Gough Suzanne, Yohannes Abebaw Mengistu, Murray Janice
Department of Health Professions, Manchester Metropolitan University, Manchester, UK.
Adv Simul (Lond). 2016 Mar 22;1:9. doi: 10.1186/s41077-016-0010-5. eCollection 2016.
Upon graduation, physiotherapists are required to manage clinical caseloads involving deteriorating patients with complex conditions. In particular, emergency on-call physiotherapists are required to provide respiratory/cardio-respiratory/cardiothoracic physiotherapy, out of normal working hours, without senior physiotherapist support. To optimise patient safety, physiotherapists are required to function within complex clinical environments, drawing on their knowledge and skills (technical and non-technical), maintaining situational awareness and filtering unwanted stimuli from the environment. Prior to this study, the extent to which final-year physiotherapy students were able to manage an acutely deteriorating patient in a simulation context and recognise errors in their own practice was unknown.
A focused video-reflexive ethnography study was undertaken to explore behaviours, error recognition abilities and personal experiences of 21 final-year (pre-registration) physiotherapy students from one higher education institution. Social constructivism and complexity theoretical perspectives informed the methodological design of the study. Video and thematic analysis of 12 simulation scenarios and video-reflexive interviews were undertaken.
Participants worked within the professional standards of physiotherapy practice expected of entry-level physiotherapists. Students reflected appropriate responses to their own and others' actions in the midst of uncertainty of the situation and physiological disturbances that unfolded during the scenario. However, they demonstrated a limited independent ability to recognise errors. Latent errors, active failures, error-producing factors and a series of effective defences to mitigate errors were identified through video analysis. Perceived influential factors affecting student performance within the scenario were attributed to aspects of academic and placement learning and the completion of a voluntary acute illness management course. The perceived value of the simulation scenario was enhanced by the opportunity to review their own simulation video with realism afforded by the scenario design.
This study presents a unique insight into the experiences, skills, attitudes, behaviours and error recognition abilities of pre-registration physiotherapy students managing an acutely deteriorating patient in a simulation context. Findings of this research provide valuable insights to inform future research regarding physiotherapy practice, integration of educational methods to augment patient safety awareness and participant-led innovations in safe healthcare practice.
毕业后，物理治疗师需要管理涉及病情复杂且不断恶化患者的临床工作量。特别是，急诊值班物理治疗师需要在正常工作时间之外，在没有高级物理治疗师支持的情况下提供呼吸/心肺/心胸物理治疗。为了优化患者安全，物理治疗师需要在复杂的临床环境中发挥作用，运用他们的知识和技能（技术和非技术），保持态势感知并过滤来自环境的不必要刺激。在本研究之前，尚不清楚最后一年的物理治疗专业学生在模拟情境中管理急性恶化患者以及识别自身实践中错误的能力如何。
进行了一项聚焦视频反思民族志研究，以探索来自一所高等教育机构的21名最后一年（预注册）物理治疗专业学生的行为、错误识别能力和个人经历。社会建构主义和复杂性理论观点为该研究的方法设计提供了依据。对12个模拟场景进行了视频和主题分析，并进行了视频反思访谈。
参与者按照入门级物理治疗师所期望的物理治疗实践专业标准开展工作。在场景中出现的情况不确定性和生理干扰中，学生们对自己和他人的行为做出了适当反应。然而，他们识别错误的独立能力有限。通过视频分析确定了潜在错误、主动失误、错误产生因素以及一系列减轻错误的有效防御措施。在场景中影响学生表现的感知影响因素归因于学术和实习学习方面以及完成一门自愿的急性疾病管理课程。模拟场景设计所提供的逼真度使学生有机会回顾自己的模拟视频，从而提高了对模拟场景的感知价值。
本研究对预注册物理治疗专业学生在模拟情境中管理急性恶化患者的经历、技能、态度、行为和错误识别能力提供了独特的见解。本研究结果为未来有关物理治疗实践、整合教育方法以增强患者安全意识以及参与者主导的安全医疗实践创新的研究提供了有价值的见解。
