Professional Stance Research Articles

How option-listing influences decision-making in orthopedic consultations: a conversation analytic study

ObjectivesExamine which practices orthopedists use to do option-listing, a technique that can facilitate shared decision-making (SDM). MethodsA conversation analytic study of 35 orthopedic consultations with newly referred patients with hip and/or knee osteoarthritis. ResultsOrthopedists implement option-listing in consultations using two organizational principles: 1) A fixed order of options that constitutes a scale (based on the severity of treatment). Presenting this scale (in two possible orders) encodes this fixed order; 2) Options are presented in relation to each other, rather than as individual options to be discussed incrementally. This format provides orthopedists with interactional slots to formulate their professional stance by presenting options as considered but rejected. Patients co-construct this list by taking a recipient role and not responding to the individual items of the list. ConclusionsOption-listing can facilitate SDM, allowing patients to choose amongst options. A drawback is that, while the organizational principles of option-listing allow orthopedists to express a professional opinion, they also place patients in an interactional position in which they have to address the orthopedists’ epistemic stance. On the other hand, patients can use the scale to propose their own preferences. Practical implicationsAwareness of the interactional consequences of option-listing might optimize SDM.

Impartiality, human rights advocacy, and teaching about politically sensitive issues: Squaring the circle

This article first describes and then proposes a practical solution to the professional dilemma between the duty of impartiality and the duty of human rights advocacy that many teachers experience when teaching and talking about politically sensitive issues with students. The article begins by presenting an analysis of the source and signification of the tension between impartiality and human rights advocacy based on evidence from research on teachers’ perspectives, the conceptual literature on teaching and learning about controversial issues, and the legal and ethical framework of education. Then, drawing on scholarship on respect for students’ right to freedom of religion, the article advances and defends set of basic pedagogical guidelines for teaching and talking about politically sensitive issues that permit teachers to maintain a professional stance of impartiality without abrogating their responsibility to act as human rights advocates. Key to squaring the circle between impartiality and human rights advocacy, the article argues, is for teachers to strive to remain descriptive in their treatment of politically sensitive issues and insist on high standards of reasoning and evidence while at the same time respecting students’ right to an opinion, no matter how mistaken that opinion may seem.

“It is very hard to just accept this” – a qualitative study of palliative care teams’ ethical reasoning when patients do not want information

BackgroundThe aim of this study was to explore how palliative care staff reason about the autonomy challenge that arises when a patient who has first said he wants full information appears to change his mind and rejects being informed.MethodsThe study had a qualitative and exploratory design. Participants (physicians, registred nurses, social workers, physiotherapists and occupational therapists) were recruited from palliative care teams in southern Sweden. Six separate focus group interviews with a total number of 33 participants were conducted. The teams were asked to discuss a fictional case of a man who first wants, then rejects, information about his situation. The interviews were audiotaped and transcribed verbatim. Reflexive thematic analysis following Braun and Clarke was undertaken to analyse data.ResultsThe analysis resulted in three themes: Patients have a right to reject information, Questioning whether this patient WANTS to reject information and There are other values at stake, too. Although participants endorsed a right to reject information, they were unsure whether this right was relevant in this situation, and furthermore felt that it should be balanced against counteracting factors. The effect of such balancing was that participants would aim to find a way to present relevant information to the patient, but in a probing and flexible way.ConclusionsIn their work with dying patients, palliative care staff meet many autonomy challenges. When faced with a choice to withhold information as per a patient’s wishes, or to provide information with the patient’s best interest in mind, staff find it hard to balance competing values. Staff also find it hard to balance their own interests against a purely professional stance. The overall strategy seems to be to look for caring ways to impart the information.

