Barriers and Coping Strategies: a Study of the Working Lives of Visually Impaired

Barriers and Coping Strategies: A study of the working lives of visually impaired physiotherapists

Sally French

Paper presented at the Qualitative Evidence-based Practice Conference, Taking a Critical Stance. Coventry University, May 14-16 2001

In December 1999 I completed my PhD thesis on the working lives of visually impaired physiotherapists. It took me 12 years. In this session I would like to describe a few aspects of the research and highlight the changes which took place in the research, and within my own thinking, during this 12 year period.

Background

Visually impaired people have been trained as physiotherapists in sizeable numbers over the course of the 20th century. There are currently about 250 visually impaired physiotherapists practising in Britain including many who are totally blind. Physiotherapy is not a profession which would immediately spring to mind as being suitable for visually impaired people. This is because it requires competent mobility around busy wards, considerable paper work and the use of sophisticated electro-medical equipment. In recent years other potential difficulties have arisen including an increase in community work which involves travel and varying environments.

Visually impaired people are trained as physiotherapists because of an historical accident. Physiotherapy evolved from massage which blind people traditionally practised. Up until 1916 they were trained in small numbers in ordinary schools of massage, which goes to show that integration is not new, but with the First World War and the large number of blinded servicemen, a special school of massage was initiated by the Royal National Institute for the Blind (RNIB) in London. This segregated arrangement lasted until 1995. The final cohort of students were accepted in 1992. Visually impaired people are now integrated into mainstream physiotherapy courses within universities. With one or two very minor exceptions they have followed the same syllabus as all other physiotherapists.

I can be regarded as an ’insider’ researcher in this research. This is because I am visually impaired myself and I trained as a physiotherapist in the RNIB School of Physiotherapy. I therefore had much in common with the people I studied. I knew some of them as acquaintances, and a few as friends. On the other hand I have spent most of my working life as an academic whereas many of the people I studied had been practising physiotherapists for twenty or thirty years. I found it very useful being an ‘insider’ researcher because it helped me to formulate questions and to understand what the research participants were saying. It may also have helped them to be open and honest. I had to justify my position as an ‘insider’ researcher but, given the criticisms of disability research in recent years, this was not too difficult.

Phase one of the study

In phase one of the research I undertook a large comparative study of visually impaired and sighted physiotherapists. For this I used questionnaires. The questionnaires gave a great deal of background information on demographic details and factors such as promotion, work setting, speciality, attitudes on various issues and job satisfaction. There were many differences and many similarities. There were, for example, far more men in the visually impaired sample, and the visually impaired physiotherapists were more likely to work in private practice and to come from non-professional backgrounds.

I also undertook semi-structured interviews with 45 of the visually impaired physiotherapists (both private practitioners and those working within the NHS). I tailored each interview to the particular person’s questionnaire, for example some were old enough to remember the introduction of the NHS and the impact that that had had on their working lives, and one had been the principal of the RNIB physiotherapy college for a number of years so I asked about that particular experience.

Diversions

All went well until 1989 when I was approached by the publisher Butterworth-Heinemann to edit a large book which would be my first. I had a very busy full-time job as a lecturer at the East London Polytechnic at the time and did not feel I could take anything else on. I declined, but six months later the publisher returned with the same request. I discussed it with my supervisor who thought I would be mad to let such an wonderful opportunity pass me by. I accepted the contract and it was at that point that the PhD started to stagnate.

The book was completed in 1992 but by then I was hooked and had already accepted several other contracts. In 1990 I started working in the School of Health and Social Welfare at the Open University a three year contract to be part of a course team writing the course The Disabling Society. I became thoroughly immersed in disability studies and started writing quite extensively in the area including six publications from phase one of the research. The new academic discipline of Disability Studies was flourishing and I was aware of my research becoming increasingly out of date. I was also becoming increasingly dissatisfied with it.

Back on track

The turning point came at a conference on disability at the end of 1995 where I met a blind woman Ayesha Vernon. As we were taking her guide dog for a long walk one evening I related the sorry tale of the PhD. She listened carefully and suggested some very drastic action. This came as a great relief to me because other people, though sympathetic, somehow didn’t believe that I was really stuck. Ayesha suggested that I should abandon the old data, collect new data and change universities – my original supervisor had moved on by this stage and I did not gel with the one I had acquired.

