Urban ideals and rural realities: Physiotherapists navigating paradox in overlapping roles
Objectives Rural practitioners who develop a sense of belonging in their community tend to stay; however, belonging means neighbours become patients and non‐clinical encounters with patients become unavoidable. Rural clinical experiences expose students to overlapping personal and professional relat...
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| Published in: | Medical education Vol. 55; no. 10; pp. 1183 - 1193 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Wiley Subscription Services, Inc
01-10-2021
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Objectives
Rural practitioners who develop a sense of belonging in their community tend to stay; however, belonging means neighbours become patients and non‐clinical encounters with patients become unavoidable. Rural clinical experiences expose students to overlapping personal and professional relationships, but students cannot be duly prepared to navigate them because ethical practice standards primarily reflect urban, and not rural, contexts. To inform such educational activities, this study examines rural physiotherapists' strategies for navigating overlapping relationships.
Methods
Constructivist grounded theory guided iterative recruitment of 22 physiotherapists (PTs) living and practising in rural, northern or remote (RNR) communities in British Columbia, Canada, and analysis of their experiences navigating overlapping relationships.
Results
PTs routinely navigate overlapping relationships while mindful of practice standards, neighbourly and community expectations, personal well‐being and patient welfare. While off‐duty, they balance opposing expectations and manage various responsibilities to achieve contradictory goals such as being a professional who protects patient confidentiality while being an active and cordial community member. While on‐duty, they face ethical dilemmas where deciding not to treat acquaintances potentially denies access to care but allows for clearer personal‐professional boundaries and deciding to treat contravenes (urban) practice standards but could allow for customised patient care based on knowledge gained through both clinical and social interactions.
Conclusion
Overlapping relationships are a rural norm. Urban ethical practice standards imposed on rural contexts put RNR practitioners in a paradoxical situation where clinical and social interactions must be but cannot be partitioned. Examining the identified strategies through the lens of paradox theory shows sophisticated cognitive framing of the conflicting and interrelated aims inherent to living and practising in RNR communities. Consequently, introducing a paradox mindset in educational activities could be explored as a way to prepare students for the ethically complex overlapping relationships that they will need to navigate during RNR clinical experiences.
Overlap between personal and professional relationships are a rural norm to which students are exposed during rural placements. The authors share strategies used by physiotherapists to navigate conflicting ethical principles in such relationships. |
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| Bibliography: | Funding information This study was fully funded by a University of British Columbia Distributed Medical Education grant awarded through the Centre for Health Education Scholarship in 2019. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0308-0110 1365-2923 |
| DOI: | 10.1111/medu.14476 |