American Association for Respiratory Care's

January-February-March 2004

Editor
Dennis R. Wissing, PhD, RRT
LSU Health Sciences Center
Dept. of Clinical Sciences
School of Allied Health Professions
PO Box 33932
Shreveport, LA 71130
(318) 675-6814
dwissi@lsuhsc.edu

Chair
Thomas V. Hill, PhD, RRT
1206 Captains Brg.
Dayton, OH 45458-5710
(937) 298-3399 x5645
Fax (937) 296-7235
thill@athenstech.edu

Past Chair
Susan P. Pilbeam, MS, RRT, FAARC
9 Althea St.
St. Augustine, FL 32084
pilbeamsue@aol.com

 

In This Issue...

COLUMNS
Notes from the Editor Dennis R. Wissing, PhD, RRT
Notes from the Chair & Past Chair Tom Hill, PhD, RRT, & Susan P. Pilbeam, MS, RRT, FAARC
Educator of the Year: Susan Pilbeam, MS, RRT, FAARC
ARTICLES
New Developments at the NBRC Susan P. Pilbeam, MS, RRT, FAARC
Professionalism: Where Is This Component in the Respiratory Therapy Curriculum? Diana Merendino, MHS, RRT, RPFT
Modified Service Learning: A Method to Develop Professional Traits in Our Students and Show Off Our Profession to Potential Recruits Jeffery Ludy, EdD, RRT
Supporting Graduates in Their Credentialing Process Ellen A. Becker, PhD, RRT-NPS,AE-C
Study Techniques of Successful Respiratory Care Students Terry S. LeGrand, PhD, RRT
Geriatric Education: Minor Trauma is a Major Problem for the Elderly Helen M. Sorenson, MA, RRT, FAARC
Louisiana Community & Technical College System: Addressing the Health Care Worker Shortage Toy Smoot, BS, RRT
Call for Papers and Presentations for Summer Forum 2004

AARC Education Section Bulletin
AARC Education Section Bulletin

Notes from the Editor

by Dennis R. Wissing, PhD, RRT

Many thanks to those who contributed to the AARC Education Section Bulletin in 2003! I am proud to be associated with such an active specialty section, and I appreciate everyone's willingness to address the issues we covered last year. I have my own thoughts on how to tweak the content and improve the Bulletin, but as always I welcome feedback and comments. Are there particular features or columns you would find useful? Which features do you least care for? Please continue to send your suggestions to me at dwissi@lsuhsc.edu.
This year, Sandra Partain and I will be presenting a series on developing effective PowerPoint slides. Using the "before and after" format, we will show how to "edit" an ineffective slide and make it more effective for teaching. We will address font selection, use of color and graphics, and content. Our guidelines will be based on principles found in visual and cognitive science. This suggestion came from a number of Bulletin readers. We look forward to offering this series over the next several issues of the Bulletin.

[Top]


AARC education Section Bulletin
AARC Education Section Bulletin

Notes from the Chair & Past Chair

by Thomas V. Hill, PhD, RRT, & Susan P. Pilbeam, MS, RRT, FAARC

Educational Ambassadors: Last year, AARC Ambassadors recruited nearly 1,000 new members into the organization. Along with the additional 3,000 people who joined on their own, new members for 2003 totaled 4,000. Now we would like to ask each member of the Education Section to recruit just one AARC member to join our section this year. We're just 160 members shy of having a seat on the Board of Directors. If everyone helps out, we can reach our goal. Consider clinicians who act as educators in the hospital, training patients and staff. Consider those who provide home care and do patient education in the home. They all certainly qualify.

Write to your Congressional representatives
: AARC Past President David Shelledy asked the audience during the Agency Update at the International Congress to please write their state representatives in support of the bill in Congress requesting reimbursement for respiratory therapists in the home. You can access information on the bill, a sample letter, and the names of your congressmen and senators. It is one of the most important things you can do to ensure the future of your profession.

