Foundations of Allied Health

Semester 1

Principles of Infectious Diseases - Transmission

• infectious disease control and prevention relies on a thorough understanding on the following factors:

• agent

• host

• disease

• environment

Mode of Transmission

• direct contact

• indirect contact

• respiratory droplets

• airborne

• vector bone

• faecal oral

• bloodborne

• vertical

Stages of an Infectious Disease

Disease Progression:

• incubation period - time from exposure to signs/symptoms of the disease

• clinical illness - between first and last disease signs and symptoms

Transmission Progression:

• latent (pre-infectious) period time between exposure and onset of infectiousness

• infectious period - the time when an infected person can transmit an infectious agent to others

Terminology/Definitions

Sporadic diseases - occasionally/unpredictable i.e. dengue fever

Endemic - predictable/regular in a population - malaria

Epidemic - acute increase above the usual/escalation or in a new population - measles

Pandemic - epidemic over a large geographic region

Principles of Infectious Diseases

Host factors - age, sex, immune status, underlying medical facto

Pathogen Factors - virulence, transmissibility and adaptability of the infectious agent

Population Factors - population density, climate, sanitation

Social Factors - cultural factors, human behaviour, policy intervention

Disease Control measures - vaccination, treatment, isolation, contract tracing

Chain of Infection

1. Pathogen

2. Reservoir or Source

3. Exit Portal

4. Route of Transmission

5. Entry Portal

6. Susceptible Host

Aim = break the chain

Hierarchy of Controls

Elimination - physically remove the hazard

Substitution - replace the hazard

Engineering Controls

• isolate people from the hazard

• use physical barriers and other forms of hazard reduction for example, ventilation controls, patient separation.

Administrative Controls

• change the way people work

• effective and consistent implementation of policies and protocols

PPE

• protect the worker

• review PPE policies & guidelines

• minimise opportunities for infection transmission

Standard Precautions

• PPE refers to a variety of barriers, used alone or in combination, to protect mucous membranes, airways, skin and clothing from contact with infectious agents 

• PPE used as part of standard precautions include gowns, gloves, surgical masks, protective eyewear and face shields 

• Selection of PPE is based on the type of patient interaction known or infectious agents, and or likely modes of transmission  

Complications of Bed Rest/Immobility

• Decreased mood 

• Confusion 

• Blood clots 

• Postural hypotension 

• Osteoporosis 

• Death 

Early Mobility

• Improves functional outcomes 

• Reduces hospital length of stays 

• Reduces mortality 

• Day 0-1 surgery, injury 

• As early as medically stable and safety aspects have been addressed 

What can you do to minimise the risk? Step 1

1. Involve the patient 

• Involve every patient regardless of their ability to move 

• Involve them by: 

• Explaining and/or demonstrating what the patient needs to do AND what the health professional will assist with - (good understanding of the important components of the activities) 

• Gaining consent as a confirmation that they understand the plan 

• Counting to 3! 

Important Components of the Sit to Stand Test

1. Bottom forward in chair and ankles behind the knees (higher chair is easier to stand up from) 

2. Hip flexion (shoulders move forward or nose over toes) Arms push in chair/chair rests 

3. Knee extension and hip extension (shoulders move upwards) 

 

What can you do to minimise the risk? Step 2

2. Assistance – Factors influencing patients movements 

 

• Vital measures 

• Level of pain 

• Cognition  

• Strength 

• Balance 

• Range of motion 

• Consciousness 

Levels of Assistance

Independent - the ability to mobilise without assistance, monitoring or verbal cues (with or without a gait aid) E.g. patient can perform the task safely if you weren’t in the room

Prompting/Verbal Cues/Supervision - the ability to mobilise without the need for a staff member to stand by or provide physical assistance, but prompting may be required for specific reasons. Does not require person to touch patient in any way.

