Autonomous Professionals Research Articles

Stort ansvar, liten myndighet.: Menighetsrådet som styringsorgan.

The parish council is a statutory governing body in the Church of Norway. Drawing on interviews with parish council leaders, this article explores how parish councils exercise their governance capacity. Findings identify how two factors impact the councils’ governance: First, tensions in their tripartite self-understanding as governing body, relational leaders and operative volunteers. Second, lack of an administrative organization and reduced manoeuvring space due to autonomous professionals, the joint parochial council, and scarce economic resources. In practice, these factors only allow the parish council to exercise a limited and “soft” form of governance, which does not equate the official role of the parish council.

L'émergence du référentiel marchand dans la tarification des cliniques privées algériennes : privatisation du financement et changement de paradigme

La convergence tarifaire participe à la privatisation progressive du système de santé algérien amorcée depuis la fin des années 80. Le passage d’une logique de gratuité à une logique marchande pour accéder aux soins représente un bouleversement pour les patients. Afin d’appréhender la formation des tarifs dans le secteur de l’hospitalisation privée, nous avons mixé une enquête qualitative par entretiens semi-directifs auprès de 16 fondateurs de cliniques privées et l’administration d’un questionnaire auprès de 40 médecins permanents de ces cliniques disposant d’une activité à plein temps. Nos résultats montrent que l’absence d’une grille officielle de tarification des prestations de soins au niveau des cliniques privées algériennes a favorisé la mise en place de modes de tarification et de systèmes de rémunération conventionnels adoptés par les différents acteurs afin de pallier le déficit de régulation du secteur privé des soins. On observe une forte adhésion collective aux dispositifs tarifaires, sans pour autant sacrifier la liberté des médecins en tant que professionnels autonomes quant à la fixation de leurs propres normes de tarification. Cette privatisation émergente du système de santé algérien s’inscrit dans une dynamique internationale d’ensemble qui nécessiterait un changement progressif de paradigme de l’action publique.

Developing a framework for initial teacher education: route map or reflective tool?

ABSTRACT Initial Teacher Education (ITE) is inherently complex. Challenges include the uncertain nature of teacher knowledge, the need to learn in both practical and theoretical contexts and the developmental journey of the beginning teacher. While one response to this complexity is greater standardisation, another is to foster thinking, autonomous professionals. Attempting to reconcile these tensions and provide a coherent ITE experience, one School of Education introduced an overarching framework of strands of content and phases of the training year. Beginning teachers, from both Primary and Secondary one-year postgraduate teaching routes, shared their experiences of this framework in a series of focus groups at different points in their training. Responses suggest that the framework does provide a valuable guiding structure and stimulus for reflection, though potential for use in school and in the latter stages of the course is yet to be completely fulfilled. In view of the individual trajectories of the beginning teacher, it is argued that future development might focus more on the framework’s value as a reflective tool in both university and school settings, rather than as a formal route map for teacher learning.

The identity work of medical directors as collateral construction

We examine identity work performed by autonomous professionals who undertook management roles and over time experienced shifting pressures from different sources. Over a period of 21 months, we interviewed and observed 20 physicians in four different health care organizations, as they assumed their management role as medical directors of their institutions. We identified three distinct trajectories in their identity work. In particular, individuals who were successful in the role self-defined by including indirect positive definitions of others were also found to integrate positive constructions of self in their new role and to perform it according to expectations. We refer to this interactional accomplishment as “collateral identity work” that sustains the self-narrative by including the definition of others.

