Athletic Trainer’s Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Interview Protocol
2.4. Procedures
2.5. Data Analysis and Trustworthiness
3. Results
3.1. Domains
3.2. Patient-Centered Care
3.2.1. Expressed Desire
“I think this [disablement model] is something that I did not previously have much experience with. In the last two years or so, it is something that is coming farther and farther into the forefront of my mind in terms of the decision-making process with patients. It fits into my mindset, by allowing me to identify problems or things that are inhibiting them from being completely healthy. It helps us identify goals that they’re trying to reach and essentially helps us identify outcomes that we as providers want to reach throughout the post injury or, any sort of similar situation.”
3.2.2. Conscious Competence
“[A disablement model framework] is not something where I’m consciously writing down or making some sort of map or listing certain aspects of it. It’s more something that stays in the back of my mind when I’m considering a patient’s well-being or their plan of care.”
3.2.3. Conscious Incompetence
“I’m not completely sure what’s entailed in the model, the framework. I am not sure exactly what barriers I come across. I am sure I have, and probably use the model without knowing it.”
3.2.4. Unconscious Incompetence
“[The disablement model] is useful, it is good to implement it, so that way you can show professionalism.”
3.3. Limitations and Impairments
3.3.1. Expressed Desire
“Each case is specific to each individual with their own goals and their own activities of daily living in mind; I know that.”
3.3.2. Conscious Competence
“Using limitations, in terms of what are their limitations in performing a specific task? Then limit activity as you discharge the patient from an injury. In terms of restrictions, what are they able to participate in, not just sport related but also school and life related.”
3.3.3. Unconscious Incompetence
“You’re taking them away from something that they’ve done for a lot of years and, especially, working in a college setting, they’ve been doing it for a long time at a very high level. So, just being there and letting the athlete or patient know that I’m here for you, we can set you up with whatever you need, whenever you need it.”
3.4. Environment and Support
3.4.1. Expressed Desire
“When I was lower ranked I faced difficulty with my colleagues and coworkers around me, trying to help them understand that there is more than just the physical aspect going on and there’s other factors that affect a patient in their treatment.”
3.4.2. Conscious Competence
“It is the wintertime, and someone has a lower extremity injury. You would have concern about how they get to their classes, how they get to the athletic training room? Do they need crutches? Do they need additional support to get to where they need to go? So, understanding the environment is important in gathering if they have limitations with transportation.”
3.4.3. Conscious Incompetence
“There are definitely other patient factors that I’m unaware of, so I try to ask some patients if they are in a third-floor apartment, or if in their dorm are there elevators? I do try and take those things into account.”
3.4.4. Unconscious Incompetence
3.5. Exposure
3.5.1. Formal
“I remember studying [disablement model frameworks] in college and I remember it getting brought up here and there and touching on points on the disablement model, but it’s never been a forefront of my mind, whereas I feel like it should be, because it was a big deal in college, it was eye opening.”
3.5.2. Informal
“I’m going to research the disablement model again, and see what it is, what is included in it, and then try to work in where I feel like I’m lacking because there’s always room for improvement.”
4. Discussion
4.1. Competence Model
4.2. Readiness for Change
4.3. Disablement Model Frameworks
4.4. Resolving the Knowledge Gap
4.5. Limitations and Future Research
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Education Overview. NATA. 27 July 2017. Available online: https://www.nata.org/about/athletic-training/education-overview (accessed on 11 February 2023).
- About Us. BOC. Available online: https://bocatc.org/about-us/what-is-an-athletic-trainer (accessed on 11 February 2023).
