Professional Power Research Articles

Contested role boundaries and professional title: Implications of the independent review of podiatric surgery in Australia.

In October 2023, the Podiatry Board of Australia commissioned an independent review of the regulation of podiatric surgery in Australia, with a remit to re-evaluate the regulatory framework, identify any risks to patient safety and recommend improvements to public protection. It reported in March 2024 and set out 14 key recommendations. The review was prompted by a number of complaints about podiatric surgeons but also reflected calls for reform by the medical profession and several critical media reports. This paper sets out to examine the review report, alongside the concerns of the medical profession and the media articles expressed within it, through the lens of an established sociological framework focused on interprofessional conflict and the contested use of professional titles. As a review rather than the research paper, the Independent Review of Podiatric Surgery (the 'Paterson Report') served as data for the sociological analysis, adopting a Neo-Weberian and Bordieuan framework to examine the strategies adopted by the medical profession and media reports cited in the report, consistent with the exercise of professional power. The sociological analysis provides insights into the ways in which professions seek to maintain symbolic, social, cultural and economic privileges and rewards through the exclusion of competitors, using strategies such as social closure, symbolic violence, symbolic devaluation, gatekeeper roles, and jurisdictional disputes. The review report acknowledges the influence of the medical profession and its opposition to the practice of podiatric surgery and use of the title 'podiatric surgeon'. The arguments made and strategies deployed are consistent with those found in the wider literature. In light of these findings, the implications for the future of podiatric surgery are considered in terms of professional practice, use of professional title, and access to public funding.

Professional disrespect between doctors and nurses: implications for voicing concerns about threats to patient safety

Purpose Previous research has demonstrated that social-relational factors are instrumental to employee voice. An essential aspect of this relates to notions of respect or disrespect. Although nurses commonly report experiencing professional disrespect in their interaction with doctors, earlier studies have focused on how the professional status hierarchy and power imbalance between doctors and nurses hinder speaking up without considering the role of professional disrespect. Addressing this gap, we explore how professional disrespect in the doctor–nurse relationship in surgical teams influences the willingness of nurses to voice legitimate concerns about threats to patient safety.Design/methodology/approach Fifty-seven semi-structured interviews with nurses drawn from a range of specialities, ranks and surgical teams in three hospitals in a West African Country. In addition, two interviews with senior representatives from the National Registered Nurses and Midwifery Association (NRNMA) of the country were undertaken and analysed thematically with the aid of NVivo.Findings Disrespect is expressed in doctors’ condescending attitude towards nurses and under-valuing their contribution to care. This leads to safety concerns raised by nurses being ignored, downplayed or dismissed, with deleterious consequences for patient safety. Feeling disrespected further motivates nurses to consciously disguise silence amidst speech and engage in punitive silence aimed at making clinical practice difficult for doctors.Originality/value We draw attention to the detrimental effect of professional disrespect on patient safety in surgical environments. We contribute to employee voice and silence by showing how professional disrespect affects voice independently of hierarchy and conceptualise the notion of punitive silence.

Defining faces, defying borders: authority conflicts between medical specialties through cosmetic interventions

At first glance, medical specializations seem to be delineated according to well-defined scientific criteria; the apparently-functional division of labor generates a general hierarchy of specialized knowledge and practice. However, this unequal apportionment of professional power and authority also depends on capitalistic organization. While the medical rationale has always been market-related, starting in the 1980s—with the initiation of its neoliberal agenda—Turkey has enacted progressively aggressive policies, privatizing healthcare service and reconceptualizing it as a dynamic market, thereby forming a medical ethos entangled with neoliberal motifs. In this article, we analyzed how unregulated market conditions give rise to a chaotic scientific field, and how this apparent disorder serves to reproduce an underlying capitalistic logic. Of the multitude of human body parts, we choose the face, because it has become a hot zone in medicine as cosmetic demands from patients have skyrocketed, and because it is an area generating conflict between medical specialties seeking more authority and power. To this end, we interviewed thirty-three specialists from dermatology, otorhinolaryngology, and plastic surgery about their experiences on authority conflicts and their motivations for entering into an unregulated market. Our research highlights how actors in the medical field constitute a relational social context within which boundaries are fiercely negotiated through a market logic. Thereafter, we argue how the ambiguities of pathology, aesthetics, body, and norms that underlie cosmetic procedures are fluidized and become instruments of power, such that this ambiguity has become the very defining characteristic of the scientific field.

