Emergency on-call duty preparation and education for newly qualified physiotherapists: a national survey

Objective

To evaluate current emergency on-call service preparation and education provision for newly qualified physiotherapists within the UK, including an audit of adherence to Standard 9 of the Association of Chartered Physiotherapists in Respiratory Care (ACPRC).

Design

National postal questionnaire survey.

Main instrument

Questionnaire including audit of adherence to ACPRC Standard 9.

Participants

Random selection of 75 UK hospital trusts that had intensive care units detailed in the Directory of Critical Care. Telephone contact was made to identify the senior/superintendent respiratory physiotherapist responsible for the on-call physiotherapy service, to whom the questionnaire was addressed.

Results

Seventy-two trusts responded, representing a range of respiratory service leads and managers responsible for on-call services. All respondents indicated provision of on-call preparation and education, although content, delivery methods and duration varied considerably. A wide variety of methods are currently used to assess newly qualified physiotherapists prior to undertaking on-call duties. Despite variations in on-call service provision, there is national adherence to ACPRC Standard 9 at the present time (92-100% adherence to Criteria 1-5). Adherence to Criteria 6, 7 and 8 occurs in fewer trusts (79%, 49% and 73%, respectively).

Conclusions

This study indicated that there is a broad level of national adherence to ACPRC Standard 9, despite the fact that this is not a mandatory requirement. National inconsistencies in preparation duration, format and ongoing education were identified. Further guidance by the ACPRC and the Chartered Society of Physiotherapy is required to provide national consistency of on-call preparation and education.     

Psychoneuroimmunology for physiotherapists

Physiotherapists working in musculoskeletal areas have acknowledged that they need to know more about the body than bones, muscles and joints. Over time, physiotherapists have expanded their knowledge into other areas and systems of the body. Psychology, the nervous system, physiology and biomechanics are all examples of areas that have been covered and analysed in greater depth. Understanding more of the body's systems and how they link together can help to reduce some of the mysteries that arise in clinics on a daily basis. Through scientific explanation of patient conditions and their response to treatment, the effectiveness of physiotherapy can be improved. A new field that offers to further improve physiotherapy understanding and patient management is psychoneuroimmunology. This article aims to introduce this field to physiotherapists and review recent findings on stress-impaired healing.     

Exploring the disclosure decisions made by physiotherapists with a specific learning difficulty

Objectives

To explore the disclosure decisions made in the workplace by physiotherapy staff with a specific learning difficulty (SpLD).

Occupational stress and coping resources in physiotherapists: a survey of physiotherapists in three general hospitals

Objectives

To identify occupational stressors and coping resources in a group of physiotherapists, and to analyse interactions between subjective levels of stress, efficacy in stress resolution and coping resources used by these professionals.

Design

A sample of 55 physiotherapists working in three general hospitals in Portugal completed the Coping Resources Inventory for Stress, the Occupational Stressors Inventory and two subjective scales for stress and stress resolution.

Main results

Most physiotherapists perceived that they were moderately stressed (19/55, 35%) or stressed (20/55, 36%) due to work, and reported that their efficacy in stress resolution was moderate (25/54, 46%) or efficient (23/54, 42%). Issues related to lack of professional autonomy, lack of organisation in the hierarchical command chain, lack of professional and social recognition, disorganisation in task distribution and interpersonal conflicts with superiors were identified as the main sources of stress. The most frequently used coping resources were social support, stress monitoring, physical health and structuring. Perceived efficacy in stress resolution was inversely related to perceived level of occupational stress (r = −0.61, P < 0.01). Significant correlations were found between several coping resources and the perceived level of stress and efficacy in stress resolution. Associations between problem solving, cognitive restructuring and stress monitoring and both low levels of perceived stress and high levels of perceived efficacy were particularly strong.

Implications for practice

The importance of identifying stressors and coping resources related to physiotherapists’ occupational stress, and the need for the development of specific training programmes to cope with stress are supported.     

Use of thoracic ultrasound by physiotherapists: a scoping review of the literature

Background

Use of diagnostic thoracic ultrasound (TUS) in medical professions to examine the pleura, lung parenchyma and diaphragm is gaining in popularity, however the ways in which physiotherapists are using TUS is unclear.

