Abstract
This thesis explores the role of therapists working within critical care, the potential staffing requirements and their impact. 'Critical care' is now used as the term that encompasses 'intensive care', 'intensive therapy' and 'high dependency' units. National guidelines provide standards and recommendations for the required staffing to meet the needs of patients requiring critical care. These guidelines also suggest the potential roles undertaken by different healthcare professions including therapy professions i.e., dietitians, occupational therapists, physiotherapists and speech and language therapists. However, limited evidence exists to either support the recommendations made or to demonstrate whether critical care units across the United Kingdom are aligned with the available guidance.This thesis presents and critiques five peer reviewed publications and integrates an additional six contributing publications. These published works are linked via an overarching theoretical framework and the utilisation of the underpinning action research methodology. Through the theoretical framework, there is recognition of the importance of the author’s professional identity and positionality in the design and conduct of each of the studies undertaken.
The studies included answer three overarching research questions: 1) what is the current evidence for the role of, and staffing levels for, therapists working in critical care? 2) how do existing staffing levels for therapists working within critical care compare to national recommendations? 3) what is the impact of therapists working within critical care, with particular focus on those working at consultant-levels of practice? Through published works 1 and 2 and unpublished supporting works, the findings have increased the evidence base regarding the perceived and expected roles of therapists working in critical care. This was formed through a detailed scoping exercise, and by seeking the opinions of those working in critical care. The findings were then used to inform published works 3 and 4, which focused on understanding the current landscape for therapists working in critical care. This included a UK-wide survey of existing staffing, and the regularity of role completion. This highlighted the significant deviation from national guidance, which was present across all professions. Further sub-analysis demonstrated how staffing, roles and responsibilities were impacted by source of funding and / or the ‘ringfencing’ of roles to critical care. Finally, published work 5 began to explore the impact of therapy professions working in critical care, with specific focus on those working at a consultant-level.
The new knowledge created through the above has already been utilised within clinical environments. The themes generated have helped to inform the creation of national capability frameworks for allied health professionals working within critical care as well as informing future iterations of the Guidelines for the Provision of Intensive Care Services (version 3).
Further work is now needed to explore the wider impact of therapists working within critical care. This needs to encapsulate the benefits to patients, the workforce and overall critical care service. This would then be able to inform future staffing models that not only suggest numbers of staffing, but also the levels of practice required and future training requirements. Additionally, the impact of national programmes of work, like the Intensive Care Society Allied Health Professional Capability Framework needs to be explored. Through this work the future of therapists working in critical care will become more sustainable and adaptable to meet future patient needs.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Mark Llewellyn (Supervisor) & Ray Higginson (Supervisor) |