Holding space and sitting with emotions: the lived experiences of physiotherapists using psychological strategies in pain care.

BACKGROUND: Persistent pain is the biggest global cause of years lived with disability. Physiotherapists working in pain care aim to take a holistic perspective helping persons to gain a multidimensional understanding of their condition and achieve meaningful goals despite their symptoms. In recent years there has been a paradigm shift in physiotherapeutic pain care toward a psychologically informed physiotherapy approach. Physiotherapists have incorporated principles of strategies such as: cognitive behavioral therapy (CBT); acceptance and commitment therapy (ACT); psychological flexibility; or mindfulness-based therapies in helping persons move forwards despite their pain. OBJECTIVES: The purpose of this study was to explore the lived experience of physiotherapists using psychological strategies in pain care. METHODS: Seven participants were purposefully recruited for this study and data was collected through semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Master themes were developed to help express the qualitative meanings of the lived experiences. FINDINGS: Seven master themes were identified: 1) Trust; 2) Active listening; 3) Developing understanding; 4) Exploring the journey; 5) Making it meaningful; 6) Being held; and 7) Holding space and sitting with emotions. All themes are interwoven and profoundly connected in the essence of a safe "space." CONCLUSION: Participants described a journey toward holding space and sitting with emotions. All themes were interwoven and profoundly connected in the essence of a safe "space," where persons can voice their emotions in a non-judgmental environment. The themes may represent a pathway for the physiotherapist to facilitate a person on their journey of healing.

Societal beliefs about pain may be more balanced than previously thought. Results of the Guernsey pain survey.

BACKGROUND: Musculoskeletal pain is multidimensional and associated with significant societal impact. Persistent or chronic pain is a public health priority. A step towards high-value care is a contemporary understanding of pain. While pain-related knowledge has been examined in specific conditions (e.g. neck pain) knowledge of the public's broader understanding regarding musculoskeletal pain per se, warrants investigation. This study examined the public's knowledge and beliefs regarding musculoskeletal pain and pain management. METHODS: This observational cohort study was conducted in Guernsey (January 2019-February 2020). Participants (n = 1656; 76.0% female) completed an online questionnaire capturing: demographics, pain experience, work absenteeism, understanding of pain and pain management, multidimensional influences, physical activity, pain catastrophising and healthcare decision-making. Statements were deemed true/false/equivocal and mapped to biopsychosocial/biomedical/neutral perspectives based upon contemporary literature. Descriptive statistics were analysed for each statement. Participants' responses were examined for alignment to a contemporary viewpoint and themes within responses derived using a semi-quantitative approach modelled on direct content analysis. Comparisons between participants with/without pain were examined (χ2-squared/Wilcoxon Rank Sum test). RESULTS: Within the cohort 83.6% reported currently experiencing pain. The overarching theme was perspectives that reflected both biomedical and contemporary, multidimensional understandings of pain. Sub-themes included uncertainty about pain persistence and evidence-based means to reduce recurrence, and reliance upon healthcare professionals for guiding decision-making. Compared to those with pain, those without had a greater belief that psychological interventions may help and lower pain catastrophising. CONCLUSIONS: Participants' understanding of pain demonstrated both biomedical and multidimensional pain understanding consistent with elements of a contemporary understanding of pain.

The lived experience of physical exertion for persons with advanced multiple sclerosis: making connections with the world.

PURPOSE: To explore the lived experience of physical exertion for persons living with advanced multiple sclerosis (MS). METHOD: An interpretive (hermeneutic) phenomenological approach was undertaken with 8 persons living with advanced MS. Interviews were conducted with exploratory questions that explored participants' experiences of physical exertion. Data was analysed using phenomenological methods and the findings presented as hermeneutic stories. RESULTS: Participants conveyed physical exertion as a means of influencing their connection with the world. Interpretation identified four subthemes; Lived Body, Sense of Self, Purpose of exertion, and Attributes of the World and an overarching superordinate theme Body-World engagement. Hermeneutic stories illuminated the intertwined relationship between the themes and the idiographic nature of physical exertion. CONCLUSION: The experience of physical exertion was meaningfully related to participants' sense of self, agency, and 'being in the world'.

