Professional Uncertainty Research Articles

Why is Everyone So Anxious?: An Exploration of Stress and Anxiety in Genetic Counseling Graduate Students

Stress is an inevitable part of daily life. Studies of graduate student stress exist, but none include genetic counseling students. The present mixed-methods study investigated 225 genetic counseling students' stress and anxiety levels using the State-Trait Anxiety Inventory (STAI; Spielberger et al. 1983), frequency and intensity of stressors associated with their graduate experience, positive and challenging aspects of their experience, and their stress management advice for prospective students. Principal axis factor analysis yielded five conceptual factors underlying the stressors: Professional Uncertainty, Personal Life Events, Interpersonal Demands, Academic Demands, and Isolating Circumstances. Exploratory model fitting using regression yielded four significant predictors accounting for 19% of the variance in state anxiety: (1) trait anxiety, (2) the Interpersonal Demands factor, (3) the Isolating Circumstances factor, and (4) the interaction between the Professional Uncertainty factor and advanced student status. Content analysis of open-ended responses identified several themes. For instance, most students enjoyed what they were learning, interactions with colleagues, and affirmation of their career choice, while certain academic and professional challenges were particularly stressful (e.g., workload, time constraints, clinical rotations). Additional findings, program implications, and research recommendations are provided.

Ethik, Empirik und Unsicherheit

Accidents can lead to difficult boundary situations. Such situations often take place in the emergency units. The medical team thus often and inevitably faces professional uncertainty in their decision-making. It is essential to communicate these uncertainties within the medical team, instead of downplaying or overriding existential hurdles in decision-making. Acknowledging uncertainties might lead to alert and prudent decisions. Thus uncertainty can have ethical value in treatment or withdrawal of treatment. It does not need to be covered in evidence-based arguments, especially as some singular situations of individual tragedies cannot be grasped in terms of evidence-based medicine.

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adults: a qualitative study of perspectives from professional practice

BackgroundChronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) can cause profound and prolonged illness and disability, and poses significant problems of uncertainty for healthcare professionals in its diagnosis and management. The aim of this qualitative study was to explore the nature of professional 'best practice' in working with people with CFS/ME.MethodsThe views and experiences of health care practitioners (HCPs) were sought, who had been judged by people with CFS/ME themselves to have been particularly helpful and effective. Qualitative semi-structured interviews following a topic guide were carried out with six health care practitioners. Interviews were audio-recorded, transcribed and subject to thematic analysis.ResultsFive main themes were developed: 1) Diagnosis; 2) Professional perspectives on living with CFS/ME; 3) Interventions for treatment and management; 4) Professional values and support for people with CFS/ME and their families; 5) Health professional roles and working practices. Key findings related to: the diagnostic process, especially the degree of uncertainty which may be shared by primary care physicians and patients alike; the continued denial in some quarters of the existence of CFS/ME as a condition; the variability, complexity, and serious impact of the condition on life and living; the onus on the person with CFS/ME to manage their condition, supported by HCPs; the wealth of often conflicting and confusing information on the condition and options for treatment; and the vital role of extended listening and trustful relationships with patients.ConclusionsWhile professional frustrations were clearly expressed about the variability of services both in primary and specialist care and continuing equivocal attitudes to CFS/ME as a condition, there were also strong positive messages for people with CFS/ME where the right services are in place. Many of the findings from these practitioners seen by their patients as helping them more effectively, accord with the existing literature identifying the particular importance of listening skills, respect and trust for establishing a therapeutic relationship which recognises key features of the patient trajectory and promotes effective person-centred management of this complex condition. These findings indicate the need to build such skills and knowledge more systematically into professional training informed by the experience of specialist services and those living with the condition.

