An exploration of the professional identity embedded within UK cardiorespiratory physiotherapy curricula

Exploring professional identity in rehabilitation professions: a scoping review

Professional identity is believed to foster self-confidence and resilience in health care professionals. While literature exists describing professional identity in medicine, the relevance of this evidence to rehabilitation professionals (occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP)) is limited due to differences between professions in decision-making authority (patient care), professional autonomy and understanding of their scope of practice. The objective was to determine the extent, range and nature of the literature on professional identity/professional identity formation in rehabilitation professionals. Findings from the scoping review based on Arksey and O'Malley's methodological framework are presented. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, and ProQuest Dissertations and Theses from 1996 to October 2020 for empirical and conceptual studies on OT, PT, and S-LP clinicians or students. Of 4983 retrieved records, 53 papers were selected for data extraction. Data were organised into themes for professional identity/professional identity formation: conceptual descriptors (dynamic state, multiple identities); influences (person, professional education/environments, profession-at-large). Findings are consistent with the professional identity literature in medicine. However, they point to gaps for further empirical inquiry in the role of symbols and rituals in the professional identity/professional identity formation of rehabilitation professionals, profession-specific differences between OT, PT and S-LP, and influences related to the profession-at-large on the professional identity/professional identity formation of rehabilitation professionals. These findings may help to inform professional education programs and health care and professional systems in developing resources to support professional identity formation of rehabilitation professionals.

Forming and shaping of professional identity within pre-registration physiotherapy curricular: A scoping review

OBJECTIVE

The purpose of this review was to explore how professional identity is formed and shaped within pre-registration physiotherapy curricular.

DESIGN

A scoping review using the PRISMA guidelines from the Joanna Briggs Institute to capture a range of evidence describing how professional identity has been formed and shaped in pre-registration physiotherapy curricular.

DATA SOURCES

Databases searched included: PubMed 1996-Present, Embase 1974-Present, CINAHL 1961-Present, ProQuest Health and Medical Collection 1938-Present and Google Scholar (2004-Present). Additional studies were identified by scanning reference lists and hand searching for relevant articles.

REVIEW METHODS

The research team collaboratively designed the data charting table and two project leads independently extracted and screened the data as per guidance from the Joanna Briggs Institute Reviewers Manual. A meta-synthesis was conducted in this scoping review to identify common themes from qualitative research to provide a deeper understanding of literature. To ensure feasibility of collating results, components of pre-registration curricular in physiotherapy students describing associations of forming and shaping professional identity were charted.

RESULTS

A total of 21 articles were reviewed. Articles were categorised into three categories of shaping (5, 24%), forming (9, 43%) or forming and shaping (7, 33%). Five themes emerged from the meta-synthesis pertaining to forming and shaping professional identity: self, skills, curriculum, program, location.

CONCLUSIONS

This scoping review illustrates the evidence for multidimensional components of physiotherapy curricular involved to assist in shaping and forming professional identity in pre-registration physiotherapy students. The results of this review can provide a foundation level into the understanding of what professional identity is, although further research is required to understand how it could be best implemented in pre-registration physiotherapy curricular.

Advancing Cardiorespiratory Physiotherapy Practice in a Developing Country: Surveying and Benchmarking

