Professional Power Research Articles

Marginalization of Professionalism in Clinical Settings; A qualitative study at Tehran University of Medical Sciences

Background: Management-level challenges are among the factors that undermine the individuals' adherence to professional behavior in clinical settings. This study investigated glitches of the management system in clinical settings from the perspective of staff, faculty members, and medical students/residents in hospitals affiliated to Tehran University of Medical Sciences. Methods: This qualitative study was conducted in 2 parts by exploring the viewpoints of personnel and physicians. In this regard, 8 focus group discussions were performed with 85 faculty members, clinical residents, and interns. Furthermore, 15 focus group discussions were held with 165 staffs. Available sampling method was applied to collect the participants and the data were analyzed using the content analysis method. Results: A total of 22 focus-group discussions were conducted with 250 participants; Participants' age ranged from 24 to 65 years. Participants' education levels varied from diploma to postgraduate for the staff and from medical student to sub-specialist for the physicians. Finally, management-level barriers, which undermine the staffs' ability to adhere to professional behavior in clinical settings were explained with 315 codes, 12 subcategories, and 2 main categories of "macro management issues " and "hospital management issues". Conclusion: Managers are required to consider providing a proper context for enforcing the professional behavior law, selecting middle managers based on their empowerment in performing the professional behaviors, prioritizing the professional behavior in policy making, and promoting the professional behavior in an administrative system consistent with the health system. In selecting the hospital managers, authorities are recommended to consider the managers' professional behavior and power in implementing the professionalism leadership. Moreover, the possibility of conducting professional behavior should be considered in making the policies.

Interprofessional collaboration practice: Are you doing it well? Individual perceptions within Sexual Assault Response Team (SART)

Abstract Purpose The purposes of this study were 1) to describe the individual member, group and organizational perception of collaboration of the Sexual Assault Response Team (SART) and 2) to focus on the individual levels of Interprofessional Collaboration (motivation, role expectations, personality style, professional power). Methods A cross sectional exploratory descriptive design. Data was collected from an online Qualtric© survey that incorporated the Perception of INterprofessional Collaboration Model Questionnaire (PINCOM) with some open ended questions. A convenience sample of SART members (n = 159) from the United States. Results The constructs for the individual level on interprofessional collaboration and the themes were categorized for the Sexual Assault Nurse Examiner, Advocate, Law Enforcement and Attorney. Three of four disciplines had a strong connection with individual motivation. Two disciplines had scores that reflected an unfavorable perception of collaboration. Scores on personality styles hindered interprofessional collaboration in all four disciplines. Conclusion Curriculum development based on the IPEC competencies may be a viable to unique groups such as the SART.

Professional power, job security, and decision making in project funding: The assessors' perspective

We examined the influence of assessors' professional power and social connections on their decision making regarding evaluation for funding of new business projects, as well as the moderating effect of the assessors' own job security. Using 1,517 observations from 2017 Beijing Innofund data, we found that the assessors' professional power and social connections were both positively related to their evaluation scores. The job security of the assessors significantly positively moderated the effect of their social connections, but the moderating effect of job security on their professional power was nonsignificant. Theoretical and practical implications are discussed.

Professional learning, positioning, and institutional power

ABSTRACT This study uses positioning theory to explore the reasons for Chinese learning assistants’ misalignment with school pedagogical ideology and their resistance to professional learning at an international English-Chinese dual-language school. This study reveals that inconsistencies between three types of positioning practices (other-positioning, self-positioning, and second-order positioning) created tension in the ongoing identity work of Chinese learning assistants – ultimately hampering their professional learning, which is essential for these learning assistants to adapt to a school’s new operational model. Findings also bring to light influential factors within the institutional structure that contribute to the conflict between the three types of positioning practices. This study suggests international schools should move beyond fixing issues at the individual level (such as cultural differences), especially when challenges occur in teachers’ professional learning, and should re-examine whether the institutional structure aligns or misaligns teachers’ duties and rights with their institutional position.

