Nursing Case Study: Improving Ethical Practice in Physiotherapy

This nursing case study reflects on an ethical dilemma encountered in physiotherapy practice within an aged care facility. The incident involves a patient who fell, and the care staff failed to document it. The subsequent physiotherapy session led to the discovery of the unreported fall due to the patient's complaints of pain. The reflection covers the importance of accurate incident reporting, ethical considerations in patient care, and the implementation of risk assessment strategies to prevent future falls. It emphasizes the significance of maintaining detailed patient records, addressing environmental hazards, and promoting a culture of mindfulness among healthcare staff. The author reflects on how this experience affirmed the need for prompt reporting, thorough risk assessment, and continuous improvement in physiotherapy practice to ensure patient safety and well-being. The case study also highlights the importance of considering factors that increase the risk of falling among older patients and implementing appropriate interventions to improve gait and balance.

Running head: Nursing Case Study
Nursing Case Study
- Ethical Physiotherapy Practice
Name of the Student
Name of the University
Author Note

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Introduction:
Physiotherapy or physical therapy (PT) is a form of treatment focused on functionality
and movement and aimed to optimize potential. The treatment attempts to improve quality of
life, movement ability in the domains of promotion, prevention, treatment, intervention,
habilitation and rehabilitation. A diverse array of physiological conditions requires PT
intervention like neuromuscular, musculoskeletal, cardiovascular and respiratory
dysfunctions (physio-pedia.com, 2018). The Australian Health Practitioner Regulation
Agency (AHPRA) and National Boards implemented the National Registration and
Accreditation Scheme under Health Practitioner Regulation National Law that regulate the
PT practice (physiotherapyboard.gov.au, 2018).
What was done:
In the given scenario, involving an accident related to the fall of the patient, and the
care staff failing to note this incident. The issue came to light when the patient complained of
pain and discomfort during the PT session, and showed concern of the possibility of a
fracture. However subsequent diagnosis ruled out the possibility of fracture.
A safety assessment of the environment of the patient was conducted, that helped to
identify any fall risks. This included improving the lighting to improve visibility, installing
double rails on staircases, grab bar, shower chair and hand held showers in the bathroom.
These are simple and inexpensive ways to make the environment safer for the patient
(ncoa.org, 2018). Additional strategies to reduce the risks of fall included improvement of
balance and gait with exercise routines, reduce tipping hazards (keeping the walkways clear
of obstacles), avoiding loose mats or rugs, performing an eye checkups and review of
medications that can cause dizziness or drowsiness (Cdc.gov, 2018). Assessment of patient’s

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ability to move due to the fall was also conducted which highlighted pain in the hip, and
discomfort in movement. Additionally, the incident was also reported to healthcare authority.
Given below is the risk assessment reference used:
Figure 1: Risk assessment- preventing geriatric falls; source: (Lee, Lee & Khang, 2018)
What was learnt:
Several factors can increase the fall risks, especially among older patients, like:
balance and gait, vision, medication, environment and chronic conditions. Any attempts to
reduce the risks of falling, needs to address one or more of these factors that actively
contribute to the chance of falling (ncoa.org, 2018). The event highlighted the necessity to
identify the risks that increase the propensity of falling. Lee, Lee and Khang (2013) pointed
out that a normal gait needs proper and appropriate functioning of the joints and muscular
contractions, as well as the requirements for accurate visual, tactile, and proprioceptive
senses. With age, the joints can stiffen, and muscle strength can decrease, and neurologic

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feedback can be adversely affected. These increase the likelihood of falling. Different
intervention strategies can be suggested to address abnormal results from the PT examination,
as shown in the figure below:
Figure 2: Interventions for Abnormal Results; source: (Lee, Lee & Khang, 2018)
The event also highlighted the necessity of maintaining accurate and up to date
records about the patient, including symptoms or medications and should include any
incidents that can jeopardize the well being of the patient. Wagner et al. (2008) pointed out
that incident reporting system is important to improve the care process, and that improvement
in the existing system of reporting is a necessity.
How the activity affirmed or influenced my practice:
The activity had profound influence on my practice in PT. Firstly; it highlighted the
necessity of prompt and accurate reporting of incidents related to the safety and well being of
the patients in the care facility. Since the fall of the patient was not reported, it resulted in the
PT aggravating the pain or discomfort, although inadvertently. If such event was reported by
the care staff the PT would have taken special care while conducting routine checkups and

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analysis. Moreover, such an overlook could also have cause serious complications, if the fall
resulted in any facture. This showed the necessity absolute mindfulness of the care staff, and
proper monitoring of the patient.
Additionally, the incident also shows the importance of risk assessment of falling or
tripping hazards. Since among the geriatric population, the ability to move gets significantly
affected, any factors that can increase the propensity of falling must be analysed and
eliminated if possible, apart from providing assistance to avoid the risk.
Conclusion:
In geriatric care, a significant health and security risk is posed due to an increased
propensity of falling. Such risks are aggravated by an abnormal gait, caused due to several
conditions related to age and degenerative diseases. Interventions that can reduce the risk
include a proper risk assessment, as well as involving activities that can improve the gait.

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References:
Cdc.gov. (2018). Simple Steps to Reduce Fall Risks. Cdc.gov. Retrieved 7 February 2018,
from https://www.cdc.gov/media/matte/2012/07_falls.pdf
Lee, A., Lee, K., & Khang, P. (2013). Preventing Falls in the Geriatric Population. The
Permanente Journal, 17(4), 37-39. http://dx.doi.org/10.7812/tpp/12-119
ncoa.org. (2018). 6 Steps for Preventing Falls in the Elderly | NCOA. NCOA. Retrieved 7
February 2018, from https://www.ncoa.org/healthy-aging/falls-prevention/preventing-
falls-tips-for-older-adults-and-caregivers/6-steps-to-protect-your-older-loved-one-
from-a-fall/
physio-pedia.com. (2018). Physiotherapy / Physical Therapy. Physiopedia. Retrieved 7
February 2018, from
https://www.physio-pedia.com/Physiotherapy_/_Physical_Therapy
physiotherapyboard.gov.au. (2018). Physiotherapy Board of Australia - Code of
conduct. Physiotherapyboard.gov.au. Retrieved 7 February 2018, from
http://www.physiotherapyboard.gov.au/Codes-Guidelines/Code-of-conduct.aspx
Wagner, L., Capezuti, E., Clark, P., Parmelee, P., & Ouslander, J. (2008). Use of a falls
incident reporting system to improve care process documentation in nursing
homes. Quality And Safety In Health Care, 17(2), 104-108.
http://dx.doi.org/10.1136/qshc.2007.022947