Bakgrund: Övergången från student till kliniskt verksam innebär en stor omställning för hälso- och sjukvårdsprofessioner, men det finns bristfällig information om ämnet gällande fysioterapeuter i en svensk primärvårdskontext. Det finns också utmaningar med att implementera evidensbaserad praktik i ett fysioterapeutiskt arbete trots en positiv inställning. Syfte: Syftet var att kartlägga fysioterapeuters upplevelser i och med övergången från student till kliniskt verksam fysioterapeut inom primärvården under det första arbetsåret samt att undersöka möjligheter och utmaningar gällande evidens och dess implementering i arbetet. Design och metod: En kvalitativ studie genomfördes med fem semistrukturerade intervjuer av fysioterapeuter inom primärvården vilka rekryterats genom ett bekvämlighetsurval. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Elva kategorier identifierades. Sex rörande övergången i sig från student till kliniker (“Tiden som kritisk faktor för att komma in i jobbet”, “Arbetsgivarens förväntningar på nyutexaminerade kan både vara hindrande och stöttande”, “Kollegornas viktiga roll”, “Inre föreställningar kan både hjälpa och stjälpa”, “Kunskapsluckor som behöver fyllas”, “Att växa in i sin profession”) och fem kategorier rörande evidens och dess implementering (“Svårt att veta vad som ska implementeras”, “Förutsättningar från arbetsgivaren är avgörande”, “Kollegornas inflytande på den formbara fysioterapeuten” “Grundkunskaper och tankesätt för evidensbaserad praktik från utbildningen”, “Personliga egenskaper och erfarenheters inverkan på evidensbaserad praktik”). Konklusion: Resultaten belyser betydelsen av arbetsplats-, person- och utbildningsfaktorer från olika vinklar i både underlättande och utmanande bemärkelse. Faktorerna var bland annat kopplade till tid, kollegor, förväntningar från arbetsplatsen samt personliga erfarenheter och egenskaper. / Background: The transition from student to clinical practitioner represents a significant adjustment for healthcare professionals, but there is insufficient information about physiotherapists in a Swedish primary care context. There are also challenges in implementing evidence-based practice in physiotherapy despite a positive attitude. Purpose: To explore physiotherapists' experiences related to their transition from student to clinical practitioner in primary care during their first year of work and investigate opportunities and challenges regarding evidence and its implementation in practice. Design and method: A qualitative study was conducted with five semi-structured interviews of physiotherapists in primary care, recruited through convenience sampling. The material was analyzed using qualitative content analysis. Results: Eleven categories were identified. Six categories were related to the transition from student to clinical practitioner ("Time as a critical factor in getting into the job”, “Employer expectations of new graduates can be both hindering and supportive”, “The important role of colleagues”, “Internal beliefs can both help and hinder”, “Knowledge gaps that need to be filled”, “Growing into one's profession”), and five categories related to evidence and its implementation (“Difficulty in knowing what to implement”, “Employer expectations are crucial”, “The influence of colleagues on the moldable physiotherapist”, “Basic knowledge and mindset for evidence-based practice from education”, “The impact of personal characteristics and experiences on evidence-based practice”).  Conclusion: The results highlight the importance of workplace, personal, and educational factors from different perspectives, both facilitating and challenging. The factors were linked to time, colleagues, workplace expectations, personal experiences and traits.

