Learning from clinical placement experience: how do undergraduate physiotherapy students approach person-centered practice?

INTRODUCTION

It is now widely accepted in physiotherapy and in other health professions, that involving patients in the design, planning and implementation of services is best practice. Little is, however, known about how physiotherapy students perceive their professional development in applying person-centered practice.

OBJECTIVE

To analyze how undergraduate physiotherapy students experience the process of learning to work in a person-centered way in clinical practice.

METHOD

Five focus-group interviews of final-year physiotherapy students.

RESULTS

It is important that students communicate in ways that accommodate the sociocultural characteristics of their patients. Students, where they experience that mutual understanding is not possible to achieve, tend to resort to the biomedical model and take on an expert instructor role that is met with acceptance from the patients. Some practice contexts were also found to strongly promote person-centered practice, others tightly restricting it.

CONCLUSION

In the educational setting, attention should be paid to the practice learning context, to the improvement of the ability of students to grasp the lived world of patients, and to activate their own identities and experiences as a relational tool in practicing person-centered care.

Organisational culture and ethnic diversity in nursing homes: a qualitative study of healthcare workers' and ward nurses' experiences

Background

The increase in care needs that comes with an ageing population, in combination with a shortage of healthcare workers, has made ethnic diversity among healthcare workers (HCW) an evident reality across many countries. This article aims to explore how a multicultural workplace is experienced, through the accounts of HCWs and leaders in nursing homes.

Methods

This article reports on the findings from qualitative interviews with 16 HCWs and managers from nursing homes in Oslo. The interviews were conducted from August to September 2021. We analysed the data using a reflective thematic analysis informed by a hermeneutic-phenomenological approach.

Results

Six themes emerged from the interview data: (1) understanding diversity through shared norms and multicultural experiences, (2) greater flexibility in a multicultural workforce, (3) challenging traditional norms in a multicultural workforce, (4) language proficiency and exclusionary practices at work, (5) perceptions of the role of the ward nurse, and (6) prejudices among and harassment from patients.

Conclusions

To ensure the effective organisation and wellbeing of HCWs in a multicultural workforce, managers must develop an inclusive organisational culture. They must be able to engage with difficult topics and conflicts that may arise in the working environment.

Healthcare professionals' encounters with ethnic minority patients: The critical incident approach

Ethnic minority patients face challenges concerning communication and are at higher risk of experiencing health problems and consuming fewer healthcare services. They are also exposed to disparaging societal discourses about migrants which might undermine healthcare institutions' ambitions of equitable health care. Therefore, healthcare professionals need to critically reflect on their practices and processes related to ethnic minority patients. The aim of this article is to explore healthcare professionals' experiences of working with ethnic minority patients by using the critical incident (CI) technique. In two focus group sessions, participants discussed challenging events in their encounters with patients. The critical incidents show that healthcare professionals may experience unfamiliar situations related to their work performance, prejudice toward patients, and labeling by patients the professionals do not identify with. The professionals' reflections are discussed in relation to social discourses on migration and their work conditions, and the possible influence on the professionals' preconceptions and the patient-professional relationship in health care. Reflections about work experiences with ethnic minority patients and aligned societal discourses should be included in healthcare workers' professional development. Critical incident reflections at work may contribute to better-coping strategies for healthcare professionals and improved patient-professional relationships with ethnic minority patients.

Treating gynecological pain: key factors in promoting body awareness and movement in somatocognitive therapy (SCT). A case study of a physiotherapy student´s treatment approaches

Background: Longstanding gynecological pain affects large numbers of women in the Western world. Somatocognitive therapy (SCT), a hybrid of cognitive psychotherapy and physiotherapy, is an evidence-based approach that has been successfully applied in the treatment of women suffering from such disorders, for example chronic pelvic pain (CPP) and provoked vestibulodynia (PVD), both demanding pain conditions. The curriculum of Oslo Metropolitan University's Mensendieck physiotherapy bachelor's program includes SCT training for the management of PVD.Purpose: The purpose of this study is to describe and explore the content of a SCT session based on a body and mind approach as performed by a physiotherapy student at a student outpatient clinic.Methods: A video-based case study of the student-patient encounter was undertaken midway through an SCT treatment course and subjected to content analysis.Findings: Three categories illustrating the learning process of body awareness, associated with the three-phase SCT were identified: 1) demystifying genital and chronic pain; 2) concentration, and body and mind experiences; and 3) patience, persistence, and willingness to change.Conclusion: The observation of the somatocognitive therapy session illustrates the value of an empathic relationship with the patient, in order to encourage her to explore body sensations and become familiar with the vulvar area. The therapy engages the patient in understanding pain mechanisms, thus educating her to overcome the fear of pain.

