If I had to do it all over again, would I follow the same path? I find that I ask myself this question on a fairly regular basis. And I have certainly thought about it recently during these trying times.
My daughter Hannah will enter physical therapy school this coming fall at the University of Central Arkansas. This is a proud moment for me, as she chose this wonderful profession on her own and has worked very hard to reach this goal. But, if she “falls in love” with wound care, what advice will I have for her? I wonder.
If I had to do it all over again, I am not sure I would. Recently, I was working on a project with Elizabeth Faust, MSN, CRNP, CWS, CWOCN-AP, DAPWCA, in which we were interviewing each other. Elizabeth asked a similar question—would I follow this same path again?—and I had to really think about it. Opportunities for therapists in wound care over my lifetime have dwindled, mostly because many hospital-based wound care clinics are not set up to include therapists in this model of care. This is a regulatory issue, and we as therapists must understand this for the sake of compliance. Until this changes remember that you can refer to physical therapy if there’s a need, or consult us as part of the team.
I have a true love and admiration for my profession—as well as a passion for wound care. It is a profession in which you learn to recognize problems with the musculoskeletal system and with all body systems, and it is a must that we set realistic, measurable goals while identifying necessary interventions to reach those goals. Due to the multiple areas in which a therapist can specialize, I asked Hannah to be open-minded as she enters school. Therapists can choose to work in acute care, outpatient clinic, long-term care, long-term acute care, acute rehabilitation, the school system, home health, and others. We can select to work with pediatrics, sports, women’s health, geriatrics, clinical electrophysiology, cardiovascular, pulmonary, neurology, orthopedics, oncology, vestibular rehab, and, of course, wound care.
Many Options For Therapists
There are also many options for us If we to become certified. Consider that the American Board of Physical Therapy Specialties offers the following certification programs: Cardiovascular and Pulmonary Certified Specialist (CCS), Clinical Electrophysiologic Certified Specialist (ECS), Geriatric Certified Specialist (GCS), Neurologic Certified Specialist (NCS), Orthopedic Certified Specialist (OCS), Pediatric Certified Specialist (PCS), Sports Certified Specialist (SCS), and Women’s Health Certified Specialist (WCS).
There are also a multitude of certifications that improve the therapist’s skills and experience. These include Advanced Exercise Therapist (AET), Certified Clinical Instructor (CCI), Certification in Applied Functional Science (CAFS), Certificate of Achievement in Pregnancy and Postpartum Physical Therapy (CAPP-OB), Certificate of Achievement in Pelvic Physical Therapy (CAPP-Pelvic), Certified Clinical Vestibular Therapist/Clinical Vestibular Therapist (CCVT/CVT), Cranio-mandibular Head, Neck, and Facial Pain (CFC), Certified Ergonomic Assessment Specialist (CEAS), Certified Functional Capacity Evaluator (CFCE), Certified Functional Manual Therapist (CFMT), Certified Hand Therapist (CHT), Certified Kinesio Taping Practitioner (CKTP), Certified Lymphedema Therapist (CLT), Certified Orthopedic Manual Therapist (COMT), Certified Personal Trainer (CPT), Certified Pilates Teacher (CPT), Certification in Rehabilitative Exercise (CREX), Certified Strength and Conditioning Specialist (CSCS), Craniosacral Therapist (CST), Certified Yoga Instructor (CYI), Certified Work Capacity Evaluator (CWCE), Doctor of Manual Therapy (DMT), Functional Capacity Evaluator (FCE), Functional Orthopedic Certification (FOC), Guild-Certified Feldenkrais Practitioner (GCFP), Holistic Health Practitioner (HHP), Jones Strain Counterstrain Certified (JSCC), Lymphedema Lower Extremity Certified (LLE), Diploma in Mechanical Diagnosis and Therapy (MDT), Manual Lymph Drainage (MLD), Manual Therapy Certified (MTC), Neuro-Developmental Treatment Certified (NDT), Postural Alignment Specialist (PAS), and Postural Restoration Certified/Trained (PRC/PRT).1
Those who wish to pursue wound care certification have options as well: the American Board of Wound Management offers a Certified Wound Specialist (CWS) and Certified Wound Care Associate (CWCA) designation; the National Alliance of Wound Care and Ostomy (NAWCO) offers the Wound Care Certified and Advanced Wound Care Certified designations.
Defining Your Team
How do you define your team, its strengths, and the available interventions to help your patients in a multidisciplinary team approach? Our inpatient facility has reached 260 consecutive pressure injury-free days and counting as a result of a multidisciplinary team approach.
Over the last 30 years, I’ve earned a seat at the wound care team table, even though to this day I continuously get asked, “Why are you in wound care?” My answer has always been, “why not?” Therapists have much to offer, and most don’t know how to tap into these resources. Yes, there are a large number of chronic wounds, there’s an increase in comorbidities, people are losing limbs, and life expectancy is decreasing. Therapy has a multitude of biophysical agents that can impact chronic wounds, but we understand a multitude of body systems and how they can impact wounds.
A few years ago, I published a survey in Today’s Wound Clinic to define who is on the wound care team and the results showed that most centers do not have depth on their teams. Surprisingly, most were not even associated with a podiatrist. And they were not fully utilizing their therapists.
My answer to Elizabeth currently is that nursing provides more opportunities at various levels to be directly involved in wound care. My passion to help others would lead me into a nursing career if I had to do it over, but my conscience still seems to redirects me to follow my education and experiences, which have been so valuable to address many of the problems seen among patients today.
And I know Hannah will carve her own niche in whatever she decides to specialize in—even if 30 years from now she has to ask herself about her intentions to remind herself about her ambitions.
Frank Aviles Jr. is wound care service line director at Natchitoches (LA) Regional Medical Center; wound care and lymphedema instructor at the Academy of Lymphatic Studies, Sebastian, FL; physical therapy (PT)/wound care consultant at Louisiana Extended Care Hospital, Natchitoches; and PT/wound care consultant at Cane River Therapy Services LLC, Natchitoches.
1. Castin M. The “alphabet soup” of physical therapy certification. Covalent Careers. https://covalentcareers.com/resources/the-alphabet-soup-of-physical-therapy-certifications/ . April 21, 2015.