Managing (im) patience of nurses and nurse's aides: Emotional labour and normalizing practices at geriatric facilities.

Nurses and nurse's aides at geriatric facilities face demanding patients and challenging situations that trigger undesired emotions. The psychological implications of care workers' emotional labour have been extensively researched, but not so their emotional experiences and the regulation of these emotions aimed at normalizing the extraordinary situations that arise in the course of geriatric care. The present study is based on data collected in interviews with 36 nurses and nurse's aides, and nine health professionals and management-level employees, on participant observations, and on field notes collected over a period of 14 months at two geriatric institutions in Israel. The data reveal the construction of patience and impatience as the pivotal emotional experience that needs regulation to cope successfully with extraordinary situations. The findings suggest that strict patience-display rules were constructed as an occupational impetus that exacts a price by increasing emotional load. Patience was regulated continually by normalizing practices that were culturally embedded in the organizations, by reframing patients' abusive behaviours, and by diffusing undesired emotions using detachment and disengagement practices. The findings contribute to the scarce empirical research on emotional labour of nurse's aides, and to the conceptualization and empirical study of nurses' normalizing regulation practices as cultural-organizational artefacts.

Qualitative exploration of physical therapists' experiences providing telehealth physical therapy during COVID-19.

BACKGROUND: Physical therapists are trained to provide treatment to patients through a mixture of strategies. The coronavirus (COVID-19) pandemic resulted in social distancing restrictions, and physical therapists, some without previous experience, adopted telehealth physical therapy modalities to treat their patients. OBJECTIVES: The objective of this study was to explore physical therapists' experiences of providing telehealth physical therapy during the COVID-19 pandemic. DESIGN AND METHODS: A multisite qualitative semi-structured interview study was conducted. Seventeen physical therapists were interviewed by videoconference or by phone, and the interviews were transcribed and analyzed thematically. RESULTS: Three main themes emerged from the study. Firstly, physical therapists experienced professional challenges with diagnosing and treating patients hands-off and becoming more verbal. Secondly, telehealth physical therapy was perceived as not feasible or effective for certain patients, attesting to the digital care divide. Lastly, participants' perceptions of patient-therapist communication varied, expressing both communicative advantages and challenges. CONCLUSIONS: Physical therapists who practiced telehealth physical therapy during the COVID-19 period experienced information and communication technology as professionally challenging. Physical therapists adapted positively to the use of telehealth physical therapy but perceived that not every patient could benefit from it. The study emphasized the need for a better understanding of physical therapists' hands-off skills for practicing telehealth physical therapy and considers the need to establish a patient classification for telehealth physical therapy.

Gaining access to the field in medical ethnography: Reflections on ethical, methodological, and structural challenges in the study of long-term care facilities.

The article extends the discussion on the challenges in gaining access to the field in medical ethnographic research, focusing on long-term care (LTC) facilities. Medical institutions have been documented to be difficult sites to access. The reference, however, is to the recruitment of patients as informants. The challenges of recruiting practitioners as informants have not been investigated at all. The article presents the key issues that emerged in the process of gaining social access at the sites of two LTC facilities as part of a study on care workers' identities. The main obstacles encountered during the fieldwork were organizational constraints and negotiating control over the process of recruiting the lower occupational tier of care workers with gatekeepers. The article presents the coping strategies implemented to overcome the ethical and methodological obstacles: continually reassessing the consent and cooperation of participants and developing a rapport with nurse's aides during interviews.

Physiotherapy services during the COVID-19 pandemic: A mediated model of physiotherapists' self-efficacy, tele-physiotherapy role stressors, and motivation to provide tele-physiotherapy.

BACKGROUND: Occupational self-efficacy is a stable predictor for professionals' motivation to engage with new methods and tasks. Yet, the delivery of tele-physiotherapy (Tele-PT) by physiotherapists (PTs) during the coronavirus disease of 2019 (COVID-19) outbreak without advance training may have had the potential to increase work stress and damage their motivation, regardless of their occupational self-efficacy. OBJECTIVES: The present study examined whether the relations between PTs' overall occupational self-efficacy and motivation to provide Tele-PT was mediated by role stress (i.e. role conflict and ambiguity). DESIGN AND METHOD: Between February 4 and April 23, 2021, 150 Israeli PTs completed an online survey that measured their overall occupational self-efficacy, their role stress induced by the provision of Tele-PT, their motivation to provide Tele-PT, and their demographic characteristics. RESULTS: PTs' overall occupational self-efficacy was positively associated with PTs' motivation to provide Tele-PT (r= 0.328, p < .01) and fully mediated by role conflict (0.1757, 95% CI = [0.0231, 0.3797]) and by role ambiguity (0.1845, 95% CI = [0.0196, 0.4184]) (components of role stress) caused by the provision of Tele-PT. CONCLUSIONS: It is important to investigate the predictors and mediators of the motivation to provide Tele-PT because in the post-COVID-19 era health organizations are likely to adopt many tele-medicine services, and they need to find ways to mitigate perceived challenges.

