‘Isn’t it all Whites?’ Ethnic diversity and the physiotherapy profession

Aim

To explore physiotherapists’ perceptions, views and experiences of ethnic diversity in relation to the physiotherapy profession.

Design

Qualitative research study, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed verbatim and the data were analysed using thematic analysis. Several verification procedures were incorporated into the design to ensure quality.

Setting

Venues chosen by the participants in North West England.

Participants

A purposive sample of 22 physiotherapists (five students, seven clinicians and 10 academics) with a range of ethnicities.

Findings

Most participants’ experiences and perceptions were of a lack of ethnic diversity within the profession. Further findings related to the impact of this included: the perception that physiotherapy is a White profession; some Black and Minority Ethnic (BME) physiotherapists felt ‘out of place’ on occasions; and failure to meet patients’ needs. The potential benefits of increased ethnic diversity and the possible risks of valuing BME staff solely in terms of their ethnicity were also illuminated by the findings.

Conclusions

This study of the perceptions and experiences of physiotherapists identified a lack of ethnic diversity within the profession. It is argued that a lack of ethnic diversity may result in a failure to meet patients’ needs. A workforce that is reflective of the population it serves can have greater cultural knowledge, and is more likely to understand and respond to patients’ needs.     

Parental Tobacco Screening and Counseling in the Pediatric Emergency Department: Practitioners’ Attitudes,Perceived Barriers,and Suggestions for Implementation and Maintenance

Introduction

The pediatric emergency department (PED) is a venue that underuses parental tobacco screening and brief cessation counseling. We sought to explore PED practitioners’ attitudes and perceived barriers regarding the implementation and adoption of tobacco screening/cessation counseling of parental smokers in the PED setting, as well as to solicit suggestions for improving the sustainability and maintenance of such practices.

Methods

We conducted an exploratory, qualitative study of a convenience sample of PED practitioners using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Individual, focused interviews were conducted to determine factors that would maximize the implementation and maintenance of parental tobacco screening and intervention counseling as standard PED practice.

Results

Thirty interviews were conducted from which relevant data, patterns, and themes were identified. Reach factors included targeting parental smokers with children with respiratory diseases, having adequate training of practitioners, and providing “prearranged” counseling packages. Effectiveness factors included practitioner desire for outcome data about intervention effectiveness (eg, changes in children’s secondhand smoke exposure and parental quit rates). Solutions to increase intervention adoption included quick electronic health record prompts and the provision of onsite tobacco cessation experts. Implementation suggestions emphasized the importance of financial support and the alignment of tobacco screening/counseling with strategic plans. Maintenance factors included institutional and technical support, as well as the importance of intervention “champions” in the PED.

Discussion

By highlighting important viewpoints of practitioners regarding tobacco screening and counseling, the findings can help guide and direct the development and evaluation of sustainable interventions to facilitate tobacco use treatment in the PED.     

“Six sessions is a drop in the ocean”: an exploratory study of neurological physiotherapy in idiopathic and inherited ataxias

Objective

An exploratory study to examine specialist neurological physiotherapy service provision and utilisation for people with progressive ataxia.

Design

Qualitative study involving thematic analysis of accounts in semi-structured interviews with physiotherapists and patients.

Setting

People with ataxia and specialist neuro-rehabilitation physiotherapists in Greater Manchester, UK.

Participants

38 people with ataxia and 8 neurological-physiotherapists working in academic and hospital and community-based services in NHS and private settings. Recruiting physiotherapists experienced in working with the patient group was a challenge.

Interventions

One hour cross-sectional semi-structured interview at physiotherapists’ workplaces or in patients’ own homes.

Results

Neurological physiotherapy was experienced by 25 (66%) of the 38 people with ataxia. The overarching themes emerging from the analysis were ‘making a difference,’ engagement and service provision. A majority of both samples felt that services should be organised so as to provide longer term therapy and support that goes beyond short care packages followed by provision of home exercise programme. Engagement with services was linked to patient expectations, adherence and perception of outcomes. The most predominant codes in the data set were encapsulated by the theme ‘making a difference,’ which further included concerns about how to measure perceived clinical improvement (as experienced by patients) in the context of progressive decline.