Research: “It feels like a safe place”: A (Re)Invitation to the Writer’s Notebook as Humanizing Pedagogy in Preservice Literacy Teacher Education

This qualitative case study examines preservice teachers’ (PTs) self-selected writer’s notebook (WNB) entries and written reflections in two literacy methods courses. The authors use thematic analysis to consider how the writer’s notebooks supported PTs’ learning to teach multilingual writers while concurrently writing for themselves and navigating contemporary sociopolitical contexts. The authors describe how PTs used their writer’s notebooks to process emotion and identity, develop professional stances, and build experiential knowledge around multilingual, multimodal writer praxis. The authors conclude with suggestions for teacher educators and researchers to expand these practices.

Social Media Use in Dermatology in Turkey: Challenges and Tips for Patient Health.

Social media has established its place in our daily lives, especially with the advent of the COVID-19 pandemic. It has become the leading source of information for dermatological literacy on various topics, ranging from skin diseases to everyday skincare and cosmetic purposes in the present digital era. Accumulated evidence indicates that accurate medical content constitutes only a tiny fraction of the exponentially growing dermatological information on digital platforms, highlighting an unmet patient need for access to evidence-based information on social media. However, there have been no recent local publications from Turkey analyzing and assessing the key elements in raising dermatological literacy and awareness in digital communication for patients. To the best of our knowledge, this study is the first collaborative work between health care professionals and a social media specialist in the medical literature. Furthermore, it represents the first author-initiated implementation science attempt focusing on the use of social media in addressing dermatological problems, with the primary end point of increasing health literacy and patient benefits. The multidisciplinary expert panel was formed by 4 dermatologists with academic credentials and significant influence in public health and among patients on digital platforms. A social media specialist, who serves as a guest lecturer on "How social media works" at Istanbul Technical University, Turkey, was invited to the panel as an expert on digital communication. The panel members had a kickoff meeting to establish the context for the discussion points. The context of the advisory board meeting was outlined under 5 headlines. Two weeks later, the panel members presented their social media account statistics, defined the main characteristics of dermatology patients on social media, and discussed their experiences with patients on digital platforms. These discussions were organized under the predefined headlines and in line with the current literature. We aimed to collect expert opinions on identifying the main characteristics of individuals interested in dermatological topics and to provide recommendations to help dermatologists increase evidence-based dermatological content on social media. Additionally, experts discussed paradigms for dermatological outreach and the role of dermatologists in reducing misleading information on digital platforms in Turkey. The main concluding remark of this study is that dermatologists should enhance their social media presence to increase evidence-based knowledge by applying the principles of patient-physician communication on digital platforms while maintaining a professional stance. To achieve this goal, dermatologists should share targeted scientific content after increasing their knowledge about the operational rules of digital channels. This includes correctly identifying the needs of those seeking information on social media and preparing a sustainable social media communication plan. This viewpoint reflects Turkish dermatologists' experiences with individuals searching for dermatological information on local digital platforms; therefore, the applicability of recommendations may be limited and should be carefully considered.

"They were very very nice but just not very good": The interplay between resident-supervisor relationships and assessment in the emergency setting.

Clinical supervisors hesitate to report learner weaknesses, a widely documented phenomenon referred to as "failure to fail." They also struggle to discuss weaknesses with learners themselves. Their reluctance to report and discuss learner weaknesses threatens the validity of assessment-of-learning decisions and the effectiveness of assessment for learning. Personal and interpersonal factors have been found to act as barriers to reporting learners' difficulties, but the precise role of the resident-supervisor relationship remains underexplored, specifically in the emergency setting. This study aims to better understand if and how factors related to the resident-supervisor relationship are involved in assessment of and for learning in the emergency setting. We conducted a qualitative study, using semistructured interviews of 15 clinical supervisors in emergency medicine departments affiliated with our institution. Transcripts were independently coded by three members of the team using an iterative mixed deductive-inductive thematic analysis approach. The team then synthesized the coding and discussed analysis following guidelines for thematic analysis. Participating emergency medicine supervisors valued resident-supervisor relationships built on collaboration and trust and believed that such relationships support learning. They described how these relationships influenced assessment of and for learning and how in turn assessment influenced the relationship. Almost all profiles of resident-supervisor relationships in our study could hinder the disclosing of resident weaknesses, through a variety of mechanisms. To protect residents and themselves from the discomfort of disclosing weaknesses and to avoid deteriorating the resident-supervisor relationship, many downplayed or even masked residents' difficulties. Supervisors who described themselves as able to provide negative assessment of and for learning often adopted a more distant or professional stance. This study contributes to a growing literature on failure to fail by confirming the critical impact that the resident-supervisor relationship has on the willingness and ability of emergency medicine supervisors to play their part as assessors.

