Using film as support to make tacit knowledge of mobility visible
Tacit knowledge within health care is commonplace in practically all professions. It has rarely been articulated, as it either is unconscious or taken for granted (Polanyi, 1967, Fugill, 2012). Polanyi (1967) identified a structure of tacit knowing and argues that tacit knowledge occurs in the periphery of a situation (Polanyi 1967). When guiding someone to move focus lay on the action of moving, communication is in the periphery of the situation. Tacit knowledge is included in everyday action (Stake, 2000) and forms the base in clinical practice (Patel et al, 1999). Spontaneous movements, communication skills and the human defence system are parts of “tacit knowledge”. We do not need to think about how we move or what we communicate verbally or non-verbally. It occurs automatically. We usually focus on actions rather then how we use hands or feet, what to say rather than the words we use. (Kindblom et al, 2011).
Natural Mobility is a method (Kindblom et al, 2011) that is used to transfer spontaneous movements (without thinking) into visible and explicit movement. Natural mobility is influenced by Dewey’s (1985) notion of “learning by doing”. It involves performing a spontaneous movement like standing up (rapidly) where the subject is asked to reflect simultaneously through prompts like “how do I do” and “how does it feel”. The action needs to be repeated several times and compared with different ways of standing up to increase awareness. When a movement turn to an explicit instruction, a person with difficulty to move independently can be guided to move with more verbal support than physical. Instructive video films as a pedagogic support in the education and an exercise afterwards may assist physiotherapy students to increase consciousness of tacit knowledge and a preparation to transfer the knowledge to relatives, patients and later health care providers.
The aims with this project were twofold.
I. To produce a number of short films to visualize the tacit dimension of mobility and the open questions used.
II. To explore the outcome of using a film to assist students to communicate the tacit dimension of mobility and the open questions to others.
Teachers at Division of Physiotherapy were the actors of three films. They were woman 50-67 years. In one film a 98 years old man, living in a Nursing home was the performer.
Four short films were produced using a mobile camera with duration of 1-5 min. The films were to capture tacit knowledge during different actions: the standing/sitting procedure, the automatic reaction of the feet when standing up spontaneously, the automatic procedure of moving between chairs saving energy by not standing up in between the movements, the automatic procedure of getting in and out of the bed in a rapid and a slow (tired) motion.
Step II. Physiotherapy students in semester III, 2016 and 2017 participated in a course under the subject “Patient-transfer knowledge”.
The structure of Intervention
The film “sit to stand action with the old man” was viewed by the students before and/or after the intervention.
The teaching was three hours Spontaneous (without thinking) transfer movements were performed and analysed from a practical/pedagogic view. Positioning of feet, the use of hands, how far to lean forward using simple expressions. The amount of strain was calculated by comparing several ways of standing up (Kindblom et al, 2011). Spontaneous movements/actions were compared between the students, within a movement related to fatigue, fear or pain. This to be able to explore and describe differences and similarities. Verbal instructions using a forceful word like lift was compared with using an energy-restricted word like roll, to value the consequences of using different instructions. The exercises were performed to make the students aware and able to more verbally guide a patient. The design of the film was to further assist students to use the pedagogic and transfer tacit knowledge to explicit.
A reflection exercise was compulsory after the course. The students described in one A4 page the process how to make a family member/friend aware of an unaware movement. The reflection exercise was performed to explore if the film was of any support for the students and to evaluate the course. Content analysis was used.
Ethical aspects: The old man received verbal and written information about the study and signed consent. Students, from whom the quotations were used, and the participating teachers received verbal information and gave verbal consent.
I. Four films on different actions were produced (see method). The “sit to stand action” performed by the old man accompanied by guided questions from a therapist was the only film tested with the students.
II. Hundred and three students submitted the reflection exercise. The main choice of movement was the standing to sitting action. Seventeen of 103 students referred directly to the film, 30 students used the same open guided questions as the film and some mentioned the verbal response from the old man without giving a direct referral to the film. All but three students mentioned the intervention directly or indirectly as support when they made a person aware of an unaware movement. Nineteen students mentioned the reflection exercise as a tool that strengthened the trust in being able to communicate tacit knowledge to another person. They illuminated their own reliance. Six students mentioned the poem as support for their thinking. Observing the person during performance was a beneficial start. To be aware of an unaware movement they described the importance of getting the person into own thinking during the movement. The process of making a person aware differed between the students. They used questioning, explaining/describing and/or performing incorrect movements.
“ After the lecture… .and after viewing the film I felt I learned a lot. Consequently I could rely on myself when I performed the task ….We started with her (grandmother) standing up from a chair. I asked her to do it ones more and than I noticed that her right foot was not pulled back as much as the left one... After going though the different components it looked much better. I believe that the most important for the learning was that I let her at first show me how she usually does ... in comparison as if I directly would have talked about the different components in the transfer process. The pedagogic technics need to be taken into consideration” Student A 2017
”what did you do with your hands? An open question, which allow (mother) to think and feel in her own body” Student B 2017
“As in the film …. to divide the movement into several parts can help a person to be aware” Student C 2017
“I tested a little like the film with the 98-years old man. I asked the person to stand up and simultaneously described for himself during the action, what he did…… I gave hints when he got stuck. That gave him the possibility to find out what components were needed. A learning approach that sticks more effectively… It feels like showing more respect and consideration for the patient with this teaching“ Student D 2017
”I was inspired by the film I saw. It was impressing that he performed so much easier just by asking leading questions and touching” Student E 2016
“I did as in the film, I asked and explained a little as in the lecture… believe that it (awareness) can shape confidence and ability Student F 2016
Almost half of the students referred to the film or described the questioning used from the film. The film seemed to have given a number of students support in communicating tacit knowledge to another person. Both intervention and the reflection exercise played an important role to help the student to make an unaware movement explicit. Therefore it is difficult to evaluate the role of the film. The students’ description/reflection gave a clear picture of what they gained from the teaching. When looking at learning, students are individuals with different knowledge and experiences, which influences the way of learning and communicating knowledge to others. For a person to make an unaware movement explicit is a complex procedure, which seemed to need several actions. If no experience, tacit knowledge seems to be hidden in the procedure. When participants can express and share their practical experiences they can according to Eriksen et al (2014) develop practical wisdom.
The reflection exercise indicated that all students increased awareness and could in different ways make another person aware of an unaware movement. A film visualising tacit knowledge may be an important support for the physiotherapy education. The produced films not included in this study, need to be tested by the students next semester and new films produced.
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