Lesson 5
General Therapy:
Respiratory Therapists and Technicians
The objective of therapy is helping individuals with physical, mental, or social disabilities to regain their capacity for self-help and interdependence. To meet this goal, different kinds of therapists are employed, each with special knowledge and skills that can be used in rehabilitation. For example, art, dance, and music therapists bring both artistic and therapeutic skills to their work and try to improve the mental and physical well being of their patients. Dance and art techniques are used as nonverbal means of communication, and, along with music, are often useful in helping patients resolve physical, emotional, and social problems. Horticultural therapists use gardening, an enjoyable and relaxing activity, for such purposes as training disabled or disabled patients, evaluating the abilities of patients, or as a social activity for patients. Corrective therapists treat their patients by using medically prescribed exercises and activities. Physical therapists work with persons who are physically disabled by illness, accident, or birth defects. They use exercise and such treatments as heat, cold, and electricity to improve the patient's condition.
Occupational therapists help individuals with physical or emotional disabilities by teaching daily living skills or job skills. Manual art's therapists use industrial arts such as graphics or wood or metalworking to rehabilitate patients. Recreation therapists use sports, games, crafts, camping, and hobbies as part of the rehabilitation of ill, disabled, or disabled persons. Athletic trainers care for and try to prevent injuries of individuals engaged in professional, amateur, and school athletics. Persons whose limbs are lost or disabled through injury, disease, or birth defects require highly skilled and specialized services, provided by orthopedists and prosthetists. Orthopedists make and fit orthopedic braces, while prosthetists make and fit artificial limbs. Speech pathologists and audiologists work with children and adults who have speech, language, or hearing impairments. Rehabilitation counselors help persons with physical, mental, or social problems return to or begin a normal life by obtaining satisfactory work. It is obvious that therapy and related activities offer a broad area for career exploration by interested individuals, and in the following pages some of the specializations not described in previous chapters are discussed in more detail.
WORK DESCRIPTION FOR RESPIRATORY THERAPISTS AND TECHNICIANS.
Most respiratory therapists work with hospital patients in three distinct phases of care: diagnosis, treatment, and patient management. In the areas of diagnosis, therapists test the capacity of the lungs and analyze the oxygen and carbon dioxide concentration and potential of hydrogen, a measure of the acidity or alkalinity level of the blood. To measure lung capacity, the therapist has the patient breathe into a tube connected to an instrument that measures the volume and flow of air during inhalation and exhalation. By comparing the reading with the norm for the patient's age, height, weight, and sex, the therapist can determine if lung deficiencies exist.
To analyze oxygen, carbon dioxide, and pH levels, therapists need an arterial blood sample, for which they generally draw arterial blood. This requires greater skill than is the case for routine tests for which blood is drawn from a vein. Inserting a needle into a patient's artery and drawing blood must be done with great care; any slip can damage the artery and interrupt the flow of oxygen-rich blood to the tissues. Once the sample is drawn, it is placed in a gas analyzer, and the results are relayed to the physician.
Treatment of patients, such as premature infants whose lungs are not fully developed or elderly people whose lungs are diseased, is another important job duty. Treatment may range from giving temporary relief to patients with chronic asthma or emphysema to emergency care for heart failure, stroke, drowning, or shock. The three most common treatments, however, are chest physiotherapy, aerosol medication, and oxygen mixtures.
Chest physiotherapy is generally performed on patients who have undergone surgery. Anesthesia depresses respiration, so this treatment may be prescribed to help return the patient's lungs to their normal level of functioning and prevent the lungs from becoming congested. Chest physiotherapy is used on patients suffering from lung diseases that cause increased amounts of sticky mucus to collect in the lungs. Chest physiotherapy helps remove mucus, making it easier for the patient to breathe. In chest physiotherapy, the patient is placed in a position to help drain mucus from the lungs. The therapist thumps and vibrates the patient's rib cage, after which the patient is instructed to cough. This procedure stimulates the lungs to expand to help clear lungs of congestion. This process helps prevent respiratory illnesses that could complicate recovery.
Respiratory therapists administer aerosols. Generally these are liquid medications suspended in a gas that forms a mist that is inhaled. Therapists administer the medicine themselves or teach patients how to do so. In either case, the therapist must instruct the patient in how to inhale the aerosol properly. If the medicine is improperly inhaled, it will be ineffective.