Professional Ambivalence: Accounts of Ethical Practice in Childhood Genetic Testing

Childhood genetic testing raises complex ethical and moral dilemmas for both families and professionals. In the family sphere, the role of communication is a key aspect in the transmission of 'genetic responsibility' between adults and children. In the professional sphere, genetic responsibility is an interactional accomplishment emerging from the sometimes competing views over what constitutes the 'best interests' of the child in relation to parental preferences on the one hand, and professional judgements on the other. In the present paper we extend our previous research into parental accounts of childhood genetic testing and explore the ethical accounts of professionals in research interviews. Interviews (n = 20) were conducted with professional practitioners involved in the genetic diagnosis and management of children and their families. We first identify four inter-related themes-juxtaposition of parental rights vis-à-vis child's autonomy, elicitation of the child's autonomy, avoidance of parental responsibility and recognition of professional uncertainty. Then, using Rhetorical Discourse Analysis, we examine the range of discourse devices through which ethical accounts are situationally illustrated: contrast, reported speech, constructed dialogue, character and event work. An overarching device in these ethical accounts is the use of extreme case scenarios, which reconstruct dilemmas as justifications of professional conduct. While acknowledging ambivalence, our analysis suggests that professional judgement is not a simple matter of implementing ethical principles but rather of managing the practical conditions and consequences of interactions with parents and children. We conclude that more attention is needed to understand the way professional practitioners formulate judgements about ethical practice.

The effects of menstrual cycle phase on clinical measures of concussion in healthy college-aged females

The management of concussion and mild traumatic brain injury is an area of clinical uncertainty for many sports medicine professionals. While recent studies suggest sex differences in neurocognitive function may exist, our understanding of the effects of menstrual cycle phase and oral contraceptive pill (OCP) use in healthy females is limited. The purpose of this study was to investigate whether there were changes in neurocognitive function, postural stability and self-reported symptoms between the early and late stages of the menstrual cycle, and also to identify whether performance across menstrual cycle would differ between females using OCP and eumenorrheic females not using OCP. Healthy college-aged females completed a standard concussion test battery including computerised assessment of neurocognitive function, postural stability and symptom status. Participants completed the counterbalanced testing design during the early and late phases of their menstrual cycle. No significant main effects or interactions for any neurocognitive function or postural stability outcome measure were observed. Eumenorrheic females endorsed a higher number of symptoms and reported an increased symptom severity score compared to females using OCP. Menstrual cycle phase had no effect on the total severity or the number of symptoms endorsed. These results suggest preseason neurocognitive and postural stability baseline tests are stable across the menstrual cycle, regardless of OCP use. Therefore, decreased performance on these measures following a suspected concussion is likely not attributable to menstrual cycle phase or use of OCP.

Exploring Periodization in the Classroom: A Seminar on the Early‐Modern World

AbstractThe idea of an ‘early‐modern world’ has come into common use despite historians’ lack of enthusiasm for it as a concept. Possible implications of teleology, eurocentrism, and artificial homogenization not unfairly discourage professional confidence in it. The article describes an undergraduate seminar that takes advantage of the professional uncertainty about early modernity. As they move through a series of thematically organized readings, participants construct and revamp a potentially multifaceted definition of the early‐modern world. Simultaneously, each student specializes in a chosen region and uses that place as a test case to evaluate the working definition as it evolves. The result is a learning experience that maximizes both cooperative and individual research to achieve a balance between the specific and the global.

The Stealth Influence of Covert Marketing and Much Ado about what May be Nothing

Most discussions of covert marketing stem from three basic statements: (1) People are generally skeptical of any business-provided sources of information, so publicity or even random endorsements by strangers on the street might provide consumers with more persuasive sales messages; (2) advertising creators repeatedly say that they need to “break out” from the increasingly cluttered mass media environment; and (3) news reports of any pervasive marketing activity include a direct assertion, or at least an implicit presumption, that business managers do it because they know it “works.” Management decisions to use any covert marketing tactic are driven by the first two beliefs, and public policy worries of its improper or deceptive influence on consumers flow from the third. However, most covert marketing efforts are undertaken with professional uncertainty of whether anything really works as they create new areas of consumer skepticism and even more commercial clutter.

