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FACTORS AFFECTING THE CLINICAL DECISION MAKING AMONG NOVICE PHYSICAL…
FACTORS AFFECTING THE CLINICAL DECISION MAKING AMONG NOVICE PHYSICAL THERAPIST CLINICIANS
To explore on contributory/hindering factors in performing clinical decision making
Patient related factors
• Patient’s Attitude and Behaviors
Physically challenged Due to Demanding patients
Comparison to treatment
Conflicts towards Patient’s preference
Compliance to Patient preference
Adjusting to patient’s negative attitude
Understanding in-pain patients’ attitudes.
Coping with various patient attitudes
Patient’s noncompliance to therapy sessions.
• Family Involvement
Conflicts towards decision making due to overly involved family.
Dealing with overly involved and nosy relatives
One consideration to overly involved family.
Therapy conflicts due to guardians perspective
Difficulty Coping with overlmeticulouss guardians
One sense of difficulty towards motivating family to therapy sessions.
Family motivation towards patient
Consideration of family’s reaction towards therapy exercises.
Dealing with overly involved and nosy relatives
Patient’s Financial Issues
Patient’s financial issues
Lack in Financial assistance
Patient’s financial difficulties.
Patient’s financial issues
Financially unstable patients
• Patient Participation
Peer Teaching as to patient management
Patient’s motivation
Patient’s sense of fear towards therapy exercise.
Practice environment related factors
• Rehabilitation Team Collaboration
Protocols (Intern's decision and Doctor's clearance.)
Discussion within the rehab team
Conflicts in Communication with Doctors
Rehab Team (Interns and doctors) Collaboration in decision making
Doctor’s misdiagnosis of the patient’s condition.
Humiliation due to Doctor’s misdiagnosis.
Accommodative co-workers as source of guide in workplace.
One sense of degadedness by Condescending doctors
Compliance due to Doctor’s authority
Strictness of clinic staff.
One sense of collaboration in clinical setting.
Doctor’s prescription exercise as basis of decision making.
Strictly Following Doctor’s protocol
Therapist discretion on treatments
Overly involved relatives
• Heavy Workload
Accomodation of too many patients
Intervention conflicts due to number of patients affecting their progress.
Fully booked appointments
PT workload
• Limited Equipment and Facility
Insufficient equipments
Difficulty in shift of therapy setting.
Difficulty in in Following strict protocol
Experience of burnout in clinical setting
Lack of supervision in homecare setting.
Different clinical setting (Physical fitness sessions)
Insufficient equipment delaying the patient’s treatment.
Personal related factors
• Time Management
Therapist-patient schedule conflicts
Delayed in treatment due to Doctor’s tardiness
Struggle on Time Management caused by number of patients
Schedule conflicts of endorsements
Multitasking of treatment management
Time management and prioritization
• PT Competence
Compliance to Patient preference
Competence as Self-assurance in PT field.
Continuous learning through patient's unusual cases.
Re-checking doctor's intervention based on patient's presentation.
Clinical competence
To explore on strategies to improve the respondents’ clinical decision making
Strategies in improving practice environment factors
• Innovative PT services
Improper physician’s assessment due to patient's incomplete medical history.
Home exercise as aid to financial difficulties of patients.
Therapist strictness to motivate Patient’s compliance
Modification of ineffective treatments with doctor's consent
Following different protocols
Strategies in improving PT-Patient Relationship
• Establishing PT-Patient and Family Rapport
Building rapport
explanation of the the importance of treatment sessions
patient education of the importance of home exercise.
adjusting to patient needs
Strategies in improving personal related factors
• Improving PT knowledge and treatment
Continuation of studies and social media educational platforms
Patient’s condition promotes further knowledge of the therapist
Seminars for additional knowledge
Continuous Learning
Using EBP for new ways to treat (2)
Learning from co-workers’ expeiences.
Updating curent learnings through seminars/continuos education
Seminar for additional knowledge’
Applying educational knowledge in the clinic
Improving treatments for patients through research
Continuous Learning
Collaborating with co-workers resulting ro broader knowledge
Strategies in improving patient related factors
• Patient centered Treatment
Importance of initial interviews for Adjusting to patient’s capability
Patient’s environment modification
Home exercise compliance resulting to improvements during sessions.
Re-assessment of home exercises.
To explore on the factors affecting the respondent’s clinical decision making
Personal related factors
• Negative Personal Factors
One sense of Uncertainty.
Own case preference according to one's training
Difficulty in Coping with patients that have professions.
