An ethnography of physiotherapy practice : a contextual exploration into the social construction of practice
Unpredictability, time constraints and having to constantly adapt to new situations
characterise modem physiotherapy practice such that everyday clinical situations can be
seen to have no easy and unambiguous solutions. Physiotherapists' practice has not yet
been explored in the U.K. and their voices not yet heard, as they cope with increasing
workloads in the day to day realities of busy hospital departments and their continuing
professional development needs.
Methodology and Design
An eight months in-depth investigation into a team of NHS physiotherapists'
construction of their day to day practice, viewed from a social constructionist stance,
was carried out. The chosen paradigm for this study was ethnography as it embraces the
importance of context related to time and the person.
Analysis and Findings
A systematic analysis of coding, categorising and identification of themes was carried
out. All observations with the participants were followed up from a reflexive stance in
the quest for a co-constituted account. Four main building blocks were identified as
major contributors to the construction of the team's practice: the team's relationships
with their patients, their negotiation and meaning of their food activities, their use of
humour and their response to the visit from the inspectors from the Commission for Health Improvement. The institutional hierarchy and the demand for leadership skills in
the senior therapist were the most potent parameters of the team's practice arena.
Contrasting themes have been presented as a way to explain the everyday world of this
team's practice. The senior therapists had to manage the differing requirements of
training the juniors alongside their own expectation of excellence. Propositional and
craft knowledge have to complement each other more and critical reflexive dialogues
are a powerful vehicle to achieve this, but the bi-annual rotations put this potential at
risk. Hierarchical stances within a department can 'blur' issues by deflecting the