Tesi sul tema "Physiotherapy professional education"

Due to the changing personal and public demands as regards health care new requirements for the health care service providers have presently arisen; consequently, the whole health care system, especially rehabilitation, has been facing new challenges. The scientific research on the physiotherapy practice, as the main providers of the previously mentioned health service, stand far behind from being developed in Lithuania. Thus, this work, which analyses physiotherapy professional education with regard to systemic view, aims at developing theoretically and empirically validated curriculum model of physiotherapy education. The development of the model includes the conception of physiotherapy, its historical evolution, defines the peculiarities of physiotherapy practice and education in foreign countries and in Lithuania, and finally, it introduces a hypothetical model of the interaction between physiotherapy practice and their competences. The empirical research with reference to holistic view precondition scientific validation of the physiotherapy education parameters and curriculum modelling. The curriculum model developed on the basis of the research results and the discussion in this dissertation reflect the tendencies of physiotherapy education in the world and presuppose further research in the field of physiotherapy practice and education.
Kintant asmens ir visuomenės poreikiams, susijusiems su sveikatos priežiūra, keliami nauji reikalavimai sveikatos priežiūros paslaugų teikėjams, o tai yra iššūkis visai sveikatos priežiūros, o ypač reabilitacijos, sistemai. Kineziterapeutų, kaip pagrindinių šias paslaugas teikiančių specialistų, veiklos ir profesinio rengimo tyrimai Lietuvoje nėra plėtojami. Todėl šio darbo, kuriame profesinis kineziterapeutų rengimas analizuojamas sisteminiu požiūriu, tikslas – sukurti teoriškai ir empiriškai pagrįstą kineziterapeutų profesinio rengimo turinio modelį. Jį kuriant aptariama kineziterapijos samprata, jos istorinė kaita, aprašomi kineziterapeutų veiklos ir jų profesinio rengimo ypatumai užsienio šalyse ir Lietuvoje, pristatomas hipotetinis kineziterapeutų profesinės veiklos ir kompetencijų sąveikos modelis. Empiriniai tyrimai, atlikti remiantis holistiniu požiūriu, sudaro prielaidas moksliškai pagrįsti kineziterapeutų profesinio rengimo turinio parametrus, modeliuoti turinį, sudaro prielaidas apibrėžti kineziterapeutų kvalifikacijos lygmenis, nustatyti jiems keliamus reikalavimus ir parengti naujas studijų programas. Tyrimo rezultatų pagrindu sukurtas ir disertacijoje aprašytas modelis atspindi pasaulines kineziterapeutų profesinio rengimo tendencijas ir suponuoja tolimesnius kineziterapeutų veiklos ir jų profesinio rengimo tyrimus.

Includes abstract.
Includes bibliographical references.
Clinical practice remains an integral part of the training of physiotherapy students. It is seen as an effective way of socialising students into the profession. By placing students in a clinical setting where under the guidance of clinicians and clinical educators, they are able to put their classroom taught procedures into practice it is believed that they then start to develop an understanding of what being a physiotherapist entails. Drawing on Lave and Wenger's model of situated learning, this research sets out to understand how final year physiotherapy students begin to develop their identity as physiotherapists. The research looks at the positioning of students within specific communities of practice and the nature of the learning that occurs within these communities.

This thesis provides a window into the world of work-placement-based pre-registration physiotherapy education in the UK. This empirical study followed final year students as they went about their everyday practices on placement in hospital-based settings. Adopting a perspective sensitive to social theories of learning, and drawing on ideas and methods from ethnography and interactional sociologies, the project makes visible some of the complex, but taken-for-granted, interactional practices and processes by which students, their educators and patients co-enact their work of physiotherapy student education. How placement education is actually done - its practical accomplishment - is captured by focusing on the minutiae of participants’ interaction performances. Physiotherapy practice interactions typically involve participants’ use of space, speech, paralanguage, touch and movement of themselves and others. The research required the development of a new method for recording interaction proxemics, kinesics and verbal elements in real time and with only paper and pencil. Created from the ideas of choreographers, social anthropologists and video/conversational analysts, the multi-modal data sets generated by the method bring interactions to life and enable the detailed exploration of participants’ practices. The evidence collected suggests that placement learning experiences are an integral part of professional development framed within a situated learning environment where the dominant discourse is of ‘physiotherapy as science’. The evidence also suggests that students’ placement practices adapt to satisfy the needs of their summative assessment. The thesis considers the impact of placement education interactions on the patients about whom they orientate. The thesis, and the new method it describes, is immediately relevant to the practice of physiotherapy, its education programmes and professional project discussions. The quality of the interaction data presented in this thesis makes physiotherapy practice education accessible and available for others to explore, and the method is suitable for transfer to other studies of human interaction.