Challenges of pre-hospital emergency care at Addis Ababa Fire and Disaster Risk Management Commission, Addis Ababa, Ethiopia: a qualitative study

BackgroundA challenge to pre-hospital emergency care is any barrier or obstacle that impedes quality pre-hospital care or impacts community pre-hospital utilization. The Addis Ababa Fire and Disaster Risk Management Commission (AAFDRMC) provides pre-hospital emergency services in Addis Ababa, Ethiopia. These services operate under a government-funded organization that delivers free emergency services, including out-of-hospital medical care and transportation to the most appropriate health facility. This study aimed to assess the challenges of pre-hospital emergency care at the Addis Ababa Fire and Disaster Risk Management Commission in Addis Ababa, Ethiopia.MethodsA qualitative descriptive study was conducted from November 20 to December 4, 2022. Data were collected through in-depth, semi-structured interviews with 21 experienced individuals in the field of pre-hospital emergency care, who were selected using purposeful sampling. A thematic analysis method was used to analyze the data.ResultsThis study includes twenty-one participants working at the Addis Ababa Fire and Disaster Risk Management Commission. Three major themes emerged. The themes that arose were the participants’ perspectives on the challenges of pre-hospital emergency care in Addis Ababa, Ethiopia.Conclusion and recommendationThe Fire and Disaster Risk Management Commission faces numerous challenges in providing quality pre-hospital emergency care in Addis Ababa. Respondents stated that infrastructure, communication, and resources were the main causes of pre-hospital emergency care challenges. There has to be more focus on emergency management in light of infrastructure reform, planning, staff training, and education, recruiting additional professional power, improving communication, and making pre-hospital emergency care an independent organization in the city.

On the need to reconcile cultural and professional power in psychotherapy: Humanistic principles that are foundational for feminist multicultural practice.

On the need to reconcile cultural and professional power in psychotherapy: Humanistic principles that are foundational for feminist multicultural practice.

Conscience and Compromise: The Struggle of Moral Codes in Business

Abstract This paper investigates the ethical dilemmas faced by consultants when balancing personal morals with professional obligations, using a real-life case study involving a consultant overhearing illegal price-fixing activities. The case highlights the consultant’s internal conflict and the decision to remain silent due to fear of professional repercussions and power dynamics. The analysis discusses violations of the Dutch OOA code of conduct, particularly concerning integrity and professional independence, and explores the ethical frameworks of moral disengagement, consequentialism, and virtue ethics. The paper emphasizes the complexity of moral integrity in consulting and the potential consequences of both action and inaction in ethically challenging situations.

How Generative AI Is Transforming Journalism: Development, Application and Ethics

Generative artificial intelligence (GAI) is a technology based on algorithms, models, etc., that creates content such as text, audio, images, videos, and code. GAI is deeply integrated into journalism as tools, platforms and systems. However, GAI’s role in journalism dilutes the power of media professionals, changes traditional news production and poses ethical questions. This study attempts to systematically answer these ethical questions in specific journalistic practices from the perspectives of journalistic professionalism and epistemology. Building on the review of GAI’s development and application, this study identifies the responsibilities of news organizations, journalists and audiences, ensuring that they realize the potential of GAI while adhering to journalism professionalism and universal human values to avoid negative technological effects.