Management of noncommunicable diseases requires the adoption of multidisciplinary interventions that targets the modification of risk factors. Cardiovascular and respiratory diseases are amongst the four main killers of noncommunicable diseases. Physiotherapists specializing in cardiorespiratory physiotherapy are in a critical position in the management of health behaviors associated with noncommunicable diseases. However, the current context of health service in Jordan does not provide sufficient support and recognition for the delivery of specialized physiotherapy services. Objectives. The primary aim of this study was to describe cardiorespiratory physiotherapy service in Jordan. The secondary aims of this study were to: (i) Identify benchmarks from international contexts and guidelines for the delivery of cardiorespiratory physiotherapy service. (ii) Identify gaps and areas for development in the current delivery of cardiorespiratory physiotherapy service. Methods. This two phase study included a survey and a conceptual review with benchmarking. Following ethics approval, a cross sectional survey of physiotherapists practicing in Jordan was conducted. In phase 1, a survey was developed to describe the relevant dimensions of cardiorespiratory physiotherapy service. In phase 2 a conceptual review of the literature was performed to identify domains of service delivery and criteria required for optimal delivery of cardiorespiratory physiotherapy service. In the discussion we integrated the results of the survey within the benchmarks that emerged from the conceptual review of literature in order to identify gaps and areas for development in the current delivery of cardiorespiratory physiotherapy service. Results. Phase 1: Data emerging from the survey suggests that Physiotherapists in Jordan lack training and autonomy, preventing them from acquiring advanced roles particularly cardiorespiratory physiotherapy that requires specialised knowledge and skills. The current delivery of the service is limited to acute interventions, and is based on limited, unstructured referral from physicians depriving the patients from the service. The context of health service in Jordan does not provide sufficient recognition for physiotherapy; neither does it support the delivery of multidisciplinary interventions by appropriate regulations and policies. Phase 2: The following three domains emerged from the literature and were used for describing cardiorespiratory physiotherapy in Jordan: people, scope of practice, and context of practice. Conclusion. Advancing practice requires developing competencies relevant to cardiorespiratory physiotherapy particularly diagnosis, health promotion, and prevention. It is recommended that health authorities should develop regulations and policies that promote the recognition and integration of physiotherapists in the healthcare system, as well as facilitating the implementation of patient centred, multidisciplinary interventions.

Studying the old masters of nursing: A critical student experience for developing nursing identity

In the past professional identity in nursing was inculcated in students alongside institutional pride. A strong sense of professional identity is key to staff retention and recruitment and key to the delivery of quality nursing care. With the wholesale transfer of pre-registration nursing education to the third level sector, however, the reality is that students now divide their affiliations between university and healthcare institutions and professional identity development may be stymied. For this reason, there is need to explore alternative means of developing professional identity. Exposure to nursing history may counteract this tendency. Based on adult nursing students' reflections of a visit to the Florence Nightingale Museum, we discuss the potential of this activity in aiding development of critical professional identity.

Giving hope, ticking boxes or securing services? A qualitative study of respiratory physiotherapists' views on goal-setting with people with chronic obstructive pulmonary disease

OBJECTIVE

To explore respiratory physiotherapists' views and experiences of using goal-setting with people with chronic obstructive pulmonary disease in rehabilitation settings.

PARTICIPANTS

A total of 17 respiratory physiotherapists with ⩾12 months current or previous experience of working with patients with chronic obstructive pulmonary disease in a non-acute setting. Participants were diverse in relation to age (25-49 years), sex (13 women), experience (Agenda for Change bands 6-8) and geographic location.

METHOD

Data were collected via face-to-face qualitative in-depth interviews (40-70 minutes) using a semi-structured interview guide. Interview locations were selected by participants (included participants' homes, public places and University). Interviews followed an interview guide, were audio-recorded and transcribed verbatim.

DATA ANALYSIS

Data were analysed using thematic analysis; constant comparison was made within and between accounts, and negative case analysis was used.

RESULTS

Three themes emerged through the process of analysis: (1) 'Explaining goal-setting'; (2) 'Working with goals'; and (3) 'Influences on collaborative goal-setting'. Goal-setting practices among respiratory physiotherapists varied considerably. Collaborative goal-setting was described as challenging and was sometimes driven by service need rather than patient values. Lack of training in collaborative goal-setting at both undergraduate and postgraduate level was also seen as an issue.

CONCLUSION

Respiratory physiotherapists reflected uncertainties around the use of goal-setting in their practice, and conflict between patients' goals and organisational demands. This work highlights a need for wider discussion to clarify the purpose and implementation of goal-setting in respiratory rehabilitation.