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Curriculum modelling of the physiotherapy professional education ; Kineziterapeutų profesinio rengimo turinio modeliavimas

46 pages
Ajouté le : 01 janvier 2011
Lecture(s) : 17
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MILDA ŽUKAUSKIENĖ     CURRICULUM MODELLIG OF THE PHYSIOTHERAPY PROFESSIOAL EDUCATIO       Summary of Doctoral Dissertation Social Sciences, Education (07 S)              Kaunas, 2011
Dissertation was prepared during the period of 2006'2011 at Vytautas Magnus University    Scientific advisor:  prof. dr. Laima Sajienė (Vytautas Magnus University, Social Sciences, Education – 07 S)    The dissertation will be defended at the Education Science Board of Vytautas Magnus University:  Chairman:  prof. habil. dr. Kęstutis Pukelis (Vytautas Magnus University, Social Sciences, Education – 07 S)  Members:  prof. habil. dr. Aleksandras Kriščiūnas (Lithuanian University of Health Sciences, Biomedical Sciences, Nursing – 11 B) prof. dr. Vilma Žydžiūnaitė (Vytautas Magnus University, Social Sciences, Education – 07 S) prof. dr. Sigitas Daukilas (Lithuanian University of Agriculture, Social Sciences, Education – 07 S) doc. dr. Vidmantas Tūtlys (Vytautas Magnus University, Social Sciences, Education – 07 S)  Opponents:  prof. habil. dr. Vilija Targamadzė (Vilnius University, Social Sciences, Education – 07 S) prof. dr. Elvyra Acienė (Klaipėda University, Social Sciences, Education – 07 S)    The defence of the dissertation will be held at 10 a.m. on 18th 2011 at the public March, session of Education Science Board of Vytautas Magnus University, Room 422. Address: K. Donelaičio st. 52, LT? 44244, Kaunas, Lithuania   This summary of the dissertation was sent out on 17thFebruary, 2011. The dissertation is available for public reading at Vytautas Magnus University Library and Lithuanian Martynas Mažvydas National Library.  
MILDA ŽUKAUSKIENĖ    KIEZITERAPEUTŲ PROFESIIO REGIMO TURIIO MODELIAVIMAS      Daktaro disertacijos santrauka Socialiniai mokslai, edukologija (07 S)              Kaunas, 2011
Disertacija rengta 2006–2011 metais Vytauto Didžiojo universitete  Mokslinis vadovas: prof. dr. Laima Sajienė (Vytauto Didžiojo universitetas, socialiniai mokslai, edukologija – 07 S)  Disertacija ginama Vytauto Didžiojo universiteto Edukologijos mokslo krypties taryboje: Pirmininkas: prof. habil. dr. Kęstutis Pukelis (Vytauto Didžiojo universitetas, socialiniai mokslai, edukologija – 07 S) ariai: prof. habil. dr. Aleksandras Kriščiūnas (Lietuvos Sveikatos mokslų universitetas, biomedicinos mokslai, slauga – 11B) prof. dr. Vilma Žydžiūnaitė (Vytauto Didžiojo universitetas, socialiniai mokslai, edukologija – 07 S) prof. dr. Sigitas Daukilas (Lietuvos Žemės ūkio universitetas, socialiniai mokslai, edukologija – 07 S) doc. dr. Vidmantas Tūtlys (Vytauto Didžiojo universitetas, socialiniai mokslai, edukologija – 07 S) Oponentai: prof. habil. dr. Vilija Targamadzė (Vilniaus universitetas, socialiniai mokslai, edukologija – 07 S)  prof. dr. Elvyra Acienė (Klaipėdos universitetas, socialiniai mokslai, edukologija – 07 S)   Disertacija bus ginama viešame Edukologijos mokslo krypties tarybos posėdyje 2011 m. kovo 18 d. 10 val. 422 aud. Adresas: Donelaičio g. 52, LT – 44244, Kaunas, Lietuva     Disertacijos santrauka išsiuntinėta 2011 m. vasario 17 d. Disertaciją galima peržiūrėti Vytauto Didžiojo universiteto ir Lietuvos Nacionalinėje Martyno Mažvydo bibliotekose
ITRODUCTIO World Health Organisation (WHO, 2002) states that due to epidemiologic and demographic changes, achievements in the field of medicine, the reform in the health care system and growing requirements of the society an urgent demand of competent specialists with corresponding knowledge and ability of efficient solution to the existing problems has been recently appreciated (Mažionienė, Žydžiūnaitė, 2009). Due to the changing personal and public demands as regards health care new requirements for the health care service providers have presently arisen; consequently, the whole health care system, especially rehabilitation, has been facing new challenges. Professional education of physiotherapists, as ones of the main specialists among other rehabilitation specialists, is closely related to the politics of health care and the development of rehabilitation science. According to Richardson (1993) physiotherapy professional education (further – physiotherapy education)has to be based on physiotherapist practical experience, their training and scientific research reciprocity.In Lithuania the field of rehabilitation specialist (not only physiotherapist) education has little been researched. It should be noted that the lack of scientific research in the field of physiotherapy education has been determined by objective circumstances. The development of the rehabilitation system in Lithuania started only in 1991. Simultaneously, the Lithuanian Institute of Physical Culture introduced a special study programme for the training of specialists in the field of physiotherapy. However, theoretical subjects were taught by the doctors with no corresponding training; consequently, it resulted in negative impact on physiotherapy profession as physiotherapy education was determined by the attitude of doctors. The then knowledge of doctors about physiotherapy could be characterised as ‘knowing that...’but not ‘knowing how...’(Ryle, 1949 see in Ryle, 2002: 27–28), and all the more not ‘knowing what...’(Brown, Duguid, 1998; Orlikowski, 2002). Currently different countries employ different standards of physiotherapy education. These standards are defined in the documents ofWorld Confederation for Physical Therapy (WCPT),European etwork of Physiotherapy in Higher Education (ENPHE), as well as the documents of other organisations. In addition to the necessary specific (professional) physiotherapy competences, these document also focus on the development of such skills as analytical thinking, problem solving, team work, communication and cooperation (oral and written), and managerial skills such as work planning and organisation or quality assessment. Also, these documents emphasise the importance of continuing development and lifelong learning. The main documents that regulate physiotherapy practice and education in Lithuania (Lithuanian Medicine Standard, 2004; Physiotherapy Education Standard, 2004) lack clear definitions for the comprehensive characteristics of physiotherapy practice and
