Shkurka, Emma;
Shannon, Harriet;
Rand, Sarah;
Wray, Jo;
(2025)
Physiotherapists’ decision-making on paediatric intensive care: development of a conceptual model.
Intensive Care Medicine – Paediatric and Neonatal
, 3
, Article 22. 10.1007/s44253-025-00078-1.
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Abstract
Respiratory physiotherapy is a commonly used treatment for children in paediatric intensive care units (PICUs). A wide range of interventions are available, and practice varies. There is no literature exploring how physiotherapists make decisions regarding treatment choice and delivery in this vulnerable and complex population. The aim of this study was to understand physiotherapists’ decision-making regarding delivery of respiratory physiotherapy in UK PICUs. This was a qualitative study, involving virtual semi-structured interviews and focus groups with PICU physiotherapists. Sixteen interviews and two focus groups (n = 7) were completed. They were audio-recorded and transcribed verbatim. Framework analysis was used. From the interview analysis, five themes were developed within a ‘Factors influencing decision-making’ framework: physiotherapist knowledge, the physiotherapist, consideration of family, other health care professionals and external influences. Clinical knowledge and understanding were key factors in decision-making. Approaches evolved with experience, opportunities for reflection and learning, plus the development of intuition. Collaboration was integral to physiotherapists’ decision-making, however this posed additional challenges. A ‘Clinical decision-making’ framework was developed from the focus groups, including three themes: information gathering, listening to the patient, and learning from experience. Active information gathering and comprehensive patient assessment were described. Listening to the patient and being able to react and adapt at the bedside were important processes involved in decision-making. A conceptual model has been developed, which depicts physiotherapists’ decision-making as complex, iterative and collaborative, with experience and expertise important factors. The findings have highlighted several areas that require consideration from a workforce and education perspective. This was a qualitative study, involving virtual semi-structured interviews and focus groups with PICU physiotherapists. Sixteen interviews and two focus groups (n = 7) were completed. They were audio-recorded and transcribed verbatim. Framework analysis was used. From the interview analysis, five themes were developed within a ‘Factors influencing decision-making’ framework: physiotherapist knowledge, the physiotherapist, consideration of family, other health care professionals and external influences. Clinical knowledge and understanding were key factors in decision-making. Approaches evolved with experience, opportunities for reflection and learning, plus the development of intuition. Collaboration was integral to physiotherapists’ decision-making, however this posed additional challenges. A ‘Clinical decision-making’ framework was developed from the focus groups, including three themes: information gathering, listening to the patient, and learning from experience. Active information gathering and comprehensive patient assessment were described. Listening to the patient and being able to react and adapt at the bedside were important processes involved in decision-making. A conceptual model has been developed, which depicts physiotherapists’ decision-making as complex, iterative and collaborative, with experience and expertise important factors. The findings have highlighted several areas that require consideration from a workforce and education perspective.
| Type: | Article |
|---|---|
| Title: | Physiotherapists’ decision-making on paediatric intensive care: development of a conceptual model |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1007/s44253-025-00078-1 |
| Publisher version: | https://doi.org/10.1007/s44253-025-00078-1 |
| Language: | English |
| Additional information: | This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10211681 |
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