Conclusions

The findings suggest a model of idealised service provision involving a holistic, open-access service including research efforts to improve the evidence base. Special attention needs to be paid to measuring improvements following therapy.     

Direct access and patient/client self-referral to physiotherapy: a review of contemporary practice within the European Union

Background

Direct access refers to service users being able to refer themselves to physiotherapy without a third-party referral. It represents a model of practice supported globally by the profession, growing research evidence and health policy in some health systems. To the authors’ knowledge, no research has been reported to ascertain the extent to which direct access is available within the physiotherapy profession within the European Union (EU).

Objectives

To survey member organisations of the World Confederation for Physical Therapy (WCPT); establish the number of member states within the EU where it is possible for individuals seeking physiotherapy services to self-refer; describe the legislative/regulatory and reimbursement contexts in which physiotherapy services are delivered; examine if physiotherapy practice is different in member states where direct access is permitted compared with member states where direct access is not permitted; and to describe the barriers and facilitators to direct access perceived by member organisations of the WCPT.

Design

Cross-sectional, online survey using a purposive sample.

Participants

Member organisations of the WCPT in the EU.

Results

Direct access is not available in all member states of the EU, despite the majority having legislation to regulate the profession, and entry-level education programmes that produce graduates with the requisite competencies. Key barriers perceived are those that can influence policy development, including the views of the medical profession and politicians. Support of service users and politicians, as well as professional autonomy, are seen as key facilitators.

Conclusion

These results represent the first report of a comprehensive mapping of direct access to physiotherapy and contexts within the EU. In over half of member states, service users can self-refer to physiotherapists. These results provide insights to further individuals’ understanding about the similarities and differences in working practices and service delivery factors, such as reimbursement across and within EU member states. The synergies between barriers and facilitators indicate the importance of targeted advocacy strategies in the introduction of direct access/self-referral to physiotherapy.     

‘Oh my gosh I’m going to have to undress’: potential barriers to greater ethnic diversity in the physiotherapy profession in the United Kingdom

Objective

To explore the views and experiences of South Asian participants in relation to the potential barriers to increasing ethnic diversity of the physiotherapy profession.

Design

A qualitative research design was utilised, drawing on ethnographic traditions and including ethnographic interviews. The interviews were transcribed and the data were analysed using thematic analysis.

Setting

A venue of the participant's own choosing in the North west of England.

Participants

•

Five, Muslim female parents; who came to the UK from Pakistan.

•

Two black and minority ethnic (BME) undergraduate physiotherapy students; one female and one male. They described their ethnicity as: British Indian and British Pakistani.

•

Three BME female physiotherapy clinicians. They described their ethnicity as Indian and British Pakistani.

Findings

From analysis of the data generated, three subthemes emerged in relation to the overarching theme; potential barriers: decreased knowledge of physiotherapy; issue of status; tension between cultures.

Conclusions

It appears that a lack of knowledge may impact negatively on BME potential students considering physiotherapy as a possible career. The status of the profession was found to be an important factor in career choice. However, a lack of knowledge led many to consider physiotherapy to be less prestigious than other healthcare professions. Finally, a lack of sensitivity with the information given during the selection process caused some participants anxiety and to question physiotherapy as a career choice. Due consideration should be given to these potential barriers to address the underrepresentation of BME groups in physiotherapy.     

Nurses’ attitudes towards older people: A systematic review

Background

The population is ageing globally. Older people are more likely to have chronic diseases and disabilities and have contact with health services. Attitudes of healthcare professionals affect the quality of care provided and individual career preferences.

Aim

To examine the international research relating to registered and student nurses’ attitudes towards older people and the potential underpinning variables.

Methods

A systematic search of 8 databases covering English and Chinese language publications since 2000 was undertaken which identified 25 papers.

Findings

Reported attitudes towards older people were inconsistent with positive, negative and neutral attitudes being noted across registered and student nurses and appear to be slightly less positive since 2000. A range of variables have been examined as potential predictors of nurses’ attitudes with age, gender and education level being investigated most frequently but none were consistent predictors. Preference to work with older people and knowledge of ageing appeared to be associated with positive attitudes towards older people.

