Re-negotiating the Boundaries: a Grounded Theory Study
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Physiotherapy’s historical adoption of the biomechanical approach which views the body-as-machine, has played an important part in defining its professional role, identity and status. But the physiotherapy profession is being challenged by increasing pressures from a changing healthcare environment, shifting government priorities and appeals from within the physiotherapy community itself, to find a different way of thinking about and practicing physiotherapy. However, there is no current consensus as to what this new physiotherapy approach should embody or how it could be achieved. The physiotherapy literature indicated that the biomechanical approach is still prevalent in practice. However, healthcare models and approaches are being used to facilitate a more inclusive practice. This study developed a theoretical framework which was applied as a tool to assess the advantages, limitations and potential application of the healthcare frameworks found in the physiotherapy literature. This critical review concluded that the current healthcare frameworks are not well understood or consistently applied in physiotherapy practice. It also suggested that current healthcare frameworks are not sufficient to be the overarching theoretical framework needed to help the profession to cohesively adopt a more inclusive approach. Instead, a different way of conceptualising an overarching theoretical framework may be needed. In this researcher’s clinical experience, some physiotherapists were already practicing with a more inclusive approach to practice. Therefore, this study investigated five musculoskeletal physiotherapists who had been identified as incorporating a ‘more than biomechanical’ approach into their private practice. It asked the question: How are musculoskeletal physiotherapists integrating a ‘more than biomechanical’ approach into their private practice? This research aimed to gain an understanding as to how and why these particular participants integrated a more inclusive approach and what this approach encompassed. Constructivist grounded theory methodology was employed and data was collected via semi-structured interviews. Constant comparative analysis, theoretical sampling and memoing were used to construct the process called Re-negotiating the Boundaries. This process illustrated seven stages of the participants’ journeys including their motivations, obstacles encountered and the ethical, professional and personal self-negotiations that occurred along the way. It also explored the common aspects of these participants’ new approach. Four common themes were identified throughout the constructed process: 1. Authentic Practice: participants’ search for ways to combine their personal values with their professional role. 2. Power of Perception: participants experienced discomfort believing their particular approach was on the margins of orthodox practice. The widening of their perception of the physiotherapy scope of practice fundamentally changed their practice. 3. Reflective Practice: participants used self-awareness and reflection to negotiate their new professional boundaries, indicating that the future of physiotherapy may lie in purposeful, reflective practice. 4. Concept of Connection: this was evident throughout these participants’ more inclusive approach and included connecting the physiotherapists’ personal values with their professional practice, connection with their clients, and connecting their client’s physical injury to their context, previous experiences and implications. The identification and exploration of these four themes offer valuable insights and alternative avenues that could be used to promote different ways for physiotherapists to think and practice.