Professional Uncertainty and Disempowerment Responding to Ethnic Diversity in Health Care: A Qualitative Study

BackgroundWhile ethnic disparities in health and health care are increasing, evidence on how to enhance quality of care and reduce inequalities remains limited. Despite growth in the scope and application of guidelines on “cultural competence,” remarkably little is known about how practising health professionals experience and perceive their work with patients from diverse ethnic communities. Using cancer care as a clinical context, we aimed to explore this with a range of health professionals to inform interventions to enhance quality of care.Methods and FindingsWe conducted a qualitative study involving 18 focus groups with a purposeful sample of 106 health professionals of differing disciplines, in primary and secondary care settings, working with patient populations of varying ethnic diversity in the Midlands of the UK. Data were analysed by constant comparison and we undertook processes for validation of analysis. We found that, as they sought to offer appropriate care, health professionals wrestled with considerable uncertainty and apprehension in responding to the needs of patients of ethnicities different from their own. They emphasised their perceived ignorance about cultural difference and were anxious about being culturally inappropriate, causing affront, or appearing discriminatory or racist. Professionals' ability to think and act flexibly or creatively faltered. Although trying to do their best, professionals' uncertainty was disempowering, creating a disabling hesitancy and inertia in their practice. Most professionals sought and applied a knowledge-based cultural expertise approach to patients, though some identified the risk of engendering stereotypical expectations of patients. Professionals' uncertainty and disempowerment had the potential to perpetuate each other, to the detriment of patient care.ConclusionsThis study suggests potential mechanisms by which health professionals may inadvertently contribute to ethnic disparities in health care. It identifies critical opportunities to empower health professionals to respond more effectively. Interventions should help professionals acknowledge their uncertainty and its potential to create inertia in their practice. A shift away from a cultural expertise model toward a greater focus on each patient as an individual may help.

Determinants of burnout among public hospital nurses

Objective: The present study extends our knowledge of the main determinants of burnout among nurses working in public hospitals and investigates the impact of work support on the stress‑burnout relationship. Design: A cross‑sectional, survey design. Setting: Data were collected from three public hospitals in south east Queensland, Australia. Subjects: A convenience sample of 273 nursing staff (235 females, 38 males) participated in the study. Main outcome measures: The influence of work stressors (ie. job‑specific stressors and role stressors) and work support (ie. supervisor and coworker support) on burnout amongst public hospital nurses. Results: Overall, nurses reported moderate levels of burnout (emotional exhaustion, depersonalisation and reduced personal accomplishment). Hierarchical regression analyses revealed that socio‑demographic factors play a small, but significant role in predicting burnout. Role Overload, Job Conflicts and Role Boundary contributed to higher levels of Emotional Exhaustion. Role Boundary and Professional Uncertainty contributed to higher levels of Depersonalisation and Role Boundary and Role Ambiguity contributed to lower levels of Personal Accomplishment. Only Supervisor Support had a significant effect on Depersonalisation and Personal Accomplishment. No evidence was found to indicate that work support had a buffering effect on the stress‑burnout relationship. Conclusions: The results highlight the need for organisational interventions to reduce the workload placed on nurses. Supervisors are in a better position than co‑workers to reduce burnout among nurses by clearly outlining the boundaries and expectations of the nursing role.

General practitioners’ perceptions and attitudes to infertility management in primary care: focus group study

Infertility management in primary care is variable. National Institute of Clinical Excellence have recommended hysterosalpingography (HSG) as a first-line investigation for tubal assessment. Aim To explore general practitioners' (GPs) perceptions of, and attitudes to, the initial management of the infertile couple and their views on open access to HSG. Qualitative study using three focus groups. Seven general practices in Newcastle upon Tyne and Northumberland. We purposively selected the three focus groups to provide a range of GPs' views. In total 13 practitioners participated: 11 GPs, one GP registrar and one nurse practitioner. The key themes to emerge were: (1) perceived professional responsibilities, (2) uncertainty and lack of knowledge, (3) consistency of approach to the initial management of infertility, and (4) access to infertility services. Some GPs felt that they should do all they possibly could, while others felt it was the responsibility of the infertility specialist. Uncertainty and lack of knowledge was linked to the relative infrequency of primary care infertility consultations and the difficulty 'keeping up to date' with rapidly advancing reproductive technologies in tertiary care. Some GPs subscribed to the notion of one suitably trained clinician delivering the service on behalf of a group of GPs. Some were unsure where HSG fitted into the overall management plan, but they were comfortable with following recommended guidelines. GPs recognize an advocacy role and many take on a significant degree of clinical responsibility welcoming the introduction of a new technology in primary care. Nevertheless, GPs feel that they lack proficiency and have little opportunity to rehearse the necessary skills. These findings contribute to an understanding of the management of infertility, an infrequently presenting problem in primary care.

