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Experiences of therapy radiographers in extended roles. Angela Eddy Senior Lecturer- Sheffield Hallam University. Background. Minimal empirical evidence around role extension/advanced/consultant practice in therapy.
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Experiences of therapy radiographers in extended roles. Angela Eddy Senior Lecturer- Sheffield Hallam University
Background • Minimal empirical evidence around role extension/advanced/consultant practice in therapy. • Limited evidence around the process of learning and professional development (Donovan and Manning 2006). • Need to explore perceptions and experiences for new roles (Probst &Griffiths 2007) • Functioning in any new role is acknowledged as difficult and stressful (Johnstone 2007, Gerrish 2000) • Know that the transition experiences will be different to the experiences of those established in roles (Williamson 2006)
Research question: • What is the developmental process of the neophyte therapy radiographer working in an extended role? Aims: • To examine the perceptions of therapy radiographers who have been working in extended roles for up to 2 years. • Gain an understanding of their professional development by exploring the nature and dynamics of the experiences that inform practice. Objectives: • Undertake open interviews using grounded theory. • Develop a substantive theory which explicates the stages and processes of professional development for extended role therapy radiographers.
Development of Confidence is an overarching theme. • Links into other themes. • What makes someone confident and how does that link into the stages and processes of professional development? • Professional confidence • Task/role orientation and knowledge based skills. • Personal confidence • Interpersonal and communication skills. • Emotional intelligence (Goleman 1997) • Theoretical Framework • Bandura “self efficacy” Framework (1982)
Banduras framework has four dimensions • What influences the development of confidence/ self efficacy ? • Enactive mastery of experiences. • Learning the skills to perform in the role. • Modelling. • Role models and mentors. • Social persuasion. • Working environment, communities of practice. • Physiological states. • Stress, anxiety, and “burn out”
Enactive mastery- skill acquisition • Clinical skills • Development – stage progression to autonomy. Not having to refer on. • repetition and having done it time and time again so if you come across a problem you can recognise it” • Underpinning knowledge – education • in the first year not to underestimate the knowledge required” • “ Even though I 've got a lot of years experience, having the M level study to underpin what I do gives me the confidence and I will argue the toss in a very confident manner"
Enactive mastery- skill acquisition • Leadership and management • Some peoples leadership skills came from outside the NHS or from previous experience as Supts. • Learning and developing their own style: • “learnt not to impose, motivate rather than be dictatorial” • Interpersonal skills – working across boundaries • “communication skills and negotiation” • “ I deliberately don’t have an ego, and make sure I am seen to not be empire building”
Modeling – role models and mentors • Who were their role models and mentors: • Mentorship/task and skill acquisition based assessments were done by Oncologists. • Case studies and problem based learning tasks • However most had sought peer support and review from other professional groups: • “good ideas from other professions – we can be too insular” • “using clinical supervision with a nurse helped me to find the confidence to deal with difficult situations and anxious patients
Mentorship – what worked? • Challenging but supportive model in a time protected environment • Someone who……“Would not stand over you and tut” • Identifying support and learning needs early in the process, not always easy • " having come from a technical background to a very patient orientated background was quite a change for me so…..it was about having someone to talk to, and reflect on situations"
Social persuasion- developing a supportive learning community • Supportive working environment -Communities of practice • Established teams in established roles • “I enjoyed it because we could discuss things and it gave me confidence” • Versus • Solitary role and a loss of identity • “Feeling of professional isolation”
Social persuasion – group working • Role of MDT’s • “steep learning curve, thrown in at the deep end” • "need to crack this relationship because its how the medical profession perceive you…its still a patriarchal system“ • Knowing the organisation – getting past information gatekeepers • “working in a small department means I know everyone , not sure that’s the same in a bigger place“ • “wasted time, a lot of information is not shared – it’s a power thing”
Physiological states and stress /burn out • Personal resilience • In established roles: • “actual transition into the role was straightforward • New Roles: • “The first 6 months is a baptism of fire” • “need to grow a second skin” • Moved along to by the end of the 2 year period • “Not accepting boundaries” but felt burnt out.
Physiological states and stress /burn out • Role and scope of practice • No clear scope of practice… two perspectives: • “that’s a good thing because I can shape the role” However…. • “if you are over ambitious its very easy to try and be involved in all bits but you cant do that” • Role boundaries: • “tensions between Superintendents and us as they cant see where we fit, where their boundaries finish and ours start”
Physiological states and stress /burn out • Structure and organisation when implementing the role. • “ had regular meetings and a structure and a plan with reviews built in” • “3 months to get it organised and if I did not , it would be squashed” • “Here is the key to your office, see you!” • Role security and sustainability of role • concerns about long term career plans • “Can this role be done by a nurse”
So…..what are the stages and processes of professional development for extended role practitioners? • There maybe trigger points in the process. • Can there be one overarching process? • It may be different depending on the nature of the role, the dynamics of the organisation and personal characteristics? • Is there room for the development of a professional self assessment inventory which may help identify aspects of personal and professional development. • Watch this space…………….