Bakgrund:Långvarig smärta definieras som smärta som kvarstår i över 3 månader. Det är vanligt förekommande i befolkningen och många söker vård för sina problem. Smärta är ett komplext begrepp som har inverkan på många olika faktorer hos individen men även en inverkan på samhället och dess resurser. Detta kan innebära utmaningar vid handläggning och framför allt vid val av behandling. Syfte:Syftet var att utforska kliniskt resonemang vid val av behandling för patienter med långvariga smärttillstånd hos en grupp fysioterapeuter i primärvården. Metod:Studien är en kvalitativ studie baserad på semistrukturerade intervjuer som analyserades med kvalitativ innehållsanalys.   Resultat:Det som ansågs spela stor roll för valet av behandling var behandlaren och patientens egenskaper och erfarenheter, relationen mellan dem samt analysen inför behandling. De riktlinjer som användes ansågs vara ett stöd men också svåra att applicera då behandlingen alltid behöver individanpassas i och med att patientgruppen är komplex. Möjlighet till samverkan ansågs vara viktigt för att bredda perspektivet och erbjuda patienten fler behandlingsalternativ. I behandlingsupplägget var målet alltid att öka funktionsnivå, vilket påverkade resonemanget kring val av behandling. Ökad kunskap hos patienten samt en ökad förmåga till smärthantering var ofta första steget. Slutsats:Många faktorer spelar in i det kliniska resonemanget för val av behandling för patienter med långvarig smärta. Erfarenhet hos behandlaren ansågs avgörande för beslutet och man kan därmed tänka sig att det är extra viktigt att nyexaminerade får möjlighet att samverka med kollegor med mer erfarenhet av patientgruppen. / Background:Chronic pain is defined as pain that remains in more than 3 months. Chronic pain is a widespread problem worldwide and there are many people who seek health care for their problems. Pain is a complex syndrome which impacts several aspects of the individual's life but also the society, which brings challenges in the assessment and the choice of treatment.  Purpose:The purpose of the study was to explore physiotherapists' clinical reasoning when choosing a treatment for patients with chronic pain in primary care.  Method:The study is a qualitative method based on semi-structured interviews which was analyzed with a qualitative content analysis.  Results:Factors that played a big part in the choice of treatment were the physiotherapist and the patient characteristics and experiences, the relationship between them and the significance of the examination. The guidelines that were used were considered to support the choice but were also seen to be difficult to apply, as the treatment always needs to be individualized because of the complexity in the patient group. The ability of cooperation was considered as a key factor to broaden the perspective and offer the patient different treatment alternatives. The treatments intended to increase function, knowledge and pain-management which had an impact on the clinical reasoning. Conclusion:Many factors play a part in the clinical reasoning for choosing treatment for patients with chronic pain. The physiotherapists experience was a crucial part of the decision and therefore it could be of importance that newly graduated physiotherapists get the possibility to cooperate with colleagues who have more experience of the patient group.

Made available in DSpace on 2016-08-10T10:55:10Z (GMT). No. of bitstreams: 1 Patricia Leite Alvares Silva .pdf: 425940 bytes, checksum: 53d7fb7ed1234667c8bfe566cbd5d3e2 (MD5) Previous issue date: 2006-06-21 / Labor is a way of survival, of self-realisation and of social integration. It can both aid and harm the dynamic equilibrium that is needed for the functioning of the organism as a whole, which we call health. The aims of this research were: to verify the perception of stress and its causes in the labour of the physiotherapist; amd to question coping and resilience in relation to stress in these professionals. A qualitative, exploratory study was done, in which participated sixteen physiotherapists (nine women and seven men) in the city of Goiânia. The study followed the injunctions of Grounded Theory , an inductive process of analysis, ordering and progressive reduction of categories in the elaboration of a theory that explains the researched question. The results indicate that physiotherapist face a variety of stress at work. Common causes of stress are: low salaries, work overload and professional under-valorization. All of these are part of the labor environment, and not of the work in itself. The profession sees itself subdued and under-valued by other professions and by society. Common psychological symptoms of stress are: anxiety, being unable to stop thinking of work and trouble concentrating. The most frequent physical symptoms are: pains and tiredness. Among coping strategies, physical activity and leisure predominate. The love for the profession, the satisfaction of being a physiotherapist, autonomy in the execution of one s work and the perceived respect from the patient are