JCPSLP Vol 20 No 2 July 2018

Table 1. Participant demographics (n=20)

Table 2. Themes and subthemes

Characteristic

% (Number)

Professional identity

Professional identity threat

Clinical setting Generalist clinicians with majority paediatric component Acute adult inpatient Brain injury rehabilitation Inpatient and / or outpatient rehabilitation

Professionalism

Threat to professionalism

Clinical autonomy and critical thinking Threat to clinical autonomy

50% (10) 20% (4) 15% (3) 15% (3)

Client focus and advocacy

Threat to client focus and advocacy

Theme 1: Professional identity The identity that emerged was of an organised, strategic and ethical professional, with high standards of behaviour and practice. Participants focused on the subthemes of SLP professionalism, clinical autonomy and client focus as key pillars of their professional identity. A range of skills were identified as enabling these professional qualities: “your typical speech pathologist… Somebody that’s got all the range of characteristics from somebody that can be … systematic, and statistical, to somebody that’s innovative and interpersonal, and a great communicator, and sensitive” (Participant #3). Professionalism Professionalism and maintenance of professional standards were viewed by participants as being integral to their role and as contributing to job satisfaction (i.e., a job well done led to being more satisfied). Participants valued and were protective of their clinical discretion and critical thinking skills as contributing to their ability to perform their role as a professional, as illustrated in the following quote: “it is my call as to whether I feel based on that screening, whether their language skills are normal or not … that’s still a clinical judgement I think as to whether that’s normal or not…” (Participant #20). fundamental principle of being a SLP, claiming it to be their ethical, legal and professional responsibility to ensure high standard care. Participants emphasised that achieving clinical outcomes efficiently is one measure they used to ascertain their level of effectiveness, as in this example: “A good speech pathologist can be very effective very quickly and is the best person … who is going to get through the waiting list and deal most effectively with it” (Participant #20). The level of clinical control and decision-making experienced by most participants contributed to the construction of the professional identity as an effective and independent clinician. Some participants explained effectiveness as being indicative of a thorough understanding of complexity and quality of care: “a lot of knowledge across a really broad caseload with little time to bring that … develop that knowledge in a way… it’s crossing multiple sites, it’s working with all the disciplines, it’s working independently…” (Participant #6). Participants discussed tensions arising from large caseloads, intensive clinical need and service access issues, including long waiting times. Despite participants reporting professional and clinical autonomy in their current service delivery models, they also described their frustration at being unable to implement professionally identified best practice due to service limitations (e.g., session limits or discharge policies): “You can’t follow… guidelines of dosage for your clients and intervention and stuff like that, Clinical autonomy and critical thinking All participants regarded clinical outcomes as a

Caseloads

Adult caseload Paediatric caseload

50% (10) 50% (10)

Working hours Full-time Part-time

75% (15) 25% (5)

Years of clinical experience Less than 10 years 10–20 years Greater than 20 years

35% (7) 20% (4) 45% (9)

questions was written based on a literature review of perceptions of working with assistants, but as the participants themselves were invited to lead the discussion, not all questions were asked in each interview. The question set evolved as knowledge grew throughout data collection (Smith et al., 2009). A sample of the interview questions is provided in the Appendix. Data analysis The qualitative principles of interpretative phenomenological analysis (IPA) were followed to examine how participants made sense of their experiences. Transcripts were examined, data assigned themes, and similarities and differences noted within and across transcripts (Smith et al., 2009). Themes were revisited many times as analysis moved from concrete to conceptual interpretation. Given that two of the authors (Authors A and C) are SLPs, it is acknowledged that a pre-existing professional perspective is brought to the research. In the interview context there was also a large degree of “insider knowledge” resulting from the interviewer being a SLP; shared assumptions and technical vocabulary of the profession rarely required clarification. Use of NVivo 10 qualitative data analysis software enabled efficient management and manipulation of the large amount of data (QSR International, 2012). Rigour All participants were invited to view and check the accuracy of their own transcripts; however, none accepted this offer. All authors were given copies of transcripts and discussed the representative nature of the dataset coding. A sample of transcripts was coded independently by two authors with 90% interrater reliability regarding category codes. Definitions of themes were finalised by consensus. Results Despite varying overall perceptions of the workforce change, it was apparent that issues of professional identity were consistent across participant reports. The analysis identified two overarching themes: (a) the presence of attitudes, beliefs and behaviours that characterised the SLP professional identity, and (b) reports of real or perceived threat to that identity. Further subthemes under each themes were also identified (Table 2).

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JCPSLP Volume 20, Number 2 2018

Journal of Clinical Practice in Speech-Language Pathology