Front-line Professionals Research Articles

Logic fluidity: How frontline professionals use institutional logics in their day-to-day work

AbstractThis article aims to gain a better understanding on micro processes of how frontline professionals use institutional logics in their day-to-day work. It contributes to the growing literature on the dynamics between institutions and the professional frontline. To further develop this field of study, a conceptual framework is presented that integrates institutional logics, vocabularies of practice, and narratives as central concepts. By adopting a composite narrative approach and identifying vocabularies of practice, the article interprets how frontline professionals make use of different logics to make sense of a new principle introduced in their professional field. Findings are based on a case study of professional patient collaboration in healthcare. The article composes five narratives that act as vehicles through which healthcare professionals use five logics: a medical professional logic, managerial logic, commercial logic, consultation logic, and patient-centeredness logic. It argues that frontline professionals use vocabularies of practice to assemble narratives that help them to navigate between a plurality of logics. It further shows that professionals move fluently from one narrative to another, critiquing the ideas of adherence to a dominant logic and conflict solving. The article finalizes with a discussion that advocates for a process studies perspective and a stronger focus on micro processes in research on professional performance in the context of institutional plurality.

“Game playing” and “docility”: youth justice in question

PurposeThe purpose of this paper is to explore young people's experiences of youth justice supervision with particular reference to the efficacy of participatory practices. This paper is based on findings from a study concerning the extent and nature of children’s participation in decision-making in youth justice. The paper uses Bourdieu’s concept of habitus, as a heuristic/practical device, to investigate children’s ability to express agency and shape or influence the content and format of interventions and approaches in youth justice.Design/methodology/approachThe researcher’s interest in understanding the perceptions and experiences of youth justice supervision led to the adoption of the qualitative approach and specifically in-depth interviews and participant observations. The researcher interviewed front-line professionals (n = 14), operational managers (n = 6) and children under youth justice supervision (n = 20). This study involved 15 months of fieldwork undertaken between 2016 and 2017 at a youth offending service in England.FindingsSeveral young people were seeking to exert minimal energy to achieve a type of passive compliance with court order requirements, adopting a “ready-to-conform” mindset. Professionals were concerned that they were also participating in this type of “game playing”.Practical implicationsA relationship-based practice that is conducive to meaningful participation can help to facilitate positive changes to lifestyles and circumstances. This paper exposes its pivotal role in bolstering children’s involvement in supervision, reducing passive compliance and preventing inauthentic transactional arrangements from forming.Originality/valueIn spite of the significant interest in the work of Pierre Bourdieu, his “thinking tools” have seldom been used to investigate the experiences, attitudes and behaviours of youth justice professionals and those under youth offending team supervision at.

Engaging and Empowering the Front Lines During the COVID-19 Outpatient Practice Reactivation

Engaging and Empowering the Front Lines During the COVID-19 Outpatient Practice Reactivation

Innovating protectives gears for frontline health professionals in the COVID-19 pandemic at a low resource setting

We communicate briefly about the innovation of protective gear (such as Hazmat suit) and respirator mask that can be used by health care professionals as mouth and nose protection tools against the penetration of the microscopic particles containing highly contagious species into the body. As a research and development support to the local entrepreneurs willing to come up with innovative products, the structural and some surface functional properties of the polymeric materials available in local market were analyzed in comparison to the commercially available gears and masks. It has been found that the respirator masks, equivalent in structure and functional properties as the common commercially available protective gears could be developed that can be used by front-line health professionals for protection against contagious environment. The research has paved way to manufacture highly useful health care products at significantly lower costs under low resource setting.

O impacto da pandemia da COVID-19 na saúde mental dos profissionais de saúde: revisão integrativa

Objetivo: Avaliar, na literatura, a saúde mental dos profissionais de saúde atuantes na pandemia da COVID-19. Método: Trata-se de uma revisão integrativa da literatura realizada nas bases de dados LILACS via Biblioteca Virtual de Saúde (BVS), MEDLINE via PubMed, PubMed Central (PMC), COCHRANE, CINAHL Database, SCOPUS, SciVerse Web of Science e PsycInfo com a questão norteadora: Como a COVID-19 afeta a saúde mental dos profissionais de saúde atuantes na pandemia? Os estudos foram selecionados considerando-se os critérios de inclusão: evidências com desenhos experimentais, quase experimentais, observacionais e de revisão completos, com recorte temporal de 2019 a 15 de maio de 2020 e com abordagem central sobre o eixo temático do estudo. Resultados: Houve a seleção de 13 evidências científicas, estabelecendo-se duas categorias de discussão: 1) O impacto da pandemia da COVID-19 na saúde mental de profissionais de saúde; 2) Estratégias para a preservação da saúde mental em profissionais de saúde atuantes na pandemia. Conclusão: O processo de cuidado direto de pacientes com coronavírus, a alta exposição ocupacional e disponibilidade inadequada equipamentos de proteção individual (EPI) geram quadros que comprometem a saúde mental dos profissionais da linha de frente nos serviços de saúde, tais como ansiedade, estresse, insônia e depressão.