the most important factors of resilience found in this study. We conclude that the labor environment of the physiotherapist is stressful and that measures concerning the organization of the work and the strengthening of the profession as a category are called for. On the other side, the professionals seem to use adequate coping strategies and demonstrate notable resilience, the later being in part directly related to their professional vocation. / v O trabalho é uma das fontes de sobrevivência, auto-realização e manutenção de relações interpessoais. A saúde, sendo um estado de equilíbrio dinâmico necessário ao bom funcionamento do organismo como um todo, pode ser promovida ou prejudicada pelo trabalho. Os objetivos desta pesquisa foram: verificar a percepção de estresse e suas fontes no trabalho do fisioterapeuta; e questionar coping (enfrentamento) e resiliência relacionados com o estresse nestes profissionais. Foi realizado um estudo qualitativo, exploratório com dezesseis fisioterapeutas (nove mulheres e sete homens) na cidade de Goiânia. A abordagem foi a Grounded Theory ou Teoria fundamentada nos dados , um processo indutivo de análise, organização e redução progressiva de categorias para elaborar uma teoria que explique a questão examinada. Os dados indicam que o fisioterapeuta convive com inúmeros estressores no seu contexto ocupacional. Fontes de estresse comuns são: baixos salários, sobrecarga de trabalho e desvalorização profissional. Elas estão ligadas às questões do ambiente de trabalho e não à própria execução do mesmo. A categoria profissional encontra-se subjugada e pouco valorizada por outros profissionais e pela sociedade. Os sintomas psicológicos mais freqüentes do estresse ocupacional são: ansiedade, incapacidade de se desligar do trabalho e distúrbios de atenção. E os sintomas físicos mais freqüentes são: dores e cansaço. Dentre as estratégias de coping a atividade física e o lazer foram predominantes. O apego à profissão, a gratificação em ser fisioterapeuta, a autonomia na atuação e o respeito recebido do paciente foram os fatores de resiliência mais importantes encontrados neste estudo. Concluímos que o ambiente de trabalho do fisioterapeuta é estressante e que medidas em termos da organização do trabalho e estruturação da categoria profissional seriam bem-vindas. Do outro lado, os profissionais lançam mão de estratégias de coping adequados e mostram uma resiliência notável, que é em parte diretamente ligada com a vocação.

Made available in DSpace on 2016-04-27T18:47:33Z (GMT). No. of bitstreams: 1 Marina Vieira da Silva .pdf: 2147621 bytes, checksum: af424b5884d188321dfaa529258d5b55 (MD5) Previous issue date: 2009-05-21 / Analyze the elderly subject is only in the biological treat it without understanding the concrete structure it represents. Thus to focus attention only on statistics does not allow it to be understood in all its complexity. The study shows the importance of the physiotherapist to have expertise in geriatrics, and especially in gerontology, and thus develop the capacity to assist the elderly not only in fighting the changes characteristic of aging or to chronic degenerative diseases, but to become so that the disease, even limits, not to take the opportunities to live other things in life. The physical therapist should instruct the elderly not to devote their attention exclusively to impossibilities arising from old age or to chronic degenerative diseases, but to develop strategies to reinvent it in this stage of life / Analisar o sujeito idoso somente no campo biológico é tratá-lo sem compreender a estrutura concreta que ele representa. Dessa forma focar a atenção somente em estatísticas não permite que ele seja compreendido em toda sua complexidade. O estudo mostra a importância de o fisioterapeuta contar com conhecimentos em geriatria e, especialmente, em gerontologia e, assim, desenvolver a capacidade de auxiliar os idosos não só no combate às alterações próprias do envelhecimento ou às doenças crônico-degenerativas, mas a se transformar de tal forma que a doença, mesmo impondo limites, não lhe tire as possibilidades de viver outras coisas na vida. O fisioterapeuta deve instruir o idoso a não dedicar sua atenção exclusivamente às impossibilidades advindas da velhice ou às patologias crônicodegenerativas, mas sim, desenvolver com ele estratégias para reinventar-se nessa fase da vida

