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- Heiwe, Susanne, et al.
(författare)
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Evidence-based practice : attitudes, knowledge and behaviour among allied health care professionals
- 2011
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 23:2, s. 198-209
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore dieticians', occupational therapists' and physical therapists' attitudes, beliefs, knowledge and behaviour concerning evidence-based practice within a university hospital setting. Design: Cross-sectional survey. Setting. University hospital. Participants: All dieticians, occupational therapists and physical therapists employed at a Swedish university hospital (n = 306) of whom 227 (74%) responded. Main Outcome Measures: Attitudes towards, perceived benefits and limitations of evidence-based practice, use and understanding of clinical practice guidelines, availability of resources to access information and skills in using these resources. Results: Findings showed positive attitudes towards evidence-based practice and the use of evidence to support clinical decision-making. It was seen as necessary. Literature and research findings were perceived as useful in clinical practice. The majority indicated having the necessary skills to be able to interpret and understand the evidence, and that clinical practice guidelines were available and used. Evidence-based practice was not perceived as taking into account the patient preferences. Lack of time was perceived as the major barrier to evidence-based practice. Conclusions: The prerequisites for evidence-based practice were assessed as good, but ways to make evidence-based practice time efficient, easy to access and relevant to clinical practice need to be continuously supported at the management level, so that research evidence becomes linked to work-flow in a way that does not adversely affect productivity and the flow of patients. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
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| 2. |
- Heiwe, Susanne
(författare)
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Experienced physical functioning and effects of resistance training in patients with chronic kidney disease
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Physical fitness declines as chronic kidney disease progresses, and is approximately 50% of the expected norm when starting dialysis therapy This means that physical fitness in these patients is so reduced that it impinge on their ability and capacity to perform activities of daily livings. Muscular weakness, caused by for instance abnormal protein metabolism, is one of the main reasons for this decline in physical functioning. Therefore, it was of interest to study effects of resistance training initiated already in the pre-dialysis phase in purpose of reducing the loss of physical functioning. Studies have shown that patients with chronic kidney disease have a lower ’health-related quality of life’, especially within the physical domain, compared to the general population. However, these results are based on different ‘health-related quality of life’ questionnaires, which are based on predetermined assumptions of what is important to measure, and it is not self-evident that the choice of items for measurements reflects the perspective of the individual whose ‘health-related quality of life’ is being assessed. Another limitation is that these questionnaires result in sub-scores or total scores, and therefore do not provide information about the various ways in which patients with chronic kidney disease experience their physical functioning. Therefore, it was of interest to use semi-structured interviews to study patients’ experiences of their physical functioning and to analyse the various coping strategies used in order to be able to perform physical activities in the daily living. I. Elderly patients in the pre-dialysis phase had a lower muscular strength/endurance and physical functioning compared with elderly healthy subjects, but improved both after 12 weeks of low intensive resistance training to the same extent as in elderly healthy subjects. Thus, resistance training, already in the pre-dialysis phase, may provide patients with chronic kidney disease with a physical basis for maintaining functional autonomy, also after maintenance dialysis becomes necessary. To maintain the patient’s ability to continue caring for her-/himself is of personal benefit, but also of importance to society in reducing costs for medical- and social care. II. There was no indication that the resistance training programme has disadvantage effects on muscle fibre histopathology in elderly patients in the pre-dialysis phase. Further, there were no differences in either muscle fibre areas or in muscle fibre proportions in the healthy exercise group and the CKD exercise group, respectively, following regular resistance training. Thus, a workload of 60% of one repetition maximum seems to be sufficient to increase muscular strength and endurance in elderly patients in the pre-dialysis phase, but not to increase muscle fibre area or change muscle fibre type proportions. III. Patients with chronic kidney disease experienced mental and physical fatigue, reduced physical functioning in terms of impact on performance and endurance, and they also experienced temporal stress in terms of lack of time as well as lack of peace, from the health-care system, in their daily life situation. IV. Three components of coping activities were used by patients with chronic kidney disease to be able to perform physical activities in their daily living: scheduling, adjusting pace, and avoiding. The coping activities were mainly problem-focused, and the patients use active-, avoidant- and social-support coping strategies. However, emotional and cognitive coping strategies were also used. An interesting finding was that none of the informants mentioned using physical exercise as a coping activity, despite the fact that regular physical exercise has been shown to improve psychosocial well-being as well as physical functioning in patients with chronic kidney disease.
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| 3. |
- Heiwe, Susanne, et al.
(författare)
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Living with chronic renal failure : Coping with physical activities of daily living
- 2004
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 6:4, s. 147-157
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Several studies have shown that patients with chronic renal failure have a reduced physical exercise capacity compared to the expected norm. In a previous study, we described and analysed the various ways in which patients with chronic renal failure experienced their physical/functional capacity and their daily life situation. It became evident that the patients experienced their physical capacity as limiting in their daily life. Coping has been proposed as an important mediating factor with regard to adaptation to illness. In the present study, our aim was to describe and analyse the qualitatively different coping strategies used by these patients to be able to perform physical activities in their daily life. Methods: Semi-structured interviews were used to collect data, which were then analysed according to a phenomenographic approach. Results: Three overarching coping strategies were discerned and categorized through the analysis, scheduling, adjusting pace and avoiding. The strategies were problem-focused, and the patients used active-, avoidant- and social-support coping strategies. Conclusions: As there is a relationship between coping and health, knowledge of the various coping strategies is important with regard to the establishment and implementation of appropriate rehabilitation interventions for patients with chronic renal failure.
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| 4. |
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| 5. |
- Holdar, Ulrika, et al.
(författare)
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Why Do We Do As We Do? Factors Influencing Clinical Reasoning and Decision-Making among Physiotherapists in an Acute Setting
- 2013
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Ingår i: Physiotherapy Research International. - : John Wiley & Sons. - 1358-2267 .- 1471-2865. ; 18:4, s. 220-229
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Despite the current movement for health-care to become more informed by evidence, knowledge on effective implementation of evidence-based practice is scarce. To improve research application among physiotherapists, the process of implementation and clinical reasoning needs to be scrutinized. The aim of this study was to identify various experiences of factors that influence the physiotherapist's clinical reasoning in specialist care. METHODS: DESIGN: A phenomenographic approach was chosen. SUBJECTS: Eleven physiotherapists at two acute care hospitals in nn. PROCEDURE: Data was obtained by observations and interviews. Phenomenographic data analysis identified various experiences of clinical decision-making. ETHICAL CONSIDERATIONS: The Ethical Review Board of the nn approved the study. RESULTS: The observations and the interviews enabled identification of various experiences that influenced clinical decision-making. The physiotherapists' clinical reasoning was perceived to be constrained by contextual factors. The physiotherapists collected current information on the patient by using written and verbal information exchange and used this to generate an inner picture of the patient. By creating hypotheses that were accepted or rejected, they made decisions in advance of their interventions. The decisions were influenced by the individual characteristics of the physiotherapist, his/her knowledge and patient perceptions. CONCLUSIONS: Clinical reasoning is a complex and constantly evolving process. Contextual factors such as economy and politics are not easily changed, but factors such as the patient and the physiotherapist as a person are more tangible. Copyright © 2013 John Wiley & Sons, Ltd.
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