Perspectives of Frontline Professionals on Palestinian Children Living with Sibling and Parental Drug Use in the UNRWA Camps, Jordan

The occupied Palestinian territories (oPt) consist of the non-contiguous West Bank including East Jerusalem and the Gaza Strip. It is densely populated within these confines and has a unique socio-economic context characterized by political and economic tensions. Around 2.2 million Palestinians are displaced and living in the ten UNRWA refugee camps in Jordan. Palestinian communities are exposed to a double burden of disease caused by the severe economic, social and health consequences of Israeli occupation and resultant displacement. Exposure to political violence, economic hardship, fragmentation of Palestinian families, unemployment, trauma and community stress underpin a reported rise in drug abuse. Method: A qualitative study using focus groups (n = 3) with a convenience sample of health care and educational professionals was conducted in two UNRWA camps (Al-Zarka, Al-Wehdat) in Jordan. Guided discussions explored the experiences of these professionals in working with Palestinian families and children affected by substance/drug use and drug use disorder in the home. Data were analysed using thematic analysis (TA). Five themes emerged from the TA. These were as follows: (1) access to drugs was perceived to be relatively easy in the camps; (2) Attitudes towards drugs appear to have desensitized, yet stigma persists; (3) families of drug users are affected by fear, social and economic poverty, with significant physical and psychological cost to children; (4) causes of substance/drug use in Palestinian communities living in Jordanian UNRWA camps is multifactorial; (5) solutions are multi-faceted and indicative of the need for prevention and support for those at risk, and affected. Threats to UNRWA from the current political climate and the reducing investment in services may exacerbate this public health and security issue. For an evidence-based approach to have credibility in the camp communities, there is a need for accurate, factual information, along with robust epidemiological data, relating to the extent, characteristics and harms associated with drug use.

Structuring mental health support for frontline caregivers during COVID-19: lessons from organisational scholarship on unit-aligned support

BackgroundAlthough the COVID-19 pandemic exposes frontline caregivers to severe prolonged stresses and trauma, there has been little clarity on how healthcare organisations can structure support to address these mental health...

The role of a Coronavirus disease 2019 pharmacist: an Australian perspective.

The coronavirus disease 2019 (COVID-19) pandemic has greatly impacted healthcare services around the world. Pharmacists are front-line healthcare professionals and integral members of the healthcare team. The deployment of a specialized ‘COVID pharmacist’ within our institution has demonstrated that the skills of the pharmacist can be adapted, expanded and utilized to alleviate the pressure of doctor shortages, reduce healthcare worker exposure to infected patients, contribute to therapeutic decisions and work collaboratively to tackle the challenges faced during this pandemic. This commentary details an Australian hospital pharmacy response to the COVID-19 pandemic, describing the unique clinical and practical contributions made by a specialized COVID pharmacist in our institution.

'Policing' a pandemic: Garda wellbeing and COVID-19.

In response to the global pandemic COVID-19, the Irish government has called upon the Garda Síochána to implement an unparalleled mode of policing to mitigate and contain the spread of the Coronavirus. Studies investigating smaller scale epidemics, such as Severe Acute Respiratory Syndrome (SARS), indicate that staff at the frontlines of an outbreak are exposed to an insuperable amount of stress and experience increased psychological morbidities as a result. Furthermore, research not only indicates that heighted levels of psychological distress are an occupational hazard associated with the law enforcement profession, but that members of the Garda Síochána feel their mental health needs are largely unmet by their organisation. Given the pandemic's propensity to expose officers to indeterminate echelons of physical and psychological threat; there has never been a more appropriate time to explore the potential burdens associated with 'policing' a pandemic, question the governments capacity to address the psychological support needs of frontline professionals, and plan future research for best practice.