Stand by Assistance - staff members stand directly beside the patient ready to assist if necessary. The person can usually mobilise with no physical assistance, but performance may be unreliable or inconsistent

Assistant - patient requires physical assistance of one or more staff members

What can you do to minimise the risk? Step 3

• Prior to moving the patient, the environment needs to be modified to suit the task 

• Bed height/chair height 

• Chair position 

• Create space to work 

• Apply bed breaks 

What can you do to minimise the risk? Step 4

• Select the correct type of equipment to assist the transfer 

• Check the weight capacity to ensure it is safe to handle patient's weight 

• Make sure selected equipment is in good working order

HoverMatt

• Reduces friction: a thin layer of air is created between the two surfaces 

• Appropriate for patients who need high levels of care 

• Assists with flat transfers (e.g. bed mobility, reclining chair) 

Hoist/Lifter

• Appropriate for patients who need high level of assistance 

• Transfers from a laying or seated position and vice versa 

• Standard lifters are not bariatric compatible 

• Ceiling hoist – takes up no floor space making it a safer workplace 

• Floor hoist – easy to move  

Powered Standing Lifter

• Appropriate for patients who can assist a bit 

• Has knee and back support 

• Transfers from sitting to standing and back to a seated position

Non-powered Standing Aid

• Appropriate for patients who can assist a bit more  

• Has knee support 

• Transfers from sitting to standing and back to seated position 

Wheeled Chair

• A qualified health professional following with a wheeled chair is appropriate for patients who: 

• Have reduced endurance and may require a rest 

• Are getting out of bed for the first time 

Slide Board

• Appropriate for patients who can assist a lot 

• Need to be able to push through the arms and have enough trunk control to maintain upright 

• Used for transfers from a seated position to a seated position 

• Both surfaces need to be close to each other 

• Best to transfer from a higher height to a lower height or height that is the same

Slide Sheets

• Reduces friction: 2 surfaces of the slide sheet slide over each other 

• Appropriate for patients who can assist  

• Last option for dependant patients  

• Not designed to assist with lifting the weight of the patient  

Walk belt/Transfer Belt

• Appropriate for patients who can assist quite a lot 

• Use for STS (hip extension) and mobility (facilitate stability) 

• Not designed to assist with lifting the weight of the patient 

FlexiMove

• Appropriate for patients who can help quite a lot 

• Indications: used for bed mobility, both short and long handles enable more gripping options 

• Two different surface materials; soiling resistant and moisture repellent nylon or soft and comfortable polyester material 

What can you do to prevent risks? Step 5

• Wide base of support 

• Toes point in the direction of movement 

• Knees bent 

• Weight close to your centre of mass (COM) 

• Maintain a neutral spine 

• Brace abdominal muscles 

• Understanding of loads and forces  

What can you do to prevent risks? Step 6

• Type 1: No skin loss 

• Type 2: Partial Flap Loss 

• Type 3: Total Flap Loss 

 

How can you prevent a skin tear? 

 

• Perform correct patient handling techniques 

• No jewellery, watches or long nails 

 

Providing Hands on Assistance 

 

• Never support a patient by grabbing their arm 

• Support the patients COM 

• Stand on patients weaker side 

• Good understanding of the important components of activities 

How do mobility aids improve stability?

• Mobility aids increase base of support 

• This is most evident during the single-leg stance phase of gait 

• By expanding BOS, the mobility aids allows the patient to keep the COM within the BOS for a greater proportion for the gair cycle 

How do mobility aids decrease LL weight bearing and support LL weakness?

• Mobility aids redistribute the weight placed on an injured/weak leg by putting more 
  weight through the aid using the upper body. Therefore, the injured leg has none/less 
  weight placed on it and the weak leg has less body weight it needs to support. 

