The history of college health nursing

Safety Events and Privilege Utilization Rates in Advanced Practice Physical Therapy Compared to Traditional Primary Care: An Observational Study

Introduction

The general practitioner shortage in the United States coupled with a growing number of Americans living with disability has fueled speculation of non-physician providers assuming a greater role in musculoskeletal healthcare. Previous physician shortages have been similarly addressed, and expanding physical therapy (PT) scope of practice may best serve to fill this need. Resistance to expanding PT practice focuses on patient safety as PTs assume the roles traditionally performed by primary care providers. While studies have shown advanced practice PT to be safe, none have compared safety events in advanced practice PT compared to primary care to determine if there are increased patient risks. Therefore, the purpose of our study is to examine the rate of safety events and utilization of services in an advanced practice PT clinic compared to a primary care clinic. A secondary aim of our study was to report safety events associated with spinal manipulation and dry needling procedures.

Materials and Methods

Productivity and safety data were retrospectively collected from Malcolm Grow Medical Center from 2015 to 2017 for the Family Health Clinic (FHC) and an advanced practice Physical Therapy Clinic (PTC). Chi-square tests for independence, risk ratios (RR) and 95% confidence intervals (95%) were used to compare the relationship between the frequency of (1) patient encounters and clinical procedures and (2) clinical procedures and safety events.

Results

Seventy-five percent (12/16) of safety events reported in the PTC were defined as near misses compared to 50% (28/56) within the FHC (RR 1.5; 95% CIs: 1.0 to 2.2). Safety events were more likely to reach patients in the FHC compared to the PTC (RR 1.9; 95% CIs: 0.8 to 4.7). Safety events associated with minor harm to patients was n = 4 and n = 3 in the FHC and PTC respectively. No sentinel events, intentional harm events, nor actual events with more than minor harm were reported in either clinic. Significant relationships indicated that prescriptions, laboratory studies, imaging studies and referrals, were all more likely to be ordered in the FHC than the PTC (p < 0.01). The PTC ordered one diagnostic imaging study for every 37 encounters compared to one in every 5 encounters in the FHC. The PTC similarly referred one patient to another healthcare provider for every 52 encounters, fewer than the one per every 3 encounters in the FHC. There was a significant relationship between encounters and diagnoses, indicating a higher number of diagnoses per encounter in the FHC, though the difference of 0.31 diagnoses per encounter may not be clinically meaningful (p < 0.01). A total of 1,818 thrust manipulations and 2,910 dry needling procedures were completed without any reported safety events.

Conclusion

These results suggest advanced practice PT has a similar safety profile to primary care. The authority to order musculoskeletal imaging and refer to other clinicians were among the most commonly utilized privileges and may be of primary importance when establishing an advanced practice PT clinic. These results support research showing advanced practice PT may lead to reductions in specialty referrals, diagnostic imaging, and pharmaceutical interventions.

Public health nursing and the issue of trust in campus sexual assault

Public Health Nurses are the largest group of public health practitioners in both local and state health departments across the United States. Essential for the delivery of health services in the community, Public Health Nurses frequently provide care for underserved and vulnerable populations. Among these populations are the victims of campus sexual assault, a growing problem on college and university campuses. Both nationally and internationally, sexual assault has been described as a public health and human rights concern. With the signing of the Senate Bill 967 in California, affirmative consent, known as "yes means yes," requires both parties in a sexual encounter to give voluntary and affirmative consent. Many colleges and universities across the country have adopted similar standards. However, students may choose not to seek health care after an assault at the Student Health Center, preferring to obtain care in community clinics or health departments. Students must be able to be safe on and off campus, and must be able to trust they will be heard by campus authorities and the health care community, and be treated with respect. Public health nurses need to be prepared to work with victims of campus sexual assault and have a solid foundation in the issues surrounding assault, and the needs of the student to trust their caregivers. This paper presents an overview of the vulnerability and risk factors in sexual assault, presents legislation on campus and institutional responsibility, and provides a foundation for Public Health Nurses working with victims of sexual assault.