A philosophical ethical amp creative conversation about how physiotherapy is was and can be Acknowledgement of country Critical physiotherapy challenges contemporary physiotherapy theory amp ID: 365547
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Slide1
Critical Physiotherapy Forum
A philosophical, ethical & creative conversation about how physiotherapy is, was and can beSlide2
Acknowledgement of country Slide3
Critical physiotherapy
challenges contemporary physiotherapy theory & practiceworks towards a more positive, inclusive, critical future for physiotherapySlide4
Speakers
Dr Ian EdwardsWhat is the source of our ethical obligation in physiotherapy practice: Codes of Conduct or the Levinasian face? Amy
Hiller
‘Insider’ research: Reflexivity as a tool to manage participant misconceptions.
Blaise
Doran
A physiotherapist prepares: Enhancing the therapeutic
alliance through
Psychological
Realism
acting methods
.
Dr
Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for researching what physiotherapy was, is and can be.
A
/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the genealogy of a profession
.Slide5
Speakers
Dr Ian EdwardsWhat is the source of our ethical obligation in physiotherapy practice: Codes of Conduct or the Levinasian face? Slide6
What is the source of our ethical obligation in physiotherapy: Codes of conduct or the
Levinasian face?Ian EdwardsSlide7
Ethics in physiotherapy sits on a fault line
Codes of conduct:
Regulation of professional
behaviour and practice
standards
To be caring and
have compassion
Delany et al (In preparation)
Josephson et al 2015Slide8
Emmanuel Levinas
Ethics as 1st philosophyAlterity – the primacy of the ‘other’The Levinasian
‘face’
(
Levinas
1969 p 66)Slide9
The boy with no eyes
From Edwards, I. The boy with no eyes – an ethics of ourselves with others. (In preparation)Slide10
Edwards et al 2014Slide11
references
Delany C, Edwards I & Fryer C. Ethical dimensions of Australian physiotherapy practice (In preparation).Edwards I. The boy with no eyes – an ethics of ourselves with others. (In preparation)Edwards I, Jones M, Thacker M, & Swisher LL
.
2014.
The Moral Experience of the Patient with Chronic Pain: Bridging the Gap Between First and Third Person Ethics.
Pain Medicine 15:
364–378
Josephson I, Woodward-
Kron
R, Delany C & Hiller A. 2015. Evaluative
language in physiotherapy practice: How does it
contribute to
the therapeutic relationship
?
Social Science and Medicine 143:128-136
Levinas
E 1969. Totality and Infinity: an essay on exteriority. Trans. Alphonso
Lingis
. Pittsburgh, Pennsylvania; Duquesne University Press, p
66.Slide12
Speakers
Dr Ian EdwardsWhat is the source of our ethical obligation in physiotherapy practice: Codes of Conduct or the Levinasian face? Amy
Hiller
‘Insider’ research: Reflexivity as a tool to manage participant misconceptions.
Blaise
Doran
A physiotherapist prepares.
Dr
Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for researching what physiotherapy was, is and can be.
A
/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the genealogy of a profession.Slide13
Speakers
Amy Hiller‘Insider’ research: Reflexivity as a tool to manage participant misconceptions. Slide14
‘Insider’ research: reflexivity as a tool to manage participant misconceptions
Amy Hiller
The University of Melbourne
Contact: a.terry@student.unimelb.edu.auSlide15
Who am I? What is my identity?
Researcher
Health care professional/ clinician/Physiotherapist
Dual clinician-researcher identity
‘insider-researcher’
(Allen, 2004; Asselin, 2003)Slide16
How do I consider what my role is? Slide17
Reflexivity
Involves “disciplined self–reflection”
Self-awareness, critical evaluation
Consideration of role and impact on
research
Benefits:
Enhances
rigor and reduces bias
Provides
guidance to manage ‘ethically important moments’
(Doyle, 2013; Finlay, 2002; Guillemin and Gillam, 2004; Johnson and Waterfield, 2004)Slide18
What are my role identities?