• Always remember – the injured leg goes forward with the aid

Four-point stick/quad stick

PROS (compared to SPS) 

• Increased stability (bigger BOS) 

• Stands up by itself 

 

CONS (compared to SPS) 

• Wider base can be a tripping hazard 

• Wider base might not fit on stairs 

• Heavier 

• Unable to transfer to uneven surfaces 

Forearm/elbow/Canadian crutches

PROS (compared to axillary crutches) 

• Able to use hands more easily 

• No trunk/axillary irritation 

• Requires less energy expenditure  

 

CONS (compared to axillary crutches) 

• Requires more balance and UL strength 

• More costly/not readily available in some hospitals 

Mobility Aid Brakes

• The brakes on most mobility aids work in a similar way to a bicycle. 

• The brakes use a simple cable braking system to apply pressure to the brake pads on the rear wheels 

• The brakes are only applied to the rear wheels which means the mobility aid can still move and the brakes only slow the device down

Self-Propelled Wheelchair

• Indications: 
  • Poor endurance – can walk but not far 
  distances 
  • LL amputation/s with prosthetics 
  • Significant bilateral or unilateral LL 
  weakness (e.g., stroke, SCI) 

• Maintaining LL weight bearing 
  restrictions with another aid is 
  impossible 
  • LL and UL injury where the UL injury has 
  weight bearing restrictions through the 
  humerus (upper arm bone) 
  • Bilateral LL weight bearing restrictions 
  • Bilateral LL amputations 
   

Assistive Technology Definition

• Are tools for enhancing the independent functioning of people who have physical limitations or disabilities 

• Replace or support an impaired function of the user but do not change the intrinsic functioning of the individual 

Matching Person & Assistive Technology

1. Get to know the person 

• Set a baseline and establish a team approach 

Considerations for setting a baseline" 

• Functional needs, capabilities and preferences 

• Prior exposure to and experiences with AT 

• Motivation and readiness to achieve goals 

• Expectations, mood and temperament 

• Lifestyle 

 

Understand the Environment  

Cultural 

• Impact on family culture 

• Impact on cultural practice 

Physical 

• Access and physical space to accommodate and use AT 

• Possibility of modification 

Legislative 

• Disability discrimination act 

• Legislation impacting on access to and use of AT 

Attitudinal 

• Support from family and peers 

• Expectation of AT 

Economic 

• Access to funds 

• Personal funds 

Consider the Technology 

• Appearance  

• Cost 

• Comfort 

• Performance 

• Availability 

Who are AHP?

• Allied health professionals are health professionals who are not part of the medical, dental, or nursing professions 

• Require a minimum bachelor's degree 

• Professions are either regulated through AHPRA or they are self-regulated 

• Individuals professions use different terminology (registered practitioners vs accredited professionals) to reflect their regulation, but this doesn't mean there is a difference in quality and safety 

• Each profession has a National Board which is responsible for overseeing education standards, managing complaints against practitioners, verifying that practitioners have met the educational standards for practice and more 

Professional Identity

Professional identity is defined as "the attitudes, values, knowledge, beliefs and skills shared with others within a professional group" 

Behaviour: Code of Conduct

Professions operate under continual scrutiny and development and are self-regulated accountable, and guided by a code of ethical conduct in practice decisions and actions 

Shared Code of Conduct:

• Safe, effective and collaborative 

• Aboriginal and Torres strait islander health 

• Respect and culturally safe practice 

• Working with patients 

5 Key Attributes of AHPs

1. The possession of coherent and disciplined sets of skills, knowledge, values and professional ethics relating to a specific health service discipline 

2. The capacity to provide quality health care/health related care such as direct treatment, assessment, primary health care, community care, health promotion 

3. a sense of professional, community and environmental responsibilities 

4. The capacity to work collaboratively with other health care providers 

5. The ability to reflect on and evaluate learning, and to learn independently in a self-directed manner 

Roles and Scope of Practice

Roles and Responsibilities 

• Specific duties and obligations that healthcare professionals are expected to fulfil in their jobs 

• E.g. Job description  

 