Stop smoking materials for students: “They're Rich, You're Dead” is an educational package well worth looking at. It contains an award winning video, video study plan, and interactive CD-ROMs (duplicated at cost) on the health consequences, addictiveness, and social aspects of tobacco and is intended for use by students in health professions. The package was developed under the auspices of Dr. Arthur Pitchenik, from the VA Medical Center in Miami, FL. A video study plan is available.

Thanks: As I officially turned over the gavel to our new section chair, Tom Hill, at the section business meeting in Las Vegas, I thought of how many people have helped me throughout the past four years. Many thanks to Jimmy Cairo, Bill Galvin, Tim Op’t Holt, Fred Hill, Dennis Wissing, Terry LeGrand, Carol Hopper, Gina Buldra, Bill Pruitt, and more. Without the help of these very generous individuals, the Summer Forums and International Congresses would not have been as spectacular as they were, our Bulletin not as full, and our abstracts and posters not as plentiful. Tom Hill will be an excellent section chair. I hope all of you will support him as you supported me. - Sue Pilbeam

[Top]


AARC education Section Bulletin
AARC Education Section Bulletin

Educator of the Year: Susan Pilbeam, MS, RRT, FAARC

Susan P. Pilbeam, RRT, respiratory care educational consultant and clinical applications specialist from St. Augustine, FL, and our Education Section chair, has been honored as the AARC's 2003 Educator of the Year.

The award, which was presented at the International Respiratory Congress in Las Vegas, NV, is bestowed annually on a member of the Education Section. Susan was recognized for her nearly three decades in the respiratory care educational arena. In addition to teaching in the community college setting, she was instrumental in helping Project Hope to develop a respiratory therapy program in Costa Rica and has authored three editions of a standard textbook on mechanical ventilation. Susan says her most significant achievement, however, has been "teaching, learning from, and working with students for more than 28 years."

[Top]


AARC Education Section Bulletin
AARC Education Section Bulletin

New Developments at the NBRC

by Susuan P. Pilbeam, MS, RRT, FAARC

Some of the most compelling news presented during the Agency Update at the International Congress in Las Vegas came from the NBRC. NBRC President Pam Bortner expressed her concerns over the recent results of the 2003 CRT exams (Jan.-Oct). Among 877 entry level graduates who took the exam, 428 failed (49% failing rate). Among 2,565 advanced level graduates who took the exam, 796 failed (31%).

The fact that graduates in some states can use a limited practice license for a year or more after graduation also disturbed Bortner. Because of the shortage of RTs, some are put in the position of working in critical care environments. To address this issue, the NBRC is considering the possibility of allowing exam candidates the option of taking the CRT exam immediately prior to graduation and holding the result confidential. When program requirements have been completed, the results would then be sent to the candidates by the NBRC. If the candidate does not pass, the NBRC would release the results to the candidate's state. This may help prevent CRT-eligible individuals who have failed the CRT exam from practicing respiratory care.

The NBRC will also spend the next several months looking at a time limitation for RRT-eligible candidates. At the present 10,783 individuals are classified as RRT-eligible by the NBRC. The board will consider a resolution on this issue at the April board meeting and is asking for feedback from the respiratory therapy community before that meeting. At present, members are considering a 3- to 5-year limitation on eligibility, without a grandfather clause. Respiratory care is unique among health care professions in that most impose a time limit for passing their credentialing exams and require some kind of remediation to re-obtain eligibility.

In response to a request from CoARC, the Board is considering a specialty examination for Adult Critical Care as well. They will do a viability study to determine whether there is a sufficient population of participants to support such an examination.

Lastly, Bortner reported that with the support of AMP/NBRC, the Latin American community now has a certification examination in Spanish. Respiratory therapists from Central America, South America, and Mexico participated in a job analysis and the subsequent development of the entry level exam. The exam consists of 350 written items, from which a 100-item exam will be created. Homer L. Rodriguez is the current executive director of the Latin-American Board for Professional Certification in Respiratory Care. He is located in Kansas City, KS.