For persons living with advanced MS:Physical exertion has the potential to enhance sense of self through regaining a lost, or creating a new identity.Physical exertion can enhance bodily consciousness and cause individuals to dwell on inability, consequently health care professionals should consider how their language and therapy focus may intensify this.Attempting to meet societally accepted standards of normal had a shaping influence on the exertional experience.The meaning of physical exertion is influenced by an individual's preconceptions and healthcare professionals should take time to understanding these, in order to optimise engagement in physical exertion.

Working as a physiotherapist in a rapid response team: 'An emotional rollercoaster'.

BACKGROUND AND INTRODUCTION: Rapid Response Teams (RRTs) are multidisciplinary, 'hospital at home' services which have developed over the last 10 years, aiming to improve recovery from illness more efficiently, prevent unnecessary hospital admission, and prevent early admission to residential care. However, little is known about the experience of professionals working in these roles. PURPOSE: The aim of this study was to explore how working in an RRT is experienced and perceived by physiotherapists. METHODS: This study used phenomenographically inspired methodology. Six participants who were working in RRTs were recruited to this study and all were working in the South of England. Data were collected via semi-structured interviews, and phenomenographic analysis was undertaken. RESULTS: Participants working in RRTs described a range of varied, concrete lived-through experiences in addition to a more rhetorical discussion of how they conceptualized their work. Six main categories of description were generated from the analysis; each was assigned a metaphor. These included 'the detective,' 'the guru,' 'the lone ranger,' 'the team player,' 'the bricoleur,' and 'an emotional rollercoaster'; all categories were present with varied meanings. 'An emotional rollercoaster' was present within and throughout participants' descriptions of all other categories. CONCLUSION: This study provides valuable insights into physiotherapists' experience and conceptualization of working within this discipline, which may have implications for physiotherapy practice, workforce development, new and current RR physiotherapy services, RRT health professionals, and physiotherapy education.

The Immediate Hypoalgesic Effect of Low and High Force Thoracic Mobilizations in Asymptomatic Subjects as Measured by Pain Pressure Thresholds (PPT).

Physiotherapists commonly use mobilizations for treating patients with thoracic spine pain (TSP). There is evidence to suggest that spinal mobilizations can decrease pain. Different doses of mobilization treatment are applied, however there is a paucity of evidence on the influence of these dosage parameters. The effect of different forces of treatment remains unknown. This study aimed to investigate whether there was a difference in the hypoalgesic effect of high and low force thoracic mobilizations. This single-blinded, randomized, within-subject, repeated measures, cross-over design recruited 28 asymptomatic participants. Participants received the experimental conditions of high (200 N) and low force (30 N) mobilizations to T6 at least 48 h apart. Pressure pain thresholds (PPTs) were measured before and immediately after each experimental intervention at three different standardized sites. The results demonstrated that high force thoracic mobilizations caused a significant increase in PPT measures compared to low force mobilizations. This effect was detected at all PPT sites. This study suggests that high force thoracic PA mobilizations cause a significantly greater hypoalgesic response in asymptomatic participants than low force thoracic mobilizations. The hypoalgesic response seems to be elicited not only locally at the site of the intervention, but in a widespread manner.

Building bespoke exercise: The clinical reasoning processes of physiotherapists when prescribing exercise for persons with musculoskeletal disorders.

AIMS: This qualitative study aimed to explore physiotherapists' clinical reasoning when prescribing exercise for persons with musculoskeletal disorders. METHODS: A constructivist grounded theory inspired methodological approach was used. Six physiotherapists working in the United Kingdom were recruited via purposive sampling. Data collection and analysis included semi-structured interviews, memo writing, coding, and a constant comparative method. FINDINGS: A concept of 'building bespoke exercise' has been generated to conceptualise the participants' clinical reasoning when prescribing exercise. CONCLUSION: The findings of this study highlight processes of co-designing and co-constructing exercise programmes in collaboration with persons receiving care. Physiotherapists can use this study to reflect on their own clinical reasoning to inform their own practice.

Frozen shoulder: living with uncertainty and being in "no-man's land".

