Professional and Ethical Issues in United States Acute Care Physical Therapists Treating Patients With COVID-19: Stress, Walls, and Uncertainty

Abstract

Objective: No peer-reviewed research has explored professional and ethical issues encountered by physical therapists in treating patients with COVID-19. The purpose of this study was to explore the experiences of physical therapists regarding the professional and ethical issues they encountered during the COVID-19 pandemic. Methods: The current study used reflexive thematic analysis, a qualitative research design developed by Braun and Clarke, to analyze individual interviews. Results: Analysis of the coded interviews produced 6 primary themes (uncertainty, physical therapist’s role, ethical dilemmas and moral distress, emotions, providing care and working conditions, and management and leadership influence) and associated subthemes. Conclusions: Physical therapists reported numerous professional and ethical issues across the individual, organizational, and societal realms during the COVID-19 pandemic. This study highlights the need for education and resources to prepare physical therapists for professional and ethical issues encountered during pandemics. Specifically, there is a need to define the physical therapist’s role in pandemics and prepare the physical therapy personnel for dealing with ethical issues, stress, uncertainty, and organizational changes associated with pandemics. Ethical guidelines would support organizations in delineating fair processes for triage and allocation of scarce resources for acute care physical therapy during healthcare emergencies. Impact: The COVID-19 pandemic has produced significant changes in healthcare and physical therapist practice. This study reports results of the first research study focusing on professional and ethical issues experienced by physical therapists in acute care during the COVID-19 pandemic. As the US faces an unprecedented spike in COVID-19 cases and deaths, results of this study may contribute to physical therapists’ preparation for and response to professional and ethical issues encountered in acute care during the pandemic.

Future Challenges for Physical Therapy during and after the COVID-19 Pandemic: A Qualitative Study on the Experience of Physical Therapists in Spain

“…Our results are consistent with previous studies [13,17] showing that once incorporated into ICUs and acute care units, PTs had the feeling of being lost, of not being sufficiently useful or also that they wanted to contribute more. In fact, their training, mainly oriented to rehabilitation and comprehensive recovery of outpatients, could place them in a more vulnerable position in relation to the emotional impact of working in first-line units [14], without having experience and/or training to deal with critical events associated with a situation such as death, disaster situations, and moral dilemmas and conflicts during the COVID-19 pandemic [13,14,17]. Our results also showed that PTs had to self-train to adapt to the demands of the pandemic care.…”

“…The presence of these conflicts in the first weeks of the first outbreak in relation to the presence of PTs in units such as the ICU could be justified by the contrast between the sense of duty that led PTs to voluntarily report to acute care [14,17] and the concern in rehabilitation services to find a balance between providing rehabilitation care to as many patients as possible, avoiding the contagion of patients at risk and protecting rehabilitation professionals, as described in countries such as Italy and Spain [6,8,11,32].…”

“…After the initial conflict, our results show that PTs participated in the care of COVID-19 patients who were admitted to acute and ICU units, by supporting professionals (prone teams) and subsequently applying physical and respiratory therapy in patients extubated and discharged from ICU. Previous studies [14,17,31] show great variability in the role of PTs in other units during the first outbreak, including screening, triage, supporting safe early discharge, and supporting other hospital staff (e.g., physicians, nurses, social workers, pharmacists) where resources were scarce. Additionally, the within-hospital roles for PTs include multiple settings, including emergency department (e.g., management of musculoskeletal concerns to assist with patient flow) and ICUs (e.g., prone teams, preventing/addressing effects of immobility) [33][34][35][36].…”

“…Qualitative research helps to describe complex processes which have a great impact on healthcare professionals and healthcare organizations and can help to understand how the COVID-19 pandemic has influenced the perspective, beliefs, and attitudes of PTs [16]. Today, only three qualitative studies have exclusively described the experiences of PTs during the COVID-19 pandemic [13,14,17]. These studies had portrayed the emotional impact of PTs working in front-line units [14], their perspective on the pandemic, their experience upon arriving home [17], and ethical and professional issues that PTs have faced during their assignment to acute COVID-19 units [13].…”

“…Today, only three qualitative studies have exclusively described the experiences of PTs during the COVID-19 pandemic [13,14,17]. These studies had portrayed the emotional impact of PTs working in front-line units [14], their perspective on the pandemic, their experience upon arriving home [17], and ethical and professional issues that PTs have faced during their assignment to acute COVID-19 units [13].…”