- Hoffman, M.A.; Johnson, S.T.; Norcross, M.F. The Intersection of Athletic Training and Public Health. J. Athl. Train. 2019, 54, 121. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hoffman, M.; Bovbjerg, V.; Hannigan, K.; Hootman, J.M.; Johnson, S.T.; Kucera, K.L.; Norcross, M.F. Athletic Training and Public Health Summit. J. Athl. Train. 2016, 51, 576–580. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Post, E.G.; Snedden, T.R.; Snedaker, K.; Bouton, J.; Wang, D. Differences in Sport-Related Concussion History, Reporting Behavior, and Return to Learn and Sport Timelines in Public versus Private High School Student Athletes. Brain Inj. 2021, 35, 596–603. [Google Scholar] [CrossRef] [PubMed]
- McGuine, T.A.; Pfaller, A.Y.; Post, E.G.; Hetzel, S.J.; Brooks, A.; Broglio, S.P. The Influence of Athletic Trainers on the Incidence and Management of Concussions in High School Athletes. J. Athl. Train. 2018, 53, 1017–1024. [Google Scholar] [CrossRef] [Green Version]
- Snyder, C.F.; Wu, A.W.M.; Miller, R.S.; Jensen, R.E.; Bantug, E.T.M.; Wolff, A.C. The Role of Informatics in Promoting Patient-Centered Care. Cancer J. 2011, 17, 211–218. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Constand, M.K.; MacDermid, J.C.; Dal Bello-Haas, V.; Law, M. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv. Res. 2014, 14, 271. [Google Scholar] [CrossRef] [Green Version]
- Andermann, A. Taking action on the social determinants of health in clinical practice: A framework for health professionals. Can. Med. Assoc. J. 2016, 188, E474–E483. [Google Scholar] [CrossRef] [Green Version]
- Picha, K.J.; Bacon, C.E.W.; Normore, M.C.; Valier, A.R.S. Social Determinants of Health: Considerations for Athletic Health Care. J. Athl. Train. 2021, 57, 521–531. [Google Scholar] [CrossRef]
- Bokhour, B.G.; Fix, G.M.; Mueller, N.M.; Barker, A.M.; Lavela, S.L.; Hill, J.N.; Solomon, J.L.; Lukas, C.V. How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Serv. Res. 2018, 18, 168. [Google Scholar] [CrossRef] [Green Version]
- Valier, A.R.S.; Bacon, C.E.W.; Lam, K.C. Disablement Model and Health-Related Quality of Life Classification for Patient-Reported Outcomes Measurement Information System (PROMIS) Instruments. J. Athl. Train. 2018, 53, 1206–1213. [Google Scholar] [CrossRef] [Green Version]
- Snyder, A.R.; Parsons, J.T.; Valovich McLeod, T.C.; Curtis Bay, R.; Michener, L.A.; Sauers, E.L. Utilizing disablement models and clinical outcomes assessment to enable evidence-based athletic training practice: Part I—Disablement models. J Athl. Train. 2008, 43, 428–436. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization. How to Use the ICF: A Practical Manual for Using the International Classifications of Functioning, Disability and Health. 2013. Available online: http://www.who.int/classifications/drafticfpracticalmanual2.pdf?ua=1 (accessed on 1 February 2023).