Advantages and disadvantages of video conferencing and direct interaction: a conceptual framework for evaluating hybrid work models

Purpose This study aims to analyse the differences between professional interaction mediated by video conferencing and direct professional interaction. The research identifies diverging interests of office workers for the purpose of addressing work ethical and business ethical issues of professional collaboration, competition, and power in future hybrid work models. Design/methodology/approach Based on 28 qualitative interviews conducted between November 2020 and June 2021, and through the theoretical lens of phenomenology, the study develops explanatory hypotheses conceptualising four basic intentions of professional interaction and their corresponding preferences for video conferences and working on site. Findings The four intentions developed on the basis of the interviews are: the need for physical proximity; the challenge of collective creativity; the will to influence; and control of communication. This conceptual framework qualifies a moral ambivalence of professional interaction. The authors identify a connectivity paradox of professional interaction where the personal dimension remains unarticulated for the purpose of maintaining professionality. This tacit human connectivity is intertwined with latent power relations. This plasticity of both connectivity and power in direct interaction can be diminished by transferring the interaction to video conferencing. Originality/value The application of phenomenology to a collection of qualitative interviews has enabled the identification of underlying intention structures and the system in which they affect each other. This research identifies conflicts of interests between workers relative to their different self-perceived abilities to persevere in competitive professional interaction. It is therefore able to address consequences of future hybrid work models at an existential and societal level.

The impact of digital technology use on nurses' professional identity and relations of power: a literature review.

This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments. Literature review. PubMed and CINAHL databases were searched in April 2023. We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023. Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented. Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required. Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession. The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care. We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review. No patient or public contribution.

'ALL ABOUT MY IDEAL MENTAL HEALTH SERVICE': Users, family members and experts by experience discussing a co-designed service.

Many studies have investigated patients' understandings of how to optimise mental health services. However, only a few studies in the Italian context have involved experts by experience (EbEs), who can be ex-users, family members of ex-usersor current service collaborators. Their role is crucial in implementing collaborative service quality assessment projects. The study investigated the experience of 35 EbEs, users, and family members who carried out a 9-month fortnightly project aimed at imagining an 'ideal service'. The facilitators of the discussion groups (two EbEs) were interviewed; written reports of each meeting were produced with relevant comments, notesand specific suggestions; and content analysis was applied. The most important result concerns the effectiveness of the project management method and group leadership carried out by the two EbEs. This approach allowed for complete autonomy of the work, without professional gaze or power imbalance. Also, the ideas and specific contents focused on by the two groups offer strategies to facilitate users' entry and reception in health care centres, to reduce the stigma of mental illness, to improve the centres' physical environment, to improve organisational aspects, to keep family members actively involvedand to network mental health services with other territorial services. EbEs have proven to be key figures in ensuring equity of role in the service co-design process. This also concerns a context, the Italian one, where their role has not yet been recognised and legalised. Their contribution and ideas to improve services could be fundamental not only in mental health centres, but also in other health facilities, and could concern the entire service delivery process rather than being limited to quality assurance, according to a virtuous circle based on active participation and transformation of the role of users. This work resulted from close collaboration between the two EbEs who conducted the groups, users and family members, the university, and the psychiatrist in charge of the service. All of them contributed to the research. The EbEs, researchersand psychiatrist participated in the interpretation of the data and are the co-authors of this paper.

Guidelines toward more socially just mental health screening in schools.

Mental health screening is a pivotal practice for promoting the social-emotional-behavioral (SEB) health and well-being of youth in schools. However, some aspects of traditional mental health screening practices may inadvertently perpetuate structural racism and unintentionally facilitate oppression and SEB disparities. We address this issue constructively by presenting an intentional approach to guide school psychologists and related professionals in implementing more socially just mental health screening in schools. Our guidelines are grounded within the four phases of the Participatory Culture-Specific Intervention Modeling (PCSIM) framework: system entry, culture-specific model development, culture-specific program development, and program continuation or extension. We propose that conceptualizing mental health screening within PCSIM methodology promotes more socially just practices by (a) displacing the implicit power of professionals, (b) giving transparent representation to local communities, and (c) employing methods that are recursive, culturally relevant, and intended to build capacity for sustained transformative change. Within each PCSIM phase, we recommend culturally responsive practices for professionals that foster equity in screening and SEB outcomes and discuss ways to resist practices that perpetuate oppression and disparities. We aim to convey a method for mental health screening that is not done to students and schools but rather done in partnership with and for the benefit of students and schools. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Um modelo de motivação do corpo docente em instituições de ensino superior analisado a partir da complexidade

