A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students

Abstract

Background: Narrative reasoning has been presented as a core component of the health professionals’ competencies.

Aim of the study: This study aimed to explore the students’ perspectives about the contribution of a narrative reasoning course to promote patient-centred practice.

Methods: An interpretative phenomenological analysis (IPA) was undertaken through focus groups. Eighteen volunteer final year students participated in three focus groups. Data analysis followed the IPA principles.

Findings: Three themes emerged: (1) “developing distinctive competencies”; (2) “shifting students’ focus” and (3) “challenging students’ professional identity”. In the first theme, students distinguished their capability to better understand patients’ experiences and needs and to be aware of the importance of a collaborative therapeutic relationship. In the second theme, students emphasized a shift from themselves as clinicians towards their patients. Finally, in the third theme participants shared the perspective that they have developed a different clinical profile, and that their reasoning and clinical actions have changed.

Conclusions: Students recognized the contribution of the course in developing competencies to facilitate patient-centred practice. Future research is needed to inform lecturers on how to best integrate narrative reasoning within the physiotherapy undergraduate curricula.     

I can't sleep at night with discharging this lady: The personal impact of ending therapy on speech-language pathologists

The ending of therapy is a crucial time for speech-language pathologists and can impact on their sense of achievement and satisfaction. Drawing on literature from psychotherapy, social work and rehabilitation as well as from the area of aphasia therapy, this paper explores how speech-language pathologists juggle the tensions of coping with real versus ideal endings, of managing the building of close therapeutic relationships which then have to be broken, and of balancing a respect for client autonomy while retaining control over caseloads and fair allocation of resources. I suggest that the way in which therapy finishes reflects a merger of how clinicians manage these tensions. Clinicians may benefit from a greater recognition of what they do and feel at discharge, not only to further reflective practice, but also to encourage more sensitive involvement with both clients and students.     

合肥市乙型病毒性肝炎感染孕妇KAP调查分析

目的：了解合肥市乙肝感染孕妇母婴阻断知识、信念、行为( KAP)状况,并对其影响因素进行分析,为开展乙肝预防健康教育提供依据。方法自行设计问卷,在合肥市四个区随机抽取200名乙肝感染孕妇,回收有效问卷169份。采用t检验、logistic回归分析对乙肝感染孕妇KAP得分的影响因素进行分析。结果乙肝感染孕妇KAP得分总体较低,平均得分为(5．20±2．24)分,及格率为47．31%。分析显示影响乙肝感染孕妇KAP的因素包括学历、居住地、被感染时间等,大专以下学历、居住地在农村的孕妇、母亲不知道自己是否乙型肝炎病毒感染者的孕妇及被感染时间短的孕妇KAP得分较低。结论公共卫生服务机构应根据乙肝感染孕妇的特征,针对性开展多种形式的健康教育,有效提高乙肝感染孕妇KAP水平。     

Exploring the safety measures by doctors on after-hours house call services

Background

Aggression against doctors involved in after-hours house calls (AHHC) is widely perceived to be high. It is, however, unclear how doctors who perform this service manage the risk of aggressive patients during home visits.

Aims

The aim of this paper is to explore if and how doctors manage the risk of violence against them during AHHC.

Methods

A survey was designed and administered to all 300 Australian-based doctors engaged in AHHC under the National Home Doctor Service (NHDS). The survey was conducted from September 2014 to November 2014.

Results

There were 172 responses (57.3 per cent). Only 43 per cent of respondents adopted personal protective measures. The remaining 57 per cent had none; of those 6 per cent had never considered protective measures, and 31.8 per cent were aware of the risk of violence, but were unsure of what to do. Measures adopted include the use of chaperones/security personnel (34.1 per cent), dependence on surgery policies (31.2 per cent), de-escalation techniques (15.2 per cent), panic buttons (7.2 per cent), personal alarms (6.1 per cent), and others (6.5 per cent). Females were more likely to adopt personal protective measures than males (OR 4.94; p<0.01; CI 1.70–14.34), and Australian-trained doctors were less likely to do so relative to overseas-trained doctors (OR 0.35; p=0.04; CI 0.12–0.99).

Conclusion

Just over half of the doctors involved in AHHC took no precautions against aggressive attacks while on duty, and nearly one-third relied on the policies of their employing surgeries.