Aging and exercise: Perceptions of the active lived-body

Exploring older people's evocation of their positive experiences of aging has been proposed as a counterweight to the Western stereotype of aging as a process of decline. The aim of this article is to explore how aging women, who participate regularly in group exercise classes, perceive their own bodies and the bodies of others. This article reports on the findings from interviews with 16 women between the age of 70 and 85. We analyzed the data using qualitative content analysis. Two overarching and interrelated themes concerning body perception emerged from the interviews: "The aging body and appearance" and "The body as subject and object." The binary discourse of old age, as either a decline or a success appears in our findings. The training contributes to a sense of well-being experienced through perceived increased physical abilities, self- image and self-esteem. Physical ability was perceived as being more important than appearance by the participants in this study, considering their preconception of an association between declining health, abilities, and older age. Involvement in physical activity appears to play a significant role in the perception of the women's own aging. Although physical attractiveness is a desirable outcome, the most important positive impact of the group exercise was related to increased social belonging and well-being, physical abilities, and capabilities. Thus implications for practice suggests that an intensive group training contributes to the opinion that an aging body is not necessarily a barrier to positive and successful aging.

Facilitating awareness of philosophy of science, ethics and communication through manual skills training in undergraduate education

BACKGROUND

Professional health science education includes a common theoretical basis concerning the theory of science, ethics and communication. Former evaluations by first-year students of the bachelor physiotherapy program at Oslo and Akershus University College of Applied Sciences (HiOA) show that they find it hard to understand the relation between these particular topics and future professional practice. This challenge is the starting point for a pedagogical development project that aims to develop learning contexts that highlight the relevance of these theoretical concepts.

AIM

The aim of the study is to explore and present findings on the value of using Sykegrep manual skills classes as an arena in which students can be encouraged to think about, reflect on and appreciate the role and value of the philosophical perspectives that inform their practice and contributes to practise knowledge.

METHOD

A qualitative study with data collection through focus groups was performed and analyzed using thematic content analysis. Eighteen first-year undergraduate students, who had completed the manual skills course, participated in the study.

FINDINGS

Analysis of the data yielded three categories of findings that can be associated with aspects of philosophy of science, ethics and communication. These are as follows: 1) preconceived understanding of physiotherapy; 2) body knowledge perspectives; and 3) relational aspects of interactions. Undergraduate students' understanding and experience of philosophy of science, ethics and communication may be facilitated by peer collaboration, reflection on intimacy and touch and the ethical aspects of interaction during manual skills training.

CONCLUSION

Practical classes in Sykegrep provide a basis for students' discussions about the body as well as their experiences with the body in the collaborative learning context. The students' reflections on their expectations of manual skills in physiotherapy and experiences of touch and being touched can facilitate an awareness of philosophy of science, ethics and communication.

IMPLICATIONS

Our study will be an incitement to further develop a manual skills teaching program that incorporates philosophy of science, ethics and communication in undergraduate education.

If I had a rich picture. . .: Insights into the use of ‘‘soft’’ methodological tools to support the development of interprofessional education

This paper describes a methodological experiment that aimed to test a small number of tools borrowed from Soft Systems Methodology. Those tools were intended to support action research for a project in interprofessional educational development. The intention with using those tools was two-fold: first, they were expected to help structure the analysis of the problem situation that the project was to address; second, they were to facilitate and document the project management process itself, by allowing for the different voices within the interprofessional project team to be heard. The paper relates how the tools functioned relatively successfully as analytical devices for the action researcher, but did not significantly contribute to further interprofessional collaboration or enhance dialogue between the action researcher and the project members. Issues of how to use the tools to support more effectively the existing dialogue across professional cultures and traditions are discussed.

Hva slags caseoppgaver inviterer til studentaktivitet og interaksjon?

Artikkelen omhandler bruk av ulike caseoppgaver som utgangspunkt for studentaktive læringsformer. Caseoppgaver har vært relatert til fysioterapiteori, et av kjernefagene i andre studieår. Artikkelen belyser hvilke oppgavetyper som er benyttet til å skrive seg inn på det fysioterapifaglige territorium. I den sammenheng drøftes hvilke typer oppgaver som synes å gi det beste grunnlaget for faglig diskusjon og klinisk resonnering.

Studentenes kritiske vurdering av egen fysioterapipraksis – en relevant metode for bacheloroppgaven

Artikkelen belyser og argumenterer for å bruke caserapporter som et alternativ til de forskningsmetoder som tradisjonelt har vært benyttet i bacheloroppgaven i fysioterapi i tredje studieår. Caserapportens relevans beskrives i lys av kunnskap om klinisk resonnering. Metoden gir fysioterapistudenter mulighet til å videreutvikle ferdigheter og forståelse i utøvelse av pasient-/klientrettet arbeid som er forankret i egen praksis. Artikkelen løfter fram problemstillinger knyttet til studenters vurderinger av ulike valg og prioriteringer i utøvelsen av kunnskapsbasert praksis. Med utgangspunkt i en caserapport illustreres noen utfordringer med å forene forskningsbasert kunnskap, erfaringskunnskap og pasientkunnskap på en konstruktiv måte. Artikkelen beskriver også et eksempel på en caserapport som er et samarbeidsprosjekt mellom to studenter. Den ene har behandlet en pasient med kroniske smerter, mens den andre har fungert som en ”kritisk venn” som har diskutert og stilt flere kritiske spørsmål som gir grunnlag for refleksjon over praksis og utvikling av økt kunnskap om klinisk resonnering.