Physiotherapists' accounts of fibromyalgia: role-uncertainty and professional shortcomings.

PURPOSE: This article examines accounts of fibromyalgia provided by physiotherapists. This qualitative study asks how physiotherapists define and understand fibromyalgia, what professional resources are available to them for treating patients, and where physiotherapists can turn when facing the scarcity of professional resources. METHOD: The data were collected by means of semi-structured, in-depth, face-to-face interviews, conducted with 20 practicing physiotherapists. The physiotherapists were recruited using a purposive-sampling strategy and had extensive experience treating fibromyalgia patients (mean value: 6.5 years). The authors analyzed the interviews in accordance with the methods of thematic analysis. RESULTS: The study findings expose two overarching themes: (a) fibromyalgia as an ambiguous and uncertain diagnosis: physiotherapists devalue the diagnosis, referring to it as a syndrome rooted on psychological factors; (b) role ambiguity and creativity in physiotherapy treatment: by questioning their role, physiotherapists end up focusing on illness management and developing creative treatments. CONCLUSIONS: The study concludes that treating fibromyalgia patients challenges physiotherapists, mainly because of professional shortcomings. The findings highlight the necessity to train physiotherapists to respond to the needs of their patients with greater competence and less ambivalence.Implications for rehabilitationHealth providers need to acknowledge the difficulty physiotherapists are facing when providing treatment to fibromyalgia patients.Physiotherapists treating fibromyalgia should undergo special training to reduce their uncertainty and role ambiguity.Health providers should improve communication between physiotherapists and the General Practitioners referring fibromyalgia patients, to enable them to set shared evidence-based treatment goals.

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.

Translation and psychometric evaluation of the Hebrew version of the Health Care Providers' Pain and Impairment Relationship Scale.

BACKGROUND AND PURPOSE: Physiotherapists' different attitudes towards low back pain (LBP) are associated with patients' attitudes towards pain and with patients' disability. The Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) is a self-administered instrument that assesses the attitudes and beliefs of health care professionals regarding LBP and the patient's daily function. The aims of this study are to translate, culturally adapt, and asses the psychometric properties of the Hebrew version of the HC-Pairs. METHODS: The English version of the HC-Pairs was forward-backward translated, pretested, and reviewed by a panel of experts. Reliability was determined by computing Cronbach's α, and validity by exploring the correlations between the HC-Pairs' scores and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) scores. Confirmatory factor analysis was performed. A convenience sample of 277 physiotherapists was invited to fill the HC-Pairs and PABS-PT questionnaires and a sociodemographic questionnaire. RESULTS: The forward-backward translation process revealed minor discrepancies between the texts. After the pretest, the expert panel agreed on a final version. A sample of 241 physiotherapists completed the questionnaires (response rate of 87%; 241/277); 213 met the inclusion criteria. Factor analysis suggests that the Hebrew version of the scale fits the one-factor model. Cronbach's α was 0.81 after deletion of two items and indicated good internal consistency. The scores produced by the instrument showed a substantial correlation with those of the biomedical dimension of the PABS-PT, and poor correlation with the behavioural dimension, in the expected directions. CONCLUSION: The findings of the present study on the psychometric properties of the HC-Pairs are positive. Nevertheless, the Hebrew version of the HC-Pairs is still in a developmental stage. Further psychometric research is needed to assess the attitudes and beliefs of Hebrew-speaking physiotherapists, which have been shown to be associated with treatment orientations and work recommendations.

When practice does not make perfect: well-practiced handwriting interferes with the consolidation phase gains in learning a movement sequence.

Practice on a novel sequence of movements can lead to two expressions of procedural memory consolidation: delayed performance gains evolving hours after training, and a decrease in the susceptibility of the training-related gains to interference by subsequent experience. It has been assumed that behavioral interference occurs only if a critical overlap between the representations of the two tasks exists, and that such overlap is more likely when the two tasks are novel, competing for general resources for their execution. We investigated whether the delayed gains in the simple finger-opposition sequence (FOS) learning task are more prone to interference by well practiced than by less practiced complex hand movements. Participants were trained on the FOS task in a baseline (no interference) and an interference training condition. In the Interference condition, after FOS practice, participants wrote Hebrew common words in Hebrew (native script) or a Latin script (Heblatin). Native script writing but not the less practiced Heblatin, interfered with FOS learning, with significantly reduced delayed gains. Our results show that interference can occur even when two tasks share little or no kinematic or dynamic features and indicate that the representation of complex but well-practiced movement sequences may overlap with the representation of simpler ones. This result is in line with the notion that well-practiced complex movement sequences come to be represented as simpler ones in long-term motor memory.