Little research has explored the dilemmas of practice experienced by practitioners
working with rehabilitation clients who are assimilating disabilities, resulting from injury or
chronic conditions, into their lives. Consequently, there is limited literature to support
educational initiatives or clinicians' decision-making in these settings. Accordingly, this
qualitative study was designed to explore 'expert' physical therapists' perceptions of dilemmas
of practice in rehabilitation settings. Using an ethnographic design, multiple interviews were
conducted over a period of six months with each of ten participants. The researcher's theoretical
background and 'insider' role were thoroughly explicated. Interpretive analysis was grounded in
three overarching themes that emerged from the participants' accounts and compared with
relevant theoretical constructs and research in physical therapy and other health professions.
In the first theme the 'authority' of the concept of evidence-based practice as it is
currently promoted within physical therapy was questioned. A need was identified to develop
rigorous alternative sources of 'evidence' to support current practice that are more congruent
with the multifactorial and client-centred nature of rehabilitation service provision. A second
theme explored situations interpreted as causing moral distress in which the participants found
themselves prevented from acting effectively on behalf of the clients, as a result of admission
and discharge decisions and perceived misuse of rehabilitation resources within the organization
and health system. The third theme related to the advantages and disadvantages of being
involved with the interdisciplinary team. A lack of understanding of different professional
philosophies of practice was perceived as a contributing factor to conflict and
miscommunication.
These themes are related to issues of professional accountability and suggest that physical
therapy needs to develop a clearly articulated philosophy and conceptual models, including the
concept of client-centred practice, that would reflect practice, serve to guide research and
promote interdisciplinary collaboration. Alternative sources of 'best' evidence need to be
developed that more realistically reflect complex 'practice' knowledge. In addition, the
profession needs to commit to developing a comprehensive ethics curriculum offered in
education programs and through interdisciplinary learning opportunities, by which physical
therapists will be better prepared for the moral deliberations inherent in their professional role.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:BVAU.2429/12970 |
| Date | 05 1900 |
| Creators | Carpenter, Christine |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Relation | UBC Retrospective Theses Digitization Project [http://www.library.ubc.ca/archives/retro_theses/] |
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