Scop of Practice 

• Specific activities and procedures that healthcare professionals are authorised to perform based on their education, training 

• e.g. information detailing scope of practice from AHPRA 

 

Ethical Principles

• Refers to rules provided by an external social system relating to a specific group that defines right and wrong behaviours 

• Example of ethics or codes of conduct in workplaces – they are governed by professional and legal guidelines 

• Disclosing confidential information or misleading a client are some examples of a breach of ethics 

• Must follow the ethical code regardless of your own feelings or preferences 

4 Ethical Principles

• Justice – fair and equitable treatment 

• Autonomy – ability to make informed decisions 

• Beneficence – doing good 

• Non-maleficence – do no harm 

Traditional Healthcare Team

A group of healthcare providers working independently of each other in the care of the same patient

Interprofessional Collaborative Healthcare Team

When multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care 

Interprofessional Collaborative Practice - Benefits

For healthcare provider: 

• A broader understanding and enriched respect of other disciplines 

• Opportunities for cooperative research ventures 

• Development of a mindset to work cooperatively 

• Improved role satisfaction for practitioners 

• Improved service productivity an use of resources 

• Wider base of professional experience 

 

For the Patient: 

• Improved problem solving 

• Improved patient efficacy in self-care behaviours 

• Reduced hospitalisation stays 

• Increased use of team members to meet clients varied needs 

• Wider range of services can be offered  

Challenges of IPCP

For healthcare provider: 

• Hierarchies of disciplines and team members e.g. physician dominance 

• Tensions related to team participation/commitment 

• Different knowledge base 

• Role confusion and blurring 

• Frequent rotation of some disciplines especially in rural and remote areas 

 

For the Patient: 

• Different technologies 

• Different language and terminology  

• Differing knowledge base 

• Role confusion and blurring 

Effective Teamwork - Communication (Key Element)

• Communication that is relevant to the client's medical history 

• Communication that is consistently authentic and demonstrates trust 

• Active listening to team members (including the patient/family) 

• Communication that ensures a common understanding of care decisions (don't use discipline specific abbreviations/language) 

• The development of trusting relationships with clients/families and other team members 

• Cultural empathy for all members of the care team 

Effective Teamwork - Leadership in Healthcare Team

• Any team member can take on the role of the leader 

• Effective leaders in team-based care value all team members' potential contributions in meeting the needs of the patients and communities 

• Effective leadership organises the team, articulates clear goals, make decisions through collective input of embers, empowers members to speak up and challenge when appropriate 

Effective Teamwork - Share the load and success

• Focus on patient outcomes 

• Problem solve together 

• Be mutually accountable for the results 

• Share responsibilities  

SMART GOALS (S - SPECFIC)

• Answers the question – who, what, where and any other details 

• Who – the patient's name should be included in the goal 

• What – what specifically does the patient want to achieve? 

  • Should directly relate to one specific activity limitation or participation restriction 

  • Functional tasks should include the following examples (as relevant): use of assistive technology/mobility aids  

• Where – is there a specific location of where the goal will be achieved? 

SMART GOALS (M - Measurable)

Answers the question – How? The proof of how you know if the patient has achieved the goal 

SMART GOALS (A - Attainable)

• With hard work, is it possible to achieve the goal by the deadline? 

• Challenging goals, which might be difficult to achieve (yet still attainable), tend to result in higher levels of performance 

 

SMART GOALS (R - Relevant)

• Does the goal matter to the patient? Is the goal meaningful to the patient? Is the goal something that the patient wants to work towards? Why is achieving the goal important to the patient? 

  • The likelihood of goal achievement is increased when the goal is relevant to the patient 

• The therapist establishes goals in partnership with the patient to ensure the goal is relevant to them. It is important the therapist assists the patient to understand the link between the goal and the management strategies 

  • Only the patient can determine whether a goal is worth the effort. It is the patient that must expend energy if the goal is to be accomplished. Therefore, the core content of the goal must come from the patient and must be stated in terms the patient can understand. 