[Top]

 


AARC Education Section Bulletin
AARC Education Section Bulletin

Professionalism: Where is This Component in the Respiratory Therapy Curriculum?

by Diana Merendino, MHS, RRT, RPFT, Program Director,
Bossier Parish Community College Respiratory Care Program, Bossier City, LA

As an educator, I would say the question posed by the title of this article is easily answered: professionalism is the curriculum. The Merriam-Webster Dictionary defines a profession as “a calling requiring specialized knowledge and often long academic preparation,” and defines professionalism as “the conduct, aims or qualities that characterize or mark a profession or professional person.” This important component of the respiratory therapy curriculum is demonstrated daily, yet students do not seem to perceive it as a vital part of their course work. From an instructor’s point of view, there is little value placed on the development of professionalism by the students. Today's classroom, instead tends to emphasize experiences that are ultimately connected to the requirements for a passing grade, with little attention given to activities and discussions related to the practice of professional conduct.

Since entering the education arena 12 years ago, I have broached the concept of “professionalism” from several different perspectives. First and foremost, I practice what I preach. I do not expect my students to become AARC members if I am not a member. I do not expect them to participate in national, regional, or local respiratory therapy events if I am not willing to participate. I often volunteer for community service projects, and return to tell the students what a great opportunity I was given by participating in the event. Of course, having said all this, I must admit leading by example has yielded few willing participants in respiratory care functions and other community related service projects.

Another method to promote professionalism is to create a Professionalism course in the respiratory therapy curriculum. What a novel idea! Even though students might express on the course evaluation that the course is “a waste of time” and “totally useless,” a discussion of scheduling conflicts, employee issues, managerial topics, and other health care issues will definitely prove valuable later on when they are faced with these issues on the job.

My latest attempt to get students to value professionalism has been to create a means for them to earn professionalism points. Initially, the point system was created for the Professionalism course, but I have expanded it by requiring points for each clinical semester. The students must accumulate a predetermined number of points, which are directly related to a course grade. They receive various point values for the amount of time, energy, and effort given to the project. This is a little more difficult to manage and monitor, but it has definitely improved student participation in community service projects. But the unexpected outcome of this system is that I have begun to see an attitude in some students that seeks the path of least resistance, students who look for the quickest and least painful way to get points for the grade. For some, there is no value (except the point value) in feeding the hospice family or participating in an asthma walk. It is just one more hurdle to leap before graduation.

This observation leads me to ask in frustration, what happened to the days of citizenship and civic duty? I remember being a grade school student when hands flew up to be chosen to “clap" the erasers or gather the equipment needed for P.E. In junior and senior high school, it was considered an honor to be picked to help mark the band practice field for football season or organize the band music into folders for the spring concert. Are these things seen as punishment today?

What happened to accountability? As 7th graders, we expected to get a grade of zero if the assignment was not turned in on time. We were expected to make up the work for the week we missed because of the flu. And we were sent to the office for counseling when there was documentation of excessive tardiness or absenteeism. Take these same issues and move them into my respiratory therapy program, and some students will challenge me for my actions.

I realize that these students’ value systems were created long before they entered my program to pursue a career in respiratory therapy. But there are a number of “old-fashioned ideas” that I intend to impart to them before they graduate:

  1. Do not hold your hand out and ask me what I am going to give you. I will only give you opportunities to succeed as a respiratory therapist. It is up to you to make these opportunities work for your growth in the profession.
  2. Do not ask me what the profession can do for you because my response will be, “What can you do for the profession?”
  3. Your actions as a student have a direct effect on you as a therapist, but they also affect your classmates, the program, the college, and ultimately, the profession. And last but not least, my all-time favorite lesson for my students (and for my children);
  4. There are some things in life you do because you “want to” (this is easy); there are other things in life you do because you “have to” (this can be more difficult); but the ultimate achievement is doing things in life because you “need to” (this can be a challenge, but very rewarding in the end).

With various strategies in place to promote professionalism, I can only hope I will have some influence on my graduates today. While I do not take all their perceived professional shortcomings personally, I do feel a great responsibility to mold these graduates into excellent respiratory care professionals, because they are the next generation of health care workers who will be taking care of my family.

