School of Health Sciences, University of Brighton, Eastbourne, UK.
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
Musculoskeletal Care. 2020 Dec;18(4):519-526. doi: 10.1002/msc.1496. Epub 2020 Jul 16.
Conceptual discussions related to clinical reasoning and decision making have evolved over the years from biomedical to incorporating more holistic approach to reasoning. Empirical studies exploring clinical reasoning and decision making in physiotherapy practice have mostly focused on aspects of managing persons with low back pain, such as exercise prescription, education and communicating diagnosis. There is a paucity of studies exploring decision making in whiplash-associated disorder (WAD); thus, the aim of this study was to explore the physiotherapists' lived experiences of decision making related to treating persons with WAD. A qualitative research design based on hermeneutic phenomenological methodology was used in this study. Five participants (physiotherapists) were purposefully recruited, and data are collected via semistructured interviews, which were recorded and transcribed verbatim. Interpretative phenomenological analysis (IPA) was used as a method for analysing the data. Emergent, superordinate and master themes emerged from the data to illuminate the lived experiences under exploration. Three master themes were identified: (1) sense of collaboration; (2) sense of being out of control; and (3) sense of emotional engagement (subthemes: feeling of satisfaction and feelings of distress and uncertainty). A sense of collaboration revealed varied meaning related to the role of persons receiving care, suggesting a lack of conceptual clarity related to shared-decision making. A perceived loss of a sense of being in control was related to experienced emotions, such as feelings of distress and uncertainty. The findings of this study highlight the importance of providing space for reflection and mentoring in the workplace.
多年来,与临床推理和决策相关的概念讨论已经从生物医学发展为纳入更全面的推理方法。探索物理治疗实践中临床推理和决策的实证研究大多集中在管理腰痛患者的方面,如运动处方、教育和沟通诊断。很少有研究探索挥鞭样损伤相关疾病(WAD)中的决策;因此,本研究旨在探讨物理治疗师在治疗 WAD 患者时的决策经验。本研究采用基于解释现象学方法的定性研究设计。通过半结构化访谈有目的地招募了 5 名参与者(物理治疗师),并收集数据,访谈内容进行了记录和逐字转录。解释现象学分析(IPA)被用作分析数据的方法。从数据中出现了出现、上级和主要主题,以阐明正在探索的生活经验。确定了三个主要主题:(1)协作感;(2)失控感;(3)情感投入感(子主题:满足感和痛苦感、不确定性)。协作感揭示了与接受护理的人角色相关的不同含义,表明与共同决策相关的概念不清。失去控制感与经历的情绪有关,例如痛苦和不确定性的感觉。本研究的结果强调了在工作场所提供反思和指导空间的重要性。