Implementation of an expanded-scope-of-practice physiotherapist role in a regional hospital emergency department.

INTRODUCTION: The aim of the present study was to describe the implementation of an expanded-scope physiotherapy service in a regional hospital emergency department (ED) in Australia and discuss the lessons learnt in terms of long-term sustainability of these roles in regional areas. METHODS: The existing ED advanced physiotherapist was trained in extended scope of practice skills. For sustainability, a senior physiotherapist was recruited to develop further ED practice skills through a locally developed professional development package and ultimately be eligible to complete extended-scope training. Mixed methods data collection included document review, patient and staff satisfaction surveys and data mining of routine clinical data sets. RESULTS: The extended-hours service operated for 12 months. The advanced physiotherapist completed postgraduate course requirements and was able to work to an expanded scope of practice including increased autonomy in management and discharge of patients treated in the ED and independent ordering and interpreting of plain film X-rays. The professional development package was not completed and the senior physiotherapist role was filled for only part of the study period. CONCLUSIONS: It is feasible to implement an expanded scope of physiotherapy service in a regional hospital ED. For sustainability in regional areas, a larger advanced-level physiotherapy workforce and easier access to expanded-scope training are required.

Illness representations of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic illness that usually follows a fluctuating course and, therefore, can be difficult to diagnose. Consequently, individuals with SLE often hold beliefs about the nature and course of the illness that are at odds with medical opinion. Clearly, a shared understanding of the illness would be beneficial to illness management. In this study, the authors used semistructured interviews and interpretative phenomenological analysis to explore the content of the illness representations held by 36 individuals diagnosed with SLE. They also identified the ways in which these illness representations were generated initially and attempted to determine whether changes occurred over time in these illness representations, as predicted by the self-regulatory model.