[Top]


AARC Education Section Bulletin
AARC Education Section Bulletin

Modified Service Learning: A Method to Develop Professional Traits in Our Students and Show Off Our Profession to Potential Recruits

by Jeffery Ludy, EdD, RRT, Program Director,
Cardiopulmonary Sciences, University of Central Florida

For the past few years, we have been using some of our student-assigned clinical practice hours for tasks other than traditional bedside respiratory care. In an effort to expand our program’s community visibility, we have started allowing selected members of our senior class to participate in alternative professional activities that expose them to the community away from the hospital and to professional duties like teaching, peer counseling, and community service.

Our Bachelor's Degree Cardiopulmonary Sciences Program has been fortunate enough to maintain its recruiting goals over the years. However, recently we have seen a change in the caliber of our applicants and a decline in overall numbers, similar to most other respiratory care programs in the United States. Today, this is a moderate concern for us, but tomorrow, if this trend continues, it may mean a decline in the quality of the practitioners we graduate as entry-level practitioners. Such a situation would be a significant blow to this program's long and positive reputation of producing excellent entry-level practitioners and this region's future respiratory care leadership.

We have attempted to counter this trend by allowing selected members of our senior class some latitude in their clinical schedule. In addition to their traditional clinical duties, these special students are involved in community education programs and assist in our community contact efforts with a local special health magnet high school program. While the number of hours utilized in this project constitute less than 10% of the total hours a student spends in his or her clinical practice, they appear to be making a positive difference. We have noticed an increase in our students' motivation to become active in our profession and in our program's community visibility as measured by evaluations we receive from the high school students we work with. Another bright spot in this process is that it is almost cost free, with our only measurable costs associated with temporary parking permits for the high school students and a few keepsakes to help them remember their trip to our campus.

While some of our students also teach in the American Lung Association of Florida’s Open Airways Program and other health related K-12 programs - similar to what other respiratory care programs are doing — we think that integrating our students into the recruiting process is somewhat unique, at least here in Florida. By trusting our seniors to highlight their college experiences (good and bad), we demonstrate a level of trustworthiness that high school students respond to and appreciate. Based on the evaluations we do with these students, our credibility is quite high when compared to the other "adult" centered activities the university puts on for local high school students.

What makes this program so popular is the time the students get to spend with our seniors talking about why they chose respiratory care as a career and what their college experience has been like. I may be an effective teacher, but I can't be as effective as my seniors are with these high school students when it comes to peer-level issues. Again, the evaluations reflect this, and I feel our seniors are learning a lot more about what it means to be a professional than I could teach them in a classroom. Consider a few quotes from our current senior assistants, Ms. Rebecca Cassady and Mr. David Moses:

Mr. Moses: Peer involvement in this project seemed to be very effective...it is important for younger students to ask questions and hear stories from people who are doing exactly what they are thinking of doing.

Ms. Cassady: I feel that hardly any 18 year-old can know exactly what they want to do with the rest of their life, straight out of high school. This project with them gives them the opportunity to explore the field of respiratory care, something that few of them know anything about... It is important for the current students to be involved with the growth of the program, as the future of our career and reputation of the school we will graduate from rests in their success.

The success we have had with this project so far has led us to plan an expansion into two other school districts in our area. While it is going to take time to make a measurable impact on the recruiting issues that plague all of us, I feel this is a worthwhile project that will enhance our image in the local high schools and give our students a broader sense of what it means to be a professional respiratory therapist.

[Top]


AARC Education Section Bulletin
AARC Education Section Bulletin

Supporting Graduates in Their Credentialing Process

by Ellen A. Becker, PhD, RRT-NPS, AE-C, Academic Coordinator,
Respiratory Care, Long Island University

The NBRC's switch to computerized testing gave our graduates tremendous flexibility in scheduling their examinations. An unintended consequence of this change was that for some students, the scheduling freedom resulted in eternal procrastination. A common theme from procrastinating graduates is that they do not want to schedule their exams because they want to study more. A vicious cycle results when these graduates do not study more, more time passes, and the decision to schedule their exams becomes even more difficult.