Early adversity predicts adoptees\u2019 enduring emotional and behavioral problems in childhood

Children adopted from the public care system are likely to experience a cluster of inter-related risk factors that may place them on a trajectory of mental health problems that persist across the life course. However, the specific effects of putative risk factors on children’s mental health post-placement are not well understood. We conducted a prospective, longitudinal study of children placed for adoption between 2014 and 2015 (N = 96). Adoptive parents completed questionnaires at approximately 5, 21, 36, and 48 months post-placement. We used time series analysis to examine the impact of pre-adoptive risk factors [adverse childhood experiences [ACEs], number of moves, days with birth parents and in care] on children’s internalizing and externalizing problems, and prosocial behavior over 4 years post-placement. Adoptees’ internalizing and externalizing problems remained consistently high over the 4-year study period, but more ACEs predicted increases in internalizing and externalizing problems. Contrary to expectations, more pre-placement moves and time in care predicted fewer problems over time, but exploratory analyses of interactive effects revealed this was only the case in rare circumstances. We identify pre- and post-removal factors that may incur benefits or have a deleterious impact on adoptees’ outcomes in post-adoptive family life. Our findings provide knowledge for front-line professionals in the support of adoptive families and underscore the vital need for effective early intervention.

Uncovering the Role of Strategic Orientation in Translating Communication Strategies to Organizational Performance: An Analysis of Practitioners From Two Chinese Societies

Integrating strategic process theory and resource orchestration view, this study challenges and extends the prior model supporting the direct effect of communication on organizational performance by examining the mediating role of practitioners’ strategic orientation. Employing two data sets of communication practitioners in China and Hong Kong, results of the structural equation model show that reputation orientation and organization-public relationship orientation represent two strategic value systems fully mediating the relationship between communication strategies and the organizational goal attainment. The findings support the proposition that business outcomes and competitive advantages at the organizational level depends not simply on various communication strategies formulated by senior executives and top communication managers, but more importantly, on how frontline communication professionals implement these strategies and translate resources into strategic communication processes. Moreover, the contextual sensitivity of findings indicates a relational shift underway in the strategic communication paradigm, but organization-public relationship is still far from a dominant cultural mechanism thoroughly endorsed by the industry.

Trabajo interprofesional en Chile Impactos de la racionalidad neoliberal y los horizontes de la justicia social

Se presentan los resultados generales de una investigación sobre trabajo interprofesional en la implementación de programas sociales, discutiéndolos a la luz de los impactos de la racionalidad neoliberal y desde una perspectiva que pone las discusiones sobre justicia social como un horizonte político insoslayable en el momento actual. Basado en la aplicación de un diseño mixto de investigación, incluyendo técnicas de producción de datos cuantitativas y cualitativas, los resultados del estudio sugieren que el trabajo interprofesional presenta una serie de nudos críticos que se relacionan con esta racionalidad neoliberal: las condiciones laborales inestables, sobrecargadas y precarias de las/os profesionales, la confianza excesiva en su capacidad emprendedora, la construcción de un estatus desigual entre las profesiones y la reproducción de lógicas individualistas y competitivas en las prácticas cotidianas.

Adaptive design: adaptation and adoption of patient safety practices in daily routines, a multi-site study

BackgroundMost interventions to improve patient safety (Patient Safety Practices (PSPs)), are introduced without engaging front-line professionals. Administrative staff, managers and sometimes a few professionals, representing only one or two disciplines, decide what to change and how. Consequently, PSPs are not fully adapted to the professionals’ needs or to the local context and as a result, adoption is low. To support adoption, two theoretical concepts, Participatory Design and Experiential Learning were combined in a new model: Adaptive Design. The aim was to explore whether Adaptive Design supports adaptation and adoption of PSPs by engaging all professionals and creating time to (re) design, reflect and learn as a team. The Time Out Procedure (TOP) and Debriefing (plus) for improving patient safety in the operating theatre (OT) was used as PSP.MethodsQualitative exploratory multi-site study using participatory action research as a research design. The implementation process consisted of four phases: 1) start-up: providing information by presentations and team meetings, 2) pilot: testing the prototype with 100 surgical procedures, 3) small scale implementation: with one or two surgical disciplines, 4) implementation hospital-wide: including all surgical disciplines. In iterations, teams (re) designed, tested, evaluated, and if necessary adapted TOPplus. Gradually all professionals were included. Adaptations in content, process and layout of TOPplus were measured following each iteration. Adoption was monitored until final implementation in every hospital’s OT.Results10 Dutch hospitals participated. Adaptations varied per hospital, but all hospitals adapted both procedures. Adaptations concerned the content, process and layout of TOPplus. Both procedures were adopted in all OTs, but user participation and time to include all users varied between hospitals. Ultimately all users were actively involved and TOPplus was implemented in all OTs.ConclusionsEngaging all professionals in a structured bottom-up implementation approach with a focus on learning, improves adaptation and adoption of a PSP. As a result, all 10 participating hospitals implemented TOPplus with all surgical disciplines in all OTs. Adaptive Design gives professionals the opportunity to adapt the PSP to their own needs and their specific local context. All hospitals adapted TOPplus, but without compromising the essential features for its effectiveness.

