The impact of one student's experience in a global setting for advancing a patient with gross peripheral nerve deficits and advancing local clinical practice: A Case Report
Abstract :
Title: The impact of one student’s experience in a global setting for advancing a patient with gross peripheral nerve deficits and advancing local clinical practice: A Case Report Background and purpose: The incorporation of international service-learning and community engagement academic experiences positively correlate with personal and professional development and improved cross-cultural competency. Since 2011, students and faculty from the Marymount University Doctor of Physical Therapy (DPT) degree program venture into Central America with a goal of advancing local physical therapist practice. In 2018, the program traveled to Masaya, Nicaragua. The purpose of this case report is to: 1) discuss the impact of one student’s international service learning experience with a complex patient presenting with gross peripheral nerve impairments; 2) postulate patient empowerment and education as tools/strategies for leading change and advancing physical therapist clinical practice in Nicaragua toward improvement in overall health and function among Nicaraguans; and 3) discuss patient empowerment through moral agency as a way to combat social injustice and health inequities/disparities. Patient Description: The patient was a 16-year-old male who sustained a fracture/dislocation of his right arm following a motorcycle accident. He was seen in a public, hospital-based outpatient rehabilitation clinic. At the time of his initial evaluation he was 5 weeks post open reduction with internal fixation of the right proximal humerus. He presented with gross sensory and motor deficits of the full upper extremity. The patient demonstrated an extinguished sense of agency and appeared resigned to the prospected poor functional outcomes. The patient and his mother both demonstrated a mistrust of the health care team that stemmed from miscommunications and delays in care previously experienced. Outcomes: The four constructs of empowerment: meaningfulness, competence, impact, and choice guided sequential construction of communication with the patient and his mother throughout treatments. As a result, the patient permitted and participated in a constructed care plan that yielded return of proximal light touch sensation and initial trace muscle activation in the right deltoid muscle. Discussion: Empowerment within each, and among the assembled team comprised of the patient, his mother and the visiting service-learning student group grew in this experience. Trust built on meaningful communications forged development of patient self-confidence to administer and take control of the prescribed treatment regimen. The patient’s mother accepted the challenge to engage and advocate on behalf of her son for a patient-centered, coordinated health care model of care (moral agency). Social responsibility in physical therapist practice requires PTs to address social injustice, reduce health disparities and health inequities situation by situation via accurate diagnosis of injustice and inclusion of an informed just response in the plan of care.
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