Conclusions

There is a growing need for registered nurses committed to working with older people, however, there is a dearth of well designed studies which investigate both the attitudes of registered and student nurses and the associated factors, and test interventions to inform workforce strategies.     

A structured educational intervention to improve targeted temperature management utilization after cardiac arrest

Purpose

Post-arrest targeted temperature management (TTM) has been shown to dramatically improve outcomes after resuscitation, yet studies have revealed inconsistent and slow adoption. Little is known about barriers to TTM implementation and methods to increase adoption. We hypothesized that a structured educational intervention might increase TTM use.

Materials and Methods

Subjects participated in mixed quantitative/qualitative surveys before and after attending a series of TTM educational courses from October 2010 to October 2011, to determine usage and barriers to implementation. A knowledge examination was also administered to participants before and after the course.

Results

Clinicians completed 227 surveys (129 pre-training and 98 post-training) and 343 exams (165 pre-training and 178 post-training). A ranking survey (score range 1-7; 7 as most challenging) found that communication challenges (mean score 4.7 ± 1.5) and lacking adequate education (4.3 ± 1.9) were the 2 most emphasized barriers to implementation. Post-survey results found that 95% (93/98) of respondents felt more confident initiating TTM post-intervention. There was a statistically significant increase in self-reported TTM usage after participation in the program (P < .01).

Conclusions

A focused TTM program led to increased confidence and usage among participants. Future work will focus on targeted training to address specific barriers and increase TTM utilization.     

Attitudes of nurses towards the use of physical restraints in geriatric care: A systematic review of qualitative and quantitative studies

Objectives

To examine nurses’ attitudes towards the use of physical restraints in geriatric care.

Design

Systematic review and synthesis of qualitative and quantitative studies.

Data sources

The following databases were searched: Medline, CINAHL, EMBASE, Psyndex, PsychInfo, Social SciSearch, SciSearch, Forum Qualitative Social Research (1/1990 to 8/2013). We performed backward and forward citation tracking to all of the included studies.

Review methods

We included in the present review all qualitative and quantitative studies in English and German that investigated nurses’ attitudes towards the use of physical restraints in geriatric care. Two independent reviewers selected the studies for inclusion and assessed the study quality. We performed a thematic synthesis for the qualitative studies and a content analysis of the questionnaires’ items as well as a narrative synthesis for the quantitative surveys.

Results

We included 31 publications in the review: 20 quantitative surveys, 10 qualitative and 1 mixed-method study. In the qualitative studies, nurses’ attitudes towards the use of physical restraints in geriatric care were predominately characterised by negative feelings towards the use of restraints; however, the nurses also described a perceived need for using restraints in clinical practice. This discrepancy led to moral conflicts, and nurses described several strategies for coping with these conflicts when restraints were used. When nurses were in doubt regarding the use of restraints, they decided predominantly in favour of using restraints. The results of the quantitative surveys were inconsistent regarding nurses’ feelings towards the use of restraints in geriatric care. Prevention of falls was identified as a primary reason for using restraints. However, the items of the questionnaires focussed primarily on the reasons for the use of restraints rather than on the attitudes of nurses.

Conclusions

Despite the lack of evidence regarding the benefits of restraints and the evidence on the adverse effects, nurses often decided in favour of using restraints when in doubt and they used strategies to cope with negative feelings when they used restraints. A clear policy change in geriatric care institutions towards restraint-free care seems to be warranted to change clinical practice. The results of this review should also be considered in the development of interventions aimed at reducing the use of restraints.     

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study

Objective

To identify elements of the physiotherapist–patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings.

Design

A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach.

Setting

Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain).

Participants

Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries.

Results

Patients based their evaluations of quality of care on their assessment of physiotherapists’ willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist–patient interaction emerged under all these themes, except for friendly and respectful communication.

Conclusion

This study identified which elements of the physiotherapist–patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients’ experiences of the physiotherapist–patient interaction in rehabilitation services to provide empirical and quantitative evidence.     