BACKGROUND: Frozen Shoulder (FS) is a painful debilitating condition that is a significant burden to those experiencing it and healthcare systems. Despite research investigating the pathogenesis and effective treatment for the condition, there is a paucity of research exploring how having frozen shoulder is lived through and meaningful to persons experiencing it. OBJECTIVE: To explore how living with Frozen Shoulder is experienced and meaningful. METHODS: A qualitative research study design using hermeneutic phenomenology methodology was used. In-depth unstructured interviews were conducted with six purposively recruited participants. Interpretive Phenomenological methods were used to analyze the data forming emergent, superordinate and master themes to qualitatively expose the meaningful aspects of living through FS. FINDINGS: Five Master themes were identified: 1) "Dropping me to my knees," an incredible pain experience; 2) The struggle for normality; 3) An emotional change of self; 4) The challenges of the healthcare journey; and 5) Coping and adapting. The overarching 'binding theme' was Frozen Shoulder: Living with uncertainty and being in "no-man's land." CONCLUSIONS: This study illuminated the struggle to maintain a normal life while living with the significant pain, physical restriction, sleep loss and disability experienced by persons with Frozen Shoulder. Attempts to cope and adapt were impeded by the challenges of the healthcare journey. The uncertainty of these experiences was conveyed as being in "no man's land" an expression that reflected the existential crisis and impact on persons' sense of self.

The lived experience of exercise in persons with depression: A journey to finding a sense of contentment.

BACKGROUND: Depression is often part of the embodied experience of persons living with pain and other health conditions. In addition to other benefits, exercise has been recognized to reduce depressive symptoms. Physiotherapists help persons to develop multidimensional understanding including an understanding of how exercise can help manage symptoms, and how they can individualize exercise to them. Thus, physiotherapists need insights into how exercise is experienced and meaningfully related to depression. PURPOSE: This study aimed to explore the lived experience of exercise in persons with depression. METHODS: In this interpretive (hermeneutic) phenomenological study, participants with depression were purposively recruited and data collected via semi-structured interviews. Hermeneutic analysis was used alongside the crafting of hermeneutic stories to reveal the meaning of exercise for these participants. FINDINGS: Participants conveyed their experience of exercise as a journey to finding a sense of contentment. Two master themes: 1) Finding the exercise for me; and 2) the experienced importance of the environment, illuminated participants' journey to finding a sense of contentment through exercise. Two subthemes 1) changing sense of self; and 2) building resilience further described participants' experience. CONCLUSION: Physiotherapists may reflect on these individual exercise stories and share these insights with persons receiving their care to explore if exercise may help them to find a sense of contentment.

"Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain".

INTRODUCTION: Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies. PURPOSE: However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP. METHOD: The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal. FINDINGS AND CONCLUSION: Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.

''It was the end of the world" - The lifeworld of elite male rugby union players living with injury. An interpretative phenomenological analysis.

BACKGROUND: Professional rugby is an aggressive sport. Consequently, injuries are an inevitable part of a rugby player's career. It is therefore crucial for sports medicine professionals to understand the subjective experience of injured athletes in order to optimize their care. OBJECTIVES: The purpose of this study was to take a lifeworld perspective to explore how living with injury was meaningful to professional rugby players. METHODS: A purposive sample of five participants were recruited and data collection undertaken via semi-structured interviews. Audio-recordings were transcribed verbatim and analyzed using interpretative phenomenological analysis methodology to develop the themes. FINDINGS: Three master themes emerged from the analysis, each comprising of two subthemes; 1) Sense of Uncertainty (1a. Fear of the Unknown, 1b. Lack of Control), 2) Experienced Change in Relationships (2a. Lived Human Relations, 2b. Coping), 3) Sense of Self (3a. Isolation and Belonging, 3b. ''Being" an Athlete). CONCLUSION: Participants described the challenge to their sense of self and 'being' athletes', as the isolation from the team deprived them of their sense of belonging. Participants illustrated the experienced significance of their relationships, the uncertainty over their lives and the unique strategies to cope. Emotions of anxiety, grief, anger, and shock reverberate throughout their accounts.

Is the biopsychosocial model in musculoskeletal physiotherapy adequate? An evolutionary concept analysis.

