A qualitative grounded theory study of the conceptions of clinical practice in osteopathy – A continuum from technical rationality to professional artistry

Abstract

a b s t r a c tHow practitioners conceive clinical practice influences many aspects of their clinical work including how they view knowledge, clinical decision-making, and their actions. Osteopaths have relied upon the philosophical and theoretical foundations upon which the profession was built to guide clinical practice. However, it is currently unknown how osteopaths conceive clinical practice, and how these conceptions develop and influence their clinical work. This paper reports the conceptions of practice of experienced osteopaths in the UK.A constructivist grounded theory approach was taken in this study. The constant comparative method of analysis was used to code and analyse data. Purposive sampling was employed to initially select participants. Subsequent theoretical sampling, informed by data analysis, allowed specific participants to be sampled. Data collection methods involved semi-structured interviews and non-participant observation of practitioners during a patient appointment, which was video-recorded and followed by a videoprompted reflective interview.Participants' conception of practice lay on a continuum, from technical rationality to professional artistry and the development of which was influenced by their educational experience, view of health and disease, epistemology of practice knowledge, theoryepractice relationship and their perceived therapeutic role.The findings from this study provide the first theoretical insight of osteopaths' conceptions of clinical practice and the factors which influence such conceptions.

Osteopaths' professional views, identities and conceptions – A qualitative grounded theory study

“…21,22,35 Previous research suggests that how these identities, views and conceptions are enacted during actual practice will influence osteopaths' clinical decision-making and ultimately the clinical approaches they take with their patients. 18,19 Importantly, research suggests that the attitudes and beliefs of manual therapy practitioners (physiotherapists, chiropractors and which overly emphasises patients' bodies (such as their movement and physical/structural characteristics) may limit practitioners' understanding to that of the objective reality of patients' anatomical, physiological and biomechanical dysfunctions. 40 This view could be considered narrow and therefore fail to connect the physical impairment with patients' social world and lived experiences, which is necessary for a deeper understanding which is embodied and relational.…”

“…-The word allowance of this paper limits this, a fuller account can be found elsewhere. 18,19,23,30 Participants A total of twelve UK registered osteopaths took part in this study. Participants' were recruited from adverts placed in the national osteopathic press and in osteopathic educational institutions (OEI).…”

“…during treatment and management) that each osteopath takes with their patients. 18,19 How an individual practitioner's personal conception of practice develops and changes during the course of their professional life is thought to be related to how they identify with their profession, their professional values and is ultimately tied to their interactions with patients which take place during the clinical milieu. The physiotherapy literature suggests that practitioners' professional values and identities develop during their interaction and socialisation with peers during their undergraduate education and continues throughout their professional careers when interacting with professional colleagues.…”

“…This paper explores experienced osteopaths' professional identities, views and overall conceptions of osteopathy, and the findings from this study form part of a broader theory of osteopaths' clinical decision-making and therapeutic approaches reported elsewhere. 18,19,23 Methods…”

Grounding osteopathic research – Introducing grounded theory

“…Through a process of moving back and forth between engaging with the data and engaging with the literature around epistemology of practice, technical rationality and professional artistry 21,28 the category of conception of practice was selected as the core category. This core category pulled the theory together, and provided order to all categories thereby helping to get behind and explain the differences between the variations in therapeutic and clinical decisionmaking approaches (see Thomson et al, 11 for a full discussion of the core category).…”