Optimising long-term participation in physical activities after stroke: Exploring new ways of working for physiotherapists

There is now good empirical evidence of physical and functional benefits for individuals with stroke from long-term engagement in a range of physical activities. However, long-term participation of stroke survivors in physical activity after rehabilitation is low, and maximum benefits are not being achieved. This article reviews relevant literature and evidence, and suggests that physiotherapists are ideally placed to support patients in long-term participation in activity as they prepare patients for the end of physical rehabilitation. However, this requires the development, testing and application of stroke-specific evidence-based behavioural and motivational interventions that are feasible in clinical practice, take account of the role of carers, and seek to address the barriers to activity faced by stroke survivors at the end of rehabilitation. It also requires physiotherapists to take a leading role in developing appropriate policies and strategies with other exercise professionals and services to address the transition from rehabilitation to an active lifestyle following stroke.     

Conceptions of physiotherapy knowledge among Swedish physiotherapists: a phenomenographic study

Objectives and design

Knowledge in physiotherapy is based on both scientific evidence and clinical practice. Different perspectives of knowledge generate different implications for theory development. The aim of this qualitative, phenomenographic study was to describe physiotherapists’ conceptions of physiotherapy knowledge.

Intervention and participants

Open, semi-structured interviews were conducted with 10 physiotherapists working in different sectors of physiotherapy. The transcribed material was analysed according to phenomenographic analysis.

Results

The physiotherapists’ conceptions of various aspects of physiotherapy knowledge are described by four qualitatively different categories: (a) interaction, i.e. the ability to create opportunities for patients and develop patients’ competencies, equally influenced by both theoretical and practical knowledge, with a patient-oriented perspective conceiving the physiotherapist as a coach; (b) personal competencies, i.e. the ability to provide good therapy influenced more by practical knowledge oriented towards the physiotherapist; (c) professional demands, i.e. the ability to be professional according to rules and scientifically proven interventions, influenced more by theoretical knowledge oriented towards the physiotherapist; and (d) scientific areas, i.e. the ability to use different knowledge, as an expert, in the interaction with the patient, strongly influenced by theoretical knowledge and oriented towards the patient.

Conclusions

The results can contribute to physiotherapy students’ understanding of the multi-dimensional nature of physiotherapy. The paradigm of physiotherapy must be studied further in order to understand and explain its complexity.     

Physical assault by patients against physiotherapists working in mental health settings

Objectives

There is a lack of empirical research about physical assault by patients against physiotherapists who work in mental health settings. This study aimed to ascertain the lifetime prevalence and 12-month incidence of assault by patients against physiotherapists in UK mental health settings. This research will inform the development of pre- and post-registration training programmes for physiotherapists.

Design

Postal questionnaire survey.

Participants

Members of the Chartered Society of Physiotherapists’ special interest group for physiotherapists working in the field of psychiatry.

Main outcome measures

Self-reported experience of physical assault by patients. Secondary outcome was self-reported training received to manage violent and aggressive patients.

Results

Questionnaires were returned by 116/178 (65%) special interest group members. Fifty-one percent (59/116) reported that they had been assaulted at work during their career, and 24% (28/116) had been assaulted by a patient in the previous 12 months. Physiotherapists in mental health settings appear to be at greater risk of assault by patients than other non-nursing clinicians.

Conclusions

Physiotherapists who work in mental health are at similar risk of physical assault by patients as their nursing colleagues, who are required by the UK Nursing and Midwifery Council to receive education and training in the prevention and management of aggression and violence in their pre-registration training. The authors recommend that appropriate training should be included in pre-registration programmes for physiotherapists.     

Identification of competencies for patient education in physiotherapy using a Delphi approach

Objectives

Patient education is a critical part of physiotherapy practice however an empirically derived set of competencies for its use does not exist. This study aimed to generate a set of competencies for patient education in physiotherapy using a consensus approach.

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.     

Barriers and facilitators to achieving competence in lung ultrasound: A survey of physiotherapists following a lung ultrasound training course

Background and purposeLung ultrasound (LUS) is an emerging tool for acute respiratory physiotherapists. In Australia, there are a select few LUS training courses run for physiotherapists. Research to date has evaluated LUS training courses for physiotherapists in terms of knowledge and skill acquisition. The impact of LUS training on user competence and confidence and whether LUS is used in clinical practice has yet to be evaluated. This study therefore explored the impact of attending a physiotherapy LUS training course on acquisition of competence and confidence and the barriers and facilitators for physiotherapists in achieving competence in LUS.MethodsA quantitative survey containing 21 questions was distributed to 77 Australian physiotherapists.ResultsOf the invited physiotherapists, 39 (50%) completed the survey. Most participants were working in intensive care, in the public hospital setting. Binary logistic regression was performed and demonstrated no significant difference in the relationship between years of clinical experience and having confidence in performing or interpreting LUS images. There was also no statistical significance in the relationship between years of clinical experience and gaining competence and accreditation in LUS. Of the 39 responders, 20 physiotherapists had performed at least one LUS scan since completing training; however, most identified they never use LUS to inform clinical decision-making. Only one physiotherapist had gained accreditation through an ultrasound-governing body. The most frequently reported barriers to achieving competence were lack of clinical time to devote to training and lack of an LUS supervisor.ConclusionA majority of physiotherapists who participated in an LUS training course did not attain competence or accreditation, nor were they confident in performing LUS and interpreting images. Barriers exist that prevent intensive care physiotherapists from being able to use LUS in clinical practice. LUS is also not frequently used by acute respiratory physiotherapists to make clinical decisions.     