While in school, students progress through their respiratory care program course by course and meet deadlines imposed by faculty and the academic calendar. Students have other classmates who regularly come to campus and study the same content, and they develop a social support network. After graduation, students suddenly need to establish their own deadlines, arrange study time with other graduates independently, and reach out when they need help. Not all graduates handle this autonomy well.

Last year our faculty implemented two interventions to address graduates’ procrastination in scheduling exams. First, monthly review sessions were set up beginning two weeks after graduation. Two graduates who had already passed their CRT exams attended the first session to continue their preparation for the registry exams. These graduates relayed their first-hand experience to their classmates, identifying what to expect at the examination center and commenting on the exam content. Equally important, the two newly-minted CRTs gave their classmates encouragement - the type of support they routinely gave each other throughout the prior two years. Graduates who had not already scheduled their CRT exams scheduled them during that first review session. Interestingly, graduates paired up, scheduling their examination time at the same time as their partner.

Second, we assigned each graduate to a faculty member for tracking. The faculty member contacts assigned graduates monthly to assess the graduates’ progress toward the registry credential. These monthly calls help keep the graduate connected with the university and our support services. Faculty can also provide customized support during these one-on-one contacts.

Have we been more successful? Partially. There were a few graduates who failed their first exam attempt and who might have delayed scheduling a retest. Our one-on-one counseling and scheduled review sessions provided the support needed to encourage these graduates to reschedule another attempt within a month. Now that most graduates are working, attendance at the monthly sessions is lower. However, several graduates working on their registry exam still attend. It may take a year or two to appropriately assess the full impact of the monthly review sessions and personal follow-up.

[Top]


AARC Education Section Bulletin
AARC Education Section Bulletin

Study Techniques of Successful
Respiratory Care Students


Terry S. LeGrand, PhD, RRT, Department of Respiratory Care,
The University of Texas Health Science Center at San Antonio

The question I hear most frequently from students is, “How should I prepare for the exam?” Unfortunately, I often hear it a day or two before the exam is scheduled to take place. While most students acknowledge that it is not a good idea to “cram” for a test, their idea of what does not constitute cramming covers a wide variety of study techniques. In a health care profession, it is not acceptable to memorize only enough facts to pass a test. Understanding theory and how to apply it is the key to competency in the clinical setting. How does one go about achieving this level of proficiency? Studying well in advance of an exam is critical to success, but the method one uses to learn and internalize the material is of equal importance.

Let me say right up front that I have no formal training in learning theory. I teach in a baccalaureate degree respiratory care education program at a large health science center in Texas. My educational background includes a BS degree in cardiopulmonary science and a PhD in cellular physiology. In spite of my lack of formal education training, I have a study technique that can work for almost anyone. This method evolved during my years in college and graduate school, and it represents a combination of techniques that I used for different courses.

I learned pretty much by accident that if a student can explain a concept to another student (or to the student's spouse or child or dog, for that matter), then the student truly understands that concept. I also learned that if the brain is systematically and repeatedly exposed to material daily for a number of days, the brain remembers the material almost effortlessly. I tell my students at the start of each new academic year exactly how to employ the techniques outlined in this article, and every year they ignore my advice...until they fail the first exam of the semester. Then I find them in my office asking, “Will you tell me again exactly HOW you suggested we study for your exams?”

Before I outline this study technique, let me explain how I came up with it. I returned to school to pursue a baccalaureate degree as a “non-traditional” student. I was married and the mother of three children, ages 14, 11, and 6. My children were involved in sports, required trips to the dentist, and expected to continue receiving meals every day, in spite of the fact that their mother was a full-time student. My husband was supportive of my decision to return to school, and he helped out whenever he could, but time to devote to my studies was limited. I realized it would be critical to make the best use of the available time.