Purpose: It is considered that implementation of the biopsychosocial model (BPSM) within physiotherapy is affected by its lack of conceptual clarity. This concept analysis explores the meaning and offers conceptual transparency to the BPSM and expands upon its current conceptual framework for practice. Method: Literature was selected through a systematic search. The studies were analyzed and the data themed following thematic analysis. Results: From the seventeen articles included, five master themes and four subthemes were constructed. The master themes were: 1) 'Bio-medical factors'; 2) 'Psychological factors'; 3) 'Social factors'; 4) 'Communication'; and 5) 'Individualized Care'. The subthemes were: 1) 'Education'; 2) 'Cognitive'; 3) 'Behavioral factors'; 4) 'Occupational factors'; and 5) 'Therapeutic Alliance'. Conclusion: A contemporary visual representation of the BPSM is presented which represents a holistic, humanist perspective. 'Communication' scaffolds the framework and supports the exploration of the person's lifeworld through the 'therapeutic alliance'.

Personalizing education: The clinical reasoning processes of physiotherapists using education for the treatment of people with chronic low back pain.

Background: Physiotherapists may use a diverse range of educational approaches during the treatment of people with chronic low back pain (CLBP). However, little is known about how physiotherapists clinically reason their use of education in practice.Purpose: The aim of this study was to develop insight into physiotherapists' clinical reasoning when using education for the treatment of people with CLBP.Methods: This qualitative study used a constructivist grounded theory inspired methodology. A purposive sample of five musculoskeletal physiotherapists from the United Kingdom were recruited via social media. Data were collected through audio recorded semi-structured interviews, field notes and memos, and were coded and analyzed using a constant comparative method.Findings: A concept of 'personalizing education' underpinned by three main categories termed 'exploring the person's world', 'making sense of the person's world' and 'tailoring education', has been constructed to explain the participating physiotherapists' clinical reasoning.Conclusion: The findings highlight how communication and interaction underpin the clinical reasoning process for using education with people who have CLBP. Participating physiotherapists explored and made sense of a person's world before tailoring their educational approach for the individual. Physiotherapists can use this paper to reflect on their practice to inform their own clinical reasoning.

Management of low back pain: Treatment provision within private practice in the UK in the context of clinical guidelines.

OBJECTIVE: To summarise the combination of treatments private UK-based physiotherapists use with patients who have low back pain (LBP) and the extent to which the treatments used are consistent with clinical guideline recommendations. DESIGN: Cross-sectional observational survey. METHODS: Data were collected from physiotherapists within private UK-based clinics using an online standardised data collection system to record the treatment they provided for patients who had LBP with/without leg pain. Treatment data were classified into those that are 'recommended', 'not recommended' and had 'no recommendation'. RESULTS/FINDINGS: Treatment provided to 8003 patients were included in the analyses. Most patients (95.0%) were provided with a 'recommended' treatment. Approximately half of the patients who received 'recommended' treatment were also provided with other treatments that were either 'not recommended' (16.7%), had 'no recommendation' (16.6%) or a combination of both (13.0%). Few patients were provided with only treatments that were 'not recommended' and/or treatment with 'no recommendation' (4.6%). CONCLUSION: This study provides insight into the self-reported practice of participating physiotherapists and highlights how they generally adopted a multimodal treatment model for patients with LBP. Consistent with the National Institute for Health and Care Excellence guidelines, most patients received information and advice often in conjunction with exercise and manual therapy. Only a small proportion of patients were provided with treatments that are 'not recommended' and/or treatment that had 'no recommendation'. These findings are useful in documenting the implementation of clinical guidelines given the need for practitioners to balance the best available evidence with patient expectation and preference and to facilitate the therapeutic alliance.

"Selling" chronic pain: physiotherapists' lived experiences of communicating the diagnosis of chronic nonspecific lower back pain to their patients.