Doctor of Philosophy (PhD)
Effective clinical reasoning and its communication are essential to health professional practice, especially in the current health care climate. Increasing litigation leading to legal requirements for comprehensive, relevant and appropriate information exchange between health professionals and patients (including their caregivers) and the drive for active consumer involvement are two key factors that underline the importance of clear communication and collaborative decision making. Health professionals are accountable for their decisions and service provision to various stakeholders, including patients, health sector managers, policy-makers and colleagues. An important aspect of this accountability is the ability to clearly articulate and justify management decisions. Considerable research across the health disciplines has investigated the nature of clinical reasoning and its relationship with knowledge and expertise. However, physiotherapy research literature to date has not specifically addressed the interaction between communication and clinical reasoning in practice, neither has it explored modes and patterns of learning that facilitate the acquisition of this complex skill. The purpose of this research was to contribute to the profession’s knowledge base a greater understanding of how experienced physiotherapists having learned to reason, then learn to communicate their clinical reasoning with patients and with novice physiotherapists. Informed by the interpretive paradigm, a hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants’ learning journeys were diverse, although certain factors and episodes of learning were common or similar. Participation with colleagues, peers and students, where the participants felt supported and guided in their learning, was a powerful way to learn to reason and to communicate reasoning. Experiential learning strategies, such as guidance, observation, discussion and feedback were found to be effective in enhancing learning of clinical reasoning and its communication. The cultural and environmental context created and supported by the practice community (which includes health professionals, patients and caregivers) was found to influence the participants’ learning of clinical reasoning and its communication. Participants reported various incidents that raised their awareness of their reasoning and communication abilities, such as teaching students on clinical placements, and informal discussions with peers about patients; these were linked with periods of steep learning of both abilities. Findings from this research present learning to reason and to communicate reasoning as journeys of professional socialisation that evolve through higher education and in the workplace. A key finding that supports this view is that clinical reasoning and its communication are embedded in the context of professional practice and therefore are best learned in this context of becoming, and developing as, a member of the profession. Communication of clinical reasoning was found to be both an inherent part of reasoning and an essential and complementary skill necessary for sound reasoning, that was embedded in the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined and should be learned concurrently. The learning and teaching of clinical reasoning and its communication should be synergistic and integrated; contextual, meaningful and reflexive.

The purpose of this study was to explore how physiotherapists working in stroke care understand their role(s) in the context of clinical practice and how this is mediated by their post-licensure educational experiences. Specifically the study focused on their experiences with the Bobath Concept, a well-developed post-licensure neurology physiotherapy program. This study was oriented within sociocultural theory as a way to understand how the experiences and interactions of physiotherapists mediate their professional practice and their sense of professional identity in a way not previously studied in physiotherapy literature. In order to honour the voices of the participants, this study drew on hermeneutic phenomenology and used a principled data analysis tool to present an understanding of the interrelationships involved in stroke care from their perspectives. Four physiotherapists participated in this study by responding in writing and orally to a clinical case and participating in an in-depth interview regarding their professional roles and experiences. The findings suggest that these physiotherapists understand the Bobath Concept as a professional stance which informs their practice and contributes to an ethos of caring, which is reflected in the ways they understand their roles in clinical practice.