Oficina de ginástica da Universidade Aberta à Terceira Idade: Relatos e vivências

Este estudo tem como objetivo relatar a experiência oriunda do projeto de extensão “Oficina de Ginástica da Universidade Aberta à Terceira Idade”, conduzido por discentes do curso de Licenciatura em Educação Física da Universidade do Estado da Bahia, Campus X. Trata-se de estudo descritivo qualitativo, realizado por meio da análise de conteúdo. A presente investigação foi realizada entre março e dezembro de 2018. As aulas do projeto foram subdivididas em três momentos, incluindo atividade inicial, atividade principal e “volta à calma”. Trinta idosas participaram das atividades da oficina de ginástica, as quais relataram que sua participação no projeto de extensão contribuiu para a melhora na qualidade de vida em aspectos relacionados à saúde física, mental, social e afetiva. Foi possível constatar o contentamento das idosas ao redescobrir o prazer ao realizar tarefas que envolviam danças, brincadeiras, diálogos e reflexões. Observou-se, ainda, que é necessário sensibilizar os homens idosos acerca da importância da prática de atividade física para a melhoria da saúde. A experiência obtida pelas monitoras possibilitou maior proximidade entre docente e discentes, fortalecendo os laços existentes, culminando na construção da presente pesquisa. A produção do conhecimento em questão reforça o papel da Universidade Pública de propiciar aos seus educandos atividades de ensino, pesquisa e extensão, de forma articulada, a fim de contribuir para a formação de profissionais autônomos e capazes de intervir positivamente na sociedade à qual estão inseridos.

Critical perspectives on implementation of evidence-based practice in occupational therapy – Exemplified by Lifestyle Redesign® in a Danish context

Introduction Evidence-based practice is an increasing demand in occupational therapy (OT), although multiple barriers can hinder the translation of research knowledge into practice. The article illuminates the transformation of results from a randomised controlled trial into a practice development project with future practice implementation in mind. Method A case study was carried out, consisting of a comparison of the US randomised controlled trials (RCTs) Lifestyle Redesign® and the derived Danish practice development project. Results The study showed how results from RCTs of Lifestyle Redesign® were transformed into a practice development project with intentions to implement the programme in a Danish context. The modifications of the US RCT into a practice development project in Denmark compromised the study’s scientific execution. The practice development project was used to legitimise the intervention within OT locally by testing an evidence-based intervention, without using associated scientific tools and without considering barriers and facilitators for implementing the project in clinical practice. Conclusion Research design compromises in practice development projects may have implications for the internal and external dynamics of professionalisation processes regarding OT and the recognition of OT as a scientific discipline and an autonomous profession, nationally and internationally.

Components of the nursing role as perceived by first-year nursing students

BackgroundIdentifying and acquiring the nursing role is key to the development of nurses' professional identity. Understanding nursing students' perceptions in this regard will enable nursing educators to choose teaching strategies that lead to positive development of their students' professional identity. ObjectivesTo describe how nursing students perceive the different components of the nursing role at the beginning of the nursing degree. DesignCross-sectional, descriptive, observational study. Participants/settings106 first-year nursing students at the University of Huelva, Spain. MethodsData on social and academic variables and variables relating to the instrumental and expressive roles were collected via an adapted, pilot-tested questionnaire assessed by experts. ResultsFor participants, caregiving is the core of the nursing role in the clinical setting, including both technical execution and patient care aspects. They highlighted the disease prevention, health promotion, restoration, and education profiles of nurses rather than their teaching, professional, and technical profiles. They were acquainted with the concept of postgraduate professional development, but were unaware of the academic pathways leading to it. They considered nurses to be decision-makers, who are nevertheless subordinate to doctors. ConclusionsStudents did not consider nursing to be an autonomous profession, although they highlighted its decision-making capacity. They placed greater emphasis on the traditional profile of primary care nurses than on their technical profile, and were able to identify the members of the multidisciplinary healthcare team.

Programas de desenvolvimento docente como ativadores da prática reflexiva de processos de aprendizagem: revisão integrativa

The reflection of the practice of learning processes, through participation in teacher development programs, contributes to professional emancipation and to the consolidation of an autonomous profession. It aimed to analyze the scientific evidence on the use of teacher development programs to activate the reflective practice of learning processes. It is an integrative review carried out in the SciELO, DOAJ and ERIC databases, in the period 2016-2020, resulting in 17 studies related to the theme. 9 (53%) publications redeemed on the DOAJ database were eligible, 6 (35%) on ERIC and 2 (12%) on SciELO. Studies have shown that continuing education programs are options to assist teachers in the process of reflecting on practice.