Conselho Nacional de Desenvolvimento Científico e Tecnológico / As práticas de cuidado em fisioterapia, em muitas situações, resgatam a função do fisioterapeuta de executor de técnicas que lhe era atribuída nos primórdios da profissão. Ao exercer essa função meramente técnica, muitas vezes deixando-se substituir pelo equipamento nas suas ações, o profissional compromete o estabelecimento do vínculo terapeuta-paciente, contribuindo para o esvaziamento do encontro em saúde. Nessas situações, predomina o êxito técnico (a eficiência na realização do procedimento) sobre o sucesso prático (os benefícios trazidos para vida das pessoas). Para que o sucesso prático seja atingido, é fundamental que haja o questionamento sobre o que sonham as pessoas, profissionais e pacientes, para as suas vidas e para a saúde, quais são suas perspectivas e projetos de vida, seus projetos de felicidade. Nesse sentido, é imprescindível considerar, também, os projetos de felicidade dos profissionais da saúde enquanto sujeitos desse encontro. Afinal, é a partir deles que o profissional elabora o seu projeto de cuidado para cada paciente. Assim, esse trabalho buscou compreender os elementos que configuram a construção de projetos de cuidado em fisioterapia a partir da reflexão dos próprios fisioterapeutas. Para tanto, utilizou-se a metodologia qualitativa de pesquisa por meio de entrevistas semi-estruturadas para que fossem produzidas narrativas da história de vida do trabalho. Os discursos foram analisados integralmente e a categorização foi feita em três sub-temas: exercício profissional, relação com os pacientes e reflexões. Foi possível perceber que muitos dos arranjos de trabalho estabelecidos visam coibir o vínculo profissional-paciente, transformando-o em valor de troca e mercantilizando a relação terapêutica. Expropriada do vínculo, a prática se resume à realização de procedimentos independentes de sua finalidade, minando as possibilidades de sucesso prático. Nesse caso, não é a tecnologia que gera o afastamento e a mecanização, mas são as estratégias de mercantilização do cuidado fisioterápico. Essa situação só pode ocorrer por um processo de subordinação do profissional e seu saber, o que está fortemente associado a condições de trabalho exploratórias. Podemos dizer que a mercantilização do cuidado facilita a restrição sobre as condições de trabalho e também é fruto dela. O problema é que essa restrição é vista pelos profissionais como não definitiva, mas como um caminho para se alcançar reconhecimento na busca pelo exercício liberal da fisioterapia. A intenção desse estudo não foi traçar um plano normativo de conduta para a profissão, mas imaginamos que o equacionamento dessas questões passa necessariamente pelo reconhecimento, pelas inquietações e indignações com o problema. O que se espera, portanto, é facilitar esse processo de desconforto por meio da proximidade dessas questões trazidas pelas narrativas. / Despite the historical fight to prove themselves as health professionals, in many situations physiotherapy care practices bring to surface the physiotherapist‟s function of a mere executor of practical techniques, which used to be attributed to them at the very beginning of their profession. However, when the practice resumes to a set of techniques and the treatment consist of a routine of mechanical acts, the physiotherapist compromises the relationship therapist-patient, leading to a tangent out of healthcare principles. The described situation favor the technical success, measured by the efficiency in the execution, with detriment to the overall success of the practical success, measured by the benefits the treatment brings to the health of patients. To achieve practical success, it is fundamental to question what people (both professionals and patients) dream for their lives, health and what are their life and success projects. In that regard, it is mandatory that healthcare professionals consider their objectives and goals, since they are the starting point for therapeutic plans and each individuals care project. This works investigates deeply the elements that compose the construction of physiotherapy care plans, starting with the reflection of the physiotherapists themselves. A qualitative methodology based semi-structured interviews gathered evidence of life and work of professionals. The answers were analyzed as a whole and three categories were identified: professional practices, relationship patient doctor and reflections. The answers pointed that the current practices aims to eliminate the relationship professional-patient, transforming the professional in a mere service provider instead of a care provider. Deprived from the relationship, the practice resumes to a collection of independent procedures and undermining any possibility of practical success. In that case, it is not the technique that originates the mechanization, but the economics underlying the physiotherapeutic care. This situation can only happen through a process of subordination of the professional and his domain of knowledge, which are strongly correlated to exploratory and predatory working conditions. The monetary policy underlying the care which facilitates the restriction over the work conditions it is also a result of those working conditions, in a vicious cycle. The problem is that this restriction is viewed by professionals not as permanent, but as a stepping stone to reach recognition in the pursuit of the independent practice of physiotherapy. The intention of this study is not to create a norm of professional conduct, but to provide an outline of possible answers to the raised questions to: recognition, anxieties and concerns. This study aims to facilitate the process of assessment that pushes professionals out of their comfort zone.