STUDENT MIDWIVES: SUPPORTING PHYSICAL ACTIVITY UPTAKE IN PREGNANCY

For healthy pregnant women, exercise, defined as physical activity (PA), is a safe and effective way of reducing adverse health risks. The lack of exercise reported by women in pregnancy is currently a significant concern, particularly in review of present maternal obesity statistics and associated risk factors. For instance, in pregnancy, obesity is recognised within 21.3% of antenatal clients.1 Adding to this, fewer than half of pregnant women (47.3%) have a normal ranged BMI.1 Urgent action is required, yet despite the well documented benefits, still 60 to 80% of pregnant women do not participate in PA.2,3,4 This is inclusive of women that are both overweight and classed as obese.2 From a health professional stance, there is an element of lack of professional education around the topic of PA in pregnancy. This article reviews the current obstacles and potential enablers, for midwives and student midwives. It critically considers how women and pregnant people can be effectively supported with PA throughout their pregnancy and, more specifically, by our future midwives.

DISHARMONISASI KEPALA DAERAH (ANALISIS FRAMING ROBERT N. ENTMAN PADA PEMBERITAAN MEDIA ONLINE ULASAN.CO)

This research aims to understand and analyze how the online media outlet Ulasan.co frames the news about the leadership of the Governor and Deputy Governor of the Riau Islands, where three months after their inauguration, they were hit by issues of disharmony. Ulasan.co is the most prominent online media platform in the Riau Islands that frequently highlights these issues. This study analyzes the news texts from Ulasan.co titled "Dirty Plates" Amid the Ansar-Marlin Dispute. The research findings indicate that Ulasan.co's news framing is considered to lack "covering both sides" as it tends to present statements from only one party. The analysis is conducted using Robert N. Entman's framing model, yielding the following results: Problem Identification (identifying the problem's causes) is attributed to internal political conflict; Diagnose Causes (assessing the root causes) point to the Deputy Governor; Make Moral Judgements (moral evaluation) involve the professional stance of the Governor in maintaining governance continuity; and Treatment Recommendations (problem-solving and resolution) involve the call for resolving the issues and conflicts between the Governor and Deputy Governor, thereby allowing them to collaborate once again in advancing the Riau Islands Province.

Facing our own dying: exploring conflicts between our individual professional stance and our own personal views on MAiD

Physician-administered euthanasia (Medical-Aid-in-Dying or MAiD) has been legally available in Canada since 2016, with ever-widening indications. Most palliative care physicians in Canada do not provide MAiD themselves but will refer to colleagues who provide this procedure. The author was involved in a qualitative research project on MAiD, looking at the views of Montreal-based palliative care physicians regarding their role. One interesting finding from that project is that our own individual personal views (i.e., what I would want for myself when I will inevitably face my own death) versus my professional views as a palliative care physician (i.e., the kind of end-of-life care that I am ready to provide, or what I think patients should receive) may radically differ.
 We teach our trainees (and the community beyond) that dying can have meaning up to the end of one’s natural life. Patients facing terminal illness commonly express a fear of becoming a burden to others. Yet we teach that this sentiment is often not well-founded, based on the expressed views of the patient’s loved ones. And yet dying can be difficult, even when patients receive the best available palliative care. Our professional view of what constitutes a dignified end-of-life and what patients and families (and I, eventually) will experience may be different.
 This presentation will spark reflection regarding this dichotomy. What feelings might this inner split provoke, when our professional and personal views conflict with each other? Am I being a dishonest physician? And yet…