Objective. This study aims to develop a model that provides a better understanding of the motivation of teaching staff in higher education institutions (HEI) from a complexity perspective. Methodology. It is a correlational-descriptive type of research, with a mixed research method and a motivation-dependent category. The research is linked to a categorical system extracted from the literature review and subsequently refined by two rounds of experts using the Delphi technique. They indicated the following 6 categories that influence teaching motivation: intrinsic, extrinsic, transform knowledge, generate research, quality in education, permanent education, and teaching as a generator of social status. Subsequently, 40 referenced subcategories were constructed that account for each category. For greater accuracy, the Lasso method was used to narrow down the subcategories to 27; this ensured the formulation of questions in a survey with 122 records of teachers, based on the Likert scale type. Results. The interdisciplinarity of complex thinking requires several factors in motivating higher education faculty. These include professional activity, comprehensiveness, effectiveness, knowledge, problem-solving, leadership, interactions, autonomous learning, methodologies, institutional issues, power relations, and social position. Discussion and conclusion. It is crucial to start from a holistic view that integrates teaching motivation in different aspects such as teaching practice, student behavior, organizational aspects, interactivity of the academic community, recognition, and historical and situational contexts. Equally crucial is achieving the integration of these elements that contribute to fostering quality training processes.

The deployment of advanced practice nurses in the French health system: From clinics to professional networks.

The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings. The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs. A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île-de-France Regional Health Agency to evaluate the deployment of APNs in the area. Data were collected through field observations and semi-structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments. The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations. The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities. The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role. APN policy should strengthen a bottom-up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other.

Good Suggestion - But No! Innovation as the Struggle Between Different Roles and Perceptions in a Municipal Organisation

Collaboration has been increasingly recognised as a key for enhancing capacity, effectiveness, and spurring innovation in the public sector. The purpose of this paper is to study empirically how different perceptions and roles within an organisation handle a proposal from strategic management related to engaging a large municipality in collaboration with social entrepreneurs. The primary focus of attention is middle managers, as they stand out as a central counterpart to the administrative and political leadership. The data collection included in-depth interviews, observation and documents. An abductive analysis that combined empirical findings with theoretical insights showed that middle managers controlled positional and professional power bases, enabling them to block the formal lines of authority. The paper contributes to view innovation as a part of the struggle between different roles and perceptions within an organisation and to an explanation for the outcome resulting from different power bases.

Certified Registered Nurse Anaesthetists’ and Critical Care Registered Nurses’ perception of knowledge/power in teamwork with Anaesthesiologists in Sweden: a mixed-method study

Efficient teamwork is crucial to provide optimal health care. This paper focuses on teamwork between Anaesthesiologists (ANES), Certified Registered Nurse Anaesthetists’ (CRNA) and Critical Care Registered Nurses (CCRN) working in challenging environments such as the intensive care unit (ICU) and the operating room (OR). Conflicts are common between physicians and nurses, negatively impacting teamwork. Social hierarchies based on professional status and power inequalities between nurses and physicians plays a vital role in influencing teamwork. Foucault was a famous thinker especially known for his reasoning regarding power/knowledge. A Foucauldian perspective was therefore incorporated into this paper and the overall aim was to explore CCRN/CRNA perception of knowledge/power in teamwork with ANES.Methods A mixed-method approach was applied in this study. Data was collected using a web-based questionnaire containing both closed-end and open-ended questions. A total of 289 CCRNs and CRNAs completed the questionnaire. Data analysis was then conducted through five stages as outlined by Onwuebugzie and Teddlie; analysing quantitative data in SPSS 27.0 and qualitative data with a directed content analysis, finally merging data together in ATLAS.ti v.23.Results The result reveals a dissonance between quantitative and qualitative data; quantitative data indicates a well-functioning interdisciplinary teamwork between CCRN/CRNA and ANES - qualitative data highlights that there are several barriers and inequalities between the two groups. Medicine was perceived as superior to nursing, which was reinforced by both social and organisational structures at the ICU and OR.Conclusion Unconscious rules underlying current power structures in the ICU and OR works in favour of the ANES and biomedical paradigm, supporting medical knowledge. To achieve a more equal power distribution between CCRN/CRNAs and ANES, the structural hierarchies between nursing and medicine needs to be addressed. A more equal power balance between the two disciplines can improve teamwork and thereby reduce patient mortality and improve patient outcomes.