Introduction: Chronic nonspecific lower back pain (CNSLBP) is a common musculoskeletal condition which can be a source of significant distress and disability for patients. Approaches to managing CNSLBP have been explored in healthcare literature, as has the importance of communication in physiotherapy practice. However, no previous studies have explored clinicians' experiences of communicating their understanding of this diagnosis to their patients.Methods: A qualitative research design, using hermeneutic phenomenological methodology, was employed. Five participants were purposively recruited for the research and data collected via semi-structured interviews. Interpretative phenomenological analysis (IPA) methods were used to analyze the data. Emergent, super-ordinate and master themes were developed to help convey the qualitative significant meanings of the lived-through experiences.Findings: Three master themes were identified, with each comprising two sub-themes. These were: 1) Patient-centeredness (1a. Understanding the patient; and 1b. emotional awareness and adaptability); 2) Getting patients "on board" (2a. the "selling" process; and 2b. paternalism and the clinician's perspective); and 3) Dealing with conflict and uncertainty (3a. fear of interpersonal conflict; and 3b. personal doubts and uncertainty).Conclusions: Personal conflicts were identified between clinicians' descriptions of their wishes to "sell" their own perspectives to patients while simultaneously wanting to demonstrate a patient-focused approach and avoid the interpersonal conflicts which arose from clashes with patients' beliefs. Building a good initial rapport, showing empathy and adapting approaches in response to perceptions of patients' reactions were perceived as strategies to help mitigate the risks of failed communication, but this was something for which participants felt unprepared by their prior training.

Sustainability in critical care practice: A grounded theory study.

BACKGROUND: Sustaining high-quality, critical care practice is challenging because of current limits to financial, environmental, and social resources. The National Health Service in England intends to be more sustainable, although there is minimal research into what sustainability means to people working in critical care, and a theoretical framework is lacking that explains the social processes influencing sustainability in critical care. AIMS AND OBJECTIVES: This study aimed to explain the concept of sustainability from the perspective of practitioners caring for critically ill patients. DESIGN: The qualitative research followed a Charmazian constructivist grounded theory approach, including concurrent data collection and interpretation through constant comparison analysis. METHODS: In-depth interviews were conducted online or by telephone with 11 health care professionals working in critical care in the South of England (8 nurses, 2 physiotherapists, and 1 technician). Schatzman's dimensional analysis and Straussian grounded theory techniques supplemented the data analysis. RESULTS: Sustainability was defined as maintaining financial, environmental, and social resources throughout the micro, meso, and macro systems of critical care practice. The most pertinent social process enabling sustainability of critical care was satisficing (satisfaction of achieving a goal of quality care while sufficing within the limits of available resources). Increased satisficing enabled practitioners to fulfil their sense of normative, responsible, sustainable, and flourishing practice. Satisficing was bounded by the cognitive and environmental influences on decisions and an ethical imperative to ensure resources were used wisely through stewarding. CONCLUSIONS: An explanation of the concept of sustainability and significant social processes, in relation to critical care, are presented in a theoretical framework, with implications for how financial, environmental, and social resources for critical care practice can be maintained. RELEVANCE TO CLINICAL PRACTICE: This theory offers clinicians, managers, educators, and researchers a definition of sustainability in critical care practice and provides a structured approach to addressing critical care sustainability issues.

Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges.

INTRODUCTION: Cauda equina syndrome (CES) is rare, but its symptoms are not and musculoskeletal physiotherapists frequently encounter persons with suspected CES. Given that delayed diagnosis of CES can result in devastating consequences for affected persons and costly litigation for healthcare organisations, it is imperative that persons presenting with suspected CES are well managed. However, this may present a challenge to physiotherapists. Therefore, the aim of this study is to explore physiotherapists' experiences of managing persons with suspected CES. METHODS: Semi-structured interviews were conducted with musculoskeletal physiotherapists. Verbatim transcripts were analysed using an interpretive paradigm and thematic analysis. ETHICAL APPROVAL: Ethical approval was obtained from a university Ethics committee and NHS Research and Development. FINDINGS: Five interlinking themes emerged. The themes of worry in relation to risk management and communication difficulties seemed to represent significant challenges. The remaining themes were described as antidotes to these challenges: Lightening the load with teamwork and shared responsibility, the usefulness of a clear pathway and perception of improved confidence and competence with experience and training. DISCUSSION: The findings are discussed in the context of other literature, and practical recommendations are made relating to pathway implementation, team working, communication aids, training on CES and measures to care for staff wellbeing. CONCLUSION: Findings suggest that it is important to be aware of and address the challenges faced by physiotherapists in order to care for clinicians' wellbeing and ensure a safe and smooth journey for persons with suspected CES. Summary Video: https://www.youtube.com/watch?v=lIHqCKIQ1jk&t=90s.