Health care professional/Physiotherapist
Caring and helping nature
Patient advocate
Influenced by professional socialization
Focus on providing a service
of patient care
(Colbourne & Sque, 2004)
Researcher
Investigational
Objectivity
Focus on generating knowledge and understandingSlide19
The clinician-researcher
Dual role or ‘insider researcher’
Benefits
Challenges
Easier
access to participants for recruitment
Easier development
of
rapport with participants
Familiarity with clinical environment and terminology
Managing the different focuses
of the roles
Understanding scope and boundaries of each role
Managing misconceptions of participants
Ethical challenges
(Allen, 2004; Asselin, 2003; Colbourne and Sque, 2004; Reed and Proctor, 1995)Slide20
ConsiderationsSlide21
The therapeutic misconception in quantitative research
Clinical trials research participants:
Confuse participation with personalized care
Do
not appreciate random assignment to
treatment
Expect direct
benefit
Ethical and methodological issues can arise
(
Appelbaum
et al., 2004; Dresser, 2002;
Glannon
, 2006;
Miller and
Joffe
, 2006; Townsend et al., 2010)Slide22
Participant misconceptions in qualitative research
Patient-participants:Feeling an obligation to participate
Expecting treatment
Practitioner-participants:
Expecting to receive feedback
Perception of being judged
(Hiller and Vears, 2016 – in press)Slide23
Conclusion
The insider-researcher must be aware of his or her role regarding potential misconceptions of participantsReflexivity is critical to achieving this awareness
Helpful tips:
Be aware of the potential for misconceptions
Talk to other researchers to gain different perspectives
Keep a research diarySlide24
Thank you
a.terry@student.unimelb.edu.auSlide25
References
Allen, D. (2004), “Ethnomethodological
insights into insider-outsider relationships in nursing ethnographies of healthcare settings”, Nursing Enquiry, Vol. 11 No. 1, pp. 14-24.
Appelbaum
, P. S.,
Lidz
, C. W. and
Grisso
, T. (2004), “Therapeutic misconception in clinical research: Frequency and risk factors”, IRB: Ethics and Human Research, Vol. 26 No.
2
, pp. 1-8
.
Asselin
, M. E. (2003), “Insider research: Issues to consider when doing qualitative research
in
your own setting”, Journal for Nurses in Staff Development, Vol. 19 No. 2, pp. 99- 103.
Colbourne
, L., &
Sque
, M. (2004). Split personalities: role conflict between the nurse and the nurse researcher.
NT Research, 9
(4), 297-304
.
Doyle
, S. (2013), “Reflexivity and the capacity to think”, Qualitative Health Research, Vol. 23 No. 2, pp. 248-255.
Dresser, R. (2002), “The ubiquity and utility of the therapeutic misconception”, Social Philosophy and Policy, Vol. 19 No. 2, pp. 271–294.
Finlay, L. (2002). "Outing" the researcher: The provenance, process, and practice of reflexivity.
Qualitative Health Research, 12
(4), 531-545
.
Glannon
, W. (2006), “Phase I oncology trials: Why the therapeutic misconception will not go away”, Journal of Medical Ethics, Vol. 32 No. 5, pp. 252-255.
Guillemin, M. and
Gillam
, L. (2004), “Ethics, reflexivity, and 'ethically important moments' in research”, Qualitative Inquiry, Vol. 10 No. 2, pp. 261-280.
Hiller, A. and
Vears
, D (2015), “Reflexivity and the clinician-researcher: managing participant misconceptions”, Qualitative Research Journal (In Press).
Johnson, R. and
Waterfield
, J. (2004), “Making words count: the value of qualitative research”, Physiotherapy Research International, Vol. 9 No. 3, pp. 121-131.
Miller, F. G. and
Joffe
, S. (2006), “Evaluating the therapeutic misconception”, Kennedy Institute of Ethics Journal, Vol. 16 No. 4, pp. 353-366. Reed, J. and Procter, S. (1995), “Practitioner research in context”, in Reed, J. and Proctor, S. (Eds.), Practitioner research in health care: The inside story, Chapman and Hall, London, pp. 3-31. Townsend, A., Cox, S. M. and Li, L. C. (2010), “Qualitative research ethics: Enhancing evidence-based practice in physical therapy”, Physcial Therapy, Vol. 90 No. 4, pp. 615-628. Slide26
Speakers
Dr Ian EdwardsWhat is the source of our ethical obligation in physiotherapy practice: Codes of Conduct or the Levinasian face? Amy
Hiller
‘Insider’ research: Reflexivity as a tool to manage participant misconceptions.
