How physiotherapists perceive,interpret, and respond to the ethical dimensions of practice: A qualitative study

The profile and reach of physiotherapy has expanded in areas of extended scope of practice, and broader engagement with population needs beyond the individual treatment encounter. These changes raise increasingly complex ethical challenges evidenced by growth in physiotherapy-based ethics studies and discussions. This paper examines how a broad cross section of Australian physiotherapists perceive, interpret, and respond to ethical challenges in their work contexts and how professional codes of conduct are used in their practice. Using an interpretive qualitative methodology, purposive sampling of 88 members of national clinical special interest groups were recruited for focus group discussions. Narrative-based and thematic data analysis identified ethical challenges as emerging from specific clinical contexts, and influenced by health organizations, funding policies, workplace relationships, and individually held perspectives. Five themes were developed to represent these findings: (1) the working environment, (2) balancing diverse needs and expectation, (3) defining ethics, (4) striving to act ethically, and (5) talking about ethics. The results portray a diverse and complex ethical landscape where therapists encounter and grapple with ethical questions emerging from the impact of funding models and policies affecting clinical work, expanding boundaries and scope of practice and changing professional roles and relationships. Codes of conduct were described as foundational ethical knowledge but not always helpful for “in the moment” ethical decision-making. Based on this research, we suggest how codes of conduct, educators, and professional associations could cultivate and nurture ethics capability in physiotherapy practitioners for these contemporary challenges.     

How Can and Do Australian Doctors Promote Physical Activity?

Background.Physical inactivity is recognized as an important public health issue. Yet little is known about doctors' knowledge, attitude, skills, and resources specifically relating to the promotion of physical activity. Our survey assessed the current practice, perceived desirable practice, confidence, and barriers related to the promotion of physical activity in family practice.Methods.A questionnaire was developed and distributed to all 1,228 family practitioners in Perth, Western Australia.Results.We received a 71% response (n= 789). Family practitioners are most likely to recommend walking to sedentary adults to improve fitness and they are aware of the major barriers to patients participating in physical activity. Doctors are less confident at providing specific advice on exercise and may require further skills, knowledge, and experience. Although they promote exercise to patients through verbal advice in the consultation, few use written materials or referral systems.Conclusions.There are significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by doctors. Future strategies need to address the self-efficacy of family physicians and involve resources of proven effectiveness. The potential of referral systems for supporting efforts to increase physical activity by Australians should be explored.     

A critical reflection on the personal impact of managerial hegemony within nurse education

This paper, written by two male nurse teachers, describes and analyses their experience of working in a nurse education culture permeated by the philosophy of business management The introduction of business management practices to nurse education is discussed as a reflection of the current political hegemony of market forces and individualism The authors discuss the implications for nurse teachers of being continually exposed to these politically motivated forces which increasingly provide the paradigm for service developments within the United Kingdom health services In discussing the impact of this exposure it is argued that at the personal level individual teachers are experiencing a degree of apathy and personal dissonance which undermines their professional value system, resulting in emotional distress and a crisis of identity It provides a critical reflection on the way organizational dynamics and power relations influence the subjective sense-making of individuals The authors use a multiplicity of perspectives, including those provided by individual psychology, power relations, feminism and personhood, to argue for the need to develop an alternative paradigm which is characterized by the valuing of individual persons, empathic sensitivity and the fostering of creativity been important to us from a personal and professional     

抑郁障碍患者人格特征与发病关系的研究

目的探讨抑郁障碍患者的人格特征与其疾病发病间的关系。方法采用自评抑郁量表(SDS)、艾森克人格问卷 (EPQ)、应对方式评定量表 (WCRS)和归因方式问卷 (ASQ)对 76名抑郁障碍患者进行测试 ,同时选取 84名健康被试进行对照研究。结果①抑郁组患者在EPQ中神经质 (N)与精神质 (P)的得分显著高于健康组。②WCRS的结果显示在“宣泄接纳”、“退避调节”两个因子上 ,抑郁组的平均得分低于健康组。③在ASQ的得分中 ,抑郁组在负性事件归因的自身性、持久性和整体性均显著高于健康组。④抑郁障碍患者的“神经质”人格特质与应对方式的“宣泄接纳”和“退避调节”因子呈负相关 (r = 0 .474)。结论抑郁障碍患者的人格特征可表现为较强的神经质及孤僻、交往障碍 ,他们这种人格特征及应对和归因方式在其发病过程中起着重要作用。     

On information field of clinical diagnosis

“Field” is a universal phenomenon existing in both nature and society, and determines the existence and significance of all materials or information. The man being has always been generating and carrying a large quantity of life information in his whole life. Each piece of life information has an independent information field. The life information field includes such three subfields as bioinformation field, psychoinformation field and psycho-bioinformation field.The clinical diagnosis information field which is a specific information field within the information field of human activities consists of all information concerning man‘s health. Only after we have cognized and ascertained the clinic diagnosis information field, can we accurately utilize its function to serve the human being.     

浅析市场经济体制下的医院管理模式

阐述了在市场经济体制下医院管理面临的新情况,提出了新的医院管理模式应以分级管理为基础, “业务部制”式管理为重点,科室成本核算为核心,注重形象管理,服从政府宏观调控,确保医院的生存和发展。