Roots Robin K, Brown Helen, Bainbridge Lesley, Li Linda C
UBC Deptartment of Physical Therapy, University of Northern British Columbia, Prince George, British Columbia, Canada.
School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
Rural Remote Health. 2014;14:2506. Epub 2014 Feb 17.
Providing rehabilitation services to address the health needs of rural residents requires overcoming the challenges of geography, limited referral options and a shortage of occupational therapists (OTs) and physical therapists (PTs). However, little is known about how rehabilitation professionals in rural areas enact their practice to meet and overcome these challenges. To address this gap and contribute to enhancing health for rural residents, this study was designed to explore rural rehabilitation practice from the perspectives of OTs and PTs in rural British Columbia (BC).
A purposive sample of OTs and PTs in rural communities (population <15 000) in northern BC was recruited for this qualitative study. Potential participants received an invitation mailed to workplaces and were selected to ensure a variety of work experiences, roles and practice settings. In semi-structured interviews, participants were asked to describe the skills and knowledge they perceived as unique to rural practice and strategies they used to overcome challenges. Guided by interpretive description, transcripts were analysed inductively using broad-level coding, and findings were collapsed into interpretive categories. Interpretations and implications for education, practice and policy were reviewed with participants to ensure relevance to rural practice.
From interviews with 6 OTs and 13 PTs, serving a total of 15 rural communities, rehabilitation practice and participants' definition of health were understood to be substantially shaped by rurality or the contextual features of geography, determinants of health and access to services. Participants considered general practice 'a specialty' requiring advanced skills in assessment. They described 'stretching their role' and 'participating in, and partnerships with, community' as ways to overcome resource shortages. Reflective practice, networking and collaboration were deemed essential to maintaining competence. Rural clinical placements, mentoring and improving access to continuing professional development were regarded as central to the recruitment and retention required to sustain optimal levels of service to residents.
The research findings illustrate the unique influence that the rural context has on the practice of OTs and PTs in BC. They underscore the importance of facilitating learning about rural health within professional training programs and of providing accessible professional development resources to address health human resource shortages and meet the rehabilitation needs of rural residents.
提供康复服务以满足农村居民的健康需求，需要克服地理条件、转诊选择有限以及职业治疗师（OT）和物理治疗师（PT）短缺等挑战。然而，对于农村地区的康复专业人员如何开展实践以应对和克服这些挑战，我们知之甚少。为了填补这一空白并为改善农村居民的健康状况做出贡献，本研究旨在从不列颠哥伦比亚省（BC）农村地区的职业治疗师和物理治疗师的角度探索农村康复实践。
本定性研究招募了BC省北部农村社区（人口<15000）的职业治疗师和物理治疗师作为目的抽样样本。潜在参与者收到了寄往其工作场所的邀请，并经过筛选以确保涵盖各种工作经历、角色和实践环境。在半结构化访谈中，参与者被要求描述他们认为农村实践所特有的技能和知识，以及他们用来克服挑战的策略。在解释性描述的指导下，使用宽泛的编码对访谈记录进行归纳分析，并将研究结果归纳为解释性类别。与参与者一起审查了对教育、实践和政策的解释及影响，以确保其与农村实践的相关性。
通过对6名职业治疗师和13名物理治疗师的访谈（他们总共服务于15个农村社区），了解到康复实践以及参与者对健康的定义在很大程度上受到农村地区或地理环境特征、健康决定因素和服务可及性的影响。参与者认为全科实践是一门“专业”，需要具备高级评估技能。他们将“拓展自身角色”以及“参与社区并与社区建立伙伴关系”描述为克服资源短缺的方式。反思性实践、建立网络和合作被认为是保持专业能力的关键。农村临床实习、指导以及改善继续专业发展的机会被视为维持为居民提供最佳服务水平所需的招聘和留用工作的核心。
研究结果表明农村环境对BC省职业治疗师和物理治疗师的实践具有独特影响。它们强调了在专业培训项目中促进对农村健康的学习以及提供可及的专业发展资源以解决卫生人力资源短缺问题并满足农村居民康复需求的重要性。