'Getting them on board': Musculoskeletal physiotherapists conceptions of management of persons with low back pain.

OBJECTIVE: Low back pain (LBP) is the leading cause of disability worldwide; however, the majority of LBP is non-specific in nature with no clearly identifiable source of pain. Contemporary understanding of LBP highlights the multidimensional nature of LBP and as a result clinical practice and guidelines have evolved and advocate a multidimensional approach to managing persons with LBP. This change in understanding and practice provides challenges for physiotherapists and persons with LBP, many who have biomedical views. The aim of this study was to explore musculoskeletal physiotherapists conceptions towards the management of LBP. METHOD: The research employed a phenomenographic inspired approach which aims to explore variations in conceptions, beliefs and understanding of a phenomenon. Six participants (physiotherapists) were interviewed via semi-structured interviews to explore their experiences of managing persons with LBP and the data was analysed using a phenomenographic framework. RESULTS: Three main categories emerged from the participants descriptions: the perceived role of preferences and expectations, therapeutic alliance development and getting the person "on board". CONCLUSION: Participants descriptions implied a therapist centred view towards the care they provided for persons with LBP. The perceived role of expectations was a significant aspect within the participants descriptions of the management of LBP. Last, the participants described the perceived development of a therapeutic alliance. These categories suggest how the physiotherapists interviewed in this study conceive the management of LBP, and these findings will provide a greater understanding around the physiotherapy management of LBP.

Musculoskeletal physiotherapists' perceptions of health promotion.

BACKGROUND: Non-communicable diseases from unhealthy lifestyles account for most preventable deaths in the UK. Physiotherapy training now includes Health Promotion (HP) for the reduction of unhealthy lifestyles such as obesity, smoking, alcohol and inactivity. However, physiotherapists' perceptions of HP in the context of musculoskeletal care in the UK have not been explored. OBJECTIVES: To explore musculoskeletal physiotherapists' perceptions of HP. DESIGN: Phenomenographic qualitative research. METHOD: semi-structured interviews with 7 musculoskeletal physiotherapists. RESULTS/FINDINGS: Physiotherapist conceptions of HP were analysed using phenomenographic analysis and three main categories emerged. These were the concepts of physiotherapists' self, education in the therapeutic alliance and persons' agency for change. Each category contained a variety of perceptions which were sometimes conflicting, and each category had scope for influencing the others. CONCLUSIONS: Participants' (physiotherapists) perceptions of their personal and professional self were entwined with perceptions of persons' agency when describing health promotion in their practice. Within the therapeutic alliance concepts of health coaching were discussed but these conceptualisations sometimes contradicted descriptions of experiences. This research may encourage physiotherapists to reflect on their perceptions of, and role in HP.

Physiotherapists' lived experiences of decision making in therapeutic encounters with persons suffering from whiplash-associated disorder: A hermeneutic phenomenological study.

Conceptual discussions related to clinical reasoning and decision making have evolved over the years from biomedical to incorporating more holistic approach to reasoning. Empirical studies exploring clinical reasoning and decision making in physiotherapy practice have mostly focused on aspects of managing persons with low back pain, such as exercise prescription, education and communicating diagnosis. There is a paucity of studies exploring decision making in whiplash-associated disorder (WAD); thus, the aim of this study was to explore the physiotherapists' lived experiences of decision making related to treating persons with WAD. A qualitative research design based on hermeneutic phenomenological methodology was used in this study. Five participants (physiotherapists) were purposefully recruited, and data are collected via semistructured interviews, which were recorded and transcribed verbatim. Interpretative phenomenological analysis (IPA) was used as a method for analysing the data. Emergent, superordinate and master themes emerged from the data to illuminate the lived experiences under exploration. Three master themes were identified: (1) sense of collaboration; (2) sense of being out of control; and (3) sense of emotional engagement (subthemes: feeling of satisfaction and feelings of distress and uncertainty). A sense of collaboration revealed varied meaning related to the role of persons receiving care, suggesting a lack of conceptual clarity related to shared-decision making. A perceived loss of a sense of being in control was related to experienced emotions, such as feelings of distress and uncertainty. The findings of this study highlight the importance of providing space for reflection and mentoring in the workplace.