Applying Clinical Reasoning Theories to Kinesiology: Advancing the Education of Future Healthcare Professionals

ABSTRACT In Canada, kinesiology academic units are undergoing change. The growth of kinesiology as a health profession is reflected in increased clinical course offerings to train student clinicians. These courses require clinical educators, however, not all programs have clinical staff and faculty with the required knowledge or experience. In particular, prospective clinical educators may lack fundamental knowledge of clinical reasoning theory. Clinical reasoning is defined as problem solving and judgment in relation to patient or client assessment, diagnosis, treatment and management, and is considered to be essential for the development of autonomous health professionals. Clinical reasoning theory is applied in an educational context to streamline and enhance student clinician development. Unlike in the education of other health professionals, there has been no literature detailing the application of clinical reasoning theory to the kinesiology educational context. Thus, the objectives of this paper are to: (1) introduce the theories in clinical reasoning relevant to kinesiology, (2) link these theories to practical educational strategies and, (3) connect these strategies directly to the teaching of clinical kinesiology subjects.

Final‐year undergraduate nursing students’ perceptions of general practice nursing: A qualitative study

To explore final-year nursing students' perceptions of general practice nursing. The need for general practice nurses has increased due to growing demands for health care in the community. This demand is exacerbated by a shortage in the general practice nursing workforce. Understanding final-year nursing students' perceptions of general practice nursing is important as these may influence career choices. Qualitative descriptive study within a mixed methods project. Telephone interviews were conducted with sixteen final-year nursing students. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Reporting follows the COREQ checklist. Perceptions of general practice nursing varied between participants and related to three main themes; ways of working; a broad role to meet diverse health needs; and relationships with patients. General practice nurses were seen to have stable and collaborative working relationships, with their role ranging from supporting general practitioners to being autonomous professionals. The nurse's broad role was associated with diverse presentations and was considered interesting and challenging. Participants perceived that general practice nurses had more time to spend with patients, and this helped establish trust, and facilitated patient-centred care. Participants' perceptions of general practice nursing varied, with some students recognising the diversity of the role and others perceiving it as limited. These views were often impacted by others experiences rather than personal experience. These variations underscore the need for students to receive greater exposure to general practice nursing. Review of undergraduate curricula to increase focus on preparing nursing students to work in general practice may help shape students' interest to seek employment in this setting. Students perceptions of a clinical setting can influence their career decisions. Understanding these perceptions can inform clinicians and managers and highlight areas that may need to be addressed to promote career opportunities.

What makes a nurse today? A debate on the nursing professional identity and its need for change.

In 2020, due to the Nightingale year and COVID-19 crisis, nursing is in the public eye more than ever. Nurses often are being seen as compassionate helpers. The public image of nursing, however, also consists of stereotypes such as nursing being a 'doing' profession and care being a 'female' characteristic. Next to that, nursing is associated with images from the past, such as 'the lady with the lamp'. Therefore, in the public eye at least, the nursing identity seems a simple and straightforward enough construct, but nothing less is true. Looking at what a professional identity consists of, historic and social developments influence a group identity as a construct. In addition, individual, professional and contemporary societal moralities, including stereotypes, play its role. Nurses themselves reinforce stereotypes in order to fit into what is expected, even when they believe professional behaviour encompasses other features. They may do so individually as well as in a group context. But nursing actually seems to be better off when viewed upon as a diverse, autonomous profession. Moral values such as compassion motivate nurses to enter the profession. Research shows that if such values are addressed in daily practice, nursing could perhaps be saved from nurses leaving the profession because of feeling unfulfilled. Another aspect concerns the huge nursing body of knowledge. If seen as the ground on which nursing behaviour is standing, it would contribute to a different image of nursing than simplified stereotypes, which do not acknowledge the complex nature of the profession. This paper challenges the idea that the nursing identity is unchangeable and the notion that 'a nurse will always be a nurse'. By doing so, the paper contributes to a debate on the supposed 'true' nature of the nursing identity and opens a discussion on the need for it to change.