During my first semester in college, I became acquainted with an Asian student. While she was proficient in spoken English, she had trouble quickly translating what the professor was saying while writing notes during lecture. Consequently, she found herself missing important points in class. Since we were students during the late 80s and early 90s, when professors did not hand a copy of their lecture slides to students, it was important to take notes in class. My friend asked me if she could photocopy my lecture notes. I was very happy to accommodate her, but when I looked at my notes and realized how messy they were and how many abbreviations they contained, I realized that I would have to rewrite them in order for her to benefit from them. So each day I rewrote my notes, adding explanatory information as needed, and then gave her a copy. What I didn't realize was that by rewriting and expanding on my notes for my friend, I was beginning to learn the material myself. So my first accidental discovery led to...

Study Technique #1: Every day, rewrite your notes from class in your own words, explaining the concepts to yourself as you write them.

But what about “notes” taken in today’s classrooms, where the contents of lectures are often given to students in the form of handouts? Students today take a bare minimum of notes in class because of this phenomenon. This fact doesn’t change Study Technique #1. At the end of the day’s classes, the first thing to do is to rewrite the contents of the slides that were covered that day in one’s own words, expanding on them as needed to explain each slide’s message.

The second discovery I made cemented Study Technique #2 and produced A’'s on almost every exam. I always read the chapters in my textbooks, but I had time to read them only once. I would take notes while reading if I came across information in the text that was not included in lecture, writing the concepts in my own words in a notebook. I never left home without my spiral notebooks filled with rewritten lecture and textbook notes. Then, when I had to wait during children’s dental appointments, or in the carpool line, or in the bleachers during my son’s baseball games, I used the time to read my rewritten notes. (Taking care to watch the action when my son was at bat or on the field, of course!) I would begin my study session each day by reading all the notes up to the point where I had left off before, then continuing with newly rewritten notes from class or from the textbook. I had time to read through notes from all my classes only one time each day, but I found that the act of rereading what I had read the previous day before reading newly added material greatly enhanced my understanding and retention of what I was reading. So Study Technique #2 was born...

Study Technique #2: Reread your rewritten notes once a day, every day.

It is important to reread the rewritten notes every day, taking only one day a week off from studying. The brain must be re-exposed to information on a daily basis until the exam on that material is given. If new course material is not reviewed daily, the information will be lost. I'm sure that those who have formal training in learning theory could explain why this technique works so well. All I know is that using it imprinted the material upon my brain so thoroughly that I could “read” my notes from the picture in my mind when it was time to take an exam. It was almost like having a legal “cheat-sheet.”

Study Technique #3 evolved when I became acquainted with another student who was equally interested in really understanding the material, not just memorizing enough information to pass the test. We set aside a specific time each day to compare notes taken during our classes to ensure that we had not missed anything. The act of verbally reviewing our notes from class turned out to be another good way to learn the material. After we rewrote our class notes, we would quiz one another about the concepts. We found that if we could explain concepts to each other, we understood them.

Occasionally, one of us would realize we hadn’'t quite grasped something as well as we thought we had. Discussing it filled in gaps in knowledge and ensured that we were not learning information that wasn't correct. A caveat regarding study partners is that students should avoid those who are not willing to work as hard as they are. While teaching concepts to weaker students is one way to learn, it can be very time consuming. When two students are of nearly equal academic ability and have the common goal of making the highest grades possible, the outcome is that both students excel as a result of helping one another learn. I do not recommend studying in groups, because it is easy for the group to lose focus and start talking about things other than the course material. So, try...

Study Technique #3: Find a study partner of similar academic abilities and systematically go over the material together, explaining it to one another to be sure you are learning the concepts correctly.

Study Technique #4 evolved in graduate school when I was completing requirements for my PhD. I was preparing to defend my dissertation, which covered knowledge gained over five years of intensive research. My dissertation defense was divided into two parts: an oral field exam and defense of my research findings. The oral field exam involved answering questions posed by members of my doctoral committee about any and all concepts related to my major field of study. While preparing for this grueling trial by fire, I read through my dissertation, including the literature review and the description of the studies I had conducted, as though I was the one who would be asking the questions. I wrote down every question that seemed pertinent, no matter how distantly related to the material it might be. I knew that anything could be considered fair game. Afterward, I wrote detailed answers to every question, then used my old technique of rereading the answers daily until the day of my field exam. It worked like a charm. So, consider...