Kintant asmens ir visuomenės poreikiams, susijusiems su sveikatos priežiūra, keliami nauji reikalavimai sveikatos priežiūros paslaugų teikėjams, o tai yra iššūkis visai sveikatos priežiūros, o ypač reabilitacijos, sistemai. Kineziterapeutų, kaip pagrindinių šias paslaugas teikiančių specialistų, veiklos ir profesinio rengimo tyrimai Lietuvoje nėra plėtojami. Todėl šio darbo, kuriame profesinis kineziterapeutų rengimas analizuojamas sisteminiu požiūriu, tikslas – sukurti teoriškai ir empiriškai pagrįstą kineziterapeutų profesinio rengimo turinio modelį. Jį kuriant aptariama kineziterapijos samprata, jos istorinė kaita, aprašomi kineziterapeutų veiklos ir jų profesinio rengimo ypatumai užsienio šalyse ir Lietuvoje, pristatomas hipotetinis kineziterapeutų profesinės veiklos ir kompetencijų sąveikos modelis. Empiriniai tyrimai, atlikti remiantis holistiniu požiūriu, sudaro prielaidas moksliškai pagrįsti kineziterapeutų profesinio rengimo turinio parametrus, modeliuoti turinį, sudaro prielaidas apibrėžti kineziterapeutų kvalifikacijos lygmenis, nustatyti jiems keliamus reikalavimus ir parengti naujas studijų programas. Tyrimo rezultatų pagrindu sukurtas ir disertacijoje aprašytas modelis atspindi pasaulines kineziterapeutų profesinio rengimo tendencijas ir suponuoja tolimesnius kineziterapeutų veiklos ir jų profesinio rengimo tyrimus.
Due to the changing personal and public demands as regards health care new requirements for the health care service providers have presently arisen; consequently, the whole health care system, especially rehabilitation, has been facing new challenges. The scientific research on the physiotherapy practice, as the main providers of the previously mentioned health service, stand far behind from being developed in Lithuania. Thus, this work, which analyses physiotherapy professional education with regard to systemic view, aims at developing theoretically and empirically validated curriculum model of physiotherapy education. The development of the model includes the conception of physiotherapy, its historical evolution, defines the peculiarities of physiotherapy practice and education in foreign countries and in Lithuania, and finally, it introduces a hypothetical model of the interaction between physiotherapy practice and their competences. The empirical research with reference to holistic view precondition scientific validation of the physiotherapy education parameters and curriculum modelling. The curriculum model developed on the basis of the research results and the discussion in this dissertation reflect the tendencies of physiotherapy education in the world and presuppose further research in the field of physiotherapy practice and education.

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Mestrado Profissional Ensino na Saúde
A implementação do Sistema Único de Saúde (SUS) e das Diretrizes curriculares Nacionais (DCNs) para a formação do fisioterapeuta trazem reflexões acerca da prática do profissional fisioterapeuta nos serviços de saúde coletiva. Na atenção básica (AB), o fisioterapeuta ainda carece de uma identidade que expresse de forma clara, para a compreensão dos atores envolvidos, a sua postura e papel nas ações que este cenário impõe. As análises e reflexões que este estudo propõe, apóiam-se nas observações da pesquisadora, fisioterapeuta, inserida numa unidade da rede municipal de saúde do município de Niterói e que vem desenvolvendo sua prática num cenário de AB. Segue com os objetivos de conhecer como se efetiva a prática profissional do fisioterapeuta que atua na AB do município de Niterói-RJ; identificar o perfil do profissional fisioterapeuta que atua na Atenção Básica do município de Niterói-RJ; descrever como a formação deste profissional o instrumentalizou para a prática de cuidados na AB; e indicar como produto, à gestão municipal de saúde de Niterói/RJ, uma oficina com propósito de repensar a atuação do fisioterapeuta na AB. A metodologia adotada é descritiva e exploratória, com abordagem qualitativa. Os participantes foram os fisioterapeutas inseridos nas policlínicas do município de Niterói e a coleta de dados se deu por meio de entrevistas semi estruturadas, gravadas, transcritas, analisadas e organizadas em três categorias temáticas: a hegemonia curativo-reabilitadora; a fragilidade da capacitação para atendimento das demandas; a mobilização para ressignificação da prática do fisioterapeuta na AB. Os participantes deixam evidenciado que a formação para o SUS só acontece após a implementação das DCNs, porém mantendo a visão curativo reabilitadora. Expressam uma carência na oferta e na procura por capacitações, seja na educação continuada ou na educação permanente, para a prática na AB e apontam ações incipientes para uma prática de prevenção e promoção da saúde. Apesar de frágeis, conclui-se que essas ações são a mola propulsora para uma nova identidade do fisioterapeuta na AB, que deverá mudar o seu objeto para o controle de riscos e agravos e não mais controle de danos, prezando pela co-gestão do usuário para a solução das demandas sociais.
The Unified Health System (SUS) implementation and the National Curriculum Guidelines (DCNs) about physiotherapists‟ academic education bring to light some reflections about their professional practice in the public health services. In Primary Care (PC), the physiotherapist still wants an identity which expresses clearly, to the involved actors‟ comprehension, their posture and function in the actions that this scenery proposes. The analyses and reflections which this research proposes, have support in the researcher‟s observations, who is a physiotherapist inserted at a Municipal Health Unit in Niterói City, who is developing her practices in an PC scenery. The research has the objectives of knowing how the physiotherapist‟s professional practice who acts in PC at the Niterói City/RJ works; identifying the profile of the physiotherapist‟s who acts in PC of Niterói City/RJ; describing how the academic education of this professional helpshim/her to the care practice in PC, and indicating, as product to the Health Municipal Management of Niterói/RJ, a workshop with the proposal of rethink the physiotherapist‟s actions in the PC. The methodology adopted is descriptive and exploratory, with qualitative approach. The participants were the physiotherapists inserted at the Polyclinics of Niterói City, and the data‟s collections were done through interviews semi structured, recorded, transcribed, analyzed, and organized in three thematic categories: the curative-rehabilitative hegemony; the capacity‟s fragility to the attendance of the demands; the mobilization for the ressignification of the physiotherapist‟s practice in PC. The participants let evidenced that the formation for the SUS, only happens after the DCN‟s implementation, but keeping the curative-rehabilitative vision.They express a shortage in the supply and demand for capacitation, either in the continuing education or in the permanent education, to the practice in the PC and link incipient actions for a prevention practice and health promotion. Although fragile, it can be concluded that these actions are the driving force to a new physiotherapist‟s identityin the PCthat should change its objective to the risks and hazard, notthe damage control anymore, valuing the user co-managementfor the social demands‟ solution.