Perceived Challenges Likely To Confront Nursing and Midwifery as Autonomous Professions in Ghana and the Way Forward

Aim: To explore the perceived challengeslikely to confront nursing and midwifery as autonomous professions in Ghana and the way forward. Design: Ten nurses and midwives from four main hospitals in the Tamale Metropolis, the respondents were from senior nursing and midwifery officer ranks. Methods: A qualitative cross-sectional in-depth interview was employed for the study among senior nurses and midwives in the hospitals in the Tamale Metropolis. Results: Participants identified specificity of professional focus and split in training arrangement as the main cause of perceived autonomy and challenge. For instance, there are still differential gaps in the training and practice functions of nurses and midwives, different examinations and clear distinctions in job descriptions of both professions. Power of association culture was considered a contributory factor. The study concludes that regardless, nursing and midwifery are two distinct but closely related professions that have similar characteristics and natural fusion of learning and work.

The (dis)obedient occupational therapist: A reflection on dissent against disciplinary propaganda

Abstract Introduction Despite struggling to establish itself as an autonomous profession, occupational therapy remains extensively regulated and controlled by discursive authorities inside and outside the discipline. After overcoming the profession’s reformist ideals, the military governance that supported its rapid expansion morphed into civil institutions but both were based on similar grounds: occupational therapists should obey a strict set of rules while disobedience and dissent are consistently repressed or silenced. Objective The objective of this article is to deconstruct dominant (consensual) discourses that shape the status quo in occupational therapy and envision alternative paths for the development of the discipline. Method Drawing on the work of Erich Fromm and Jacques Rancière, we propose a (critical) theoretical analysis of the concepts of disobedience and dissensus as they apply to occupational therapists. Results The concepts of disobedience (Fromm) and dissensus (Rancière) can be used to revisit the consensus shaped by discursive authorities inside and outside occupational therapy and expose the political nature of such processes. We argue that remaining oppressive forces similar to those of a warfare regime persist in regulating occupational therapy practice and knowledge by enacting a form of ‘disciplinary propaganda.’ Rather than threatening the development of the discipline, disobedience and dissensus constitute critical responses to disrupt dominant discourses and give rise to healthier concepts. Conclusion The use of politically charged terms such as disobedience or dissensus can be seen as controversial and unsettling for a profession like occupational therapy but we believe they are necessary for the future of our discipline.

The use of the objective structured clinical examination (OSCE) in a practice-based health discipline: Academic and student experience in paramedicine

Abstract:Purpose:Over the past two decades, the discipline of Paramedicine has seen expediential growth as it moved from a work-based training model to that of an autonomous profession grounded in academia. With limited evidence-based literature examining assessment in paramedicine, this paper aims to describe student and academic views on the preference for OSCE as an assessment modality, the sufficiency of pre-OSCE instruction, and whether or not OSCE performance is a perceived indicator of clinical performance.Design/Methods:A voluntary, anonymous survey was conducted to examine the perception of the reliability and validity of the Objective Structured Clinical Examination (OSCE) as an assessment tool by students sitting the examination and the academics that facilitate the assessment. Findings:The results of this study revealed that the more confident the students are in the reliability and validity of the assessment, the more likely they are to perceive the assessment as an effective measure of their clinical performance. The perception of reliability and validity differs when acted upon by additional variables, with the level of anxiety associated with the assessment and the adequacy of feedback of performance cited as major influencers. Research Implications:The findings from this study indicate the need for further paramedicine discipline specific research into assessment methodologies to determine best practice models for high quality assessment.Practical Implications:The development of evidence based best practice guidelines for the assessment of student paramedics should be of the upmost importance to a young, developing profession such as paramedicine.Originality/Value: There is very little research in the discipline specific area of assessment for paramedicine and discipline specific education research is essential for professional growth.Limitations:The principal researcher was a faculty member of one of the institutions surveyed. However, all data was non identifiable at time of data collection. Key WordsParamedic; paramedicine; objective structured clinical examinations; OSCE; education; assessment.