its regulations. Therefore, physiotherapists with different levels of education, professional qualifications and experience are employed presently in Lithuania. Physiotherapy practice is hardly licensed, there are no defined requirements for the physiotherapist professional development, and there is a lack of scientific research into the field of physiotherapy practice and education. These downsides precondition the determination of the curriculum of physiotherapy education and its inadequacy to societal needs. With regard to this problem of scientific research,the following object research as relevant in this dissertation has been chosen: physiotherapy professional education curriculum. The aim of the research to develop a theoretically and empirically valid is curriculum model of physiotherapy education. Having in mind the aim of the research process to discuss potential physiotherapy education curriculum, i. e. to develop the model of the curriculum, and to identify all the specific physiotherapy competences and generic skills, the research is aimed at providing solutions to the followingproblem questions: What are the main physiotherapist work areas, functions and necessary competences to perform these functions What is a hypothetical model of the interaction between physiotherapy practice and physiotherapy competences What curriculum model of physiotherapy education could ensure physiotherapy education that satisfies the needs of social health care It is important to note that curriculum model of physiotherapy professional education and its development principles are characterised with regard to social needs and holistic attitude towards a human and health. To find solutions to the problem questions and to achieve the aim of the research the followingresearch objectiveshave been set: 1. discuss the conception of physiotherapy and the development of physiotherapyTo professional practice with regard to the paradigm changes in biomedical sciences. 2. To summarise the experience of Lithuania and foreign countries in the field of physiotherapy education. 3. To develop hypothetical model of the interaction between physiotherapy practice and physiotherapy competences with regard to the identified physiotherapy practice and competences. 4. To prove the hypothetical model of the interaction between physiotherapy practice and physiotherapy competences empirically. 5. To develop the curriculum model of the physiotherapy professional education. Defendable propositions of the dissertation  Transformations in professional physiotherapy practice and competences determine pending changes in the physiotherapy study outcomes, and
simultaneously the necessity to update and develop the curriculum of physiotherapy education;  The developed curriculum model of physiotherapy education preconditions the definition of the physiotherapy qualification levels, the identification of the requirements, and the development of the new curriculum. The research presented in this dissertation can be distinguished for itsscientific novelty andtheoretical significance. Regardless of the fact that Lithuanian state health policy is being positioned on the recommendations of WHO and is mainly focusing on the prevention of illnesses and injuries, and promotion of physical activity, the research on the physiotherapy practice, as the main providers of the previously mentioned health service, stand far behind from being developed in Lithuania. No scientific research to validate the curriculum model of physiotherapy education has been detected. Therefore, this dissertation that provides systematic analysis of physiotherapy education is novel and important as it not only proposes the curriculum model of physiotherapy education but it also discusses the conception of physiotherapy, its historical evolution, defines the peculiarities of physiotherapy practice and education in foreign countries and in Lithuania, and finally, it introduces a hypothetical model of the interaction between physiotherapy practice and their competences. The empirical research with reference to holistic view precondition scientific validation of the physiotherapy education parameters and curriculum modelling. The curriculum model developed on the basis of the research results and the discussion in this dissertation reflect the tendencies of physiotherapy education in the world and presuppose further research in the field of physiotherapy practice and education.  In addition to its theoretical novelty, the accomplished research can also be distinguished for itspractical significanceas the results of the research predetermine the identification and definition of the physiotherapy practice areas, functions and competences, subsequently; they allow the development of regulations in the study field, professional education standard, also the update the curriculum of physiotherapy professional education. It should also be noted that the research is concurrent with the strategic objectives for the development of physiotherapy practice and education in Lithuania.  The followingscientific research and statistical analysis methodshave been employed in this dissertation: 1.Scientific literature analysis. With reference to scientific literature, this dissertation is aimed at substantiating the topicality and novelty of the subject, revealing the nature and historical evolution of physiotherapy as a profession, portraying the peculiarities of physiotherapy practice and the experience of physiotherapy education in