Understanding Emotional and Behavioral Disorders: Are We Paying the Cost of Borderline Ethics?

On this special occasion of celebrating thirty years of the TECBD Conference, I am honored to share my ideas with such a distinguished group of professionals and acknowledge their collective contributions to the field of emotional and behavioral disorders (EBD). My background for talking about these issues is a deep familiarity with the contributions of research on various topics such as early intervention and prevention, academic instruction, social skills training, teacher effectiveness, and positive behavior supports for students with EBD. However, rather than deal with any of those subjects in detail, I propose to engage in a process of clarification and reflection. Students with EBD often exhibit moderate to severe broad academic deficits in multiple areas as compared to their normative peers (Lane, 2004); they engage in aggressive acts and receive less positive attention by peers and adults. As a result, they are more likely to drop out of school, stay unemployed, engage in delinquent behavior, and have unsuccessful interpersonal relationships. Without appropriate educational services and social interventions, children with EBD are at significant risk for school failure and mental health and adjustment problems. However, it is difficult to overlook the fact that a substantial proportion of students with EBD are still deprived of services, partially due to professional uncertainty about what works in a specific context and how to implement what works in that context, or simply due to lack of resources. Special education policies such as, "inclusion for all" have been adopted despite research evidence or professional wisdom that does not fully support the use of these practices with all students with EBD. Additionally, some popular beliefs, such as segregating students with EBD in the self-contained settings without access to the general education curriculum continue without any scientific basis. Clearly, progress has been dismantled by policies that were preposterous. No contribution has been without limitation. Useful though the current knowledge is, much still remains to be discovered (Wood, 2004). In "The Ethics of Excellence" (1993), Price Pritchett emphasized that excellence never happens by accident, but by focusing on intentions and processes. But he also cautioned about what can happen to excellence, when one feels surrounded by many who begin to cut corners, cover the truth, make deals, and follow the road of least resistance. We begin to face ethical dilemmas and the quality of the product goes down. As professionals in the field of EBD, we need to pause and reflect on the right things for students with EBD. After reading Pritchett, I started to ask myself larger questions concerning the challenges associated with our field and began to revisit traditional frameworks related to EBD. The issues of definition, interventions, research, and policies began to surface. Quickly, I realized that although we have made significant progress by removing many artificial boundaries created by research, policy, and practice to serve the students with EBD, we have a long way to go. The focus of this article is to share apprehension, uncertainty, and concerns related to the definition of EBD and ethical issues involved in educational practice, teacher education, and research. The purpose is not to diminish or undermine the professional work that already exists, but to raise awareness that despite accumulating knowledge, we have compromised in making sound decisions for students with EBD. As professionals, we are working under competing loyalties and legal pressures. In becoming too faithful to the concept of inclusive education, unintentionally, we may be undermining the importance of individualized programming for students with EBD, thereby depriving many of these students of their right to an appropriate education. Sometimes, we may misuse or disregard professional knowledge at multiple levels of decision-making, e. …

A Sociological Concept of Client Trust

The aim of this article is to theoretically analyse and to define client trust. A concept of client trust is developed that explains why and under what conditions the professional–client relationship – in contrast to other service relationships – involves a certain kind of trust. It is argued that the form of the professional–client relationship and the nature of professional work hold uncertainties for the client that make it impossible to make a fully rational decision whether to consult and cooperate with a professional. Trust is conceptualized, following Simmel, as enabling social action in decision situations where the actor is uncertain about the course of future events and, following Luhmann, as a risky investment. Moreover, it is argued that client trust is impersonal trust given on the basis of general notions generated by such intermediaries as professions and allied institutions. Furthermore, behavioural expectations institutionalized in the professional role and the display of professionality promote client trust in the interaction situation of the consultation. On this basis, the article concludes by defining what questions have to be asked in order to determine whether sociostructural, organizational, and occupational change over the last four decades have had a negative effect on client trust.