Blaise
Doran
A physiotherapist prepares: Enhancing the therapeutic
alliance through
Psychological
Realism
acting methods
.
Dr
Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for researching what physiotherapy was, is and can be.
A
/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the genealogy of a profession
.Slide27
Speakers
Blaise DoranA physiotherapist prepares: Enhancing the therapeutic alliance through Psychological Realism acting methods. Slide28
Enhancing the therapeutic alliance through
Psychological Realism
acting methods.
A physiotherapist prepares
Blaise Doran, BSc Physiotherapy, Grad. Dip.
Neuro
. Rehab.
Psychological Realism
Events
Objectives
and
Actions
Putting it to use
;
questionsSlide29
“Psychological Realism” AKA
The Method
Kogan
, S [Ed.
Kogan
, H] (
2010)
.
The Science of Acting
,
Routledge
, UK.
Sam
Kogan
(1946 – 2004)
Maria
Knebel
(1898 - 1985)
Konstantin Stanislavsky
(1863 – 1938)
“Psychological Realism”
in acting.Slide30
y
x
t
= n
Intensity of thought
Physiotherapy
C
BT
Circumstance
Events
Anticipation
Dissipation
Events ≠ physical
happenings
That which intensifies our thinking
or
Intensified thinking itself (
Kogan
, 2010)Slide31
Objectives
and Actions (Purposes)
Purposes
(long term)
Super-purpose
Objective
s (short or medium term)
Purposes
&
objectives
:
A
want
; a change we want to fulfil
Happiness
:
Achieving purposes…
Actions:
What we do to achieve our purpose.
Birth
Death
Super-purpose
Purpose
Objective
Objective
Value oriented / goal oriented.Slide32
y
x
t
= months
Intensity of thought
C
W
Accident
Dissipation
PHYSIO
Anticipation
Afterburn
1
2
3
5
4
6
Objectives
What is the
want
driving them to see you?
Egotistical objective
– wanting to change the thinking of another person
Altruistic objective
– a thought you want to achieve in your own head.
Are your objectives (collectively)
complementary
or
contradictory
?
Actions
What are they doing to try to achieve their objective?
Thought
physical behaviour
Questions:
Can you teach empathy?
Does a formula lead to failure?
Putting it togetherSlide33
Speakers
Dr Ian EdwardsWhat is the source of our ethical obligation in physiotherapy practice: Codes of Conduct or the Levinasian face? Amy
Hiller
‘Insider’ research: Reflexivity as a tool to manage participant misconceptions.
Blaise
Doran
A physiotherapist prepares: Enhancing the therapeutic
alliance through
Psychological
Realism
acting methods
.
Dr
Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for researching what physiotherapy was, is and can be.
A
/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the genealogy of a profession
.Slide34
Speakers
Dr Gwyn OwenThinking through the body: embodiment as a conceptual framework for researching what physiotherapy was, is and can be. Slide35
Thinking through the body: embodiment as
a conceptual framework for researching what physiotherapy was, is and can beGwyn Owen PhD MCSPSlide36
Background
research developed in response to gaps in the literature about the evolution of physiotherapy practice and the uncertainty emerging from within UK physiotherapy during 2000s about its identity and practices bodies of physiotherapists experiencing and producing physiotherapy appeared to be an absent presence within the literaturegenealogical study of existing literature, documentary data from physiotherapy’s qualifying curricula and oral accounts of practice generated by physiotherapists who qualified during the 1940/60s. Slide37
Embodiment…
is about the interplay between the body and the world the body lives inchallenges physiotherapy’s dualistic mode of thinking about the body and bodily practicesunderstands the body to be a dynamic interface for exploring discursive practices, lived experiences and ways of being and doingSlide38
Method/ology
Genealogical approachData generated from national physiotherapy qualifying curricula and depth interviews with 12 physiotherapists who had qualified during 1940/60sSlide39
professionalising bodies
1928
1977
1991
2015
1950s
1960s
1930/40sSlide40
conclusion
Embodiment offers a conceptual framework for uncovering relationships between physiotherapy’s identity (being) and practice (doing). For example:- what physiotherapists’ bodies can do in a given time/place- how physiotherapists/clients/technologies work together to produce physiotherapy’s identities/practices- how physiotherapy’s identities/practices multiply as it moves through space and timeSlide41
prompts for a conversation
…We all have and are a body. But there is a way out of this dichotomous twosome. As part of our daily practices, we also do (our) bodies.