Une posture professionnelle pour l’accompagnement clinique des adolescents dans l’entre-deux : entre rigueur et souplesse

Dans le cadre de cet article, en partant d’une compréhension progressive de sa propre subjectivité déterminante pour développer sa capacité d’entendre les adolescents, l’auteur avance l’hypothèse qu’une posture professionnelle qu’il qualifierait de « l’entre-deux » exige de la rigueur et de la souplesse permettant au professionnel de rester poreux aux mobilisations inconscientes des sujets-adolescents ainsi qu’aux siennes propres. Il s’appuiera sur les résultats d’une recherche longitudinale et partenariale qu’il a conduite auprès de dix adolescents, entre 2015 et 2020, avec une équipe d’éducateurs et d’éducatrices de prévention spécialisée. Plus particulièrement, l’auteur fera le choix d’analyser quelques passages rétrospectifs de sa rencontre avec l’une des adolescentes du groupe pour montrer ce que pourrait être la rigueur d’une posture de l’entre-deux pour un « professionnel du lien ».

L’entre-deux comme posture professionnelle en éducation et formation

L’entre-deux comme posture professionnelle en éducation et formation

Communities of practice as a methodology for creating value on innovative practices for better integration of social and health organizations

Introduction/background summary: Communities of practice (CoPs) are groups of practitioners who share a domain of interest and strive to learn from each other by interacting regularly in order to improve practice. CoP as a methodology can reveal, clarify and support the development of new roles and innovative practices rooted in local contexts and networks and contribute to more integration of social and health organizations.
 Targeted population: In this case, the target population of CoPs is practitioners, organizations and communities willing to develop innovative practices and roles for better integration of health and social care for patients/users.
 Participants: In Brussels, four CoPs –each anchored in a different district- bring together twelve practitioners from different social and health organizations and disciplines, and two moderators. A total of forty-eight practitioners and eight moderators participate in the CoPs.
 Description of the initiative: Members of the CoP are enrolled in monthly meetings throughout the year where they share difficulties, resources and find solutions together, creating value through social learning. These health, care, and community workers identify as ‘Trusted frontline professionals”. In this role, practitioners aim to support and guide the patient/user according to his/her needs and goals through the social and health system. CoPs are guided by moderators who use different methods and tools to facilitate exchanges and to support CoP members in their ‘Trusted frontline professional’ role. 
 Thematic analysis is in progress using NVIVO 12 on data collected during CoP and moderators’ meetings through participatory observation, as well as on CoP monitoring tools, conventions and previous reports. A documentation grid was developed through a participatory process within the CoPs.
 Results: Data from thirty-five CoP meetings, involving forty-eight practitioners will provide insights categorized by established areas of the documentation grid: 1) profile of patients/users supported and practitioners involved; 2) types of situations encountered and actions; 3) proposed solutions and clues from other CoP members; 4) available tools and resources in local networks; 5) development of professional stance; and 6) impact of participation on CoP members and represented organizations. Data from seven moderators’ meetings highlight key elements of CoP organization and facilitation methods, which will be compiled in a methodological guide.
 
 Learning for the international audience: CoP as a valuable methodology for exploring and defining innovative roles such as that of ‘Trusted frontline professional’. Social learning processes reveal specific needs of patients/users and practitioners playing this role, resources and tools available to practitioners. Social learning creates value by helping practitioners to be better equipped to play the role of ‘Trusted frontline professional' within local contexts and networks.
 Next steps: Capturing and capitalising on the value created within these four CoPs can be used to build further CoPs to support practitioners in the 'trusted frontline professional' role in other local areas or to develop and monitor the implementation of other roles.

Exploring professionals' practices and perspectives on supporting parents with intellectual disabilities: a qualitative study.

