Investigating service user and staff assumptions about neurological rehabilitation practice, their influence on inclusion and examining conditions for change

Atkin, Helen (2017) Investigating service user and staff assumptions about neurological rehabilitation practice, their influence on inclusion and examining conditions for change. Doctoral thesis, Northumbria University.

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Abstract

Assumptions are our taken for granted interpretation of the world. They are identified as important in reasoning, sense making, behaviour and action. Anecdotal evidence from users of neurological rehabilitation services suggest that assumptions influence how they are perceived and related to, impacting on their experiences of inclusion. This study investigates the assumptions held by service users and staff about neurological rehabilitation, examines their influence on inclusion and explores the conditions influencing change in assumptions.

This doctoral study drew largely on data generated as part of a funded research project, which investigated perceptions of inclusion and inclusive practice in neurological rehabilitation. Both the funded research project and this study adopted a participatory action research approach, using photography, mapping, diaries, interviews and focus groups to generate data. Additional data was generated for this doctoral study through a workshop and reflective questionnaire which focussed specifically on assumptions. Data analysis and sense making used framework analysis and a thematic approach. Research participants and critical friends contributed to validation of findings.

The findings identified that assumptions do form the basis for interactions and practices that influence whether neurological rehabilitation is inclusive and/or effective. Addressing assumptions requires that specific attention and scrutiny are given to situations where taken for granted thought has been disrupted, therefore, creating opportunities for critical dialogue and new understanding to be developed. Importantly, when service users and staff work collaboratively to ask the question “how do we do this together” assumptions of role, knowledge and expertise can be challenged and inclusion facilitated.

The study recognises that addressing assumptions in practice requires a change in the way of working in neurological rehabilitation. A re-framing of practice is called for and a critical relational ontology proposed to replace the currently advocated person centred approach, with the acknowledgement that this is likely to radically challenge current principles and practices in neurological rehabilitation.

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