Seit dem Jahr 2001 werden in Deutschland aufgrund von Länder – oder Fachhochschulinitiativen zunehmend Studiengänge für Physiotherapie etabliert, ohne dass es sich jedoch zunächst um einen vom Bund mitgetragenen und somit rechtlich abgesicherten neuen Berufsabschluss handelt. Die rasante Zunahme der Studiengänge geht einher mit einer maximalen Varianz hinsichtlich der Dauer, der Inhalte, der fachlichen Ausrichtung und Organisationsform sowie der Anbindung an unterschiedlichste Fakultäten. Die Studierenden dieser ersten Generation sind somit diejenigen, die mit ihren subjektiven Einstellungen, Wünschen, Ängsten, Erwartungen und Wahrnehmungen über einen neuen Blick verfügen. Sie können als die zentralen ExpertInnen in der Beurteilung eines deutlich Verunsicherung schaffenden Professionalisierungsprozess betrachtet werden. Mit der Einführung dieser neuen Studiengänge (z.T. im Sinne des Bolognaabkommens) werden vor dem Hintergrund der Fragen zur Existenz einer physiotherapeutischen Identität, eines physiotherapeutischen Habitus sowie der professionellen Selbstverortung drei unterschiedliche Forschungsstränge aufgegriffen: 1. Berufswahlmotive, existierende Bilder von Physiotherapie vor und nach der Ausbildung, Beurteilung der fachschulischen Ausbildung, Berufseinstieg 2. Gründe für die Aufnahme des Studiums, Vor- und Nachteile des Studiums, Bewertung des Studiums, Erwartungen an das Outcome, Probleme 3. Einstellung gegenüber Profession, Professionalisierung und Professionalität Methodologisch wurde das Forschungsdesign der ExpertInneninterviews gewählt. Die mit 33 Studierenden der unterschiedlichen Fachhochschulen geführten und vollständig transkribierten Interviews sind dann mittels eines qualitative Forschungsdaten verarbeitenden Softwareprogramms sequenzialisiert und codiert worden, um die Ergebnisse des Antwortverhaltens der Studierenden in eine mögliche Typisierung zu überführen. Um die studentische Binnensicht beruflicher Kulturalität um eine Außenaufsicht zu ergänzen, wurden zwei weitere nicht-studentische, jedoch professionszugehörige ExpertInnen interviewt.
The first university degrees in Physiotherapy have been developing in Germany since 2001, without however, any formal, legislative introduction by government. The rapidly increasing number of these courses vary considerably with regard to duration, contents, staffing and faculty membership. In this process of professionalization the students of this first generation of higher education are of particular interest. They are the “experts”, able to look at the profession from a new and different point of view. Their perception of the profession, their insecurities, wishes, hopes and needs highlight a process which could be described as unstable and confusing. The objective of this research project was to investigate whether a PT identity and a PT professional habitus exist and how the students themselves perceive the status of the profession. Expert interviews with students from different universities were chosen to gather the data which was subsequently analysed and codified using a qualitative research softwear to identify response types. In addition to the 33 students’ interviews portraying an “insider´s view” of the cultural identity, 2 further interviews were carried out with non-student experts in the field to represent an “outsider´s view”. This resulted in the examination of these distinct areas: 1. Career choice, satisfaction with initial PT training course, experiences on entering employment 2. Advantages and disadvantages of studying, satisfaction with the degree course, expectations of the outcome, problems 3. Attitude towards the profession, the status of professionalization and professionalism