Evidence suggests that parents with intellectual disabilities require appropriate parenting support. However, professional practices vary widely, and several barriers and challenges persist in supporting parents with intellectual disabilities. To identify effective and collaborative practices, this study investigated practices reported by professionals and their roles in providing services to parents with intellectual disabilities. Semi-structured interviews were conducted with 22 professionals from three sectors (disability, early childhood, and healthcare), and the content was analysed using inductive thematic analysis. Thematic analyses yielded four main themes: (1) Perceived professional practices, (2) professional stances, (3) the frame of reference and the ethics of support, (4) the experience of providing support. They are described in terms of content and distribution across sectors to provide an overview of practices as well as potential discrepancies. This study concludes by developing recommendations on good practices for support professionals to respond as adequately as possible to meet the needs of parents and future parents with intellectual disabilities, which include structural support and guidelines for professionals to provide sensitive, family-centred, and enabling support.

Style in a school community—“Ne” deletion in French preschool

AbstractThis article explores the question of style in a school community, through negation use among the adults and children in a French preschool. Thirteen adults and 61 pupils aged 3–6 years were followed over a period of 2.5 years. The findings draw on a corpus of oral data collected in an unsupervised manner and comprising almost 640,000 transcribed words (428,100 for the children and 210,241 for the adults). The findings show, on the one hand, that the teachers adapt stylistically to their interlocutors and that their professional stance leads to more formal speech and, on the other hand, that the children's use of bipartite negation is marginal before the age of 6 years and does not present notable stylistic variations.

A constructivist grounded theory of counselling psychologists’ in-the-moment decision-making process about touching their clients

BackgroundClinician-client touch is controversial, and seemingly widespread. However, talking therapists report little-to-no training on it and major accrediting bodies offer no explicit guidance. Consequently, some clinicians feel a lack confidence and competence around touch and fear accusations of bad practice. There is no research on counselling psychologists’ (CoPs’) ‘in-the-moment’ (in-session) decision-making process about touching their clients. Hence, this study aimed to develop a constructivist grounded theory (CGT) of this process to facilitate best practice by identifying issues and evaluating and recommending changes to existing models, guidelines, and training.MethodologyFollowing a CGT methodology, cycles of semi-structured interviews were conducted with nine CoPs, one clinical psychologist and two body psychotherapists about their process. The interview transcripts were analysed following Charmaz’s (2014) three-stage CGT coding process.FindingsA dual process model of touch-decision-making was produced, with the core category ‘weighing the predicted balance of appropriateness’: participants use an embodied sense of ‘felt appropriateness’ and a cognitive process of ‘considering the appropriateness’ to assess whether a ‘touch-related action’ is likely to be experienced as minimising harm and maximising therapeutic benefit to the client.ConclusionThe findings indicate a need for a CoP ‘professional stance’ towards touch-decision-making and talking about and upholding touch-boundaries in clinical practice.

Policymakers' corner: Challenges of monetary policy in a developing country

For a central bank to be successful in regulating the financial sector, it must have relevant and pragmatic policies. It should ensure that all financial institutions, including banks, comply with prudential and management norms. Both internal and external factors are making it difficult for Bangladesh Bank to monitor and regulate the financial sector, especially banks. Bangladesh Bank has to move away from its present conventional stance towards a heterogeneous, unconventional and implementable approach. It must strike a balance showing an appropriate professional stance while avoiding the negativity of politically motivated reforms in a highly technical domain.

Cultivating reflective teachers: Challenging power and promoting pedagogy of self-assessment in Australian, Bhutanese, and Canadian teacher education programs

In this article, we look at three teacher education programs across three countries—Australia, Bhutan, and Canada—to examine how reflection is cultivated in pre-service teachers (also referred to as teacher candidates) through a pedagogy of self-assessment. We begin from the premise that a cornerstone of effective teaching is the capacity of an educator to reflect on their practice and to use their reflections for professional growth and development. Qualitative data were collected from teacher candidates from one teacher education program in each country to obtain the views and reflections of teacher candidates about the power and pedagogy of self-assessment to inform their learning and development. Analysis of results led to three overarching themes: (a) consistent learning priorities of pre-service teachers as they engage with reflection; (b) pedagogical features that leverage self-assessment strategies to enhance reflective practice; and (c) the possibilities for reflection to facilitate a professional stance towards learning. Each theme is discussed with consideration for teacher education practices and theory.

