Pashley Emilie, Powers Ashley, McNamee Nicole, Buivids Rachel, Piccinin Joanne, Gibson Barbara E
Emilie Pashley, BSc, MScPT: Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario.
Physiother Can. 2010 Summer;62(3):224-34. doi: 10.3138/physio.62.3.224. Epub 2010 Jul 23.
To describe the clinical and contextual factors that influence physiotherapists' discharge decision-making processes in outpatient orthopaedic settings.
The study used a descriptive qualitative design that included three key-informant interviews and two focus groups (n=7) of orthopaedic physiotherapists (total n=10) working in the Greater Toronto Area. Interviews and focus groups followed a semi-structured interview guide that included questions pertaining to participants' discharge decision-making processes, salient contextual factors, and challenges. Data were coded and analyzed for emerging categories and themes using constant comparison techniques and group analyses.
Participants indicated that a combination of factors and strategies were brought to bear on discharge decision making but that the process changed with clinical experience. Over time, further emphasis was attributed to the patient's role in his or her rehabilitation, and self-management goals were increasingly promoted. Experience affected how therapists conceptualized their roles in discharge decisions and how they negotiated goals with patients.
Discharge decision making is a complex process that requires integrating numerous factors and negotiating with patients. Physiotherapists' decision-making practices evolve with experience and reveal the complexity of implementing models of "client-centred care" in practice. Further research is needed to explore these findings in other settings.
描述影响物理治疗师在门诊骨科环境中做出出院决策过程的临床和背景因素。
本研究采用描述性定性设计，包括对大多伦多地区工作的骨科物理治疗师进行的三次关键 informant 访谈和两个焦点小组（n = 7）（共 n = 10）。访谈和焦点小组遵循半结构化访谈指南，其中包括与参与者出院决策过程、突出的背景因素和挑战相关的问题。使用持续比较技术和小组分析对数据进行编码和分析，以找出新出现的类别和主题。
参与者表示，多种因素和策略共同影响出院决策，但该过程会随着临床经验而变化。随着时间的推移，更多的重点被放在患者在其康复过程中的作用上，自我管理目标也得到越来越多的推广。经验影响治疗师在出院决策中如何界定自己的角色以及如何与患者协商目标。
出院决策是一个复杂的过程，需要综合考虑众多因素并与患者进行协商。物理治疗师的决策实践会随着经验而演变，这揭示了在实践中实施“以客户为中心的护理”模式的复杂性。需要进一步研究以在其他环境中探索这些发现。
