微观、中观和宏观层面之间的紧张关系：物理治疗师对其在社区预防跌倒中的角色的看法——一项定性研究。
The tensions between micro-, meso- and macro-levels: physiotherapists' views of their role towards fall prevention in the community - a qualitative study.
机构信息
Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, 0130, Oslo, Norway.
出版信息
BMC Health Serv Res. 2020 Feb 6;20(1):97. doi: 10.1186/s12913-020-4940-1.
BACKGROUND
Falls are a global public health concern. Physiotherapists are a key resource in this context, but there is sparse knowledge about how they perceive their role in the primary care setting. Therefore, the purpose of the present study is to explore physical therapists' (PTs) view of how they experience and perceive their role working with fall prevention in a community care setting.
METHODS
Semi-structured interviews were conducted with 17 physiotherapists. Data were analysed using a qualitative thematic analysis.
RESULTS
The analysis resulted in a core theme and three subthemes. The core theme was 'capability to cope with the tensions between the micro-, meso- and macro-levels in fall, prevention', which indicated the importance of an evolving multifaceted, evidence based and innovative physiotherapy role. A key factor for this role is to take an integrative biopsychosocial approach based on how biological and psychosocial factors are uniquely related in fall prevention. The three themes were as follows: 1) always moving and changing: the competent explorative knowledge-hungry clinician's multifaceted role; 2) multiprofessional - but in the end alone; 3) reaching out - from the bottom to the top. Success in the role of physiotherapists in fall prevention depends on the empowering leadership and working culture, as well as on the time and multifaceted professional competence of the clinicians.
CONCLUSION
Our findings indicate that the PTs' role reflects their abilities to change and improve their professional work in accordance with evidence based knowledge. To ensure good quality the PTs focused on the special needs of the patients, evidence-based fall prevention, interdisciplinary team work, good clinical competences, good skills in communication, and interpersonal relations. Attention should be placed on the importance of biopsychosocial perspective framing in the actual clinical and political context. The PTs saw the need for working at the micro-, meso- and macro-levels to succeed in the work of fall prevention.
背景
跌倒在全球范围内都是一个公共卫生关注点。在这种情况下，物理治疗师是一个关键资源，但关于他们如何看待自己在初级保健环境中的角色的知识却很少。因此，本研究的目的是探讨物理治疗师（PT）如何体验和感知自己在社区护理环境中预防跌倒的工作角色。
方法
对 17 名物理治疗师进行了半结构化访谈。使用定性主题分析对数据进行分析。
结果
分析产生了一个核心主题和三个子主题。核心主题是“在跌倒预防中应对微观、中观和宏观层面之间紧张关系的能力”，这表明了一个不断发展的多方面、基于证据和创新的物理治疗角色的重要性。这个角色的一个关键因素是基于生物和心理社会因素在跌倒预防中独特相关的方式，采取综合的生物心理社会方法。三个主题如下：1）不断移动和变化：有能力的探索性、求知欲强的临床医生的多方面角色；2）多专业——但最终是孤独的；3）从下到上的拓展。物理治疗师在预防跌倒中的角色的成功取决于赋权的领导力和工作文化，以及临床医生的时间和多方面的专业能力。
结论
我们的研究结果表明，PT 的角色反映了他们根据循证知识改变和改进专业工作的能力。为了确保高质量，PT 专注于患者的特殊需求、基于证据的跌倒预防、跨学科团队合作、良好的临床能力、良好的沟通和人际关系技能。应重视生物心理社会视角在实际临床和政治背景下的重要性。PT 们认为需要在微观、中观和宏观层面上开展工作，以在预防跌倒的工作中取得成功。
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