title: Physical therapist practice in the acute care setting: a qualitative study.
abstract: BACKGROUND
  Physical therapist practice in the acute care setting is not thoroughly understood, and it has been argued that skilled care is not required.
  
  
  OBJECTIVE
  The objective of this study was to describe the role of physical therapists, the clinical reasoning processes used by physical therapists, and the context for providing physical therapy services in the acute care setting.
  
  
  METHODS
  A convenience sample of 18 physical therapists working in 3 academic medical centers in the United States was included in this qualitative study with grounded-theory methods.
  
  
  METHODS
  Semistructured interviews were conducted. Transcripts were coded, and a constant comparative process of analysis was used to determine common themes. A theoretical model was derived.
  
  
  RESULTS
  Eight themes were identified: collection and analysis of medical information, application of specialized physical therapy knowledge, communication to gain information, communication to provide information, continual dynamic assessment, professional responsibility, complex environment, and decision making for patient care. Among the limitations of this study were that the sample and method limited the generalizability of the findings, the participants were not observed in their practices, and researchers' preconceived views may have influenced the interpretation and derivation of themes.
  
  
  CONCLUSIONS
  Physical therapists in the acute care setting used clinical reasoning that required the ability to integrate medical information with physical therapy knowledge. Clinical reasoning required continual dynamic assessment of patients in a crowded, complex, fast-paced environment and resulted in rapid decision making. Constant communication with many people was critical to the process. The major concerns for physical therapists in the acute care setting, like physical therapists in other settings, were patients' mobility and safety. The goals were an optimal plan of care and an appropriate discharge setting for each patient. The therapists' roles reflected professional core values applied in ways unique to the acute care setting.
authors.affiliation: Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT 05401, USA.
authors.forename: Pauline M
authors.initials: PM
authors.lastname: Masley
authors.forename: Carey-Leah
authors.initials: CL
authors.lastname: Havrilko
authors.forename: Mark R
authors.initials: MR
authors.lastname: Mahnensmith
authors.forename: Molly
authors.initials: M
authors.lastname: Aubert
authors.forename: Diane U
authors.initials: DU
authors.lastname: Jette
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D003142:Communication; D003657:Decision Making; D005260:Female; D006272:Health Facility Environment; D006801:Humans; D008297:Male; D017146:Models, Organizational; D026741:Physical Therapy Modalities; D026761:Physical Therapy Specialty / Q000458:organization & administration*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D024382:Professional Role; D036301:Qualitative Research