Esta investigación emerge del proceso de reflexión que cuestiona las relaciones entre la teoría y la práctica de la Fisioterapia en Atención Primaria de Salud (APS), centrando la mirada en la intervención domiciliaria, no desarrollada hasta la fecha en Mallorca. Desde un paradigma crítico social, esta investigación cualitativa explora las perspectivas de distintos colectivos profesionals de APS sobre la fisioterapia en Atención Primaria domiciliaria. Fueron entrevistados 54 profesionales de forma individual o en grupo, presentando en los resultados las consideraciones de la atención domiciliaria en APS, la fisioterapia y su desarrollo en el contexto. La discusión presenta críticamente los aspectos emergidos bajo la perspectiva las necesidades de salud, la equidad, el acceso a la salud, la formación de profesionales y el papel de la Atención Primaria de Salud, con énfasis en la fisioterapia. Todo ello encamina a las implicaciones para la política, las prácticas, la investigación y la educación.
This research arises from a process of reflection questioning the relations between theory and practice related to Physiotherapy in Primary Health Care (PHC). It focuses on home physiotherapy, which is not, to date, offered within this system in Majorca. A qualitative research was developed to explore the perspectives of PHC professionals about home physiotherapy using the social critical paradigm as theoretical perspective. A total number of 54 PHC professionals were interviewed, using individual and group interviews for data collection. The results include their considerations about home care in PHC, physiotherapy and the development of home physiotherapy in PHC in the context. The discussion presents critically the topics that emerged during the research, highlighting the issues of the health needs, equity, access to health, health professional education and the role of Primary Health Care, with emphasis in physiotherapy. That leads to the implications regarding to the policies, practices, research and higher education.

This study focuses on physiotherapy professional development and professional education and the multitude of theoretical, practical and political forces that shape and influence physiotherapy education. It does so by addressing the questions: how is an undergraduate physiotherapy curriculum within a historically disadvantaged university responding to post apartheid societal transformation in South Africa; and why is the curriculum responding in the way that it is within the current social, economic, political, cultural and historical context of South Africa. The study is theoretically and methodically located within critical, feminist and post-modern framings that disturb and disrupt the dominant medical model of health sciences practice. Employing narrative inquiry as the selected methodology, data was produced through multiple methods to obtain multiple perspectives and orientations. This multi-sectoral data production approach involving student physiotherapists, physiotherapy academics and practicing physiotherapists included in-depth focus group interviews, individual interviews, life-history biographies and open-ended questionnaires. The data is analysed firstly separately for each group of research participants - physiotherapy students, practitioners and academics, and then followed by a cross-sector analysis. The analysis illustrated current disciplinary trends and shortcomings of the physiotherapy undergraduate curriculum, whilst highlighting that which is considered valuable and progressive in physiotherapy and health care. The dominant themes that emerged included issues relating to physiotherapy theory and practice, and issues that influenced the construction of relationships in the curriculum. The main thesis presented is that for physiotherapy in the South African context, the notion of caring is identified as the link between transformation and professional development. The model proposed is: A Caring-Transformative Physiotherapy Practitioner Model for physiotherapy professional development advancing a view of what it could mean to be an agent of transformation in South Africa within the health care system. This model is located within multiple framings of caring that re-casts the physiotherapy professional previously located primarily within a medical model ideology, into a practitioner with a broadened view of practice and professional accountability within a critical-feminist framing.
Thesis (Ph.D.) - University of KwaZulu-Natal, 2006.