- Ibsen, C.; Maribo, T.; Nielsen, C.V.; Hørder, M.; Schiøttz-Christensen, B. ICF-Based Assessment of Functioning in Daily Clinical Practice. A Promising Direction Toward Patient-Centred Care in Patients With Low Back Pain. Front. Rehabilitation Sci. 2021, 2, 732594. [Google Scholar] [CrossRef] [PubMed]
- Stallinga, H.A.; Bakker, J.; Haan, S.J.; van Os-Medendorp, H.; Kars, M.C.; Overgoor, L.; Stewart, R.E.; Roodbol, P.F. The Usability of the Preliminary ICF Core Set for Hospitalized Patients After a Hematopoietic Stem Cell Transplantation From the Perspective of Nurses: A Feasibility Study. Front. Rehabilitation Sci. 2021, 2, 710127. [Google Scholar] [CrossRef]
- Marcelin, J.R.; Siraj, D.S.; Victor, R.; Kotadia, S.; Maldonado, Y.A. The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It. J. Infect. Dis. 2019, 220, S62–S73. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Parsons, J.T.; McLeod, T.C.V.; Snyder, A.R.; Sauers, E.L. Change Is Hard: Adopting a Disablement Model for Athletic Training. J. Athl. Train. 2008, 43, 446–448. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Valovich McLeod, T.C.; Snyder, A.R.; Parsons, J.T.; Curtis Bay, R.; Michener, L.A.; Sauers, E.L. Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part II: Clinical outcomes assessment. J Athl. Train. 2008, 43, 437–445. [Google Scholar] [CrossRef] [PubMed]
- O’Brien, B.C.; Harris, I.B.; Beckman, T.J.; Reed, D.A.; Cook, D.A. Standards for reporting qualitative research: A synthesis of recommendations. Acad. Med. 2014, 89, 1245–1251. [Google Scholar] [CrossRef]
- Hill, C.E. Consensual Qualitative Research (CQR): Methods for Conducting Psychotherapy Research. In Psychotherapy Research; Gelo, O., Pritz, A., Rieken, B., Eds.; Springer: Vienna, Austria, 2014; pp. 485–499. [Google Scholar] [CrossRef]
- Keeley, C. Conscious competence model and medicine. Foot Ankle Surg. Tech. Rep. Cases 2021, 1, 100053. [Google Scholar] [CrossRef]
- Peel, J.L.; Nolan, R.J. You Can’t Start a Central Line? Supervising Residents at Different Stages of the Learning Cycle. J. Grad. Med. Educ. 2015, 7, 536–538. [Google Scholar] [CrossRef] [Green Version]
- Hodges, B.; Regehr, G.; Martin, D. Difficulties in Recognizing One’s Own Incompetence: Novice physicians who are unskilled and unaware of it. Acad. Med. 2001, 76, S87–S89. [Google Scholar] [CrossRef]
- Hashemzadeh, M.; Rahimi, A.; Zare-Farashbandi, F.; Alavi-Naeini, A.M.; Daei, A. Transtheoretical model of health behavioral change: A systematic review. Iran. J. Nurs. Midwifery Res. 2019, 24, 83–90. [Google Scholar] [CrossRef] [PubMed]
- Prochaska, J.O.; DiClemente, C.C. Transtheoretical therapy: Toward a more integrative model of change. Psychother. Theory Res. Pract. 1982, 19, 276–288. [Google Scholar] [CrossRef]
- Abdi, S.; Spann, A.; Borilovic, J.; De Witte, L.; Hawley, M. Understanding the care and support needs of older people: A scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatr. 2019, 19, 195, Erratum in BMC Geriatr. 2020, 20, 23. [Google Scholar] [CrossRef]
- Wilson, C.J.; Eberman, L.E.; Redinger, A.S.; Neil, E.R.; Winkelmann, Z.K. Athletic trainers’ viewpoints of patient-centered care: Preliminary findings. PLoS ONE 2022, 17, e0274577. [Google Scholar] [CrossRef] [PubMed]
- Bacon CE, W.; Eppelheimer, B.L.; Kasamatsu, T.M.; Lam, K.C.; Nottingham, S.L. Athletic Trainers’ Perceptions of and Barriers to Patient Care Documentation: A Report From the Athletic Training Practice-Based Research Network. J. Athl. Train. 2017, 52, 667–675. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Commission on Accreditation of Athletic Training Education. 2020 Standards for Accreditation of Professional Athletic Training Programs; Master’s Degree Programs; CAATE: Austin, TX, USA, 2018; p. 22.