Evaluation of Social Workers' Perceptions of Personal and Professional Power Regarding with Some Variables

Bu araştırmanın amacı iş yerindeki kişisel, kişilerarası ve sosyo-politik güç unsurlarına göre sosyal hizmet uzmanlarının kişisel ve mesleki güç algılarını araştırmaktır. Araştırma, tarama modelinde yapılmıştır. Sosyal Hizmet Uzmanları Derneği’ne üye olan 2200 uzmandan 551 uzmana ulaşılmıştır. Veri toplama aracı olarak literatür aracılığı ile oluşturan anket formu ve Sosyal Hizmet Uzmanlarının Kişisel ve Mesleki Güç Algıları Ölçeği kullanılmıştır. İş yerindeki kişisel (mesleği isteyerek seçme, başka bir kuruma geçme isteği, sosyal hizmet mesleğini bırakma isteği, doğrudan sosyal hizmet uygulaması yapma, alan deneyimine uygun çalışma), kişilerarası (meslektaşlarından destek ve öneri alma, kurumdaki tüm meslek elemanlarının ortak bir amaca sahip olması, amir yönlendirmesi, üstler ile yaşanan sorunları çözüme kavuşturma, yönetimin tutumu, yönetim ile ilişkiler) ve sosyo-politik (kadro durumu, işin yapılma şekli konusunda müracaatçılardan ve üstlerden gelen baskı, çalışma yoğunluğu, görüşme sayısı, vaka sayısı, çalışma ortamı, otonomi, ilerleme imkânı) düzeydeki güç unsurları bağımsız değişkenler olarak kabul edilmiştir. Sonuç olarak literatürde iş yükü başlığı altında belirtilen çalışma yoğunluğu, görüşme sayısı ve vaka sayısı gibi hususların güçsüzleştirici unsurlardan olduğu ifade edilirken çalışmada güçlendirici unsurlar olduğu sonucuna ulaşılmıştır.

The whole elephant: Defining evaluation

Definitions help us understand the characteristics of an object or phenomenon and are a necessary precursor to understanding what a good version of it looks like. Evaluation as a field has resisted a common definition (Crane, 1988; Morell & Flaherty, 1978; M. F. Smith, 1999), which has implications for marketing, training, practice, and quality assurance. In this position paper, I describe the benefits and challenges of not having a clear, agreed-upon definition, then propose and explore the implications of two definitions for the evaluation profession based on values and valuation as the core of evaluation practice. The purpose is to describe a possible way forward through definition that would increase our professional profile, power, and contribution to social justice. The paper concludes with implications for evaluator competencies and evaluation education and questions for further research.

Nurses' experiences of informal coercion on adult psychiatric wards.

Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as 'a necessary evil', confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients' dignity and autonomy. To describe nurses' experiences of being involved in informal coercion in adult psychiatric inpatient care. The study has a qualitative, inductive design. Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one's actions and learning together. Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and 'house rules' in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients' dignity and autonomy. If there is a need for coercion, that is, if the coercion is found to be an 'unpleasant good', rather than 'necessary evil' considering the consequences for the patient, it should be subject to reflecting and learning together with the patient.

Physicians and management of emergency hospitals: professional power threatened?

Kanban is a technical arrangement for the organization of hospital care focused on the management of beds and clinical care, aimed at the quality and comprehensiveness of care and greater hospital bed turnover, and thus a reduction in length-of-stay and hospital costs. The system's most striking and innovative feature is constant, updated patient follow-up, shared by the professional team in systematic meetings. Characterize the probable impacts from the arrangement's adoption on physicians' professional power (autonomy and authority). Qualitative study in a municipal urgency-emergency hospital using the following data production techniques: ethnography of the hospital's routine, with observation and records in field diaries, and shared seminars with researchers and teams. Physicians value multi-professional work for qualifying their practice, as an ancillary and complementary line. Kanban tends to be controlled by "hybrids" (physicians who accumulate management and clinical functions) that express synergies between "clinical management" and "hospital bed management". Thus, in this arrangement interferences in physicians' work are not exercised from outside, and physicians' clinical decisions still condition the work of the other professional groups. Physicians do not see their authority and autonomy threatened by Kanban, given the linkage between management authority and professional authority. Still, aspects related to hybridization and internal stratification of the medical profession need to be better addressed in the debate on health professionals' power.

Sexual Misconduct: ACOG Committee Opinion Summary, Number 796.

