Thomson Di
Academic Department of Physiotherapy, School of Biomedical Sciences, Kings College, London University, London, UK.
Physiother Theory Pract. 2008 Nov-Dec;24(6):408-22. doi: 10.1080/09593980802511805.
Changes in health care brought about by the increased incidence of chronic conditions have resulted in an increased focus on patient self-directed care. This ethnographic study explores from the therapists' perspectives how therapist/patient interactions influence success or contribute to meeting the patients' goals on a pain management program. A team of physiotherapists were observed individually with their patients over a period of 6 months. Their interactions were audiotaped, transcribed, analysed, and cross-referenced to the field notes and the follow-up interviews with the therapists after each observation. The analysis was iterative, guided by questions and contextualised. Codes, categories, and evolving patterns of behaviour were documented, and three major themes were identified. The therapist/patient interactions demonstrated certain consistent standpoints toward the purpose of the program. The team judged those who achieved positive outcomes, as having entered into interactions typified by assertiveness, negotiation, and critical reflection. However, even the most able team of therapists will not be able to create a collaborative framework unless their patients are willing to grasp the opportunity offered to them, and they judged their least successful patients as having adopted unwilling and unrealistic interactions. Interactions of resistance or an inability to carry over problem solving skills into their lives resulted in a negative outcome for the patients and a stunting of the team's potential.
慢性病发病率上升所带来的医疗保健变化，使得人们越来越关注患者的自我导向护理。这项人种学研究从治疗师的角度探讨了治疗师与患者的互动如何影响疼痛管理项目的成功，或如何有助于实现患者的目标。在6个月的时间里，观察了一组物理治疗师与他们各自患者的互动情况。他们的互动被录音、转录、分析，并与每次观察后的现场记录以及对治疗师的后续访谈进行交叉参考。分析是迭代的，以问题为导向并结合具体情境。记录了行为的代码、类别和不断演变的模式，并确定了三个主要主题。治疗师与患者的互动对项目目的表现出某些一致的立场。该团队认为那些取得积极成果的患者，其互动方式具有坚定自信、协商和批判性反思的特点。然而，除非患者愿意抓住提供给他们的机会，否则即使是最有能力的治疗师团队也无法创建一个协作框架，并且他们认为最不成功的患者采取的是不情愿和不切实际的互动方式。抵触性互动或无法将解决问题的技能应用到生活中，会给患者带来负面结果，并阻碍团队潜力的发挥。