EXPERIENCES OF SOCIAL WORKERS IN WORKING WITH HEALTH CARE PRACTITIONERS: A MULTIDISCIPLINARY TEAM APPROACH

This article uses role theory as a lens to explain the experiences of social workers working within healthcare multidisciplinary teams, which are characterised by interprofessional dominance and subordination. A qualitative case study design was used to explore and describe the experiences of social workers in working with other healthcare practitioners in multidisciplinary teams. A purposeful sampling technique was used to select sixteen participants from a particular health district. Data were collected through interviews and analysed using thematic analysis. Professional power dynamics, a sense of agency with a need for collaborative contribution, and a lack of understanding of the social work profession are three themes that summarise the findings. The article concludes that the ineffective management of multidisciplinary themes creates a barrier to different professionals’ ability to communicate, work and learn together. The article recommends preparatory training for multidisciplinary team members and the need for a structured framework for interprofessional engagement. Keywords: collaboration, healthcare, healthcare practitioner, multidisciplinary team, social worker, teamwork

Enhancing critical social work practice: Using text-based vignettes in qualitative research

There exist ongoing calls among social work scholars and practitioners to cultivate applied knowledge of critical and emancipatory practice. In this paper, I explore the utility of text-based vignettes as instruments that can be used to elicit insight from marginalized service users on critical social work practice. To do this work, I draw on data from interviews with 20 transgender and gender diverse (TGD) social service users, along with 10 social workers, whose responses to a text-based vignette were originally used to build an understanding of the constituents of equitable social work practice with TGD people. Incorporating critical pragmatism as a conceptual framework and constructivist grounded theory as a methodological orientation, I analyze data from this study as an exemplar that substantiates the promise of using text-based vignettes in qualitative social work research to generate knowledge of critical social work practice. Specifically, I demonstrate how text-based vignettes in this study (1) contextualized the meaning, significance, and impact of oppression for service users, (2) built insight on practice that reflects solidarity and allyship, and (3) identified opportunities for social workers’ reflexive use of professional power to effect change. Accounting for the tensions between empiricism and critical praxis in social work, I consider the promise of incorporating text-based vignettes to develop empirical social work literature that is rooted in the voices of marginalized service users.

Entrusting life to professionals: A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services.

Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations. This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home. This study has a qualitative design with a lifeworld approach. A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70-93 years. Care-dependent older persons' participation in prehospital emergency care means 'Entrusting life to professional caregivers' when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain. Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living. Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.

Reevaluating Contour Visualizations for Power Systems Data

Effective visual analytics tools are needed now more than ever as emerging energy systems data and models are rapidly growing in scale and complexity. We examined the suitability of colored contour maps to visually represent bus values in two different power system models: a dense 24k-bus distribution system and a 240-bus transmission system. In a quantitative analysis, we found that contour maps misrepresent power systems data, changing the statistical dispersion of the bus values, including the loss of extreme values. In a controlled empirical study with thirty professional power system research engineers, we found that these distortions significantly impact excursion identification tasks. Additionally, the engineers were less confident in their assessments using contour-based visualizations than glyph-based visualizations.

Exploring the Path of College Students' Participation in Education Poverty Alleviation under the Background of "Internet+": Taking "A Class in Childhood" as an Example

Since the 19th National Congress of the Party, China has been paying more attention to education as well as emphasizing education equity. In order to respond to the national call, the traditional offline teaching mode is combined with the Internet to build an Internet+ education poverty alleviation model with university students as the main teachers, online teaching as the main focus, and offline field research as the supplement. This paper takes the online teaching platform A Class in Childhood as an example and explores the path of college students participation in education poverty alleviation. In summary, the platform is committed to using the sufficient, professional, and high-quality educational resources and teachers power of universities to alleviate poverty in education and culture for elementary schools in remote and poor areas. Meanwhile, the platform has alleviated the contradiction between the educational resources in rural areas and urban areas, helped the psychological health development of local children, and brought new inspiration to the way of education poverty alleviation in poor areas.