A Critical Practice Model For Physiotherapy

A perspective in critical social science is concerned with knowledge, power and critique. This thesis explores the question: What would physiotherapy practice look like if it were informed by critical social science? This question originated from four observations: (1) physiotherapists work with constantly changing health care demands, (2) traditional practice approaches underpinned by rational objectivity widen the gap between theory and practice, (3) professional judgments are based on more than objective, rational thinking, and (4) concluding from the first three observations clinical physiotherapists rely more and more on thinking for themselves. If physiotherapists were to adopt a critical social science perspective they would question their practice, identify taken-for-granted, unreflected assumptions and unnecessary system constraints and liberate themselves, their practice and patients, thereby enhancing both the quality of patient care and the practitioner’s professional work experience. Following the hermeneutic tradition I constructed texts from pertinent literature as well as transcripts from participants’ interviews, action plans and field notes. I developed an integrative design to interpret these texts drawing from philosophical and critical hermeneutics as well as action research. The question and answer dialogue methodology consisted of four cycles including deep, critical and transformative dimensions. These I labelled critical transformative dialogues. The first dialogue was with the critical social science literature and with the Gadamer-Habermas and Foucault- Habermas debates in particular. These debates addressed issues of rationality, knowledge and power. Further, I reviewed relevant education, nursing and health promotion literature that addressed these critical social science themes. This first dialogue crystallised my identification of key CSS dimensions relevant to physiotherapy practice. The second dialogue comprised physiotherapy literature that related to these identified critical social science dimensions, as well as transcripts from physiotherapists’ interviews. This dialogue critically interpreted current practice models in their historical, educational and practice contexts. It highlighted the finding that physiotherapy practice is currently dominated by instrumental thinking rather than critical thinking, and that there is a lack of engagement of physiotherapy practice with CSS. The third dialogue was with physiotherapists trialling CSS in practice. Physiotherapists of this trialling group designed action learning “contracts” where they set out to change their practice in the sense of adopting CSS principles and activities in their practice. I explored with these participants how CSS could work or fit in their practice and practice contexts and how this would be experienced. Through this action learning project of endeavouring to transform their practice towards a CSS model I explored participants’ capacity to learn about posing problems concerning their practice, recognise practice contradictions, experience practice challenges and recognise their motivations and interests. This exploration illuminated the viability of CSS in their practice. The fourth dialogue was with physiotherapists who operationalised CSS values or who could visualise a CSS framework for their practice whether they used this terminology or not. This dialogue brought critical understanding of the advantages and potential limitations of realising a CSS-centred physiotherapy practice. I conclude the thesis with twelve propositions arising from these four critical transformative dialogues. Based on the trialling, transforming and visioning of CSS as a model for physiotherapy practice, the relevance of these propositions for critical physiotherapy practice is asserted and implications for education and further research are discussed. The contribution that CSS can make to physiotherapy practice is to add critical transformative dialogues as a strategy to advance practice that is patient-centred and multidisciplinary in approach, inclusive of sociopolitical environments, mindful of professional power and open about professional values

Educating the deliberate professional and enhancing professional agency through peer reflection of work-integrated learning

Educating reflexive, socially responsible and action-oriented future professionals who can contribute to a better future remains a core task of higher education. These graduate characteristics describe the deliberate professional. Within this article, we examine the value of a post-work-integrated learning peer reflection activity to foster professional agency and develop the deliberate professional in our students. Students participated in a post-work-integrated learning peer reflection activity, termed a huddle to signpost its informal yet respectful nature, and then completed a written reflection on the nature and value of this reflective experience. Findings demonstrate participants’ engagement with as well as limitations towards becoming deliberate professionals. Implications for future use and further research of this peer reflection activity are offered. This study contributes new evidence that suggests that purposefully structured, dialogic and written post-work-integrated learning peer reflections are an effective approach towards developing professional agency and educating the deliberate professional

Bourdieu and Jung: A Thought Partnership to Explore Personal, Social, and Collective Unconscious Influences on Professional Practices

This paper introduces a thought partnership between Pierre Bourdieu and Carl Jung used to explore clinical play therapists’ understanding and critical reflexivity of unconscious influences on their relational practices with parents. The partnership is situated within a broader methodological partnership between Paul Ricoeur and Jung discussed by the authors in another paper in this issue. The purpose of the Bourdieu and Jung partnership is to design a comprehensive theoretical tool kit that enables the exploration of the interrelated nature of personal, social, and collective unconscious influences on professional practices. The paper discusses seven Bourdieusian and ten Jungian thinking tools and how they were brought together within a critical imaginal hermeneutic approach drawn from the first author’s doctoral study. The application of the conceptual partnership to the study’s text sets is then discussed to provide an in-depth structural analysis of the study’s phenomenon. The results highlight how the application of the thinking tools provide a critical and systemic awareness of how personal, social, and collective unconscious influences shape professional practices. Implications for professional practice are discussed as well as the role the Bourdieusian and Jungian thinking tools can play in enhancing the fundamental aims of qualitative research, particularly critical inquiry