other countries, and, consequently, developing the hypothetical model of the interaction between physiotherapist practice and their competencies. 2.Document analysis. The method of document analysis was employed to spotlight the peculiarities and differences of physiotherapy education and physiotherapy practice in Lithuania and in other countries. 3.Modelling.The method of modelling helped to develop a hypothetical model of the interaction between physiotherapy practice and physiotherapy competences, and a curriculum model of physiotherapy education. 4.Questionnaire survey. The survey of the physiotherapists in practice and all the physiotherapy students involved in Lithuanian higher institutions enabled to validate the correlation between the specific competences and generic skills that are necessary in physiotherapy practice and the ones acquires at higher education institution. It also contributed to the validation of the manifestation of the hypothetical model of the interaction between physiotherapist practice and their competences. 5.Statistical analysis.The method of statistical analysis was employed to process the data of a questionnaire survey. Statistical analysis was carried out using the programme of SPSS (Statistical Package for Social Sciences). The research involved the procedures for non?parametric hypotheses verification and ranking scales.Mann)Whitney, Wilcoxon Zwere applied to verify statistical hypotheses.criteria 6.Disperse analysis. The method of disperse analysis was employed to verify the hypothesis of equality of two or more sample averages. In all the statistical hypotheses verification procedures the null hypothesis is rejected at the level of significance when p < 0.05 (Gonestas, Strielčiūnas, 2003). 7.Factorial analysis.of factorial analysis was employed to group theThe method propositions for physiotherapy competences into the clusters of a larger?scale. 8.Expert interview method. This method was invoked to identify the attitude of experts towards the peculiarities and transformations in the physiotherapy practice and physiotherapy education curriculum. This method was also significant for the validation of the hypothetical model of the interaction between physiotherapist practice and their competences in relation to the results of questionnaire survey and the development of the physiotherapy education curriculum model. 9.Content analysis method. The latter method was used for the analysis of transcribed expert interview. As regardsmethodologythis dissertation is based on the systematic conception of a human and his/her health approached from the holistic point of view towards health, illness, and disability, and implicating the change of the physiotherapy education curriculum.   
The research is based on the following: The identification of the interaction between physiotherapy practice and physiotherapy competencies, and the curriculum modelling for the physiotherapy education are based on theholistic – systemic (ecologic) theory: Physiotherapy practice is related to human entity that is perceived not only as the  existence of a physical body but also as a complicated energetic system (Daukilas, 2010).  System is a certain order that is determined by the planned and systemic distribution of interrelated elements (Bertalanffy, 1989).  The hypothetical model of interaction between practice and competences, and the curriculum model of physiotherapy education are independent formations (systems) composed of a certain number of components (practice areas, competences, and study outcomes respectively) with a much higher level of interrelation and interdependence as compared to other systems existing in the same formation.  is represented by the reaction ofThe interdependence of the elements in the model its all elements to external factors. A model as a system has a characteristics of self? regulation: when one element changes, other elements react to these changes and all the system re?adjust to a new situation (Bronfenbrenner, 1979). Philosophical principles of thePragmatism theory:  the process of scientific research through interaction withTruth search takes place in the world (James, 1995).  Professional practice is most efficient when it is based on the results of the scientific research performed in clinical surroundings (Plack, 2005; Roskel et al., 1998).  The diversity of reality has impact on physiotherapy practice. This impact is significant and it influences the changes in physiotherapy practice and physiotherapy education curriculum (Shaw et al., 2010).  The curriculum has to ensure the acquisition of competences for qualitative practice in specific practice areas. Professional Education theory:  Professional education has to provide the qualifications adequate to the changes and needs of the society (Laužackas, 1999; Sajienė, 2000).  Subjectively, a profession reflects the relationship of a person to a certain activity on the basis of personal attitudes.  Objectively, a profession reflects the entirety of specific practice functions and their requirements.  The interaction and inconsistency of subjective and objective aspects of the profession predetermine the nature of other phenomena and processes related to the profession, professional education being among them.
