Parkinson's Disease through Pictures and Poetry: neurological narratives in pre-registration physiotherapy education

Purpose: Sharing understanding of healthcare stories lies at the heart of patient-centred care, shared decision making and service improvement. The People with Experience ? User Involvement work group of CETL4HealthNE, a collaboration of Universities and NHS partners, established a web-based multi-media narrative archive to share stories of healthcare collected by partners and demonstrate the use of narratives in healthcare education. Relevance: Pictures and poetry about living with PD were donated by artist/author Ruth Nicholson (RN), who has the condition, and with her permission scanned and placed on the internet with her audio commentary. RN is keen to educate people about PD, and physiotherapy educators want to link the psychosocial aspects of living with PD with its biological basis. Description: A narrative approach using web-based materials supplemented with real time involvement of RN preand post-session via the lecturer is employed, to inform her of the session, gain an update on her condition and provide feedback. First year physiotherapy students, who have not undertaken a practice placement, are set preparatory independent learning via completion of a worksheet on PD. Students interact with pictures and poetry about living with PD in seminar groups with clear learning outcomes (in italics below). The WHO International Classification of Functioning (ICF) provides a theoretical focus for feedback from discussion in small groups. Evaluation: The seminar was evaluated by student feedback (n = 131 (2006?2009) evaluated 5 learning outcomes), observation and interviews with an educator (n = 1) and students (n = 2). All students felt the seminar enabled them to gain a user perspective on PD; student interview data emphasised the power of connecting with a ?real? rather than ?paper-based? person. The seminar helped all students identify impairments, activity limitations and participation restrictions associated with PD. Observation showed that the use of a familiar framework (ICF) combined with a novel teaching resource helped students to identify the relationship between theory, practice and the individual with the condition. The majority felt the seminar was useful in terms of identifying helpful characteristics in healthcare professionals, with interview data specifying evocation of empathy in particular. Observation highlighted group discussion about teamwork, communication and shared decision-making. The seminar provided an opportunity to consider how a user perspective could help in the education of healthcare professionals, and students reported that they would like more sessions in this format. The seminar aided identification of physical management approaches for most students; interview data suggested the educator could illustrate further physical management approaches through group discussion. Interview data highlighted the importance of completing preparatory independent learning in order for students to fully realise the seminar learning outcomes. Conclusions: Evaluation data has demonstrated that a narrative approach is successful in supporting students to link psychosocial with biomedical aspects of PD, which extended to other neurological conditions later in practice. Likewise the significance of shared decision-making was validated during practice placements. Long term follow up of impact of narrative sessions is recommended. Implications:Targeted use of a narrative approach across different levels of physiotherapy specific and interdisciplinary education could help promote a biopsychosocial and partnership approach to practice