Phase two of the study

In March 1996 I transferred my PhD to School of Health and Social Welfare at the Open University. Although I wanted to abandon the old data completely, I was persuaded to retain it and to turn the research into a longitudinal study. With that end in view I interviewed 20 of the original 45 visually impaired physiotherapists but this time concentrated entirely on those who worked within the NHS. I took the questionnaire data to descriptive statistics only which eventually served as a background chapter. The time lapse made it more acceptable than it was in 1988 (when I started the research) to concentrate almost entirely on the qualitative research where my interest really lay.

There was a good rationale for a longitudinal study as much had happened between phase one and phase two of the research. Work practises within physiotherapy had changed quite drastically with the 1990 NHS and Community Care Act, the Disability Discrimination Act had been passed and equal opportunity policies were more in evidence.

I used both phases of the study to write four case studies of individual physiotherapists. This complemented the thematic analysis used to analyse the interviews and to tease out specific points.

Writing up the research was an odd experience. I had to justify and critique the first phase of the research which I had written almost as a different person. Through my writing and teaching I realised that I had played my part in the development of Disability Studies and was advised to capitalise on this. I had already written much of the material for different audiences and purposes. I was also able to use the six publications I had written from phase one of the study even though that data was never fully analysed.

Major findings

1. A sizeable percentage of the visually impaired physiotherapists had met with major barriers in the following areas:

* Mobility, particularly on wards.

* Inaccessible equipment.

* Inaccessible information - e.g. patients’ notes

* Inaccessible meetings – e.g. paper work, non-verbal communication.

* Inaccessible work-related education – e.g. visual aids, lack of Braille.

* Transport – the increasing need for a car and the expectation that everyone drives.

* Attitudes and behaviour of some colleagues.

The physiotherapists found that work had become easier in some ways, for example less overt discrimination and the government’s Access to Work Scheme (which equips people with specialised computers and readers), but had become harder in some ways, for example increased community work, increased paper work, a faster turnover of patients and an increased pace of work. Overall the physiotherapists felt that work had become more difficult and some related this to the NHS and Community Care Act (1990). In many ways little had changed over the course of the study which is very worrying.

A wide range of strategies were used to cope with these barriers. These included:

* Help from patients and clients.

* Help from colleagues.

* Specialised equipment and readers.

* Taking more time (from own time).

* Cognitive skills e.g. ‘echo location’ and developing a good memory.

* Good communication skills.

* Openness and assertion.

* Minimisation and ‘passing’.

* Over-compensation.

Although there was considerable agreement among the physiotherapists with regard to barriers and coping strategies, it was also clear that barriers are perceived, appraised, experienced and acted upon differently. Both contextual factors (for example position in the hierarchy) and individual factors (confidence and assertion) can modify barriers, for example when working in intensive care.

The study indicates that barrier removal is complex. Despite sophisticated computer equipment, for example, most of the physiotherapists felt that it took them considerably more time to successfully hold down their jobs.

Reliance on cognitive strategies was said by most of the physiotherapists to be exhausting and most people were motivated to change the environment rather than attempt to change themselves.

There was considerable difference regarding barriers and strategies according to the level of sight of the physiotherapists. Blind physiotherapists, for example, were more likely to be offered help but many tasks were more difficult for them. It was far more difficult for the totally blind physiotherapist to ‘pass’ as non-disabled. People also used different methods to overcome barriers, for example audiotape, large print, Braille or a combination of these.

The physiotherapists were prepared to cope with difficult barriers in order to satisfy their own goals and aspirations. People did not necessarily work in areas where lack of sight was less of a problem although some people did go into private practice for that reason – so they could effectively create their own environment. Reasons such as ‘believing in the NHS’ and ‘not being a businessman’ dissuaded many of the physiotherapists from private practice. Thus, visual impairment is just one attribute of the person which interacts with all other attributes. It is, therefore, very difficult to make predictions for any particular person.

CONCLUSION

This study provides a detailed exploration of the ways in which visually impaired physiotherapists cope with their work entirely from their own perspective. Although the sample was very specific, most of the findings can be related to other visually impaired employees and disabled employees generally. It highlights the complexity of barrier removal and the creativity of disabled people who contend with barriers at work on a daily basis.