The practice of obstetrics and gynecology includes interaction in times of intense emotion and vulnerability for patients and involves sensitive physical examinations and medically necessary disclosure of private information about symptoms and experiences. The patient-physician relationship is damaged when there is either confusion regarding professional roles and behavior or clear lack of integrity that allows sexual exploitation and harm. Sexual misconduct by physicians is an abuse of professional power and a violation of patient trust. Although sexual misconduct is uncommon in clinical care, even one episode is unacceptable. Routine use of chaperones, in addition to the other best practices outlined in this Committee Opinion, will help assure patients and the public that obstetrician-gynecologists are maximizing efforts to create a safe environment for all patients.

Sexual Misconduct: ACOG Committee Opinion, Number 796.

The practice of obstetrics and gynecology includes interaction in times of intense emotion and vulnerability for patients and involves sensitive physical examinations and medically necessary disclosure of private information about symptoms and experiences. The patient-physician relationship is damaged when there is either confusion regarding professional roles and behavior or clear lack of integrity that allows sexual exploitation and harm. Sexual misconduct by physicians is an abuse of professional power and a violation of patient trust. Although sexual misconduct is uncommon in clinical care, even one episode is unacceptable. Routine use of chaperones, in addition to the other best practices outlined in this Committee Opinion, will help assure patients and the public that obstetrician-gynecologists are maximizing efforts to create a safe environment for all patients.

Occupational Therapists as Street-Level Bureaucrats: Leveraging the Political Nature of Everyday Practice.

As front-line service providers who often work in systems regulated by governmental bodies, occupational therapists can be conceptualized as "street-level bureaucrats" ( Lipsky, 1980/2010 ) who effect and are affected by policy. Drawing on understandings from a study of long-term unemployment, this article proposes that occupational therapists, as street-level bureaucrats, respond to inter-related policies and systems in ways that can perpetuate, resist, or transform opportunities for doing and being. By highlighting practitioners' everyday negotiation of governmental, organizational, and professional power relations, the notion of street-level bureaucracy illuminates the political nature of practice as well as the possibilities and boundaries that policy can place on ideal forms and outcomes of practice. Framing occupational therapists as street-level bureaucrats reinforces practitioners' situatedness as political actors. Mobilizing this framing can enhance awareness of occupational therapists' exercise of discretion, which can be investigated as a basis for occupation-focused and emancipatory forms of practice.

Guest Editorial: Medpower 2018 Selected Papers

Guest Editorial: Medpower 2018 Selected Papers

Track 2.c Introduction: Gender of/in design practice and profession

Social constructionist feminist research of the last decades has shown that if we look closely enough we can see that artifacts are gendered by design. Some artifacts are gendered explicitly through their direct association with the traditional binary of women or men users; while gender is inscribed into others in more subtle ways through the normative conceptions regarding (1) their use contexts (public/private), (2) gender symbols and myths (strong/weak, rational/emotional, dirty/clean, adventurous/safe etc.) and (3) relationship with technology. This dualistic view serves as a useful strategy in design and marketing to create new segments to expand the market. Yet artifacts shaped by this view embody, represent and reproduce asymmetries in gender power relations (Kaygan, Kaygan and Demir, 2019).
 These asymmetries also find form in the professional work cultures and power dynamics of design practice (Armstrong, 2012; Kaygan, 2016). Gender dynamics are both seen and unseen; played out in the everyday interactions of the design office or studio and in the public performance of the designer’s role for client or public audiences (Rossi, 2009). As such, implicitly and explicitly, gender roles have the capacity to enable or inhibit the role of designer as an agent for social change.
 This track seeks to open up a new avenue for feminist scholarship and trans/gender research in design innovation by exploring the relationship between design and gender and its implications for design as both practice and profession. To this end, we invited papers addressing the questions including but not exclusive to:
 
 What is the relationship between gender and design practice and how is this changing in contemporary design culture?
 How and to what extent can designers act as agents of change by formulating gender inequalities in terms of design problems?
 Are there any design methodologies and tools that encourage inclusive and gender-sensitive design practices?
 How can contemporary post-colonial theory and trans/gender research generate new approaches?
 What insights can gender and design histories bring to contemporary research?
 How can design educators better contribute to creating an awareness in young designers to design for a more egalitarian world for people with various gender identities?

General practitioners' perceptions of delayed antibiotic prescription for respiratory tract infections: A phenomenographic study.

