Greenfield Bruce H, Jensen Gail M, Delany Clare M, Mostrom Elizabeth, Knab Mary, Jampel Ann
B.H. Greenfield, PT, PhD, MA(Bioethics), Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1462 Clifton Rd NE, Suite 312, Atlanta, GA 30322 (USA).
G.M. Jensen, PT, PhD, FAPTA, Department of Physical Therapy, Creighton University, Omaha, Nebraska.
Phys Ther. 2015 Jun;95(6):924-33. doi: 10.2522/ptj.20140085. Epub 2014 Dec 18.
This perspective article provides a justification for and an overview of the use of narrative as a pedagogical tool for educators to help physical therapist students, residents, and clinicians develop skills of reflection and reflexivity in clinical practice. The use of narratives is a pedagogical approach that provides a reflective and interpretive framework for analyzing and making sense of texts, stories, and other experiences within learning environments. This article describes reflection as a well-established method to support critical analysis of clinical experiences; to assist in uncovering different perspectives of patients, families, and health care professionals involved in patient care; and to broaden the epistemological basis (ie, sources of knowledge) for clinical practice. The article begins by examining how phronetic (ie, practical and contextual) knowledge and ethical knowledge are used in physical therapy to contribute to evidence-based practice. Narrative is explored as a source of phronetic and ethical knowledge that is complementary but irreducible to traditional objective and empirical knowledge-the type of clinical knowledge that forms the basis of scientific training. The central premise is that writing narratives is a cognitive skill that should be learned and practiced to develop critical reflection for expert practice. The article weaves theory with practical application and strategies to foster narrative in education and practice. The final section of the article describes the authors' experiences with examples of integrating the tools of narrative into an educational program, into physical therapist residency programs, and into a clinical practice.
这篇观点文章为教育工作者将叙事作为一种教学工具提供了正当理由和概述，以帮助物理治疗专业的学生、住院医生和临床医生在临床实践中培养反思和自反性技能。叙事的运用是一种教学方法，它为分析和理解学习环境中的文本、故事及其他经历提供了一个反思性和解释性的框架。本文将反思描述为一种既定的方法，用于支持对临床经验的批判性分析；协助揭示参与患者护理的患者、家庭及医疗保健专业人员的不同观点；以及拓宽临床实践的认识论基础（即知识来源）。文章开篇探讨了实践智慧（即实践和情境性）知识与伦理知识如何在物理治疗中用于促进循证实践。叙事被视为实践智慧和伦理知识的一个来源，它与传统的客观和经验知识互补但不可简化，而传统客观和经验知识是构成科学训练基础的临床知识类型。核心前提是，撰写叙事是一种认知技能，应通过学习和实践来培养专家实践所需的批判性反思。本文将理论与实际应用及策略相结合，以在教育和实践中促进叙事。文章的最后一部分描述了作者在将叙事工具整合到教育项目、物理治疗住院医生项目及临床实践中的经验。