Trends and Variations in the Use of Spine Surgery

Examining trends and geographic variations in clinical care offers insights into changes in clinical decision making. We summarized data on spine surgical rates, trends, and variations in the United States to highlight areas of professional uncertainty and questions for future research. The United States has the highest rate of spine surgery in the world, but spine surgery shows wider geographic variations than most other procedures. For example, Medicare data for 2001 showed sixfold variations in spine surgery rates among United States cities, and 10-fold variations in spine fusion rates. United States spine surgery rates rose 55% in the 1980s. In the 1990s, studies of surgical rates became more difficult because 20% of discectomies shifted to an out-patient setting. Extrapolations from states with ambulatory surgery data suggest overall lumbar surgery rates continued to rise throughout the 1990s. The most rapid increase was for spinal fusion, which tripled during the 1990s and accounted for an increasing proportion of all spine procedures. Some increases coincided with the introduction of new surgical implants. Despite new technologies, rates of repeat surgery after fusion were no lower than the rates after decompression alone. As new technology for spine surgery is introduced at an accelerating pace, we anticipate substantial changes in surgery patterns. Analysis of population-based data may be useful for surveillance of changes and their impacts.

Risk and security in childbirth

Risk and security are often defined as being complementary. Security is based on risk calculations, which undergo constant change. An increasing number of abnormalities can be uncovered in the human body, and more and more people are defined as being at risk for various diseases or at risk as child bearers. The aim of this paper is to examine the notion of risk, and to understand it in different ways as it is applied to childbirth. General and professional perspectives on risk are different; views vary as to what constitutes acceptable risk, and the association between normalcy and complications is socially and culturally determined. Figures for risk and reliability are not objective values. The safe and the risky are anchored in certain symbol systems. Alternative and dialogic notions have been introduced in conversations and thinking about risk, and medicalism and paternalism have been questioned. This questioning has thus far had little influence on clinical practice. The two opposite perspectives of risk and security in the area of pregnancy and birth should be taken into consideration. The childbearing woman has preferences of her own. Dialog with the health professional and information about professional facts and professional uncertainty should be offered.

Stultifera Navis: Institutional Tensions, Conceptual Chaos, and Professional Uncertainty at the Beginning of the Decade of Education for Sustainable Development

The main idea this article develops is the conceptual chaos, methodological tensions and epistemological conflicts that are being experienced in the field of environmental education as a result of the uncertainty generated by some institutions and international organisms. The authors’ perspective starts from the idea that too many expectations have been invested in the celebration of the Decade of Education for Sustainable Development. The celebration will contribute to making the tensions and fractures grow between the different collectives and professional cultures that inhabit this educational field. While some will find their channels of expression waning and their work models delegitimated, others will increase their popularity and extend their hegemonic power over the dominant models of intervention and the securing of financial resources through the programs and grant competitions they enter. The reason for these tensions lies in the underlying focus promoted by the model of celebration that has been advocated by the institutions leading the process.

Protecting Professional Identities: Service User Involvement and Occupational Therapy

Service user involvement in the delivery of health care is now a government priority yet, with some exceptions, it does not seem that the occupational therapy profession is meeting the challenges that this poses. In the light of the profession's emphasis on client-centred practice and individual empowerment, this is surprising. The authors argue that professional insecurity and role uncertainty are inhibiting the vigorous development of advocacy in occupational therapy. They propose that a preoccupation with establishing professional demarcations prevents the openness necessary for the lively and genuine involvement of service users.