Strengthening screening for infectious diseases and vaccination among migrants in Europe: What is needed to close the implementation gaps?

Migration to the European Union (EU)/European Economic Area (EEA) affects the epidemiology of infectious diseases, including tuberculosis (TB), HIV, hepatitis B/C, and parasitic diseases. Some sub-populations of migrants are also considered to be an under-immunised group and thus at risk of vaccine-preventable diseases. Providing high-risk migrants access to timely and efficacious screening and vaccination, and understanding how best to implement more integrated screening and vaccination programmes into European health systems ensuring linkage to care and treatment, is key to improving the health of migrants and their communities, alongside meeting national and regional targets for infection surveillance, control, and elimination. The European Centre for Disease Prevention and Control (ECDC) has responded to calls to action to improve migrant health and strengthen universal health coverage by developing evidence-based guidance for policy makers, public health experts, and front-line healthcare professionals on how to approach screening and vaccination in newly arrived migrants within the EU/EEA. In this Commentary, we provide a perspective towards developing efficacious screening and vaccination of newly arrived migrants, with a focus on defining implementation challenges and evidence gaps in high-migrant receiving EU/EEA countries. There is a need now to leverage the increasing momentum around migrant health to both strengthen the evidence-base and to advocate for universal access to health care for all migrants in the EU/EEA, including undocumented migrants. This should include voluntary, confidential, and non-stigmatising screening and vaccination that should be free of charge and facilitate linkage to appropriate care and treatment.

Italian Public Health Response to the COVID-19 Pandemic: Case Report from the Field, Insights and Challenges for the Department of Prevention.

The coronavirus disease (COVID-19) outbreak is rapidly progressing globally, and Italy, as one of the main pandemic hotspots, may provide some hard lessons for other countries. In this paper, we summarize the current organizational capacity and provide a pragmatic and narrative account of strategies and activities implemented by the Department of Prevention (Dipartimento di Prevenzione)—the regional entity of the Local Health Authority of the Italian National Health Service in charge of public health—since the beginning of the outbreak. We conduct a preliminary analysis of general strengths, weaknesses, opportunities, and threats (SWOT) of the response strategies from a local perspective. Furthermore, we provide firsthand insights on future directions and priorities to manage this unprecedented pandemic. Our case report gives a qualitative view of the healthcare response, based on the experience of frontline professionals, with the aim to generate hypotheses about factors which may promote or hinder the prevention and management of a pandemic locally. We highlight the importance of a public health approach for responding to COVID-19 and reshaping healthcare systems.

Quality improvement education for medical students: a near-peer pilot study

BackgroundQuality improvement (QI) is an essential component of modern clinical practice. Front-line professionals offer valuable perspectives on areas for improvement and are motivated to deliver change. In the UK, all junior doctors are expected to participate in QI in order to advance to the next stage of their training. However, UK undergraduates receive no standardized training in QI methods. This is perpetuated within medical schools by a lack of teaching capacity and competing priorities, and may lead to tokenistic engagement with future QI projects.MethodsWe describe a near-peer teaching programme designed to introduce students to QI methods. This pilot study was conceived and delivered in full by junior doctors and used existing resources to ensure high quality teaching content. 111 fifth-year medical students from the University of Cambridge were taught in interactive, participative workshops that encourage them to develop their own QI change ideas and projects. Core topics included the model for improvement, driver diagrams, stakeholder engagement, measurement for improvement and analysing and presenting data. Students completed surveys before and immediately after this intervention to assess their understanding of and confidence in utilizing QI methods. Questionnaires were also completed by junior doctor tutors.ResultsAnalysis of questionnaires completed before and immediately after the intervention revealed statistically significant improvements in students’ self-reported understanding of QI (p < 0.05) and confidence in applying techniques to their own work (p < 0.05). Students expressed a preference for QI teaching delivered by junior doctors, citing a relaxed learning environment and greater relevance to their stage of training. Tutors reported increased confidence in using QI techniques and a greater willingness to engage with QI in future.ConclusionsIn this single-centre study, near-peer teaching produced significant improvements in students’ self-reported understanding of QI and confidence in applying QI methods. Near-peer teaching may constitute a sustainable means of teaching essential QI skills at undergraduate level. Future work must evaluate objective measures of student engagement with and competence in conducting QI.