Antibiotic use is a major driver of antibiotic resistance. Although delayed antibiotic prescription is a recommended strategy to reduce antibiotic use, practices vary; it appears less commonly used in southern European countries where antibiotic consumption is highest. Despite these variations, few qualitative studies have explored general practitioners' perceptions of delayed antibiotic prescription. We therefore aimed to explore and describe the perceptions of delayed antibiotic prescription for respiratory tract infections among general practitioners in Malta. This qualitative phenomenographic study was conducted in Malta. A semi-structured interview guide was developed in English, pilot tested and revised accordingly. Interview topics included views on antibiotic resistance, antibiotic use and delayed antibiotic prescription for respiratory tract infections, and barriers and facilitators to antibiotic prescription. Individual, face-to-face interviews were held in 2014 with a quota sample of 20 general practitioners and transcribed verbatim. Data were subsequently analysed using a phenomenographic approach. General practitioners perceived delayed antibiotic prescription in five qualitatively different ways: (A) "The Service Provider"-maintaining a good general practitioner-patient relationship to retain patients and avoid doctor-shopping, (B) "The Uncertainty Avoider"-reaching a compromise and providing treatment just in case, (C) "The Comforter"-providing the patient comfort and reassurance, (D) "The Conscientious Practitioner"-empowering and educating patients, and limiting antibiotic use, and (E) "The Holder of Professional Power"-retaining general practitioner responsibility by employing a wait-and-see approach. Although general practitioners were largely positive towards delayed antibiotic prescription, not all supported the strategy; some preferred a wait-and-see approach with follow-up. Many delayed antibiotic prescription users selectively practiced delayed prescription with patients they trusted or who they believed had a certain level of knowledge and understanding. They also preferred a patient-led approach with a one to three day delay; post-dating delayed antibiotic prescriptions was uncommon. In this study we have shown that general practitioners hold varying perceptions about delayed antibiotic prescription and that there is variation in the way delayed antibiotic prescription is employed in Malta. Whilst delayed antibiotic prescription is utilised in Malta, not all general practitioners support the strategy, and motivations and practices differ. In high consumption settings, formal and standardised implementation of delayed antibiotic prescription could help curb antibiotic overuse. Diagnosis-specific delayed antibiotic prescription recommendations should also be incorporated into guidelines. Finally, further investigation into patients' and pharmacists' views on delayed antibiotic prescription is required. NCT03218930.

Towards a ‘client professionalization’ process? The case of the institutionalization of executive coaching in France

AbstractDrawing on the ‘corporate professionalization’ model (Kipping, Kirkpatrick, and Muzio 2006; Muzio et al. 2011) of new strategies adopted by managerial occupations, this article explores professionalization processes taking into account the role of the client. Based on an analysis of the professionalization of executive coaching, it demonstrates the influence of the client organizations in such processes, at a collective and institutional level. This influence tends to favor new professionalization strategies of differentiation, regulation, and dissemination. The article suggests that this influence does not necessarily limit the power of corporate professionals, at least in the institutionalization phase, especially if we redefine power as consisting ‘not in restriction and exclusion, but in extension and linking’ (Eyal 2013: 876). Framed primarily to analyze corporate occupations practiced by independent professionals, the ‘client professionalization’ model suggests better taking into account the influence of client organizations in further research on professionalization processes, in line with the research conducted on ‘client capture’ (Leicht and Fennell 2001; Dinovitzer, Gunz, and Gunz, 2014). By studying an emergent corporate profession that is practiced by self-employed, solo practitioners and freelancers, which have been largely overlooked in the literature, this article contributes overall to a more diverse understanding of corporate professions and the ways in which they professionalize.

Professional and organizational power intertwined: Barriers to networking?

In recent years, the field of child protection has been characterized by the promotion of collaboration and networking initiatives throughout the western world. Using Norway as an example, we address potential barriers to networking by studying how problems are perceived by local child protection service workers and their co-actors. Informed by an institutional logics perspective, this article sheds light on how manifestations of logics take shape on the ground, focusing on their internal differentiation as well as possibilities and barriers to their (re)combination. The Norwegian case is intriguing because it suggests that a specific intertwinement of organizational and professional power might create distinctive barriers to networking. In Norway, “child protection pedagogues” take the position of specialized professionals endowed with both state power and management skills. As risk managers promoting prevention and marketing for reputation, while at the same time claiming professional and bureaucratic authority, these actors seem to take on a “hyper-hybrid” form that is likely to cause irritation and anxiety among their co-actors, resulting in the perception of poor collaboration. Thus, relating our findings to the international literature, we argue that excessively hybrid combinations of institutional logics, based upon different forms of knowledge and power, can entail specific barriers to networking.