- Kruger, J.; Dunning, D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J. Pers. Soc. Psychol. 1999, 77, 1121–1134. [Google Scholar] [CrossRef] [PubMed]
- Rivera, M. Indiana State University Rethinking Quality Improvement in Athletic Health Care. Clin. Pract. Athl. Train. 2020, 3, 3–5. [Google Scholar] [CrossRef]
- Batalden, P.B.; Davidoff, F. What is “quality improvement” and how can it transform healthcare? Hearth 2007, 16, 2–3. [Google Scholar] [CrossRef] [Green Version]
- Embree, D.J.L. Teaching Nurses How to Create a Personal and Professional Development Plan. J. Contin. Educ. Nurs. 2022, 53, 438–441. [Google Scholar] [CrossRef]
- Shnayder-Adams, M.M.; Sekhar, A. Micro-habits for life-long learning. Abdom. Radiol. 2021, 46, 5509–5512. [Google Scholar] [CrossRef]
- Gardner, B.; Lally, P.; Wardle, J. Making health habitual: The psychology of ‘habit-formation’ and general practice. Br. J. Gen. Pract. 2012, 62, 664–666. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- ICF Model: A Framework for Athletic Training Practice. NATA. 17 March 2016. Available online: https://www.nata.org/blog/beth-sitzler/icf-model-framework-athletic-training-practice (accessed on 24 February 2023).
Participants | Gender | Level of Education | Work Setting | Years of Experience |
---|---|---|---|---|
Participant 1 | Female | Master’s | College/University | 5 |
Participant 2 | Female | Master’s | College/University | 4 |
Participant 3 | Male | Post-Professional Master’s | Secondary School | 47 |
Participant 4 | Female | Post-Professional Master’s | College/University | 17 |
Participant 5 | Male | Master’s | College/University | 7 |
Participant 6 | Female | Post-Professional Master’s | Secondary School | 9 |
Participant 7 | Female | Post-Professional Master’s | College/University | 17 |
Participant 8 | Female | Post-Professional Master’s | College/University | 5 |
Participant 9 | Female | Post-Professional Master’s | College/University | 5 |
Participant 10 | Female | Master’s | Secondary School | 3 |
Participant 11 | Male | Post-Professional Master’s | Health/Fitness/ Sports Performance | 11 |
Participant 12 | Male | Bachelor’s | Secondary School | 5 |
Participant 13 | Male | Post-Professional Master’s | College/University | 8 |
|
|
|
|
|
|
|
|
|
Domains and Category | Frequency (n = 13) | Commonality |
---|---|---|
Patient-Centered Care | ||
Expressed Desire | 84% (n = 11) | Typical |
Conscious Competence | 84% (n = 11) | Typical |
Conscious Incompetence | 38% (n = 5) | Variant |
Unconscious Incompetence | 69% (n = 9) | Typical |
Limitations and Impairments | ||
Expressed Desire | 15% (n = 2) | Variant |
Conscious Competence | 77% (n = 10) | Typical |
Conscious Incompetence | 0% (n = 0) | None |
Unconscious Incompetence | 31% (n = 4) | Variant |
Environment and Support | ||
Expressed Desire | 38% (n = 5) | Variant |
Conscious Competence | 77% (n = 10) | Typical |
Conscious Incompetence | 31% (n = 4) | Variant |
Unconscious Incompetence | 54% (n = 7) | Typical |
Exposure | ||
Formal | 38% (n = 5) | Variant |
Informal | 54% (n = 7) | Typical |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Haffey, R.T.; Rivera, M.J.; Young, J.P.; Winkelmann, Z.K.; Eberman, L.E. Athletic Trainer’s Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study. Int. J. Environ. Res. Public Health 2023, 20, 4440. https://doi.org/10.3390/ijerph20054440
Haffey RT, Rivera MJ, Young JP, Winkelmann ZK, Eberman LE. Athletic Trainer’s Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study. International Journal of Environmental Research and Public Health. 2023; 20(5):4440. https://doi.org/10.3390/ijerph20054440
Chicago/Turabian StyleHaffey, Rylee T., Matthew J. Rivera, Justin P. Young, Zachary K. Winkelmann, and Lindsey E. Eberman. 2023. "Athletic Trainer’s Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study" International Journal of Environmental Research and Public Health 20, no. 5: 4440. https://doi.org/10.3390/ijerph20054440