“Definitely a Dark Time:” professional and ethical issues in post-acute care physical therapy during the COVID-19 pandemic

ABSTRACT

Background

Disproportionate effects of the SARS-CoV-2 (COVID-19) pandemic on older adults in post-acute care settings created many professional and ethical challenges for patients and healthcare providers.

Objective

The purpose of this study was to examine the professional and ethical issues of physical therapists (PTs) and physical therapist assistants (PTAs) in providing facility-based post-acute care in residential settings (skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals) during the COVID-19 pandemic.

Methods

A qualitative descriptive research design was used to explore professional and ethical issues during the COVID-19 pandemic. PTs and PTAs described their experiences during semi-structured interviews conducted virtually. Interview data was analyzed with reflexive thematic analysis.

Results

Thematic analysis produced 4 themes: facility-wide battle against infection and death, doing the best you can to provide care amidst COVID-19 constraints, promoting ethical good and doing the right thing, and a dark intense time.

Conclusions

Professional and ethical constraints on providing care faced by PTs and PTAs during the COVID-19 pandemic can inform current and future clinical practice. Although some of the challenges faced by PTs and PTAs were unique to COVID-19, many problems represent preexisting systemic and organizational issues that were exacerbated by the pandemic.

KEYWORDS:

• Ethics
• professionalism
• post-acute physical therapy
• skilled nursing
• reflexive thematic analysis
• qualitative research

Acknowledgments

Although none of the interviews referred to moral resilience or moral courage, we were inspired by the resilience and courage of the participants in this study. We thank them for telling us their stories.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the University of South Florida Center for Neuromusculoskeletal Research. The funders had no role in design, implementation, or interpreting the results of the study.