Exploring experiences of physical activity among people with Alzheimer's disease and their spouse carers: a qualitative study

Objectives

To improve understanding about the barriers and facilitators to physical activity for people with Alzheimer's disease and their spouse carers, and to consider the development of activity interventions that would be acceptable, sustainable and feasible for both groups.

Design

A qualitative approach, using semi-structured interviews, facilitated exploration of physical activity in a small group of people with Alzheimer's disease and their spouse carers.

Setting

Participants were recruited from one memory clinic in South West England.

Participants

Potential participants were identified by clinical psychologists at the memory clinic and were given information about participating in the research. Five people with Alzheimer's disease and their spouse carers were subsequently recruited for semi-structured interviews, which took place at the memory clinic. Interviews were audio-recorded and transcribed verbatim.

Main outcome measures

Qualitative data were analysed using thematic analysis. Three major themes have been presented.

Results

The findings illustrate the complex interplay between the overarching themes ‘self’, ‘others’ and ‘couple’ that affect physical activity for both people with Alzheimer's disease and their spouse carers, and which are linked to the progression of dementia.

Conclusions

An individually tailored approach for couples, which values the role of the carer and accounts for the progressive and changing nature of dementia, should be a guiding principle for intervention design.     

Physiotherapy intervention practice patterns used in rehabilitation after distal radial fracture

Objectives

To identify the type and frequency of interventions used by physiotherapists in rehabilitating patients after a distal radial fracture; and, to examine whether any patient or therapist characteristics had an effect on the frequency of interventions administered.

Design

Observational study.

Setting

Four metropolitan outpatient physiotherapy departments.

Participants

14 physiotherapists reported on 160 distal radial fracture consultations.

Main outcome measures

Physiotherapists recorded the type of interventions and time spent administering interventions during each distal radial fracture consultation.

Results

A combined site response rate of 70% was achieved (160/204). The most common interventions were exercise (155/160), advice (144/160), passive joint mobilisation (88/160) and massage (60/160). Patient characteristics and physiotherapist experience had little impact on the type and frequency of interventions reported by physiotherapists.

Conclusions

Exercise and advice were the most frequently administered interventions for patients after a distal radial fracture irrespective of physiotherapist or patient factors. During rehabilitation, these interventions aim to restore wrist mobility and are consistent with both fracture management principles and a self management approach. Due to the routine use of exercise and advice there is a need for further research to provide high quality evidence that these interventions improve outcomes in patients after a distal radial fracture.     

Physiotherapy students’ experiences of bullying on clinical internships: a qualitative study

Objectives

To consider the experiences of final-year physiotherapy students who have experienced workplace bullying on a clinical internship.

Design

Qualitative methodology using individual semi-structured interviews.

Setting

A university in the Midlands region of the UK.

Participants

Eight undergraduate physiotherapy students who had experienced one incident of bullying on a clinical internship.

Main outcome measures

Thematic analysis of semi-structured interviews.

Results

Four main themes were identified: (1) external and situational influences of bullying; (2) students’ reactions to the experience of bullying; (3) inability to reveal the experience; and (4) overcoming problems. Bullying had a range of adverse effects on the students, with many expressing self-doubt in their competence and viewing their supervisor as unapproachable and unsupportive. Five students were not initially able to recognise the experience as bullying. In addition, students did not feel able to report the experience and use the support mechanisms in place. This may have been a result of having concerns that the problem would escalate if they reported the experience and, as a consequence, have a negative effect on their grade. Students were keen to offer a range of strategies for clinical practice in order to prevent bullying for future generations of students.

Conclusions

Students’ health, security and confidence in their ability as a physiotherapist can be at great risk from bullying. Steps are needed to ensure that students are better protected from bullying, and feel more able to address bullying behaviour during clinical internships.     

Physiotherapists’ perceptions of equity and career progression in the NHS

Objective

To evaluate physiotherapists’ personal perceptions of equality and diversity both in the NHS and within their profession. In order for policy to make a difference and change to occur in actual practice, personal beliefs of frontline staff must be evaluated and incorrect beliefs challenged.

Design

National Survey.

