Critical Thinking In Radiation Therapy

Critical thinking involves evaluating information and deducing consequences in order to solve problems and improve outcomes. The critical thinking steps are as follows: Identify the problem, investigate the problem, formulate viable solutions, and select the best solution (Adler & Carlton, 2012). Critical thinking skills are essential in radiation therapy. Patients arrive daily with unique challenges that do not fit the mold of normality. Creativity is necessary to ensure every patient receives the quality of care required by the radiation therapy practice standards and code of ethics (Washington & Leaver, 2010). This essay will examine different scenarios that present in the practice of radiation therapy.
The first scenario is a patient

who does not speak English. Communicating with this patient is vital to ensure informed consent and patient identity. The patient cannot be properly informed if the details of the procedures are not fully understood (Washington & Leaver, 2010). If informed consent documentation has already been established, then the radiation therapist should check with the hospital for a translator. If a translator is not available and the identity of the patient has been confirmed, the therapist should respectfully use verbal and nonverbal communication, including demonstration and pantomime, to guide the patient through the procedure. Most smart phones have an app available that can translate languages. It is important for the therapist to smile and remain calm with the patient. The therapist’s paralanguage must be mindful (Adler & Carlton, 2012). Just because the patient does not understand English does not mean the patient cannot interpret the therapist’s tone of voice. The therapist must constantly monitor the patient’s nonverbal cues. If at any time the patient seems unsure or upset, the therapist should contact a supervisor and stop the procedure until a translator can be located.
The second scenario involves a radiation therapist (Bob) acting unprofessionally with an elderly male patient. During Bob’s interactions with the patient, he belittles and constrains the patient against the patient’s will. Bob’s behavior is unacceptable both ethically and legally. The Department of Health and Human Awareness Administration on Aging (2014) defines elder abuse as physical, emotional, sexual, neglect, exploitation, and abandonment. Bob clearly physically and emotionally abused the patient. By holding the patient against a wall without authorization, Bob was in violation of false imprisonment tort law. By pushing the patient’s chest, Bob was in violation of battery tort law (Washington & Leaver, 2010). A fellow therapist (Angie) who witnessed the incident is obligated to intervene. If Angie is aware of a potential legal situation and does nothing, she is in violation of the Doctrine of Foreseeability (Washington & Leaver, 2010). Since Bob is already agitated and the patient visibly distraught, Angie should not confront Bob directly. Angie should ask Bob if he would mind seeing her next patient allowing Angie to treat his present patient. If Angie is successful in diverting further harm, she should treat the patient calmly and gently, as long as the patient agrees, and contact a supervisor. The supervisor must be aware of the situation for ethical and legal reasons. Due to the Doctrine of Respondeat Superior, the radiation department and the hospital could be held liable for Bob’s actions (Washington & Leaver, 2010). Bob is also in need of counseling on job specifications, proper patient care, ethical behavior, and anger management, if he is lucky enough to keep his job!
The third scenario involves a radiation therapy student in a clinical situation with a sick patient who needs a treatment, but all therapists have gone to lunch. Should the student treat the patient without supervision, wait on a therapist to return, or call a therapist back from lunch? As a student, clinical education requires a credentialed radiation therapist immediately available any time ionizing radiation is in use with patients (Adler & Carlton, 2012). The student should not administer radiation without proper supervision to ensure patient safety. Secondary reasons include program violations, which could put the student’s graduation and career in jeopardy as well as legal implications. If the student administers the radiation and the patient experiences adverse effects, the student could be liable of negligence, even if the student acted carefully and the injuries were unintentional (Washington & Leaver, 2010). In this situation, the student should call a therapist back from lunch and remain with the patient, monitoring the patient’s condition, until a therapist returns and treatment can commence. The student should remain professional and inform the patient that all credentialed therapists are busy at the moment. If a therapist refuses to return immediately or if the patient’s condition worsens, a supervisor or physician should be contacted.
The fourth scenario is a female patient with severe abdominal pains required to stand upright for a procedure. Even though the patient said she would try to stand for the procedure, the therapist’s first priority, according to the American Registry of Radiologic Technologist’s (ARRT) code of ethics, is to act in the patient’s best interest (Washington & Leaver, 2010). Allowing a patient who is clearly weak and in pain to stand for the procedure alone in a room with no support could lead to the patient sustaining an injury from a preventable fall. This would be negligence on the part of the therapist and could create legal implications for the therapist, department, and hospital with a malpractice lawsuit (Washington & Leaver, 2010). The therapist should research substitute positions that would offer the same quality images. Perhaps the patient could sit upright in a chair for a vertical view of the abdomen. If sitting is not an option, a left lateral decubitus view is a substitute for an upright acute abdominal series. The left lateral view shows free air in the upper right abdomen above the liver where no bowel gases are normally present (Herring, 2012). The therapist should verify a viable substitute with the ordering physician as to limit excess radiation exposure to the patient.
The fifth scenario involves a female patient receiving a radiation treatment while in an immobilizing mask.

From outside the room, the radiation therapist notices the patient becoming nauseous during the actual treatment. The radiation therapist is obligated to act in the patient’s best interest as outlined in the ARRT’s code of ethics (Washington & Leaver, 2010). The fact that treatment has commenced creates a challenge. The therapist cannot just run into the room while the radiation is on. The therapist, however, cannot risk harm to the patient. If the patient vomits while immobilized on her back, the patient could choke and aspirate fluid into her lungs before the therapist could get into the room. If the therapist feels strongly that the patient is going to vomit before the treatment ends, the therapist must stop the treatment. If the therapist waits for treatment to end and an injury to the patient ensues, legal repercussions including negligence and malpractice could occur (Washington & Leaver, 2010). The therapist must contact the radiation oncologist and radiation physicist to see what course of action should follow. It could be as simple as administering antiemetic medication to the patient and continuing the treatment. It could, however, require recalculating the doses over the course of the treatment

schedule.
The final scenario involves a radiation therapy student’s neighbor requesting the student to obtain copies of confidential medical records.

Since the student is not a credentialed radiation therapist and is not assigned to the neighbor’s care, the student should not retrieve the confidential records. Retrieving the records would be in direct violation of the Health Insurance Portability and Accountability Act (HIPPA) of 1996 which states that “patient records should only be accessed by those with a specific need to know the content, or those required to document care within the record” (Washington & Leaver, 2010, p. 32). Retrieving the records for the neighbor would also violate the ARRT’s code of ethics concerning confidentiality (Washington & Leaver, 2010). An ethical violation could result in the student’s removal from the program of study as well as the student being barred from ever becoming credentialed. HIPPA violations can result in steep fines for both the student and the hospital. Even though the health records belong to the hospital, the information in the record belongs to the patient; therefore, the neighbor has a right to obtain the information (Adler & Carlton, 2012). The student should inform the neighbor that the records can and must be obtained from the treating physician through written

consent.
The preceding six scenarios are just a glimpse into the situations that present in healthcare and the practice of radiation therapy every day. It is evident that most situations involve more than one problem and multiple viable solutions to those problems. Narrowing the viable solutions down to the best solution can be challenging. Failing to act in the patient’s best interest is in direct violation of the ARRT’s code of ethics. The key is to know the code of ethics and practice standards for radiation therapy, remain flexible and remember that not all situations follow a specific format. Patient safety and quality of care must always be the determining factor when evaluating challenges.