nÃo hà / A compreensÃo dos aspectos biopsicossociais dos sujeitos que buscam atenÃÃo em saÃde surge como carÃter atrelado a uma boa prÃtica. Nesse contexto apresentamos a prÃtica do profissional fisioterapeuta cuja formaÃÃo apresenta resquÃcios da concepÃÃo biomÃdica de educaÃÃo em saÃde caracterizada pelo forte enfoque na doenÃa em detrimento do sujeito que a apresenta. Consideramos a relaÃÃo dialÃgica que ocorre durante o atendimento fisioterapÃutico elemento importante na mediaÃÃo para a compreensÃo da integralidade do sujeito-paciente. A pesquisa A relaÃÃo dialÃgica na prÃtica clÃnica do profissional fisioterapeuta e a visÃo integral do sujeito-paciente, tem como objetivo compreender como ocorre a comunicabilidade relacional dialÃgica na prÃtica desse profissional de Fisioterapia visando a identificaÃÃo de aspectos subjetivos e objetivos que estabelecem uma visÃo integral do sujeito-paciente. Ã, portanto, uma pesquisa cientÃfica do tipo qualitativa com abordagem fenomenolÃgica hermenÃutica dialÃtica. O campo de pesquisa foi a Universidade de Fortaleza â UNIFOR. As fontes utilizadas na pesquisa foram: fisioterapeutas egressos da UNIFOR, coordenadora do curso de Fisioterapia da referida instituiÃÃo e documentos oficiais que regem a profissÃo. As tÃcnicas de coleta de evidÃncias foram: anÃlise documental e entrevista reflexiva. Os resultados da pesquisa indicam que o diÃlogo que acontece durante a prÃtica clÃnica em Fisioterapia configura-se momento que favorece a compreensÃo do sujeito-paciente e seu contexto. PorÃm, tal compreensÃo nÃo supera a importÃncia que o componente fÃsico estabelece durante o tratamento. Assim, com vistas à reabilitaÃÃo do sujeito-paciente, o fisioterapeuta lanÃa mÃo de conhecimentos tÃcnicos cientÃficos para tal fim. A tese inicial proferida: na relaÃÃo fisioterapeuta/sujeito-paciente, hà indÃcios da valorizaÃÃo da intersubjetividade com forte presenÃa de condutas clinicas que privilegiam o corpo fÃsico nÃo ocorrendo uma comunicabilidade que supere a dicotomia corpo/mente, foi parcialmente confirmada pelos dados e anÃlises realizadas. ConcluÃmos que os discursos dos sujeitos desta pesquisa anunciaram uma conscientizaÃÃo acerca da compreensÃo dos aspectos subjetivos dos sujeitos-pacientes evidenciando ainda a importÃncia da perspectiva da visÃo integral dos mesmos a partir da intersubjetividade. Constatamos, portanto, nÃo apenas indÃcios e sim afirmaÃÃes acerca de que somente a utilizaÃÃo de condutas voltadas para a funcionalidade nÃo dà conta da demanda do cuidar no Ãmbito da prÃtica em Fisioterapia e que a comunicabilidade exercida durante a prÃtica clÃnica promove o desenvolvimento da compreensÃo das dimensÃes biopsicossocial daquele que busca tratamento. / Understanding the biopsychosocial aspects of the subjects who seek health care emerges as a character tied to good practice. In this context we present the practice of physiotherapist whose training has remnants of biomedical conception of health education characterized by strong focus on disease rather than the subject that presents. We consider the dialogic relationship that occurs during physical therapy important element in mediation for understanding the entirety of the subject-patient. The research The dialogical relationship in clinical practice of the physiotherapist and the full view of the subject-patient, aims to understand how does the dialogic relational communicability in practice this professional physiotherapy for the identification of subjective and objective aspects that establish a comprehensive view of the subject -patient. It is therefore a scientific qualitative study with a phenomenological hermeneutic dialectic approach. The research field is the University of Fortaleza - UNIFOR. The sources used in the research were: graduates of UNIFOR physiotherapists, physiotherapy course coordinator of that institution and official documents governing the profession. Evidence collection techniques were: document analysis and reflective interview. The survey results indicate that the dialogue that happens during clinical practice in Physiotherapy set up time that favors the understanding of the subject-patient and their context. But this understanding does not outweigh the importance of the physical component sets during treatment. Thus, with a view to rehabilitating the subject-patient, the therapist makes use of scientific expertise for this purpose. The given initial thesis: the physiotherapist relationship / subject-patient, there is evidence of the appreciation of intersubjectivity with a strong presence of clinical behaviors that favor the physical body is not experiencing a communicability that overcomes the body dichotomy / mind, was partially confirmed by the data and analyzes. We conclude that the speeches of the subjects of this research announced an awareness of the understanding of the subjective aspects of the subjects-patients still showing the importance of the perspective of integral vision of the same from the intersubjectivity. We note, therefore, not only evidence but statements about that only the use of targeted behavior for functionality not cope with the demand of care within the practice in Physiotherapy and communicability exercised during clinical practice promotes the development of understanding of biopsychosocial dimensions of those who looks for treatment.