Gestão organizacional: proposta de um método de avaliação sob a ótica do conceito de entropia organizacional

A evolução do conhecimento científico durante séculos possibilita cada vez mais a integração das ciências exatas e humanas em prol de um único objetivo. A aplicação dos princípios da termodinâmica em sistemas abertos torna a compreensão da gestão organizacional mais próxima da essência dos sistemas e possibilita inferir sobre seu funcionamento dinâmico. O objetivo desta pesquisa foi desenvolver um método de avaliação para elevar o nível de compreensão das práticas de gestão, sob a ótica da entropia em sistemas abertos para proporcionar ao gestor um panorama do ambiente interno e externo da organização em seu contexto. Foi realizado um levantamento por meio de amostragem por conveniência em uma população de especialistas-consultores empresariais que atuam em entidades privadas, pequenas, médias e grandes organizações nacionais e internacionais, bem como profissionais autônomos que atuam na prestação de serviço de consultoria empresarial, com foco em gestão organizacional, estratégia organizacional, liderança, processos de negócios, desenvolvimento organizacional, inovação e sustentabilidade no estado do Rio de Janeiro. Através do método proposto poder-se-á compreender os fatores intrínsecos à gestão que gerem maior ou menor ganho ou perda de energia, o que poderá contribuir para tomada de decisão, criando um ambiente fértil às mudanças.

Experiences of and visions for collaboration between midwives and nurses in Nova Scotia

ProblemIn jurisdictions where midwifery and nursing are autonomous and separate health care professions, little is known about how they collaborate during the delivery of perinatal health care services. BackgroundMidwifery became a regulated profession in the province of Nova Scotia, Canada in 2009. Since regulation, midwives and nurses have worked together at three models sites for the delivery of midwifery services and perinatal care. QuestionHow do midwives and nurses collaborate during the provision of birthing care in Nova Scotia, Canada? MethodsThis was an instrumental case study guided by feminist poststructuralism. Individual interviews of 17 participants were audio-recorded and transcribed verbatim. Twenty-five documents were reviewed, and field notes were gathered. Feminist poststructuralist discourse analysis was used. FindingsMidwives and nurses collaborated well together. Participants described how positive collaborative experiences could influence a new way for midwives and nurses to work together. In this paper we present the theme Moving forward: A Modern Model for Nurses and Midwives working together, and its sub-themes of 1)’The birthing culture has changed’ and 2) ‘Allies and advocates’. DiscussionWithin the global context of strengthening midwifery and nursing, this study illustrated the potential for developing formal, collaborative perinatal models of care led by midwife and nurse teams to address inequities in perinatal health care services. ConclusionMidwives and nurses need more opportunities to collaborate and to build professional relationships. Establishing a midwife-led and nurse supported model of care may transform existing perinatal health care values, beliefs, and practices.

Acompañamiento Pedagógico Digital para Docentes

Una de las exigencias asignadas a los docentes es el cambio de sus prácticas por ser una necesidad de la era digital. Por tal motivo, es fundamental tomar distancia respecto de la práctica educativa, analizarla en cada una de sus dimensiones, por lo tanto, de esta manera descubrir su significado para poder realizar interpretaciones desde distintos ángulos. El proyecto tuvo como objetivo repensar las prácticas docentes mediadas por las Tecnologías del Aprendizaje y del Conocimiento (TAC) a partir de la implementación del programa de acompañamiento a docentes en la era digital. El desarrollo profesional guiado a través de actividades de seguimiento incluyó el trabajo colaborativo entre tutores y colegas con el objetivo de mejorar su práctica. El modelo de facilitación tuvo como centro del aprendizaje, a los docentes considerándolos como profesionales autónomos con capacidad para modificar su práctica. Se utilizó el enfoque cualitativo para realizar un análisis inductivo de los diferentes datos recolectados. Los resultados arrojados a partir de distintas estrategias de recolección de datos evidenciaron creencias, experiencias, resistencias, saberes, fortalezas y debilidades que los docentes poseían al integrar las tecnologías educativas en el aula. Con respecto a las conclusiones arrojadas se puede expresar que a pesar de los beneficios que trae la implementación de las tecnologías en la educación algunos docentes temen por llegada de nuevas herramientas digitales pues, consideran que puedan desplazarlos de su labor. La actitud de los docentes frente a la integración de las tecnologías educativas supuso un desafío en cuanto al cambio de paradigma en su cultura profesional.