Uncertain with things to do
Overconfidence of PTs.
Self-doubt
PT depends on patient’s manifestation
• Positive Personal Factors
Stress management
Overqualification on the assigned task.
Handling different patients
Clinical Experience as basis for making decisions.
Own Creative strategy in making clinical decisions.
Continuing education as strategy.
Clinical Confidence
Further studies of the clinical field to generate strategies.
Dedication towards treating patients
One sense of joy and pity over patients
One sense of clinical competency towards treatment decision
Independence in treatment management with doctor’s consultation.
Confidence as assurance of patients and family
Clinical competence
Adaptiveness of treatments through improvisions of creativity
Book reference and internet
PT rationale
Patient related factors
• Family Involvement
Conflicts towards decision making due to overly involved family.
Dealing with overly involved and nosy relatives
One consideration to overly involved family.
therapy conflicts due to guardians perspective
Difficulty Coping with overlmeticulouss guardians.
One sense of difficulty towards motivating family to therapy sessions.
Family motivation towards patient
Consideration of family’s reaction towards therapy exercises.
Dealing with overly involved and nosy relatives
Patient’s Financial Issues
Patient’s financial issues
Lack in Financial assistance
Patient’s financial difficulties.
Patient’s financial issues
Financially unstable patients
Practice environment related factors
• Rehabilitation Team Collaboration
Conflicts in Communication with Doctors
Rehab Team (Interns and doctors) Collaboration in decision making
Protocols (Intern's decision and Doctor's clearance.)
Doctor’s misdiagnosis of the patient’s condition.
Humiliation due to Doctor’s misdiagnosis
One sense of degadedness by Condescending doctors
Compliance due to Doctor’s authority
Strictness of clinic staff.
One sense of collaboration in clinical setting.
Accommodative co-workers as source of guide in workplace.
Delayed in treatment due to Doctor’s tardiness
Ineffective management given by doctors
Distant approach of Doctors to PTs
Colleagues close relationship.
: Good relationship among colleagues benefit endorsement management
Ineffective doctors order.
Treatment suggestions promote trust with the doctor
Unfamiliarity towards doctors prescription
Goal coordination thru good team communication
Following doctors protocol
Inquiries regarding doctor's prescription through Communication
Comparing PTs through treatments
handful doctors prescriptions
Good relationship with co-workers
Patient’s betterment as main team goal.
• Limited Equipment and Facility
Insufficient equipment delaying the patient’s treatment.
Insufficient equipments
Difficulty in shift of therapy setting.
Difficulty in in Following strict protocol
Experience of burnout in clinical setting
Lack of supervision in homecare setting.
Different clinical setting (Physical fitness sessions)
PT-Patient Relationship
•Establishing Rapport
Build a of rapport good establishment among patients.
Building a trusting relationship w/ patients
Therapist-patient Good rapport
Gradual Building rapport w/ patients
Patient Centered Treatment
Promoting Patient Motivation
Motivation through patient’s understanding of therapy purpose.
Strategic adaptiveness of strategic planning of patient’s therapy routines.
Treatment Progression
Patient Education
Long term rehabilitation
Patient compliance
Patient’s responses an indication of treatment effectiveness.
One sense of fulfilment towards patients progress
One sense of compliance on Challenging patient endorsements.
Assessment of Patient's progression
Good Communication benefit patient endorsement
Individualized PT Treatment
Handling patients of different cases.
Education of patient regarding the purpose of the activity.
Patient education
Patient's unawareness of real condition knowledge
Initial Assessment of patient’s Impairments
Patient’s tolerance capacity towards exercise.
Prior Explanation of treatment purpose
Educating patients about possible home exercises
Assessment as source of identifying patient's needs
Assessing for impairments
Impairment Assessment procedure in making clinical decision
Assessment every session
Patient’s Personal Background and Medical History
Firm decision making based on Patient’s capacity.
Patient’s Check-up record.
Patient’s medical history
Therapist’s physical difficulty due to patient’s body weight.
Patient’s history/background
Patient’s various presentations.
Treatment caution to Patient’s capacity
Repetition of maintenance in geriatics
Patient’s presentation
treatments based on Patient’s capacity
Patient and treatment assessment
Lifestyle as source of patient’s condition
Patient’s profile and background.
Patient’s presentation
Theoretical knowledge and Patient presentations
Patient’ Background
Therapy treatments based on Individual patient presentations
Treatment based on Patient’s presentation
Patient’s unattainable goals due to condition.
Incompatible treatments due to Patient background
choosing treatments that are feasible for the patient