In practice we enact them. If the body we
have
is the one known by pathologists after our death, while the body we
are
is one we know ourselves by being self aware, then what about the body we do? What can be found out and said about it? Is it possible to inquire into the body we do? And what are the consequences if action is privileged over knowledge?
Mol
& Law, 2004.
Body and Society
10(2-3)43-62
pp45Slide42
Speakers
Dr Ian EdwardsWhat is the source of our ethical obligation in physiotherapy practice: Codes of Conduct or the Levinasian face? Amy
Hiller
‘Insider’ research: Reflexivity as a tool to manage participant misconceptions.
Blaise
Doran
A physiotherapist prepares.
Dr
Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for researching what physiotherapy was, is and can be.
A
/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the genealogy of a profession.Slide43
Speakers
A/Prof David NichollsPhysiotherapy as exotic abstraction: The role of luxury and surplus in the genealogy of a profession. Slide44
Physiotherapy as exotic abstraction: The role of luxury and surplus in the genealogy of a
profession
A/Prof Dave Nicholls
Head of Learning and Teaching
AUT University
Auckland, New ZealandSlide45Slide46
ArchivesArchives New Zealand
Alexander Turnbull LibraryNational Library of New ZealandPapers Past digital archiveSampling strategyPrimary sourcesPublished/unpublished manuscriptsPeriod newspapersPersonal accounts
Legislation
Institutional records
Oral histories
Correspondence
Registers and directories
Photographs
Secondary texts
Existing histories
Search terms
balneo
*,
exercis
*,
hauwai
,
waiariki
,
ngawha
,
masseu
*,
mirimiri
, “Swedish movement cure”, gymnastics AND correct*,
electrotherap
*, health AND physical, “hot springs”Slide47
Traditional Māori healingSlide48
Settler practicesSlide49
“Ankles, Weak—Treatment: Bathe in sea water; wear lace boots…use friction at time of bathing.”
“Asthma—Treatment: Inhale chloroform; smoke from brown paper—Stramonium cigarettes; blotting paper, soaked in strong solution of
nitre
, dried, and fumes inhaled. If no Bronchitis, give twenty or thirty drops of laudanum.”
“Bite of dog—Treatment: Immediately suck the wound and apply caustic; if dog is certainly mad, part should be cut out and washed with vinegar and water, or burnt with a hot iron.”Slide50
A few isolated practitionersSlide51
Argument
Physical therapies v popular in Europe and N America in C19thNo evidence of any PTs in NZ at same time – no luxury or surplus time/moneyMāori PTs decimated, settlers too isolated for public services, atomistic, self-reliant – “just get on with it”Took political action after 1890 and then birth of welfare state to make physio possibleIs physio dependent on luxury and surplus?
Not if there is a welfare state…but what happens now welfare state is being dismantled?
Will PT become a profession only for those who can afford it?Slide52
Speakers – Questions?
Dr Ian EdwardsWhat is the source of our ethical obligation in physiotherapy practice: Codes of Conduct or the Levinasian face? Amy
Hiller
‘Insider’ research: Reflexivity as a tool to manage participant misconceptions.
Blaise
Doran
A physiotherapist prepares.
Dr
Gwyn Owen
Thinking through the body: embodiment as a conceptual framework for researching what physiotherapy was, is and can be.
A
/Prof David Nicholls
Physiotherapy as exotic abstraction: The role of luxury and surplus in the genealogy of a profession.Slide53
Critical Physiotherapy Forum
PanelSlide54
Critical Physiotherapy Forum
A philosophical, ethical & creative conversation about how physiotherapy is, was and can be