Practitioner permeability and the resolution of practice uncertainties : a grounded theoretical perspective of supervision for allied health professionals

Harding, Deborah (2019) Practitioner permeability and the resolution of practice uncertainties : a grounded theoretical perspective of supervision for allied health professionals. (PhD thesis), St George's, University of London, .


This thesis provides a constructivist grounded theoretical perspective of supervision for three of the larger UK-registered allied health professions (AHPs): occupational therapy, physiotherapy and speech and language therapy. The third largest workforce in the UK NHS, AHPs are regulated by The Health and Care Professions’ Council whose Standards of Proficiency for Practice encourage supervision. There is a lack of agreement about supervision across health and social care professions’ literature and limited focus on AHP supervision. Nineteen therapists were interviewed. They spoke about career-long practice uncertainties. Some uncertainties arise because of practice demands and others, conceptualised as ‘platform for practice’ uncertainties, relate to therapists’ knowledge, skills, experiences and preferences. Socio-professional uncertainties may arise when a therapist compares herself with others. Uncertainties prompt therapists to share concerns, explore alternatives and adjust practice; activities regarded as practitioner recalibration. A therapist’s readiness for recalibration hinges on a constellation of behaviours and characteristics conceptualised as practitioner permeability; awareness, awareness-sharing, feedback-seeking, critical awareness, openness to alternatives and willingness to change. Supervision may be a place for recalibration, offering sanctuary for awareness-sharing and meta-practice opportunities to support learning and practice adjustments. From Dewey (1910) to Webster-Wright (2010), there is established interest in the relationship between uncertainty and learning. Through integration with this literature, practitioner uncertainties are conceptualised as opportunities for professional learning. In common with other 21st century researchers, including Dall’Alba (2009), a phenomenological being-in-the-world perspective is also considered, recognising that epistemological practice uncertainties of knowing-that and knowing-how are interwoven with ontological knowing-how-to-be. It follows that a practitioner values supervision which supports the resolution of both epistemological and ontological dimensions of her uncertainties. Having heard that therapists tend to develop supervision skills vicariously, there is scope for a stronger focus on the development of practitioner permeability and on recognising practice uncertainties as an opportunity for professional learning.

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