物理治疗师对循证实践面临的挑战的看法以及环境赋权在预防市政跌倒中的重要性——一项定性研究。
Physiotherapists' perceptions of challenges facing evidence-based practice and the importance of environmental empowerment in fall prevention in the municipality - a qualitative study.
机构信息
Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
出版信息
BMC Geriatr. 2020 Oct 29;20(1):432. doi: 10.1186/s12877-020-01846-8.
BACKGROUND
Falls in older adults are an increasingly important public-health concern. Despite abundant research, fall rates have not been reduced, because implementation of evidence-based fall-prevention measures has been slow and limited. This study aims to explore physiotherapists' perceptions on external factors, such as public policy, organisation and leadership, regarding the relation between knowledge translation and the three elements of evidence-based practice (EBP) to effectively address barriers and facilitate the uptake of EBP in fall prevention.
METHODS
We conducted semi-structured interviews with 18 physiotherapists (men = 7; women = 11) working with fall prevention in the primary healthcare system. The physiotherapists ranged in age from 27 to 60 years (median 36 years) and had worked as a physiotherapist from 1 to 36 years (median 7 years). Data are analysed using thematic analysis.
RESULTS
The analysis revealed one main theme and four sub-themes. The main theme was 'Environmental empowerment enhances physiotherapists' capabilities for using EBP'. A resourceful work environment facilitates EBP, having access to information about research-based knowledge, supportive leadership, enough human resources and opportunities to learn and grow at work. The four sub-themes were as follows: 1) 'Tension between attributes of research-based knowledge and organisational routines and practices'; 2) 'Evidence must be informed by policymakers-What works?'; 3) 'Empowering culture and work environment-A steppingstone to EBP' and 4) 'Organisation readiness for EBP, managerial and clinical relations'. Success in environmental empowerment depends on the leader's role in creating preconditions at the workplace that may lead to important positive personal and organisational outcomes for EBP. Two-way communication and transfer-of-information are also key factors in the development of positive work engagement when using EBP.
CONCLUSION
The findings of this study outline tension between policy, leadership, organisational facilitators and EBP. Leadership is influenced by policy with ripple effects for the organisation and clinicians. Organisational facilitators form structural empowerment, which is the foundation for creating an EBP environment.
TRIAL REGISTRATION
2018/2227/REC south-east C. Registered 19 December 2018, Norwegian Ethics Committee for Medical and Health Research Ethics.
背景
老年人跌倒已成为日益严重的公共卫生问题。尽管有大量研究，但跌倒率并未降低，因为实施基于证据的预防跌倒措施进展缓慢且有限。本研究旨在探讨物理治疗师对公共政策、组织和领导力等外部因素的看法，这些因素与知识转化和基于证据的实践（EBP）的三个要素有关，以有效解决障碍并促进跌倒预防中 EBP 的采用。
方法
我们对 18 名在初级医疗保健系统中从事跌倒预防工作的物理治疗师（男性 7 名；女性 11 名）进行了半结构化访谈。这些物理治疗师的年龄从 27 岁到 60 岁（中位数 36 岁），从开始从事物理治疗师工作到现在的时间为 1 年到 36 年（中位数 7 年）。数据采用主题分析进行分析。
结果
分析结果揭示了一个主要主题和四个子主题。主要主题是“环境赋权增强了物理治疗师使用 EBP 的能力”。一个资源丰富的工作环境促进了 EBP，使他们能够获得有关基于研究的知识的信息、得到支持性的领导、有足够的人力资源以及有机会在工作中学习和成长。四个子主题分别是：1）“基于研究的知识属性与组织惯例和实践之间的紧张关系”；2）“证据必须由决策者告知——什么有效？”；3）“赋权文化和工作环境——迈向 EBP 的垫脚石”和 4）“EBP 的组织准备、管理和临床关系”。环境赋权的成功取决于领导者在工作场所创造前提条件的作用，这可能会为 EBP 带来重要的积极的个人和组织成果。双向沟通和信息传递也是在使用 EBP 时发展积极工作投入的关键因素。
结论
本研究的结果概述了政策、领导力、组织促进因素和 EBP 之间的紧张关系。领导力受到政策的影响，对组织和临床医生产生连锁反应。组织促进因素形成结构赋权，这是创建 EBP 环境的基础。
试验注册
2018/2227/REC 东南 C。于 2018 年 12 月 19 日注册，挪威医学和健康研究伦理委员会。
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