The motivations and aspirations of Indian physiotherapists who migrate overseas to study and work: a grounded theory study

ObjectiveTo explore why Indian physiotherapists seek to migrate overseas for study and work.DesignQualitative research using Constructivist Grounded Theory (CGT) methodology.SettingIndividual interviews and focus groups were conducted in the UK and India, at university, clinic or hotel locations convenient to the participants.ParticipantsNineteen physiotherapists from across India. Thirteen had studied or worked in the UK, Australia or Kuwait, and six had no overseas experience.FindingsThe participants desired a ‘better life’ due to factors perceived as less favourable in India: pay levels, professional respect and professional development. These elements were inter-dependent and their importance varied between participants and according to gender. Indian societal values amplified the importance of pay for male physiotherapists, whereas females prioritised professional development. Migrant physiotherapists aspired to professional autonomy through the development of knowledge, skills and experience. Respect was important, but there were different perspectives on its achievement and the relevance of titles. For those studying overseas, work was sought to recoup the cost of that study, and, importantly to consolidate learning and experience of autonomous physiotherapy practice. They all planned to return to India and wished to transfer their knowledge and skills back into practice in India.ConclusionPay, respect and professional development are all motivators for Indian physiotherapists to study and work overseas. An ability to practise physiotherapy autonomously is a key factor underpinning the achievement of each of these elements and thus the ultimate aspiration to have a ‘better life’.     

Limited clinical reasoning skills used by novice physiotherapists when involved in the assessment and management of patients with shoulder problems: a qualitative study

The aim of this study was to explore the clinical reasoning process used by novice physical therapists in specific patient problems. Nine physical therapists in the UK with limited experience of managing musculoskeletal problems were included. Semi-structured interviews were conducted on how novice physical therapists would assess and manage a patient with a shoulder problem; interviews were transcribed and analyzed using framework analysis. To be included as a final theme at least 50% of participants had to mention that theme. A large number of items (n = 93) were excluded as fewer than 50% of participants referred to each item. Included items related to seven main themes: history (16), physical exam (13), investigations (1), diagnostic reasoning (1), clinical reasoning process (diagnostic pathway) (3), clinical reasoning process (management pathway) (5) and treatment options (1). Items mostly related to information gathering, although there was some use of hypothetico-deductive clinical reasoning there appeared to be limited understanding of the clinical implications of data gathered, and clinical reasoning through use of pattern recognition was minimal. Major weaknesses were apparent in the clinical reasoning skills of these novice therapists compared to previous reports of expert clinical reasoning, indicating areas for development in the education of student and junior physical therapists.     

Perceptions of emergency department staff of the role of physiotherapists in the system: a qualitative investigation

Objectives

To investigate the perceptions of doctors, nurses and physiotherapists of emergency department physiotherapy for acute patients, and explore the scope of its contribution in an otherwise nontraditional allied health setting in Australia.

Design

Qualitative investigation using semi-structured interviews.

Setting

A large, metropolitan tertiary hospital with a well-established emergency department physiotherapy/allied health network in place.

Participants

Two emergency department doctors, two emergency department nurses and two senior physiotherapists working in an emergency department were recruited purposefully from the study hospital.

Interventions

Semi-structured interviews lasting from 20 minutes to 1 hour were conducted with each participant by the lead investigator. Data were analysed using NVivo software, coded manually and verified with member checking, facilitating constant case comparisons.

Results

Issues explored included defining the role of physiotherapists, uncovering organisational themes from the introduction of physiotherapy into the established emergency department setting, and conflicts around preserving and expanding an allied health identity in a highly-medicalised clinical environment.

Conclusions

Participants described the benefits of having physiotherapists located in the emergency department, and the physiotherapists were eager to advance their roles and responsibilities, but were, at times, restricted by a complicated organisational landscape influencing professional autonomy and capacity for professional advocacy. Ongoing evidence supporting the breadth of physiotherapy practice in the emergency department is needed to further advocate the usefulness of the profession in this acute setting.