Effects of a Decision-Making Intervention to Help Decide Whether to Disclose HIV-Positive Status to Family Members on Well-Being and Sexual Behavior.

An HIV diagnosis is often followed by uncertainty, questions over next steps, and concerns over how to share the diagnosis with others. The goal of the current study was to investigate the effects of an intervention designed to help people living with HIV decide whether or not they want to disclose their status to family members (i.e., decision-making process rather than actual disclosure) and the subsequent decision on their well-being and sexual behavior. Additionally, differences in outcomes among men who have sex with men (MSM), heterosexual men (HSM), and women were examined. A total of 346 women and men living in the Southeastern part of the United States. Participated in the study, which consisted of a baseline assessment, followed by randomization into either the disclosure intervention or attention control case management group. Both treatments consisted of seven sessions over a 12-month period. Results from repeated measures ANOVA indicated that although there was no significant intervention effect, participants in both groups reported some improvements in well-being and decreases in risky sexual behavior. However, no consistent differences in outcomes emerged among MSM, HSM, and women. Assisting with the disclosure decision-making process and reducing HIV transmission risk should continue to be an essential focus in future research endeavors and for frontline professionals dedicated to HIV-related care and prevention.

The texture of narrative dilemmas: qualitative study in front-line professionals working with asylum seekers in the UK.

Asylum seekers are required to narrate past experiences to the UK Home Office, doctors, lawyers and psychologists as part of their claims for international protection. The Home Office often cites perceived inconsistencies in asylum interviews as grounds for refusal of their claims. A number of processes affect asylum seekers' abilities to narrate past experiences fully to the professionals interviewing them. The dilemmas around disclosure that asylum seekers face have received little attention to date. This work aims to explore the perspectives of UK-based medico-legal report-writing doctors, lawyers and psychologists whose work involves eliciting narratives from asylum seekers on the processes that affect asylum seekers' abilities to disclose sensitive personal information in interview settings. Eighteen professionals participated in semi-structured interviews in individual or focus group settings to discuss, from their perspectives of extensive collective professional experience, the narrative dilemmas experienced by asylum seekers with whom they have worked. Professionals identified a number of processes that made disclosure of personal information difficult for asylum seekers. These included asylum seekers' lack of trust towards the professionals conducting the interview, unclear ideas around pertinence of information for interviewers, feelings of fear, shame and guilt related to suspicions around collusions between UK and their country-of-origin's authorities, sexual trauma and, occasionally, their own involvement or collusion in crimes against others. Recommendations are made on how to improve the interview environment to encourage disclosure. These have important implications for future research and policy initiatives.

Frontline Professionals Performing Collaborative Work with Low-Income Families: Challenges across Organizational Boundaries

This article discusses certain challenges relating to interagency collaboration between the Norwegian Labour and Welfare Administration (NAV) and Child Welfare Services (CWS). We have asked what obstacles to holistic work with low-income families who receive measures from NAV and CWS simultaneously can be identified. The departure point is collaboration on a local project at the municipal level. The differences between the views of the individual services (and the mandates based on these views) with regard to parental obligations have proved challenging. Using the theory of institutional logic, we have explored how different logics have influenced these services’ approaches to parenthood and the significance of these influences for interagency collaboration. We have also investigated how caseworkers in the two services have managed to create reflective spaces for negotiating and bridging various understandings to create new ways of working together.&#x0D; In addition to collecting and analysing data, our task as researchers has been to facilitate joint working processes in the project. The article is based on interviews with caseworkers from both services, discussions during two workshops, and a subsequent dialogue seminar with employees from the two services.&#x0D;

Listening to the voice of the child: listening to laughter

ABSTRACT Opportunities for pupils to discuss with their teachers matters affecting their education are considered a positive step towards delivering a rights-based pedagogy. The suitability of this initiative may be questioned if pupils whose voice has been compromised are unwilling or unable to have their say. The substance of pupil-teacher dialogues will be reviewed in order to justify the inclusion of a radical supplement to existing speech-based engagements. Laughter’s facility for transmitting information could be one way to avert some of the issues that may be holding back one or both parties in these conversational exchanges. Mikhail Bakhtin’s work on dialogism, with its divergent and competing voices, and his interest in laughter, with its conflicting and ambiguous tendencies, provides the inclusive-exclusive theoretical grounding. The role played by teachers in attempting to make sense of their pupil’s laughter behaviour is considered both in their capacity as front-line professionals and as parents/caregivers.