Respiratory therapists use various kinds of equipment to administer oxygen and oxygen mixtures. In one case, a patient may need an increased concentration of oxygen. The therapist simply places an oxygen delivery device, such as a mask or a nasal cannula, on the patient and sets the oxygen flow at the level prescribed by the physician. In the case of patients who cannot breathe on their own, someone who has undergone heart surgery for example, the therapist would connect the patient to a ventilator, a machine that pumps air into the lungs. The therapist inserts a tube through the patient's mouth into the trachea, or windpipe, connects the tube to the ventilator, and sets the rate, volume, and oxygen concentration of the air entering the patient's lungs.
Monitoring patients who are using oxygen and ventilators occupies a good portion of the therapist's day. Patients and equipment must be checked regularly. If the patient appears to be having difficulty or if the oxygen, carbon dioxide, or pH level of the blood is unstable, the ventilator setting must be changed. The therapist alerts the doctor and adjusts the ventilator according to the physician's order. In addition, therapists continually check equipment to ensure that there are no mechanical complications and that the equipment is in working condition.
Providing respiratory care at home is a rapidly expanding area of practice. Respiratory therapists have long administered oxygen to patients in their homes. Increasingly, however, mechanical ventilators and other sophisticated life support systems are being used in the home. Therapists teach patients and their families how to use the equipment. Many of the people who receive home respiratory care will need it for the rest of their lives. They are taught how to operate complex equipment themselves, with several visits a month from respiratory therapists to inspect and clean the equipment and ensure its proper use. Other duties include keeping records of the cost of materials and charges to patients, and maintaining and making minor repairs to equipment. Some therapists teach or supervise other respiratory therapy personnel. Respiratory care is moving into new areas, notably cardiopulmonary care and cardiopulmonary rehabilitation. A growing number of respiratory therapists are being cross-trained in pulmonary and cardiac procedures. Others are specializing in the special needs of newborn and premature infants.
Questions:
What are the three distinct phases of care for a Respiratory Therapist?
For what reason would a Respiratory Therapist draw blood?
What kinds of patients do Respiratory Therapists treat?
WORKING CONDITIONS FOR RESPIRATORY THERAPISTS
Respiratory therapists generally work a 40-hour week. Because hospitals operate around the clock, therapists may be required to work evenings, weekends, or holidays. Respiratory therapists spend long periods standing and walking between patients' room. In an emergency, they work under a great deal of stress. Gases used by respiratory therapists are potentially hazardous because they are used and stored under pressure. However, adherence to safety precautions and regular maintenance and testing of equipment minimize the risk of injury.
EMPLOYMENT OPPORTUNITIES
Respiratory therapists hold about 60,000 jobs. About nine out of 10 jobs are located in hospitals in departments of respiratory care, anesthesiology, or pulmonary medicine. Oxygen equipment rental companies, ambulance services, nursing homes, and home health agencies accounted for most of the remaining jobs.
Question:
Where are most of the jobs for Respiratory Therapists?
TRAINING, OTHER QUALIFICATIONS, AND ADVANCEMENT
Respiratory care equipment has become increasingly complex, and formal training is important for entry to the field. Training for respiratory therapy is offered at the post-secondary level in hospitals, medical schools, colleges and universities, trade schools, vocational technical institutes, and the armed forces. The Committee on Allied Health Education and Accreditation (CAHEA) of the American Medical Association accredits about 300 programs for respiratory therapists. Another 180 programs offer CAHEA accredited preparation for respiratory therapy technicians.
Formal training programs vary in length and in the credential or degree awarded. Twenty-three of the CAHEA accredited therapist programs are four-year programs that lead to a bachelor's degree; most of the others are somewhat shorter in length and lead to an associate degree. Technician courses usually last about one year, and graduates are awarded certificates. Areas of study for both types of programs include human anatomy and physiology, chemistry, physics, microbiology, and mathematics. Technical courses deal with procedures, equipment, and clinical tests.
The courses are more extensive for the respiratory therapist than for the respiratory technician. The program for therapists includes social sciences basic to understand patient relationships such as psychology, communication skills, and medical ethics. Clinical training and special procedures applicable to different age groups are also provided. Pharmacology and clinical medicine are included. This enables the therapist to exercise more judgment and accept more responsibility in performing therapeutic procedures. Respiratory therapists may act as consultants to physicians, to help train student technicians and assistants.
Thirty-seven States license respiratory care personnel. The National Board for Respiratory Care offers voluntary certification and registration to graduates of CAHEA accredited programs. Two credentials are awarded to respiratory care practitioners who satisfy the requirements: Certified Respiratory Therapy Technician (CRTT) and Registered Respiratory Therapist (RRT). All graduates--those from two and four-year programs in respiratory therapy, as well as those from one-year technician programs--may take the CRTT examination first. CRTT's who meet education and experience requirements can take a separate examination, leading to the award of the RRT.