Treatment of pregnancy-related pelvic girdle and/or low back pain after delivery design of a randomized clinical trial within a comprehensive prognostic cohort study [ISRCTN08477490

BackgroundPregnancy-related pelvic girdle and/or low back pain is a controversial syndrome because insight in etiology and prognosis is lacking. The controversy relates to factors eliciting pain and some prognostic factors such as the interpretation of pain at the symphysis. Recent research about treatment strategies also reflects those various opinions, in fact suggesting there is professional uncertainty about the optimal approach. Currently, physiotherapists often prescribe a pain-contingent treatment regime of relative rest and avoiding several day-to-day activities. Additionally, treatment more often includes an exercise program to guide rectification of the muscle imbalance and alignment of the pelvic girdle. Effectiveness of those interventions is not proven and the majority of the studies are methodologically flawed. Investigators draw particular attention to biomedical factors but there is growing evidence that important prognostic issues such as biopsychosocial factors appear to be even more important as point of action in a treatment program.Methods/designThis pragmatic randomized controlled trial is designed to evaluate the effectiveness of a tailor-made treatment program with respect to biopsychosocial factors in primary care. The effect of the experimental intervention and usual care are evaluated as they are applied in primary health care. The trial is embedded in a cohort study that is designed as a longitudinal, prospective study, which studies prevalence, etiology, severity and prognosis during pregnancy until one year after delivery. The present paper focuses on choices regarding recruitment procedures, in-/exclusion criteria and the development of a well-timed intervention.DiscussionThis section briefly discusses the actions taken to minimize bias in the design, the proper time-window for the experimental intervention and the contrast between the experimental intervention and usual care.

The new politics of community-based governance requires a fundamental shift in the nature and character of the administrative bureaucracy

The politics of social policy played out in the era of globalization has profoundly altered the relationship between Canadian citizens and their governments. This change in relations, among other things, is marked by a turn to the “community” as a resource in solving social problems. Critics of this movement, however, express the view that the strategic application of community as a central social policy tactic seems to be less about inventing a new social architecture for Canada and more about a shift of government responsibility to the individual away from society as a whole through state institutions. For child welfare services, this expanded role of community is fraught with uncertainty, contradictions, and complexities for both human services professionals and for the children and families in receipt of services.

Professionals' views on the issues and challenges arising from providing a fertility preservation service through sperm banking to teenage males with cancer

Interviews were undertaken with 22 health and social work professionals. Their analysis was completed using “selective transcription”, noting understanding of process, issues and themes, and building a picture against which to consider the analysis of subsequent interviews with teenagers and parents. Professionals were also asked to identify areas for feedback from these participants. This work was part of a larger study of (i) the perceptions of adolescent males and their parents of fertility preservation services following a cancer diagnosis, and (ii) national postal surveys of common practices, areas of variance and issues experienced by professionals in UK regional paediatric oncology centres and licensed assisted conception centres. A large number of concerns were identified, which reflected professionals' difficulties in building and maintaining a relevant, adequate knowledge and skills base given the limited numbers of teenagers offered this service. The lack of appropriate training about the legal and consent frameworks, and the processes involved was also highlighted across all professional groups as was the confusion around professional and legal responsibilities for follow up. Thus, there was considerable professional uncertainty in a number of aspects of this sensitive area of service provision. Consideration needs to be given to the needs for national guidance, for training, support and updating, for liaison between the different health and social care sectors that may be involved, and for appropriate information systems. These need to be in place for each stage of the process, from diagnosis through to eventual discharge from the health system.

Dental health professionals' treatment of children with disabilities: a qualitative study

As children and adolescents with disabilities may be difficult to treat, there is a risk that the disability may constitute a barrier preventing these children from receiving good odontological treatment in the same conditions as other children. Objectives: To describe Swedish dental care professionals' understanding and knowledge of orofacial problems and treatment needs in children with disabilities. Methods: In‐depth interviews focusing on orofacial function, and carried out with 18 informants (dentists, dental hygienists, dental assistants), were transcribed verbatim and analysed in open and focused (selective) coding processes in accordance with grounded theory. Results: A core category labelled variability in treatment with the dimensions professional uncertainty and professional commitment emerged from the data in the analysis. Variability in treatment could be described as forming a continuum between two end‐points captured in the dimensions. The dental teams' treatment of children with disabilities and their families could be placed anywhere along this continuum depending on contributing individual strategies and/or organizational conditions. Conclusions: The dental treatment for children with disabilities varied greatly, implying a risk for inequalities in treatment as well as in oral health. There is a need for more educational opportunities, better financing, and more support on the organizational level in order to improve odontological care for young special care patients.