A Critical Imaginal Hermeneutics Approach to Explore Unconscious Influences on Professional Practices: A Ricoeur and Jung Partnership

Professional relationships are at the heart of professional practice. Qualitative studies exploring professional practice relationships are typically positioned in either the social constructivist (interpretive) paradigm where the aim is to explore actors’ subjective understandings of their relationships and relational practices, or in the critical paradigm where the aim is to reveal objective unconscious structures and hidden power plays influencing actors’ practices. This paper introduces critical imaginal hermeneutics as a systemic philosophical and methodological approach situated on the juncture of the social constructivist and critical paradigms where the dual aim is to explore both actors’ subjective understanding and meaning-making processes associated with their relational practices as well as explore objective unconscious structures and power relations influencing their relational practices. At the core of this approach is a Critical Imaginal Hermeneutic Spiral – a methodological guide for text construction and interpretation processes developed by partnering Paul Ricoeur’s critical hermeneutics and Carl Jung’s imaginal arts-based approach. The spiral was developed, employed, and coined as part of the first author’s doctoral thesis exploring clinical play therapists’ relational practices with parents. It incorporates the Bourdieu and Jung thought partnership explored by the authors in another paper in this volume. The approach provides a systemic guide for developing practitioners’ critical reflexivity regarding personal, social, and collective unconscious influences on their relational practices, and in turn minimising the unconscious influences that undermine the quality of professional practice relationships

Impact of Disability Placements on Allied Health Students: Placement Educators’ Perspectives

Research on the relevance of placements to the development of allied health student skills to work with people with disability, is an underexplored area. This knowledge is important for several reasons: to prepare students for disability placements, develop their work readiness skills to work with people with disability upon graduation, inform placement curriculum development, and ensure placement educators are supported to provide effective and efficient supervision of students on disability placements. The study discussed in this article, explores placement educators’ perceptions of powerful learning experiences during disability placements that shape students’ attitudes and perceptions of working with people with disability. Allied health placement educators from three Australian disability organisations, were invited to attend focus groups on this topic. Two focus groups, with a total of seven participants, were conducted in February and May 2016. The allied health disciplines represented in the focus groups were Speech Pathology, Occupational Therapy, and Physiotherapy. Thematic analysis technique was used to analyse focus group data. Findings related to the following four key topic areas, are discussed in this  article: a. Reasons for placement educators entering and staying in the disability sector; b. Placement educator perceptions of changes in student attitudes and skills post disability placements and how their experiences shape their approaches to student placement education; c. Recommendations for universities to better prepare students to work with people with disability; and d. Preparation of students for job-seeking in the disability sector

Vocal convergence in a multi-level primate society: insights into the evolution of vocal learning

The extent to which nonhuman primate vocalizations are amenable to modification through experience is relevant for understanding the substrate from which human speech evolved. We examined the vocal behaviour of Guinea baboons, Papio papio, ranging in the Niokolo Koba National Park in Senegal. Guinea baboons live in a multi-level society, with units nested within parties nested within gangs. We investigated whether the acoustic structure of grunts of 27 male baboons of two gangs varied with party/gang membership and genetic relatedness. Males in this species are philopatric, resulting in increased male relatedness within gangs and parties. Grunts of males that were members of the same social levels were more similar than those of males in different social levels (N = 351 dyads for comparison within and between gangs, and N = 169 dyads within and between parties), but the effect sizes were small. Yet, acoustic similarity did not correlate with genetic relatedness, suggesting that higher amounts of social interactions rather than genetic relatedness promote the observed vocal convergence. We consider this convergence a result of sensory-motor integration and suggest this to be an implicit form of vocal learning shared with humans, in contrast to the goal-directed and intentional explicit form of vocal learning unique to human speech acquisition

Developing professionalism in physiotherapy and dietetics students in professional entry courses

In a context of education focused on skill mastery and graduate-level competence in preparation for professional practice, the notion of professionalism could be reduced to measurable and rules-based concepts, and the values, ethical decision making and professional autonomy that underpin it could be overlooked. Using a blend of hermeneutic phenomenology and discourse analysis, this article explores how professionalism is understood, talked about and experienced by lecturers and students in physiotherapy and dietetics courses at an Australian university. The findings of the study highlight the complex and evolving nature of professionalism. Understandings of professionalism appeared to be influenced by opportunities to think about and discuss values that inform them. Moreover, issues like cultural competence and environmental sustainability were not part of participants\u27 understandings of professionalism, suggesting a need to rethink philosophical approaches and pedagogical strategies to develop a notion of professionalism that adequately prepares students for the demands of contemporary professional practice