[Truncated abstract] This PhD project was comprised of three major studies. Study 1 utilised the Nominal Group Technique (NGT) to identify a typology of difficult patients in private practice physiotherapy and to determine strategies physiotherapists use and would like to improve, when dealing with such patients. Physiotherapists (n=37) also shared their expectations of patients and their perceptions of patient expectations of physiotherapy. Results showed that the two areas most difficult to manage were behavioural problems of patients followed by patient expectations. To assist in their interaction with difficult patients, physiotherapists identified communication skills and behaviour modification techniques as strategies they would most like to learn. While physiotherapists expressed the greatest number of expectations in the behavioural domain, identification of patient expectations was not elicited as a strategy to manage difficult patients. Results of this qualitative study contribute to the evolving literature relating to physiotherapist-patient interactions and form a useful basis for educational programs directed at improving the therapeutic relationship in private practice physiotherapy. Study 2 involved applying the NGT with separate groups of patients (n=26) to identify patient expectations of the qualities of a ‘good’ physiotherapist, and to ascertain the characteristics of good and bad experiences in private practice physiotherapy. Findings indicated that the qualities of a ‘good’ physiotherapist related to their communication ability, professional behaviour and organisational ability, and characteristics of the service provided. The most important expectations of patients were for example, symptomatic relief, self-management strategies and ‘hands on’ treatment; associated with the physical domain. When comparing equivalent groups from Study 1, with patient expectations, most patient groups identified that the most important expectations of physiotherapists would relate to patient behaviours such as; compliance, honesty, payment of their account, being punctual, cooperating, trusting and showing respect for their physiotherapist. However, physiotherapists’ rankings of the most important expectations held by patients were not congruent with patient rankings providing an explanation as to why problems may arise in the physiotherapistpatient interaction from the patient’s perspective. Based on the findings of Study 2 it was suggested that physiotherapists should actively seek to involve patients in their management. To do this effectively, physiotherapists would benefit from further training in communication skills to ensure that they can successfully adopt a patientcentred approach and to optimise the physiotherapist-patient interaction in private practice physiotherapy.

By using the scientific essay as a method, I explore what facts affect the roles of me, the professional, and the patient during our first interaction. I also explore in which way the interaction could be affected by its location. My own professional experience as a physiotherapist is portrayed by two examples of patient-therapist interaction where the dialogue is “slow” and a sense of consensus, which is my goal, does not occur. Philosophers, authors and scientists help me to explore and reflect about my practical knowledge and how it can be developed. The essay shows different aspects on what losing health is about and how it influences the inequality in the interaction between the patient and the healthcare provider. Dialogue is a part of the treatment and when establishing a plan of rehabilitation it is important to get the relatives involved. By using different aspects of interpersonal meetings between me and the patient in this essay I want to develop the art of acting wisely in the moment, phronesis, which is the term philosopher Aristoteles created.