A Seat at the Table: Information Literacy Assessment and Professional Legitimacy

This qualitative study explores academic librarians’ perceptions of and experiences with information literacy assessment, focusing primarily on issues of professional identity, agency, and power. Findings from in-depth interviews reveal that instruction librarians view teaching as integral to their professional identity and use assessment to legitimize that identity, both personally and at the institutional level. While this suggests that assessment has the potential to elevate the status of librarians on campus, the interviews also highlight ongoing professional and organizational tensions that hinder assessment efforts and inhibit librarian agency. The authors recommend more transparent communication, among other strategies, to address these challenges.

Gender Sensitive Language in Media Practice in Serbia

Gender sensitive language as a part of non-discriminatory speaking and writing is an important aspect of language planning. There is no such official policy of language planning in Serbia, and the whole process in public goes with resistance and disputes of individuals or groups. At the same time, the argumentation and importance of language planning are not considered when it comes to its gender dimension. Given the strong media influence on public opinion, speaking and writing, I decided to research proofreaders’ attitudes to the use of gender sensitive language in Serbian daily newspapers. The proofreaders have a power of linguistic knowledge to direct language policy in media, but their professional power could be reduced by the attitudes of editors and authors. On the other hand, given the relation between the prescriptive norm and the language practice, proofreaders are often influenced by individual attitudes of Serbian philologists who prescribe that norm. The attention here is to show an interdependence of professional power and linguistic knowledge in the processes of standardisation of the Serbian language in the case of proofreading services in daily newspapers in Belgrade and Novi Sad printed in 2016.

Is Co-production Just a Pipe Dream for Applied Health Research Commissioning? An Exploratory Literature Review.

Background and Rationale: Internationally, the idea of “co-production' has become more popular in health research because of the promise of partnership between researchers and patients to create research that focuses on patients' needs. Patient and public involvement (PPI) at an early stage in deciding what research should be funded, can improve the quality and impact of research. However, professional power over the process places limits on the public practising their participatory rights for involvement in commissioning research that affects them and can leave members of the public feeling unheard or excluded, particularly within the context of early phase applied health research.Aim: This article explores whether and how the public can be involved in the co-production of research commissioning early on in the process, with a focus on the power relations that pervade basic and early phase translational applied health research.Methods: An exploratory literature review of international peer-reviewed and gray health research literature using structured searches of electronic databases and key search terms.Results: There is very little literature that critically evaluates how PPI is embedded into the early phases of the commissioning process. The field of basic or early translational applied research appear to be particularly challenging. Four themes which emerged from the review are: reasons for PPI in research commissioning; benefits of PPI at strategic levels of research commissioning; contributions of patients and members of the public; improving PPI in research commissioning.Conclusion: Although the public are being consulted at some stages of the research commissioning process, it is evident that the process of determining research priorities and agendas is far from being widely co-produced. Moving PPI from a consultative paternalistic model to a collaborative partnership model should be a priority for commissioners. Significant changes to communication, practices, systems, structures, or cultures that exclude patients and the public from contributing in meaningful ways, are needed to fulfill the potential of co-produced models of research commissioning.

'Whatever decision you make it will be the right one': A parent's reflection on difficult decision-making in premature birth.

In 2007, our daughter Lily was born prematurely. My husband and I were faced with a very difficult decision about the level of intervention for her, a decision that had to be made in an emergency situation under the pressure of time. As a paediatric nurse I had more knowledge about prematurity than most parents, and it was certainly enough to appreciate the fragility of babies born early, and their uncertain and often complicated path through neonatal intensive care. What I didn't fully appreciate was the key role of health professionals, not only in providing care, but in supporting difficult decision-making. In the years since Lily's birth I've also reflected on the power of health professionals to shape, or reshape, the narrative of premature birth which is pivotal in the long-term psychological trajectory of parents.