Individuals who have completed a 4-year program in a non-respiratory field, but have college level courses in anatomy, physiology, chemistry, biology, microbiology, physics, and mathematics, can become a CRTT after graduating from AMA accredited one or two-year programs. After they receive two years of clinical experience, they are eligible to take the registry exam to become an RRT.
Most employers require that applicants for entry level or generalist positions hold the CRTT or are eligible to take the certification examination. Supervisory positions and those in intensive care specialties, usually require the RRT (or RRT eligibility).
Technicians' roles are more limited, depending on the regulations and policies of the employing institution. They work under close supervision as their training focuses mainly on techniques and less on the theory behind them. A technician may advance to therapists' status with additional required study.
People who want to enter this field should enjoy working with people and be sensitive to patient’s physical and psychological needs. Respiratory therapy workers must pay attention to detail, follow instructions, and work as part of a team. Operating complicated respiratory therapy equipment requires mechanical ability and manual dexterity.
Students interested in a career in respiratory care are encouraged to take courses in health, biology, mathematics, chemistry, and physics, as a working knowledge of science and mathematics is essential. Respiratory care involves basic mathematical problem solving--an ability to use percentages, fractions, logarithms, exponents, and algebraic equations, and a knowledge of the English and metric systems of measuring. Calculus is not required but is helpful. An understanding of chemical and physical principles such as general gas laws, the states of matter, chemical reactions at the atomic level, and the periodic table are also important. Computing medication dosages and calculating gas concentrations are just two examples of the need for knowledge of science and mathematics.
Question:
What kind of degree program is offered for Respiratory Therapists?
What kinds of college course should students take, who are interested in respiratory therapy?
Respiratory therapy technicians and assistants can advance to the therapist level by taking the appropriate courses or through on-the-job training. Some technicians work part-time while studying to be therapists. Respiratory therapists advance in clinical practice by moving from care of general to critical patients. Additional knowledge and skills are needed to provide respiratory care for patients with significant problems in other organ systems such as the heart or kidneys. Sometimes such specialization means a new job title. Respiratory therapists may fill positions as cardiopulmonary technologists, for example, after gaining experience in arterial blood pressure monitoring, electrocardiographs (EKG), and related procedures.
Therapists may advance to supervisory or managerial positions. With additional education or experience, promotion to the position as chief of the respiratory therapy department is a possibility. Credentials as a registered respiratory therapist (RRT) are often required for administrative positions.
The field of education offers opportunities for career development. Jobs for hospital in-service educators are available for therapists with teaching skills. Many therapists have found careers as instructors in respiratory therapy education programs; with additional academic preparation, they are eligible to advance to professor or program director. Other therapists leave the field to work as sales representatives for equipment manufacturers.
JOB OUTLOOK
Employment of respiratory therapists is expected to increase faster than the average for all occupations through the year 2010 because of substantial growth of the middle-aged and elderly population, a development that will heighten the incidence of cardiopulmonary disease.
The elderly are the most common sufferers from respiratory ailments and cardiopulmonary disease such as pneumonia, chronic bronchitis, emphysema, and heart disease. As their numbers increase, the need for respiratory therapists will increase as well. In addition, advances in treating victims of heart attacks, accident victims, and premature infants (many of whom may be dependent on a ventilator during part of their treatment) will require the services of respiratory care practitioners. Rapid growth in the number of patients with AIDS will boost demand since lung disease often accompanies AIDS.
Very rapid growth is expected in home health agencies, equipment rental companies, and firms that provide respiratory care on a contract basis. As in other occupations, most job openings will result from the need to replace workers who transfer to other jobs or stop working all together.
EARNINGS
Median annual earnings for respiratory therapists who work year around and full-time are about $38,000. The middle 50 percent earn between $32,116 and $42,236. The lowest 10 percent earn less than $22,528, the top 10 percent, more than $54,048.
According to a national survey of hospitals and medical centers conducted by the University of Texas Medical Branch, the median annual salary for respiratory therapists, based on a 40-hour week and excluding shift and area differentials, was about $34,000. The average minimum annual salary is $29,770 and the average maximum is $48,553.
Question:
What are the median annual earnings for Respiratory Therapists?
RELATED OCCUPATIONS
Respiratory therapists, under the supervision of a physician, administer respiratory care and life support to patients with heart and lung difficulties. Other workers who care for, treat, or train people to improve their physical condition include dialysis technicians, registered nurses, occupational therapists, physical therapists, and radiation therapists.
ADDITIONAL INFORMATION
For information concerning a career as a respiratory therapy practitioner, contact: