Summarising Practitioner Permeability as a foundation for the resolution of

A range of characteristics and behaviours which support the therapist to resolve her practice uncertainties have been co-constructed as the researcher conceptualised indicators from participant accounts. These behaviours and characteristics can be regarded as the dimensions of an overarching core category of ‘practitioner permeability’, (see table 11 below and figure 11 overleaf).

Core Conceptual Category

Dimensions

Practitioner Permeability

Awareness of self Awareness of others

Awareness for others (Vigilance) Awareness-sharing disposition Feedback-seeking orientation Openness to alternatives

Practitioner agency/ Critical awareness (appraising feedback and alternatives)

Willingness to change / learning disposition

Table 11 Dimensions of the Core Conceptual Category ‘Practitioner Permeability’

Practitioner permeability is regarded as the core category because it is foundational in the recognition of and resolution of practitioner’s uncertainties.

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Figure 11: Components of Practitioner Permeability

As the term permeability implies, practitioner permeability is not fixed or rigid but may vary between individuals and may also vary for a given individual. In the excerpts below, Rosie indicates varying permeability in relation to career points and wider life contexts, while Leanne suggests links between experience and assumptions which could reduce permeability and Sam indicates how permeability may be restricted for novice practitioners:

‘I think it’s just about whether, where you’re at in your own life really and I think we all get to that sometimes, when we just want to come to work 9 to 5. Quite happy. It pays the bills and that’s what it’s for. But I think when you’re in a really um, high reputation hospital you’re around people and here because you want to keep learning and you don’t want to take that back seat yet, so it’s you do still want that opportunity’ Rosie

‘I suppose when I first came into post, I was learning very much through my MDT and through other networks of, cos, because it’s got that flavour to my job as well. Erm, so yeah, I do do that as well, but I don’t know if everyone would, kind’ve, cos it’s not, it’s not as formal. So, I think, I think and particularly as you become, you know, more experienced, more confident and I think that’s when you’re in more danger because you’re, there is some more sort of assumption that you, you’re ok.’ Leanne

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‘In some places where I’ve worked in, band 5 have been very challenging ok.

Because of, because they’ve been supervised by a different supervisor. That person had a different school of thought and if I try and introduce something new they’re like ‘Foo, rubbish! That thing don’t work that way because we’ve got our own trust in that person, and he was the ‘god’, ‘my therapy god’’ and all that.

So, they’re different. And I don’t think it’s easy to change that unless you spend more time with them. So that was a challenge. And also, lack of information sometimes can harm, ok. So sometimes they, rather than learning, they’re like

‘I’ve done my duty. I’ve learned a lot. It’s my time to just shine.’ You know? And it was hard you know? And they’re like ‘All this I had from my previous,’ you know? ‘I’m amazing! So, let’s go for it!’ Sam

It might be anticipated that a newly qualified therapist, eager to learn and add new experiences to her novice platform for practice, will be more permeable than a more established colleague. However, Sam’s instance above, the earlier instance of the newly qualified physiotherapist who was too intent on sticking to a treatment protocol or Pauline, feeling she was yet to do anything she recognised as therapy with her patient, indicate that a newly qualified therapist with fixed ideas, can also present as less permeable. Experienced Charlotte provided many instances of permeability yet the uncertainty she spoke about as an experienced therapist when applying aspects of her platform for practice in a new post is indicative, in permeability terms, of a temporary but otherwise uncharacteristic unwillingness to embrace alternative ways to apply her practice in the new setting. Furthermore, variations in permeability are apparent in the many accounts where a therapist expresses uncertainty relating to expectations of herself as a supervisor, anticipating that her supervisee might expect her to have all the answers while, in the same account, suggesting that she does not expect her own supervisor to have all the answers, only to contradict this later by expressing disappointment because her supervisor does not appear to have sufficient knowledge to help her resolve her uncertainties.

This variation in permeability did not develop into a main focus in the grounded theory research but the instances in accounts are indicative of a spectrum of permeability. This is not to say that a given practitioner could be placed at a given point on the spectrum.

There is variation across professionals as well as for a given practitioner whose

147 permeability may also vary in the face of differing practice scenarios. Conceptually, it is proposed that between the extremities, in any given practice context, there is an optimum range of practitioner permeability which supports practice, as illustrated in figure 12 below.

Figure 12: A possible spectrum of practitioner permeability

This notion of a spectrum supports the instances of variation in the first-hand accounts.

In the face of some practice demands and or the influence of particular life events, as Rosie indicates, a practitioner may be more or less permeable. However, this spectrum implies that a practitioner who is consistently at one or other extremity may be fragile because she is less well equipped to recognise uncertainties and to engage in recalibrating practices. Conceptually, a highly permeable or porous practitioner may remain highly dependent and overly feedback-seeking, while at the other extreme the impermeable practitioner, as Leanne describes, may remain unaware of uncertainties or choose not to be awareness-sharing as with colleagues who participants regarded as feedback-avoidant.

When faced with socio-professional, practice platform or practice demand uncertainties, permeability supports the therapist to engage in activities and behaviours which facilitate the resolution of her uncertainties. Conceptually, these activities and behaviours prompt the therapist to address the socio-professional, platform for practice and practice demand factors which may be contributing to her practice uncertainties.

Recalibrating activities and behaviours are many and varied and might include checking-in checking-informally with peers as Simon described, attendchecking-ing a conference as a physiotherapy

148 participant described or going on a course as Nina indicated. Participants in this research indicate that supervision is also a culturally-established part of AHP practice in which permeable therapists engage as part of the endeavour to recalibrate and to resolve practice uncertainty concerns. The place of supervision in resolving practitioners’ uncertainties, as indicated in the practitioner accounts will now be considered further in chapter seven.

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Chapter 7. Turning to Supervision: exploring and