Nurses role, importance and status in Armenia: A mixed method study.

To assess the perception of the nursing profession in Armenia from the perspective of multiple stakeholders, including nurses and the general public. Nurses' role perception is a complex phenomenon defined by multiple stakeholders. The assessment used a convergent parallel mixed-methods design, with a dominant qualitative status. We conducted the qualitative phase through focus group discussions and in-depth interviews with 235 people and collected quantitative data in a cross-sectional telephone survey with 389 participants. The nursing profession has been influenced by medical hierarchy and subordination, and none of the participants recognized nursing as an autonomous health care profession. The quantitative survey findings were largely consistent with the qualitative results. Our findings highlighted empathy and compassion as inherent qualities of nurses in Armenia. To change opinions about the nursing profession and highlight nurses' meaningful contribution to the provision of health care services, it is important to develop a national definition of nursing and introduce higher educational opportunities for nurses in Armenia. The paper highlights the importance of quality education for preparing highly competent nurse managers who can become role models in promoting nurses' roles in health care systems and improving the professional and public image of nursing.

Los protocolos de actuación y la calidad de la atención de enfermería del paciente con enfermedad de Parkinson.

El enfermero como profesional autónomo tiene ante sí, no solo el compromiso, sino además el reto que supone generar los conocimientos necesarios para establecer protocolos de actuación que coadyuven al perfeccionamiento de su acción cuidadora al ofrecer pautas que la orienten, faciliten la adopción de ideas y la estandarización de cuidados específicos. El presente artículo tiene como objetivo reflexionar sobre la relación existente entre los protocolos de actuación y la calidad de la atención de enfermería del paciente con enfermedad de Parkinson. Para garantizar la calidad de la atención de enfermería del paciente con enfermedad de Parkinson se hace necesario adoptar protocolos que permitan guiar, unificar y sustentar científicamente el accionar del personal de enfermería con influencia directa en la calidad de la atención.

Systematic review of barriers to, and facilitators of, the provision of high-quality midwifery services in India.

The Indian government has committed to implementing high-quality midwifery care to achieve universal health coverage and reduce the burden of maternal and perinatal mortality and morbidity. There are multiple challenges, including introducing a new cadre of midwives educated to international standards and integrating midwifery into the health system with a defined scope of practice. The objective of this review was to examine the facilitators and barriers to providing high-quality midwifery care in India. We searched 15 databases for studies relevant to the provision of midwifery care in India. The findings were mapped to two global quality frameworks to identify barriers and facilitators to providing high-quality midwifery care in India. Thirty-two studies were included. Key barriers were lack of competence of maternity care providers, lack of legislation recognizing midwives as autonomous professionals and limited scope of practice, social and economic barriers to women accessing services, and lack of basic health system infrastructure. Facilitators included providing more hands-on experience during training, monitoring and supervision of staff, utilizing midwives to their full scope of practice with good referral systems, improving women's experiences of maternity care, and improving health system infrastructure. The findings can be used to inform policy and practice. Overcoming the identified barriers will be critical to achieving the Government of India's plans to reduce maternal and neonatal mortality through the introduction of a new cadre of midwives. This is unlikely to be effective until the facilitators described are in place.