 Study results are determined by the requirements set for the physiotherapy professional practice. The latter theoretical propositions in the context of new professional practice requirements and needs approach the education curriculum structure in a new light and emphasise the significance of generic skills. The upturn of the significance of generic skills imply corresponding transformations in the curriculum of education (Laužackas, 1999). Holistic view towards physiotherapist professional education is revealed bythe conception of consistency between qualitative and quantitative(Bitinas, 2006). The purpose of this conception is to obtain as much as possible information about the research object: the dimension and significance of specific competences and generic skills for the physiotherapy education curriculum at Lithuanian higher education institutions (the quantitative research involves digital accumulation of information and its statistical analysis), and holistic manifestation of physiotherapy practice peculiarities and their influence on the education curriculum development (qualitative research involves the accumulation of the systemic verbal and visual information). The empirical qualitative research is based onthe conception of qualitative content analysiswhich involves reading the text under analysis again(Žydžiūnaitė, 2005) and again, and, with reference to ‘key’ words, allows distinguishing manifest categories which is followed by their distinction into subcategories and categories on the basis of their contents, and, subsequently, these subcategories and categories are interpreted and validated. The Definition of the Physiotherapy In Lithuania the term kinesitherapy (kinesis therapy) (earlier and further in this + context:physiotherapyand it means treatment by movement (physical exercises,) is used therapeutic gymnastics, massage, and etc.) (Tarptautinių žodžių žodynas, 2003). In the world the termsPhysiotherapyandPhysical therapyare considered to be synonymous and are used as bearing the same meaning. In many European countries there are different terms, however, the list of professions regulated by the European Commission names a profession of a ‘physiotherapist’.WCPTdefine physiotherapy as an internationally acknowledged health care profession (WCPT, 1995: 22). This profession involves service provided for the individuals or groups of individuals aimed at the development, maintenance or rehabilitation of maximum movement and other functional abilities in cases when movement or other functions are disordered or disabled due to the age, injuries, illnesses or various external factors. Physiotherapy is related to the identification and development of movement abilities and possibilities and involves the areas of health promotion, prevention, treatment and rehabilitation. The physiotherapy practice, as concerns the identification of movement possibilities and projection of general treatment
aims, emphasises the importance of not only unique physiotherapist knowledge and skills, but also the interaction among physiotherapist, patient, family members and other involved service providers (WCPT, 1999: 4). The definitions ofphysiotherapy in the main Lithuanian documents that regulate physiotherapy practice and physiotherapy education differ. The standard of medicine ratified by the Lithuanian Republic health care minister on December 14th, 2004 under the order No.V?934 (Medicinos norma, 2004) defines physiotherapy as ‘rehabilitation, and maintenance of health or physical state, compensation of disability by movement or physical elements’. The standard of physiotherapy education ratified by the Lithuanian Republic education and science, and social security and labour ministers on December 31st, 2004 under the order No. ISAK?2093/11?301 (Kineziterapeuto rengimo standartas, 2004) proposes that ‘the aim of a physiotherapist is to provide health care service by treatment, rehabilitation, maintenance, and health intensification based on movement and physical elements’. Thus, the above definitions might involve ambiguities due to possible translations of the termphysical the Lithuanian language (namely: ‘fizinis’ and into ‘fizikinis’) In many countries physiotherapy involves both means of treatment, i.e. treatment by exercise and massage (‘fizinis’), and treatment by heat, cold, light, electricity, water, and etc. (‘fizikinis’), and is undoubtedly considered as one of treatment methods. Moreover, physiotherapy is closely related to health promotion, maintenance of good health, prevention, treatment or rehabilitation of/after illnesses, injuries or other dysfunctions, most frequently the dysfunction of movement. The physiotherapist competence also involves patient and his/her family members’ instruction and illness prevention. It can be concluded, with reference to various definitions of physiotherapy as profession, thatphysiotherapyis a health care profession aimed at the examination and assessment of functional and physical state of a person, treatment by employing exercise and other physical means, compensation of dysfunction, health care, prevention, health promotion and instruction.   Changes in the physiotherapist practice The development of physiotherapy is closely related to the development of biomedical sciences. The physiotherapy practice and its aims are defined by the change of paradigms in biomedical sciences (see Table 1).