Making breathing your business: enterprising practices at the margins of orthodoxy

"I've learned to look at things in a different way": exploring patients' perspectives on participation in physiotherapist delivered integrated stress inoculation training and exercise for acute whiplash

PURPOSE

To explore patient perspectives of the integrated intervention (intervention arm) of a recent randomised clinical trial that found clinically relevant and sustained benefits of a physiotherapist delivered integrated stress inoculation training (SIT) and exercise for people with acute whiplash-associated disorders (WAD) and at risk of poor recovery.

MATERIAL AND METHODS

Twelve patients from the 53 who participated in the SIT and exercise arm of a randomised controlled trial (StressModex RCT) participated in semi-structured interviews. Data were analysed using inductive thematic analysis.

RESULTS

Five main themes were identified: "balance between the physical and psychological components," "dealing with stress," "coping with the injury," "pain relief and return to function," and "elements enhancing therapeutic alliance."

CONCLUSIONS

The majority of patients found the SIT techniques to be helpful in managing stress and pain, coping with their injury, and returning to function. The patients also found the exercises useful and acknowledged the importance of both the physical and the psychological aspects of whiplash injury.IMPLICATIONS FOR REHABILITATIONPatients with acute WAD at risk of poor recovery welcomed the inclusion of psychological strategies as part of physiotherapy treatment.The patients nominated both the psychological (SIT) component and exercise as assisting them with their stress, pain, and recovery.Physiotherapists could consider including strategies targeting early stress responses in their management of patients with acute WAD.

Physiotherapists' attitudes toward low back pain treatment: Do work setting and clinical experience with low back patients matter?

RATIONALE, AIMS, AND OBJECTIVES

Physiotherapists' attitudes toward low back pain (LBP) are linked to patients' attitudes toward pain, chronicity, and disability. Nevertheless, there is a scarcity of studies exploring the variables associated with physiotherapists' attitudes. The present study seeks to explore whether there is an association between the physiotherapists' work setting and their attitudes toward LBP, whether there is an association between the physiotherapists' clinical experience with LBP patients and their attitudes toward LBP, and which variable best predicts physiotherapists' attitudes toward LBP.

METHOD

A self-administered questionnaire was used to collect the data which included a socio-demographic section, self-reports about the work setting, and a clinical experience section. Participants also completed the 15-item Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) questionnaire. The HC-Pairs is scored on a 7-point Likert scale, a high score indicating a stronger belief that pain limits daily function.

RESULTS

A total of 213 physiotherapists completed the questionnaire. The mean HC-Pairs score of community-orthopaedics physiotherapists was significantly lower than that of non community-orthopaedics physiotherapists (mean 44.02- + 9.44 vs 48.69- + 10.89, t = -3.29, P < 0.001) indicating that community-orthopaedics physiotherapists hold a weaker belief that pain limits daily function. Analysis suggests that there is a statistically significant difference in the mean HC-Pairs scores between the high-frequency and the low-frequency group (F = 4.688, P < 0.05) implicating that as physiotherapists experience more frequent encounters with LBP patients, their belief that pain limits daily function of these patients weakens. Work setting is the only variable that predicts the HC-Pairs scores.

CONCLUSIONS

There is an association between physiotherapists' work setting and clinical experience with LBP patients and their attitudes toward LBP. These findings have implications for future educational programs for physiotherapists and suggest the need to adapt programs to the work setting of physiotherapists and to their level of clinical experience.

Health sociology from post-structuralism to the new materialisms

The article reviews the impact of post-structuralism and postmodern social theory upon health sociology during the past 20 years. It then addresses the emergence of new materialist perspectives, which to an extent build upon insights of post-structuralist concerning power, but mark a turn away from a textual or linguistic focus to address the range of materialities that affect health, illness and health care. I conclude by assessing the impact of these movements for health sociology.

Self-employed nurses as change agents in healthcare: strategies, consequences, and possibilities

Purpose

– The purpose of this paper is to report on ethnographic research that investigated how self-employed nurses perceive the contemporary healthcare field, what attributes they possess that facilitate their roles as change agents, what strategies they use to influence change, and what consequences they face for their actions, thus contributing to what is known about organizational change in institutionalized settings such as healthcare.

Design/methodology/approach

– Focussed ethnography was used to explore self-employed nurses’ work experiences and elucidate the cultural elements of their social contexts, including customs, ideologies, beliefs, and knowledge and the ways that these impact upon the possibilities for change in the system.

Findings

– These self-employed nurses reflected on the shortcomings in the healthcare system and took entrepreneurial risks that would allow them to practice nursing according to their professional values. They used a number of strategies to influence change such as capitalizing on opportunities, preparing themselves for innovative work, managing and expanding the scope of nursing practice, and building new ideas on foundational nursing knowledge and experience. They had high job satisfaction and a strong sense of contribution but they faced significant resistance because of their non-traditional approach to nursing practice.

Originality/value

– Despite dramatic restructuring in the Canadian healthcare system, the system remains physician-centered and hospital-based. Nursing ' s professional potential has been largely untapped in any change efforts. Self-employed nurses have positioned themselves to deliver care based on nursing values and to promote alternative conceptions of health and healthcare. This study offers a rare exploration of this unique form of nursing practice and its potential to influence health system reform.