From discourse to visioning : eliciting future practice and marginalia

We start this chapter by parading the professional practice discourse on the historical stage. This then sets the backdrop for our discussion of visioning practice and marginalia into the future. Most accounts of the past are at the same time a preparation stage for new beginnings. At times there are smooth transitions from past to present but at other times there are abrupt stops and sudden starts. We then draw out the inevitable and essential opacity of practice. We discuss emergent new speculations about possible future practices and marginalia. We disrupt a seemingly smooth historical flow by discussing current game changers of practice discourse and muse with science fiction to envision what frames practice and marginalia in a post digital, hyper historical and post human world. We ask what will happen to practice discourse as the new public sphere increasingly blurs the professional-educational and public-personal boundaries. What will lead future professional practices and how will politics and power be redistributed in coming eras? In mobile conditions that reduce distances, gaps and blur boundaries who will be the experts, the clients and the learners? What will marginalia look like as neoliberalism continues to radiate the world? We conclude that in the mobile age, discursive conditions have radically revolutionised the possibilities for refreshing practice discourses. There is a need more urgently than ever before to theorise about the human condition and its purpose in a prospective post-human era

Diálogos críticos transformativos: Un método de investigación más allá de la fusión de horizontes

Die Art und Weise, wie wir Texte hermeneutisch interpretieren, aus der Exegese biblischer Texte hervorgegangen, ist übergegangen in dialogische Konstellationen mit dem Ziel, wechselseitiges Verstehen zu generieren, dieses Verständnis, wenn erzielt, weiter zu hinterfragen und Bedeutung auch über den Dialog hinaus zu generieren. In diesem Beitrag zeichnen wir den Fortschritt und die Verschränkung verschiedener hermeneutischer Ansätze vom Konzept der "Verschmelzung von Horizonten" bei GADAMER über die GADAMER-HABERMAS-Debatte zur Frage der Verbindung interpretativer und kritischer Ansätze der Textinterpretation hin zu einer Forschungsstrategie, die aus dieser Debatte heraus entstanden ist. Diese Strategie kritisch-transformativer Dialoge beinhaltet a) ein Interesse an einem tiefgehenden Verstehen des interessierenden Forschungsphänomens, b) eine skeptische Positionierung und Hinterfragung dieses im Forschungsprozess gewonnenen Verstehens und c) die Wertschätzung von Dialogen, die über eine "Verschmelzung von Horizonten" hinausgehend zu transformativem Handeln beitragen. Der Einsatz dieser Strategie wird an einem Gesundheitsprojekt demonstriert, bei dem die Untersuchungsfrage und deren Erforschung in einen emanzipatorischen Praxis-Dialog gemündet sind. URN: urn:nbn:de:0114-fqs090169The way we interpret texts in hermeneutic research has evolved from guidelines for interpreting biblical texts to engaging in question and answer conversations with the aim of finding mutual understanding, to challenging reached mutual understandings and finding meaning beyond the dialogue partners' understanding. We present a progression and blending of different hermeneutics from the fusion of horizons approach of GADAMER's philosophical hermeneutics, through the GADAMER-HABERMAS debate to explore the interface between interpretive and critical approaches to text interpretations, to arrive at a research strategy that was created out of this debate. This strategy, critical transformative dialogues, emphasises a) a deep understanding of the phenomenon being researched as well as b) a sceptical stance to this newly found deep understanding and c) the value of dialogue in transcending a fusion of understandings to achieve transformative action. This strategy is explored in a project in the health sector in which the phenomenon being investigated, as well as the research approach, created emancipatory dialogues in practice. URN: urn:nbn:de:0114-fqs090169La manera de interpretar los textos en la investigación hermenéutica ha evolucionado desde las directrices para la interpretación de textos bíblicos hasta centrase en las conversaciones con preguntas y respuestas con el fin de hallar el entendimiento mutuo, con el desafío del acuerdo alcanzado, y encontrar un significado más allá de la comprensión del diálogo entre los participantes. Presentamos una mezcla y progresión de diferentes hermenéuticas desde del enfoque de fusión de horizontes de la hermenéutica filosófica de GADAMER, pasando por el debate GADAMER-HABERMAS para explorar la relación entre los enfoques interpretativos y críticos en la interpretación de textos, hasta llegar a una estrategia de investigación que se deriva de ese debate. Esta estrategia, diálogos crítico transformativos, hace hincapié en: a) una profunda comprensión del fenómeno que está siendo investigado, así como, b) una postura escéptica hacia esa comprensión profunda recién encontrada y, c) el valor del diálogo para trascender a la fusión de entendimientos para realizar acciones transformadoras. Esta estrategia se explora en un proyecto en el sector de la salud en el que el fenómeno que se investiga, así como el enfoque de investigación, crean diálogos emancipadores en la práctica. URN: urn:nbn:de:0114-fqs09016