Setting

The UK.

Respondents

Four hundred and twenty physiotherapists.

Results

The findings were assessed in relation to respondents’ own beliefs in relation to equality and diversity. Key findings included that 88% of respondents agree that diversity is important in the NHS and that equality and diversity policies make a difference. However, 24% think the NHS is not working hard enough to promote equality and diversity. Fifty-five percent of respondents agreed that women experience barriers to career progression. Sixty-three percent of respondents think that black and minority ethnic (BME) groups are not well represented at senior levels in the NHS, 65% of respondents think that BME groups are not well represented at senior levels in physiotherapy. Overall, 19% of all respondents reported being treated differently in the workplace, yet 36% of non-white respondents reported being treated differently in the workplace.

Conclusions

Policy and procedures are making a difference in the NHS. However, as advocated, the CARE framework (http://www.liverpool.ac.uk.clinpsy.breakingbarriers) would be beneficial in facilitating change. Further efforts are required by NHS and physiotherapy leaders to promote equality in the workplace and diversity within the workforce.     

Patients with rotator cuff tendinopathy can successfully self-manage,but with certain caveats: a qualitative study

Objectives

Evidence has emerged supporting the value of loaded exercises for rotator cuff tendinopathy but there are barriers that might prevent implementation of this intervention in the real-world. The purpose of this study was to explore these potential barriers with participants involved in a pilot randomised controlled trial (RCT) investigating a self-managed loaded exercise intervention.

Design

A qualitative study within the framework of a mixed methods design. Data were collected using individual interviews and analysed using the framework method.

Setting

One private physiotherapy clinic in northern England.

Participants

Six patients and two physiotherapists were purposively sampled from those allocated to the self-managed exercise group within the RCT.

Results

Three themes were generated: (1) Expectations and preferences, (2) characteristics of an unsuccessful outcome, (3) characteristics of a successful outcome. Most patients expressed expectations contrary to the philosophy of a self-managed approach. But this did not serve as a barrier when the intervention was offered within a positive and supporting environment where patients understood the reasons for undertaking the exercise, effectively self-monitored and engaged with pro-active follow-up. An early and appreciable response to therapy was also a key factor influencing continuing engagement with the exercise programme.

Conclusion

With certain caveats including the need to recognise and respond to individual characteristics, implement effective knowledge translation strategies and the need to engage with appropriately timed pro-active follow-up, the potential to implement programmes of self-managed loaded exercise for patients with rotator cuff tendinopathy in the real-world and in further research studies appears feasible but challenging.     

Factors associated with nurses’ reporting of patients’ aggressive behavior: A cross-sectional survey

Background

Aggressive behavior and violence directed by patients at nurses are increasing worldwide. Aggressive behavior against nurses in their workplace can result in personal problems, such as impairment of physical and mental well-being, and, consequently, in organizational problems. Underreporting of patients’ aggressive behavior is prevalent among nurses. Although underreporting might lead to inefficient attention to strategies for preventing aggressive behavior, the reasons for such behavior not being reported frequently have not been well examined.

Objectives

To explore the frequency of nurses’ reporting to their managers of patients’ aggressive behavior by type and degree of impact suffered by the nurses, to examine the association between reporting of aggressive behavior and demographic factors, and to determine the reasons for underreporting.

Design

A questionnaire-based cross-sectional survey.

Setting

Six acute care hospitals in two regions in Japan.

Participants

A total of 1953 nurses working at general acute care hospitals participated.

Methods

Data were collected through a questionnaire seeking sociodemographic information, information on experience of aggressive behavior from patients, and the frequency with which they had reported such behavior in the previous month. The questionnaire also contained items assessing barriers to reporting of patients’ aggressive behavior. The association between the possible influencing factors and reporting behavior was assessed using multiple logistic regression analyses.

Results

Of the 1953 questionnaires distributed, 1498 (76.7%) were returned, and 1385 (70.9%) fully completed questionnaires were analyzed. More than one-third of the respondents had experienced the mildest assessed level of impact from patients’ aggressive behavior, and 70% of those hardly reported any incidents. The milder the impact was, the less the nurse victims tended to report the incident. Nurse's tendency to feel that aggressive behavior was mitigated by the situation, less work experience, and lack of confidence that management would defend staff nurses from patients’ aggressive behavior were found to be negatively associated with reporting behavior.

