My Scope of Practice: Eclectic Interests + Varied Experience = Skilled Clinician/Teacher

    Darren Hammond, MPT, CWS, is a man of many callings. First he pursued a Bachelor's degree in Athletic Training. Then he earned his Masters degree in physical therapy. That spawned an interest in chronic wound care, which soon evolved into concern for skin integrity.

Later, he worked in home care and served as a Director of Rehabilitation Services for an agency that contracted its services to local nursing homes and had oversight of occupational and speech therapists as well as physical therapists. He grew to love teaching and is now an Adjunct Assistant Professor at Drexel University, Philadelphia, Pa., in addition to serving as the Coordinator of the Office of Continuing Education at Mercy Rehab Associates in Darby, Pa. Plus, he assists with daily patient care as a physical therapist on the Wound Care Team at Mercy-Fitzgerald Hospital, Darby, Pa., and Mercy Hospital of Philadelphia (Pa.) Through it all, Darren has kept his sights set on one goal: to make the patient better and heal the chronic wound, no matter which discipline takes the lead.

    After he received his Masters in Physical Therapy, Darren worked in the spinal cord unit of Rancho Los Amigos National Rehab Center in Downey, Calif. There he became adept at caring for the chronic wound population (spinal cord injury is related to a higher incidence of pressure sores). His primary responsibility was post-myocutaneous flap surgery patients; he cared for a similar population when he later moved to Philadelphia and began working at the Magee Rehabilitation Hospital. His participation in the facility's Skin-Tegrity Program involved a great deal of collaboration with nurses and physicians to develop specific protocol for range-of-motion and seating. "The protocol comprised various therapies, including electrical stimulation and ultrasound," Darren says. "But multidisciplinary cooperation was the most important aspect."

    When he started teaching at different healthcare education institutions, while still seeing patients at Magee, he was put in charge of the wound care curriculum at Hahnemann University, now Drexel University, both in Philadelphia. Darren says, "At that point, wound care was considered an elective, so I was a per diem instructor. I had that schedule for 2 years. In 1998, I was appointed as an Assistant Professor in the Department of Physical Therapy at Hahnemann University. In 2000, I started doing continuing education as part of a 1-day course offered by the Rehabilitation Institute of Chicago (RIC) that addresses wound education for allied health professionals. This eventually evolved into its current format: a 3-day course that provides continuing education throughout the US. In addition to the RIC courses, I also have taught various other courses on interdisciplinary wound care throughout the country. Following a brief stay as an Assistant Professor in the Department of Physical Therapy at the University of the Sciences in Philadelphia, I am back teaching the wound care module at Drexel University. I also work approximately 20 to 30 hours a week in two of the Mercy Healthcare facilities, where 90% of my clients are wound care patients with pressure, venous, and diabetic ulcers and wounds that dehisce from CABGs. As part of the wound care team, comprising physicians, nurses, and PTs, my input is solicited on plan of care, in addition to product selection and trial. More than ever, I am still a proponent of a multidisciplinary wound care approach."

    Darren assimilated all of his experiences and helped establish an educational program at Drexel that ensures PTs are educated appropriately regarding the integumentary system and that they understand the importance of an interdisciplinary team approach when working with individuals who have chronic wounds. Since returning to the clinic at Mercy Rehab Associates, he has worked with other healthcare professionals who have established a wound care program unique in the field of physical therapy. "The collaborative team approach takes the responsibility off the nurses to expedite patient assessment," Darren says. "In addition, as physical therapists, we assist with patient care by offering expertise in sharp debridement and physical modalities. The interdisciplinary team allows patients to be seen at the hospital, with PTs having an important role in guiding care. The PTs can perform vacuum-assisted closure, electrical stimulation, and daily dressings to accelerate closure until the nurses assume responsibility for care."
In addition to his hands-on clinic responsibilities and his duties at Drexel, Darren has been solicited to offer lectures at the LaSalle University School of Nursing (Philadelphia, Pa.) in their Wound Ostomy Nursing Education Program. He speaks to students about the different modalities available to wound care clinicians - modalities usually associated with PTs. "Teaching is what I like most," Darren says. "Some wound care practice is based on ritual or habit, not necessarily on clinician-based research. Because of my diverse experience, I can teach about wound care from several perspectives and address different steps in the wound care regimen, including diagnostics, dressings, and therapies. I also enjoy enlightening students who remark, 'I didn't know PTs were involved in wound care'."

    Darren takes pride in the intra-discipline collaboration he helps foster. He teaches the collaborative approach when speaking at various national nursing and physical therapy association gatherings. "I like to show what PTs can do. The occupational and speech therapists who also attend his presentations get a fresh perspective on their roles as well. Occupational therapists help patients adjust to handling activities of daily living with a chronic wound. Speech therapists incorporate the nutrition component of their skills into care - if a patient is having difficulty swallowing, he or she can't ingest the proteins and other elements essential to health and healing. Back in my Rancho days, the PTs did the swallowing evaluations until we finally got Speech involved."

    Darren also sees proliferating the capabilities of PTs as a way to overcome the obstacles of reimbursement and strives to earn "buy in" from physicians still reluctant to allow PTs a greater role in providing wound care. "They need to learn they can consult us," Darren says. "But I'm still mostly lecturing to PTs and nurses."

    "I also enjoy my clinic time - keeping up my skills, working with clinicians to bring more evidence into practice. It's interesting and gratifying to take those case studies and abstracts to patient care. It brings an energy into the process, challenging the clinician who may be stuck in a pattern to integrate new ideas." Darren's plans to continue to teach part-time while retaining his clinic and newly acquired coordinator of clinical education responsibilities, getting students involved in teaching and clinic practice. "The tide is slowly turning," he says of his desire to instill the importance of multidisciplinary wound care. "Physicians are recognizing the vitality, knowledge, education, and experience that physical therapists - indeed, nurses, occupational and speech therapists - offer in my scope of practice." 

My Scope of Practice is made possible through the support of ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