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C. Watkins1
1Keele University, School of Allied Health Professions, Newcastle-under-Lyme, United Kingdom
Background: Beliefs and values of healthcare professionals can greatly influence the quality of care delivered to older adults. As such, practice may be positively or negatively influenced by past experiences and interactions, with resultant impact on quality of care.
Purpose: The aim of this study was to explore physiotherapists’ clinical experiences with older adults, including practice within a secondary care setting, and how these experiences may have informed their practice.
Methods: Purposive sampling was used to recruit physiotherapists working in a secondary care hospital in the United Kingdom (N=15) with a range of experience (2-30 years) working in clinical areas that included interactions with older adults. Data were collected utilising semi-structured interviews and a phenomenological approach. Audio recordings were transcribed verbatim and thematic analysis was undertaken. Findings from the themes ‘The practitioner journey’ and ‘Practice challenges’ are presented.
Results: In the practitioner journey theme, nine participants (all qualified physiotherapists) of varied grade and experience identified a range of specific seminal experiences from their clinical practice, which were a mix of both positive and negative interactions with older adults. Some experiences, linked to patients with confusion/dementia, involved situations that significantly challenged or reframed their understanding about this patient group. Other participant experiences involved situations where they felt they had first recognised the person within the patient. Finally, some participants had gained a fuller understanding of holistic management, of balancing care with quality of life and recognising the vulnerability of this patient group. These seminal experiences had engendered an (often implicit) positive evolution in/enhancement of their practice.
Participants identified several practice challenges, particularly around organisational practices. Institutional labelling of all older adults, regardless of ability, cascaded down to clinical practice, with care based less on individual ability and more on stereotypical expectations reinforced by institutional practices, such as segregation of older adults based upon age alone. They described a tension between institutional aims, such as quick discharge, and their own desire to continue to provide therapy to achieve effective rehabilitation. Their mitigation strategies included using their voice to advocate for further rehabilitation, education of other healthcare professionals, and developing/maintaining stronger links with community services. Participants recognised the pressures inherent in secondary care, such as high admissions and limited bed availability, which were key drivers in organisational practices. However, they felt that small changes in ethos such as condition rather than age-based practice and removal of the label of ‘frail elderly’ wards would benefit both the organisation and the individual patient.
Participants identified several practice challenges, particularly around organisational practices. Institutional labelling of all older adults, regardless of ability, cascaded down to clinical practice, with care based less on individual ability and more on stereotypical expectations reinforced by institutional practices, such as segregation of older adults based upon age alone. They described a tension between institutional aims, such as quick discharge, and their own desire to continue to provide therapy to achieve effective rehabilitation. Their mitigation strategies included using their voice to advocate for further rehabilitation, education of other healthcare professionals, and developing/maintaining stronger links with community services. Participants recognised the pressures inherent in secondary care, such as high admissions and limited bed availability, which were key drivers in organisational practices. However, they felt that small changes in ethos such as condition rather than age-based practice and removal of the label of ‘frail elderly’ wards would benefit both the organisation and the individual patient.
Conclusions: These findings suggest that past clinical experiences clearly influenced participant’s current practice. Whilst more negative experiences had the potential to adversely influence perceptions, they were instead used as drivers to develop/enhance practice and ensure better care for older patients.
Implications: These findings suggest that physiotherapists’ implicit reflections on practice resulting from their dynamic interactions with their patients have a direct influence on their practice with older adults. In situations with organisational challenges, opportunities for best practice need to be maximised and physiotherapists are ideally positioned to mitigate some of these challenges.
Funding acknowledgements: This work was unfunded
Keywords:
Experiences
Challenges
Practice
Experiences
Challenges
Practice
Topics:
Older people
Professional practice: other
Older people
Professional practice: other
Did this work require ethics approval? Yes
Institution: Keele University
Committee: University Ethics Review Panel
Ethics number: No number provided
All authors, affiliations and abstracts have been published as submitted.