Conclusions

This study identified factors associated with nurses’ reporting of patients’ aggressive behavior. Underreporting was found to be associated with the level of impact, managerial attitudes, nurses’ work experience, and nurses’ perception that the behavior was mitigated by the situation. Improving education among nurses to promote reporting incidents and establishing an organized system is needed.     

Barriers and facilitators to providing undergraduate physiotherapy clinical education in the primary care setting: a three-round Delphi study

Background

With the global shift in health care from secondary to primary care, employment opportunities for newly qualified physiotherapists are likely to be in the primary care setting. However, to date, undergraduate physiotherapy clinical education has been centred around secondary care, focusing on acute services in large teaching hospitals. For contemporary physiotherapists to become effective first-contact primary care providers, they need to be exposed to the primary care environment during their undergraduate education.

Objectives

To explore the concept and identify perceived barriers and facilitators to providing physiotherapy undergraduate clinical placements in the primary healthcare setting

Design

A three-round Delphi survey was used. Participants were asked to answer open-ended questions with regard to: (i) student preparation for and (ii) provision of primary care placements (Round 1). Content analysis was employed to identify key themes. These themes generated statements for Round 2. In Round 2, participants were asked to rate their level of agreement/disagreement with the generated statements. In Round 3, a final rating process was conducted. Level of consensus was established as ≥70% agreement, with an interquartile range of ≤1.

Participants

One hundred and ninety-eight primary care physiotherapy staff.

Results

Barriers identified included shortage of resources (e.g. staff) and a lack of tradition; in other words, students are not traditionally educated in the primary care setting. Response rates were 60% (120/198), 70% (84/120) and 76% (64/84) for Rounds 1, 2 and 3, respectively. All seven key facilitators identified reached consensus. They included additional support for staff taking students and motivated students.

Conclusions

This study revealed that there is support for the provision of physiotherapy clinical education in the primary care setting. Through careful consideration with clear planning and collaboration with all stakeholders, it may be possible to convert the main barriers identified into facilitators to ensure that there will be an adequately prepared physiotherapy work force in the future.     

Enhanced education and physiotherapy before knee replacement; is it worth it? A systematic review

Background

Around 20% of knee replacement have an unsatisfactory outcome. Pre-operative physiotherapy and education have been proposed to improve post-operative outcomes.

Objectives

This systematic review evaluated whether these factors improved length of stay and patient reported outcomes after knee replacement surgery.

Data sources

Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO and PEDro were searched on the 1st January 2013.

Study selection or eligibility criteria

Randomised or quasi-randomised studies assessing either pre-operative education or physiotherapy on patients undergoing a planned total or partial knee replacement were included in the review. Only studies with a control group receiving a defined standard of pre-operative care were included.

Results

Eleven studies met the inclusion criteria set. Two studies analysed the effect of pre-operative education, seven pre-operative treatment by a physiotherapist and two studies used both factors. No study found significant differences in validated joint specific patient reported outcome measures. The education studies found a decrease in pre-operative expectation and an improvement in knowledge, flexion and regularity of exercise. Two studies found an improvement in muscle strength in the group treated by a physiotherapist at three months. The combination of education and physiotherapy was shown to reduce patient length of stay and cost in one study.

Conclusion

The evidence reviewed is insufficient to support the implementation of either pre-operative education or physiotherapy programmes. The combination of pre-operative education and treatment by a physiotherapist may reduce the medical costs associated with surgery.     

Factors affecting the integration of immigrant nurses into the nursing workforce: A double hermeneutic study

Background

Variations in nursing practice and communication difficulties pose a challenge for the successful integration into the workforce of immigrant nurses. Evidence for this is found in cultural clashes, interpersonal conflicts, communication problems, prejudiced attitudes and discrimination towards immigrant nurses. While the evidence shows that integrating immigrant nurses into the nursing workforce is shaped by factors that are socially constructed, studies that examine social structures affecting workforce integration are sparse.

