Physiotherapy's role in emergency department settings: a qualitative investigation of emergency stakeholders' perceptions

The principal aim of the research was to explore the varying perceptions of what physiotherapy can offer the emergency department system based on the opinions of doctors, nurses, physiotherapists and patients in that system, and opinions of the community health sector. In conjunction with existing literature and the research findings, conceptual models of emergency department (ED) physiotherapy were developed to illustrate appropriate clinical practice and integration of the position within the emergency department system. Two overarching aims were to: identify different stakeholders’ expectations and interpretations of ED physiotherapy; and have stakeholders consider how physiotherapy contributes to the emergency department system. The main objective was to formulate conceptual models of physiotherapy’s integration into the emergency department system based on these varying perspectives. This study employed an interpretivist-systems theory-case study methodology; a unique direction for physiotherapy research. The qualitative data sources were continually aligned within a broader ‘systems’ framework. The participants represented individual elements in the emergency department system. General systems theory, combined with principles of Soft Systems Methodology, appropriately highlights pragmatic components of the research, such as what the physiotherapy role encompasses and how it influences emergency department service delivery. It is also sensitive to the meaning of social, cultural and political undercurrents embedded in participants’ responses; acknowledging diverse world views and respecting the value of different voices in the research, even if they differed from the researcher’s own world view. Case study method added structure to the conduct of the research, making it further amenable to qualitative data techniques. Data collection used a variety of qualitative approaches including surveys of patients (N=80), questionnaires for community health professionals (N=35) and in-depth interviews with emergency department staff (N=12). The Townsville Hospital, Queensland, and the Austin Hospital, Victoria, were the two cases under investigation, the former having no official full-time ED physiotherapy service and the latter having used physiotherapy to treat acute patients in the department for over seven years. The varied dataset provides one of the most comprehensive qualitative perspectives on emergency department physiotherapy to date. Components of research rigour were meticulously considered and findings were intermittently realigned to systems theory principles to provide fresh insight into ED physiotherapy’s professional contribution. Stakeholders’ perceptions were considered from a systems theory view, professional practice perspective and in the sphere of the broader health system. Three categories of conceptual models were built based on agreed features of ED physiotherapy across the stakeholders and two cases. The models, as abstractions, highlight appropriate integration of physiotherapy within the emergency department; core clinical competencies; and suitable ownership of ED physiotherapy to preserve its identity and accountability within the emergency system. The participants’ voices dominate the research, creating a rich, nuanced view of ED physiotherapy as an Australian practice. The conceptual models attempt to unify these voices. The thesis is advantageous to the physiotherapy profession by not isolating opinion to a physiotherapy-only perspective and encouraging future discourse to overcome barriers, potential conflict and misconceptions of physiotherapy practice so that ED physiotherapy is better understood and appropriately implemented