ZANOTELLI, Germana Albuquerque Costa. A relação dialógica na prática clínica do profissional fisioterapeuta e a visão integral do sujeito-paciente. 2015. 154f. – Tese (Doutorado) – Universidade Federal do Ceará, Programa de Pós-graduação em Educação Brasileira, Fortaleza (CE), 2015. / Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2015-12-04T13:08:26Z No. of bitstreams: 1 2015_tese_gaczanotelli.pdf: 1834194 bytes, checksum: a2d5a4936cc6a37279ca79257b36f9e9 (MD5) / Approved for entry into archive by Márcia Araújo(marcia_m_bezerra@yahoo.com.br) on 2015-12-08T17:15:11Z (GMT) No. of bitstreams: 1 2015_tese_gaczanotelli.pdf: 1834194 bytes, checksum: a2d5a4936cc6a37279ca79257b36f9e9 (MD5) / Made available in DSpace on 2015-12-08T17:15:11Z (GMT). No. of bitstreams: 1 2015_tese_gaczanotelli.pdf: 1834194 bytes, checksum: a2d5a4936cc6a37279ca79257b36f9e9 (MD5) Previous issue date: 2015 / Understanding the biopsychosocial aspects of the subjects who seek health care emerges as a character tied to good practice. In this context we present the practice of physiotherapist whose training has remnants of biomedical conception of health education characterized by strong focus on disease rather than the subject that presents. We consider the dialogic relationship that occurs during physical therapy important element in mediation for understanding the entirety of the subject-patient. The research The dialogical relationship in clinical practice of the physiotherapist and the full view of the subject-patient, aims to understand how does the dialogic relational communicability in practice this professional physiotherapy for the identification of subjective and objective aspects that establish a comprehensive view of the subject -patient. It is therefore a scientific qualitative study with a phenomenological hermeneutic dialectic approach. The research field is the University of Fortaleza - UNIFOR. The sources used in the research were: graduates of UNIFOR physiotherapists, physiotherapy course coordinator of that institution and official documents governing the profession. Evidence collection techniques were: document analysis and reflective interview. The survey results indicate that the dialogue that happens during clinical practice in Physiotherapy set up time that favors the understanding of the subject-patient and their context. But this understanding does not outweigh the importance of the physical component sets during treatment. Thus, with a view to rehabilitating the subject-patient, the therapist makes use of scientific expertise for this purpose. The given initial thesis: the physiotherapist relationship / subject-patient, there is evidence of the appreciation of intersubjectivity with a strong presence of clinical behaviors that favor the physical body is not experiencing a communicability that overcomes the body dichotomy / mind, was partially confirmed by the data and analyzes. We conclude that the speeches of the subjects of this research announced an awareness of the understanding of the subjective aspects of the subjects-patients still showing the importance of the perspective of integral vision of the same from the intersubjectivity. We note, therefore, not only evidence but statements about that only the use of targeted behavior for functionality not cope with the demand of care within the practice in Physiotherapy and communicability exercised during clinical practice promotes the development of understanding of biopsychosocial dimensions of those who looks for treatment. / A compreensão dos aspectos biopsicossociais dos sujeitos que buscam atenção em saúde surge como caráter atrelado a uma boa prática. Nesse contexto apresentamos a prática do profissional fisioterapeuta cuja formação apresenta resquícios da concepção biomédica de educação em saúde caracterizada pelo forte enfoque na doença em detrimento do sujeito que a apresenta. Consideramos a relação dialógica que ocorre durante o atendimento fisioterapêutico elemento importante na mediação para a compreensão da integralidade do sujeito-paciente. A pesquisa A relação dialógica na prática clínica do profissional fisioterapeuta e a visão integral do sujeito-paciente, tem como objetivo compreender como ocorre a comunicabilidade relacional dialógica na prática desse profissional de Fisioterapia visando a identificação de aspectos subjetivos e objetivos que estabelecem uma visão integral do sujeito-paciente. É, portanto, uma pesquisa científica do tipo qualitativa com abordagem fenomenológica hermenêutica dialética. O campo de pesquisa foi a Universidade de Fortaleza – UNIFOR. As fontes utilizadas na pesquisa foram: fisioterapeutas egressos da UNIFOR, coordenadora do curso de Fisioterapia da referida instituição e documentos oficiais que regem a profissão. As técnicas de coleta de evidências foram: análise documental e entrevista reflexiva. Os resultados da pesquisa indicam que o diálogo que acontece durante a prática clínica em Fisioterapia configura-se momento que favorece a compreensão do sujeito-paciente e seu contexto. Porém, tal compreensão não supera a importância que o componente físico estabelece durante o tratamento. Assim, com vistas à reabilitação do sujeito-paciente, o fisioterapeuta lança mão de conhecimentos técnicos científicos para tal fim. A tese inicial proferida: na relação fisioterapeuta/sujeito-paciente, há indícios da valorização da intersubjetividade com forte presença de condutas clinicas que privilegiam o corpo físico não ocorrendo uma comunicabilidade que supere a dicotomia corpo/mente, foi parcialmente confirmada pelos dados e análises realizadas. Concluímos que os discursos dos sujeitos desta pesquisa anunciaram uma conscientização acerca da compreensão dos aspectos subjetivos dos sujeitos-pacientes evidenciando ainda a importância da perspectiva da visão integral dos mesmos a partir da intersubjetividade. Constatamos, portanto, não apenas indícios e sim afirmações acerca de que somente a utilização de condutas voltadas para a funcionalidade não dá conta da demanda do cuidar no âmbito da prática em Fisioterapia e que a comunicabilidade exercida durante a prática clínica promove o desenvolvimento da compreensão das dimensões biopsicossocial daquele que busca tratamento.