Study Technique #4: When preparing for a comprehensive oral or written examination, go through the material, writing down questions as though you are the questioner, answer all the questions in detail, and then reread the questions and answers daily until the exam.

Do the study techniques outlined in this article require commitment and an investment of time? You bet they do. Do these techniques result in not only learning new information, but achieving greater understanding of concepts and the ability to apply new knowledge? Absolutely. Students (or their parents) pay a great deal of money in exchange for a college education. In addition to a diploma, students who enter a health care profession should leave school with the ability to apply their knowledge in the clinical setting. I know that if I ever wake up on the receiving end of a ventilator circuit, I want the respiratory therapist taking care of me to know not only what types of therapy I need, but also to understand why I need them and how to assess my condition to modify that therapy. This level of understanding occurs only when a student obtains a firm grasp of the theory behind the therapy.

[Top]


AARC Education Section Bulletin
AARC Education Section Bulletin

Geriatric Education: Minor Trauma is a
Major Problem for the Elderly

Helen M. Sorenson, MA, RRT, FAARC, Assistant Professor, Department of Respiratory Care, The University of Texas Health Science Center at San Antonio

The Canadian Journal of Emergency Medicine published case studies of two older adults (ages 78 and 85) who had suffered minor injuries. Both patients were previously healthy and active. Both were evaluated in the emergency room (ER) and found to have within range vital signs, CBC, electrolytes, and ECGs. Both had sustained bruising and rib fractures, and presented with chest pain. Both were discharged to home/to the care of their families with prescriptions for pain relief (oxycodone and Tylenol with codeine). Both presented back to the ER two days later in respiratory distress and with a variety of additional symptoms. Both expired that day.(1)

What happened? What went wrong? What is the message?

When sustained by older adults, minor injuries of the thoracic cage most commonly seen after blunt chest trauma can lead to life-threatening complications. The mortality rate from isolated rib fractures in elderly patients could be as high as 20%.(2) There are some normal age-related changes in the pulmonary system that contribute to the unexpected severity of post-chest trauma problems.
After age 55 the chest wall becomes stiffer. The intercostal cartilage begins to calcify, and many adults have arthritis of the costovertebral joints. Post-menopausal females are at increased risk for osteoporosis and kyphosis. Respiratory muscles gradually lose strength, including the diaphragm, which may weaken by up to 25%.(3) There are predictable losses in pulmonary function values. Loss of elasticity, loss of chest wall compliance, and early airway collapse (related to loss of elastic recoil) ultimately increase ventilation/perfusion mismatching. In healthy older adults, these normal detrimental changes are inconsequential. Coupled with chest trauma, however, they become an adverse contributing factor,

Because the chest wall is in close proximity to the lungs, even minor bumps and bruises can become serious. Fractures can result in trauma to the pleura and the underlying parenchyma. A slow bleed or air leak can develop into a pneumothorax or hemothorax. The pain associated with chest trauma can lead to a diminished ventilatory effort. Pain medications further blunt the respiratory drive. Decreased ventilation, reduced tidal volumes, an ineffective cough, and retained secretions are precursors to a downhill spiral of events that can lead to hypercarbia, hypoxemia, pneumonia, and/or respiratory failure. The fact that in older adults there is an overall decreased sensitivity of the respiratory centers to hypoxia and hypercapnia further magnifies the problem.(4)

Obviously, all elderly patients who present to the ER with bumps and bruises cannot be admitted to intensive care units, but there does need to be a heightened awareness that they are at increased risk. Unfortunately, rib fractures are often missed by chest-x-rays. A new technique using ultrasound has shown moderate success in diagnosing rib fractures. Dr. Kara and colleagues at the University of Kirikkale evaluated 37 patients admitted with blunt chest trauma in which CXR revealed no fractures. Ultrasound detected rib fractures in 15 (40%) of these patients.(5) Knowledge of the increased risk and availability of diagnostic technology are the best preventative weapons we have at the present time. It is important to be aware of the normal age-associated changes in our patients and to understand why the combination of age plus trauma can be hazardous to the older adult's health.