Objectives

The aim of this study was to examine interplaying relationships between social structures and nurses’ actions that either enabled or inhibited workforce integration in hospital settings.

Design

Giddens’ Structuration Theory with double hermeneutic methodology was used to interpret 24 immigrant and 20 senior nurses’ perceptions of factors affecting workforce integration.

Results

Four themes were identified from the data. These were: (1) employer-sponsored visa as a constraint on adaptation, (2) two-way learning and adaptation in multicultural teams, (3) unacknowledged experiences and expertise as barriers to integration, and (4) unquestioned sub-group norms as barriers for group cohesion. The themes presented a critical perspective that unsuitable social structures (policies and resources) constrained nurses’ performance in workforce integration in the context of nurse immigration. The direction of structural changes needed to improve workforce integration is illustrated throughout the discussions of policies and resources required for workforce integration at national and organisational levels, conditions for positive group interactions and group cohesion in organisations.

Conclusion

Our study reveals inadequate rules and resources used to recruit, classify and utilise immigrant nurses at national and healthcare organisational levels can become structural constraints on their adaptation to professional nursing practice and integration into the workforce in a host country. Learning from each other in multicultural teams and positive intergroup interaction in promoting intercultural understanding are enablers contributing to immigrant nurses’ adaptation and workforce integration.     

Exploring aspects of physiotherapy care valued by breast cancer patients

Objective

To explore the reported value of physiotherapy care received by patients who had accessed a Specialist Breast Care Physiotherapy Service.

Design

Exploratory qualitative study using in-depth interviews to explore aspects of physiotherapy care valued by breast cancer patients. Thematic network analysis was used to interpret the data and bring together the different experiences of the participants and identify common themes.

Setting

Physiotherapy Department at a NHS Foundation Trust Teaching Hospital.

Participants

Nineteen participants were recruited and three were selected to take part in the in-depth interviews. All participants had received physiotherapy care from a Specialist Breast Care Physiotherapy Service and had been discharged within the last six months.

Results

Participants valued a patient-centred holistic approach to care and access to a Specialist Service with an experienced clinician. In particular the importance of the therapeutic alliance and the value of psychological, emotional and educational support emerged, with the participants feeling empowered in their recovery.

Conclusion and clinical implications

Participants reported an overall positive experience of their physiotherapy care. This study supports the need for service providers to evaluate their current physiotherapy provision and subsequently develop Specialised Services to meet the physiotherapy needs of breast cancer patients throughout all stages of their treatment pathway from the delivery of pre-operative care through to post-treatment follow-up.     

Motivations and barriers to implementing electronic health records and ED information systems in Japan

Background

Although electronic health record systems (EHRs) and emergency department information systems (EDISs) enable safe, efficient, and high-quality care, these systems have not yet been studied well. Here, we assessed (1) the prevalence of EHRs and EDISs, (2) changes in efficiency in emergency medical practices after introducing EHR and EDIS, and (3) barriers to and expectations from the EHR-EDIS transition in EDs of medical facilities with EHRs in Japan.

Materials and methods

A survey regarding EHR (basic or comprehensive) and EDIS implementation was mailed to 466 hospitals. We examined the efficiency after EHR implementation and perceived barriers and expectations regarding the use of EDIS with existing EHRs. The survey was completed anonymously.

Results

Totally, 215 hospitals completed the survey (response rate, 46.1%), of which, 76.3% had basic EHRs, 4.2% had comprehensive EHRs, and 1.9% had EDISs. After introducing EHRs and EDISs, a reduction in the time required to access previous patient information and share patient information was noted, but no change was observed in the time required to produce medical records and the overall time for each medical care. For hospitals with EHRs, the most commonly cited barriers to EDIS implementation were inadequate funding for adoption and maintenance and potential adverse effects on workflow. The most desired function in the EHR-EDIS transition was establishing appropriate clinical guidelines for residents within their system.

Conclusion

To attract EDs to EDIS from EHR, systems focusing on decreasing the time required to produce medical records and establishing appropriate clinical guidelines for residents are required.