARC Times 1/98 pg.
25-28
9) Milligan, Shrake, et al. "Lewin report"
http://aarc/org/members_area/lewin_report/chapter_two.html pg. 1-30
10) Baker, Chris PHD. Lecture notes and various related teachings. 7/97-12/99`
11) Richards, Joe BS. Lecture notes and various related teachings. 7/97-12/99