Bakgrund: Magmuskeldelningen mellan de två rectusbukarna benämns även rectusdiastas (RD) och ökar under graviditeten pga. hormonell och mekanisk inverkan. Återhämtning sker naturligt de första åtta veckorna postpartum men delningen kan kvarstå därefter. I denna studie benämns patologisk diastas för ökad RD. Kvinnor kan påverkas fysiskt och psykiskt av ökad RD och barnmorskor ska enligt ICM kunna identifiera tillstånd som avviker från det normala och vid behov kunna samverka och remittera till andra yrkeskompetenser.Syfte: Syftet med studien var att undersöka barnmorskors och fysioterapeuters erfarenheter av att möta kvinnor med ökad rectusdiastas efter graviditet.Metod: Kvalitativ innehållsanalys inspirerad av Malteruds (2012) analysmetod Systematisk textkondensering (STC) utfördes på data från semistrukturerade fokusgruppintervjuer med sammanlagt nio fysioterapeuter och sju barnmorskor runt om i Mellansverige.Resultat: Fyra övergripande områden identifierades; Ökad kroppsmedvetenhet i dagens samhälle, Syn på ökad RD som symtom på ohälsa, Kunskapsbrist kring ökad RD och inhämtning av kunskap genom eget intresse samt Syn på yrkesansvar och önskan om samarbete och riktlinjer.Slutsats: Barnmorskor och fysioterapeuter upplever låg erfarenhet och kunskapsbrist gällande ökad RD. För en mer patientsäker vård behövs nationella riktlinjer samt ett bättre samarbete.Klinisk tillämpbarhet: Studien kan inspirera arbetsplatser att satsa på interprofessionell fortbildning samt uppmanar till utformning av riktlinjer som grundas på mer omfattande forskning. / Background: The abdominal muscle separation between the two rectus abdominis muscles is also known as diastasis recti (DrA) and expands during pregnancy. The duration of the natural recovery takes approximately eight weeks postpartum, but for some people the separation will remain much longer. In this paper, the diastasis will be referred as an increased DrA. According to ICM, midwives should be able to identify what deviates from normal, and if necessary, to collaborate and refer to other professionals. Aim: The aim of the study was to explore midwives and physiotherapists experiences regarding meeting women with increased diastasis recti after pregnancy.Method: A qualitative content analysis with Malteruds method systematic text condensation (STC) of focus group interviews were conducted with a total of nine physiotherapists and seven midwives around Sweden.Results: Four overall areas were identified; Increased body awareness in today's society, Views of increased DrA as a symptom of illness, The lack of knowledge about increased DrA and the acquisition of knowledge through own interest and Views on professional responsibility and the desire for cooperation and guidelines.Conclusion: Midwives and physiotherapists say they lack experience and knowledge regarding increased DrA. National guidelines and a more improved collaboration is needed for safer patient care.Clinical application: The study can inspire workplaces to invest in interprofessional training and establish guidelines based on more extensive research.