Higher Education Instructors’ Self-Assessment of Implementation of Flexible Learning Guidelines

This descriptive quantitative study discusses the instructors’ implementation of the flexible learning guidelines during the pandemic as perceived in their self-assessment results. Assessing how the instructors dealt with the flexible learning modality will lead to better curricular planning and implementation in higher education in the new normal. Using a survey rating scale and checklist, the respondents rated their own implementation of the flexible guidelines. A self-assessment process can facilitate curricular and instructional improvements on the part of the instructor, upgrading the professional stance of these teachers and achieving the standard guidelines set along the way. Results showed that the instructors are Always implementing the flexible learning guidelines specifically on the general guidelines, requirements and qualifications for flexible learning, implementing policies and procedures on facilitating online teaching, social-emotional learning, rules and discipline, teacher organization and communication, assessment, support services, and adherence to data privacy. Yet, the instructors had a lower rating on assessment which means a need for support on online assessment. Also, the instructors expressed their concerns on the LMS, virtual synchronous platform, access and connectivity, students’ concerns, and general concerns on teachers’ coursework and online learning. It is recommended to conduct impact studies on flexible learning and to provide further professional development sessions to enrich the curriculum and instruction needs of instructors.

Migrant doctors’ narratives about patients

Abstract Narratives of personal and vicarious experience are part and parcel of being a doctor, as doctors routinely (re)interpret and (re)tell patients’ narratives when reflecting on clinical cases. Taking an interest in migrant doctors’ self-initiated narratives about patients in doctor-researcher interviews about cultural transitions, this study examines over thirty hours of audio-recordings of forty semi-structured interviews conducted as part of a collaborative project in Chile and Hong Kong. The study explores how migrant doctors construct their professional ‘self’ through narratives about patients, and how these narratives help migrant doctors legitimise their arguments and professional stance in criticizing cultural and societal attitudes towards health and illness, and the professional practices of local doctors. Finally, the paper reflects on the ways in which migrant doctors’ identity positionings provide space for the creation of a “symbolic territory” in which the practices of migrant doctors co-exist within the boundaries of the practices of local doctors in the host culture.

(Un)desirable approaches in therapy with Swedish individuals practicing BDSM: client’s perspectives and recommendations for affirmative clinical practices

ABSTRACT This transformative study aimed to explore how people who practice BDSM (bondage, discipline, dominance, submission, sadism, masochism) experience therapy; specifically, what sort of therapist responses and qualities they described as problematic and desirable in relation to addressing BDSM in therapy. Semi-structured interviews were conducted with 27 Swedish BDSM practitioners with experiences of psychotherapy. The interviews were analysed using inductive thematic analysis. Three themes were identified: ‘A professional stance’, relating to how therapists handled their professional roles when BDSM was addressed, ‘Therapists’ approaches towards BDSM’, regarding therapists’ opinions and attitudes towards BDSM, and ‘Conversations about BDSM’, regarding how therapists handled conversation about the topic. Participants reported negative experiences where therapists expressed prejudice, judgment or pathologizing attitudes, failed to contain their own emotions, questioned their clients about BDSM, used their clients to inform themselves about BDSM, avoided or focused excessively on the topic. Positive experiences were characterised by non-judgement, asking client-centred questions, and stimulating a collaborative exploration of matters relevant to the client. BDSM practitioners’ experiences of therapy were related to those documented in the literature on other minoritized identities. This study contributes to the growing literature on kink-aware therapy, which makes psychotherapy more affirmative, accessible, and rewarding to BDSM practitioners.