The Development of Narrative Reasoning: Student Physical Therapists’ Perceptions of Patient Stories

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Internet Journal of Allied Health Sciences and Practice







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Narrative reasoning is an inductive cognitive strategy used to understand patients’ experiences with illness within the biosocial context of their lives. The purpose of this study is to examine the meaning of the patient’s illness experience to physical therapist students and propose a theory of narrative reasoning development in these novice clinicians.The data collected from twenty-one first year physical therapy students consisted of narratives written during their clinical internships describing a patient’s experience with illness and post-internship interviews telling the patient’s story. Data were analyzed in a process of constant comparison, evolving codes, and researcher memoing using both grounded theory and narrative analyses. Themes that emerged in open coding and core categories were validated in selective coding. In the final stage of theoretical coding, relationships between the saturated core categories and relevance to current theory were established. The final result was a model of the development of narrative reasoning, illustrating contributions to current theory. The main themes that emerged from the data related to the novice therapist’s development of narrative reasoning were in four areas: perspective, clinical narrative focus, reflective skills, and therapeutic alliance. The theoretical model advanced by this study is a recursive, spiraling developmental process of narrative reasoning through phases that are influenced by drivers and/or barriers. The process includes co-construction of narrative reasoning through encounters with patients, families, clinical instructors and other team members. Establishing a therapeutic alliance is a pivotal point in the development of narrative reasoning and is based on an empathic perspective and strengthened through a reflective approach. In conclusion, this study contributes to the understanding of the development of narrative reasoning. This model of narrative reasoning in student physical therapists has implications for educational interventions aimed at providing learning experiences that parallel the development of narrative reasoning.