References

  1. Campbell SG, Dingle MA. Rib fractures following minor trauma in older patients: a not-so-benign injury. Canadian Journal of Emergency Medicine; Vol 2(1) 2001.
  2. Abella HA. Ultrasound finds rib fractures missed by x-ray. Diagnostic Imaging Online. Available; [http://www.diagnosticimaging.com/dinews/2003110701.shtml]
  3. Beers MH, Berkow R (Eds.) The Merck Manual of Geriatrics; Aging and the Lungs. Merck & Co. 2000-2003.
  4. Tonner PH, Kampen J, Scholz J. Pathophysiological changes in the elderly. Best Practice and Research in Clinical Anesthesiology; Vol 17(2), June 2003, p. 163-177.
  5. Kara M, Dikmen E, Erdal HH, Simsir I, Kara S. Disclosure of unnoticed rib fractures with use of ultrasonography in minor blunt chest trauma. European Journal of Cardio-Thoracic Surgery, 2003. 24:608-613.

AARC Education Section Bulletin
AARC Education Section Bulletin

Louisiana Community & Technical College System: Addressing the Health Care Worker Shortage

by Toy Smoot, BS, RRT,
Louisiana Technical College-West Jefferson Campus

The Supply and Demand Databases and Modeling Subcommittee of the Health Works Committee has identified respiratory therapists as one of five top priorities for combatting health care worker shortages in Louisiana. In recent years, about 10 percent of the positions for RTs in Louisiana have gone unfilled.
Louisiana Community and Technical College System (LCTCS) has 40 branch campuses, five of which serve the metropolitan New Orleans area. The Louisiana Technical College-West Jefferson Campus has the only entry-level respiratory care program. To address the health care worker shortage, LCTCS President Dr. Walter G. Bumphus held a meeting with chancellors, deans, and department heads representing various LCTCS colleges in the areas of nursing and respiratory care. While most of the emphasis was placed on addressing the nursing shortage, respiratory care was included in the top priorities sent to the Louisiana Legislature.

The LCTCS has produced a white paper titled, “Addressing the Healthcare Workforce Shortage in Louisiana: A Strategic Analysis.” It provides several strategies important to respiratory care:

  1. LCTCS will focus its efforts on achieving parity in regard to faculty vs. practitioner salaries.
  2. LCTCS will partner with area health education centers to promote health care careers in schools.
  3. LCTCS should develop promotional materials to support the effort to educate people regarding health care careers through LCTCS colleges.
  4. LCTCS will identify opportunities for distance learning venues to increase access of place-bound students and students who need courses not offered in their area.
  5. LCTCS will develop continuing education programs for health care professionals that will provide ease of access and affordability, and will articulate them to the appropriate level of health care boards.

[Top]


AARC Education Section Bulletin
AARC Education Section Bulletin

Call for Papers and Presentations for
Summer Forum 2004

Summer 2004 seems a long way off, but now is the time to start putting together your proposal to submit a research abstract or poster presentation. The AARC Education Section is looking for educational research and experience with models and instructional methods that may be useful to educators. Submitted work is peer-reviewed by a nationwide committee of educators, and the authors of the selected pieces are invited to present their research at the Summer Forum. The deadline for submission of proposals is April 1. All proposals should be either a research abstract dealing with RT education or a poster presentation describing innovative educational models, methods, or materials. Details regarding the format for submitting work will be announced in AARC Times, or you can contact the committee chair:

Bill Pruitt, MBA, RRT, CPFT
Chair, Abstract & Poster Review Committee
University of South Alabama
1504 Springhill Ave. Room 2545
Mobile AL 36604-3273
(251) 434-3405
fax (251) 434-3941
wpruitt@jaguar1.usouthal.edu

[Top]


Back