SMART GOALS (T - Time Bound)

• When will the patient reach their goal? 

• Without a time-frame, there is less urgency towards achieving the goal 

• It is best to specify by a date, rather than by a length of a time 

• The therapist needs to consider factors discussed in the attainable section when determining an appropriate time-frame 

The Bio-Pyscho-Social Model of Disability

The international Classification of Function, disability and health, is based on an integrated biopsychosocial model of disability where: 

• Bio: physiological pathology 

• Psycho: thoughts emotions and behaviours such as psychological distress, fear/avoidance beliefs, current coping methods and attribution 

• Social: socio-economical, socio-environmental, and cultural factors such as work issues, family circumstances and benefits/economics 

What is the ICF?

ICF stands for the International Classification of Functioning, Disability and Health 

The ICF defines functioning and disability as multi-dimensional concepts relating to: 

• The body functions and structures of people 

• The activities people do and the life areas in which they participate 

• The factors in their environment which affect these experiences

Why the ICF?

• Provide a scientific basis for understanding and studying health and health-related states, outcomes, determinants, and changes in health status and functioning; 

• Establish a common language for describing health and health-related states in order to improve communication between different users, such as health care workers, researchers, policy-makers and the public 

ICF Framework

ICF Terms 

• Health condition 

• Body functions (physiology) & structures (anatomy) 

  • Impairment – primary 'damage' or 'loss' 

• Activity – ability to perform certain skills or tasks  

  • Activity limitations 

• Participation – function level achievable; involvement in life and environment 

  • Participation restrictions 

• Contextual factors – environmental and personal

Body Functions examples

• Mental functions 

• Sensory functions and pain 

• Voice and speech functions 

• Functions of the digestive, metabolic and endocrine systems 

Body Structure examples

• Structure of nervous system 

• The eye, ear and related structures 

• Skin and related structures 

Activities examples

• Learning knowledge 

• Communication: speaking, writing 

• Self-care: showering, toileting 

Participation Examples

• Applying knowledge 

• Major life areas 

• Mobility in different environments 

• Interpersonal interactions and relationships 

Environmental examples

Physical Factors: 

• Climate 

• Terrain 

• Building design (e.g. home workplace) 

• Products and technology (e.g. Bluetooth phone) 

• Natural environment and human-made changes to environment (e.g. roads, distance to health care) 

 

Social Factors: 

• Support (emotional/physical) 

• Service, systems and policies 

• Attitudes of carers, family, community 

• Laws 

• Transportation services 

Personal examples

• Age 

• Ethnicity 

• Fitness 

• Lifestyle 

• Gender 

• Family 

Access to Healthcare

• 'rural' community: dependent upon primary industry 

• 'remote' location 

• People living in rural and remote areas often need to travel significant distances to access specific health services: 

  • Travel and accommodation costs 

  • Time off work/loss of income 

  • Family disruption/care arrangements  

• Local services can vary according to staffing: 

  • Recruitment/retention 

Education

• Educational levels can influence mode of information sharing 

  • Diagram, drawings, pictures can all hep 

  • More time needed in explanation 

  • May need support personnel 

• Lack of educational opportunities can underpin biased views 

  • Myth may need to be clarified 

• Access to internet facilities patient knowledge and expectations  

• Educational role in AHP services: patients need to be provided with adequate information to make an informed and collaborative decision about health management  

Socio-economic factors

• Treatment affordability 

• Public versus private systems 

• Equipment provision 

• Housing and environmental considerations 

• Community supports 

  • Local council services 

• Government support systems 

  • NDIS 

Glasgow Coma Scale

• measurement of patient’s level of consciousness

• completely unresponsive = 3 points

• normal alertness = 15 points

• minor brain injury = 13-14 points

• moderate brain injury = 9-12 points

• severe brain injury = 3-8 points