Professional Vulnerability Research Articles

Ordinary defensive medicine: in the shadows of general practitioners’ postures toward (over-)medicalisation

This paper draws on qualitative research using focus groups involving 38 general practitioners (GPs). It explores their attitudes and feelings about (over-)medicalisation. Our main findings were that GPs had a complex representation of (over-)medicalisation, composed of many professional, social, technological, economic and relational issues. This representation led GPs to feel uncomfortable. They felt pressure from all sides, which led them to question their social roles and responsibilities. We identified four main GP-driven proposals to deal with (over-)medicalisation: (1) focusing on the communication in doctor–patient relationships; (2) grounding practices in evidence-based medicine; (3) relying on clinical skills, experience and intuition; and (4) promoting training, leadership bodies and social movements. Drawing on these proposals, we identify and discuss five paradigms that underpin GPs’ attitudes toward (over-)medicalisation: underlying social factors, preventing medicalisation, managing uncertainties, sharing medical decision-making and thinking about care as a rationale. We suggest that these paradigms constitute a defensive posture against GPs’ uncomfortable feelings. All five defensive paradigms were identified in our focus groups, echoing contemporary political debates on public health. This non-exhaustive framework forms the outline of what we call ordinary defensive medicine. GPs’ uncomfortable feelings are the origin of their defensive solutions and the manifestation of their vulnerability. This professional vulnerability can be shared with the patient’s vulnerability. In our view, this creates an opportunity to rediscover patient–doctor relationships and examine patients’ and doctors’ vulnerabilities together.“There are many cases in which—though the signs of a confusion of tongues between the patient and his doctor are painfully present—there is apparently no open controversy. Some of these cases demonstrate the working of two other, often interlinked, factors. One is the patient’s increasing anxiety and despair, resulting in more and more fervently clamouring demands for help. Often the doctor’s response is guilt feelings and despair that his most conscientious, most carefully devised examinations do not seem to throw real light on the patient’s “illness”, that his most erudite, most modern, most circumspect therapy does not bring real relief.” (Balint M. The Doctor, His Patient and the Illness. New York: International Universities; 2005. [1957].)“Theories about care put an unprecedented emphasis on vulnerability—taking up that challenge to transform what really counts in today’s hospitals implies letting colleagues inside previously closely guarded professional boundaries” (2, our translation).

From Perspectival Myopia to Professional Transformation: An Autoethnographic Retrospection of a High School Principal from Nepal

ABSTRACT This paper presents a re-storied account of my (lead author) decade-long (2007–2017) professional journey as a high school principal in diverse educational settings in Nepal. Using an autoethnographic approach, I have theorized my leadership transformation approaches through professional storytelling, employing critical reflexivity to trace intimate leadership experiences where authoritarian approaches to leadership, disparities, and inequalities in schools run rampant. My perspectival myopia, professional vulnerabilities, and the discrepancies between my leadership ideals and behaviors resulted in issues such as perceptions of disengagement, underperformance, and dissatisfaction on the receiving end, prompting me to contemplate professional transformation. While outlining several significant steps and missteps in transforming my actional and cognitive behaviors, this paper explores my evolution toward a more reflective, democratic, ethical, equitable, and participative conceptualization of educational leadership and underscores the transformative potential of personal-professional development through adaptable perspectives and critical self-reflection, offering valuable insights for educational leaders globally.

Experiences of Nursing Students Regarding Challenges and Support for Resilience during Clinical Education: A Qualitative Study.

Nursing students require resilience to navigate the complexities of clinical practice. This characteristic is essential for managing demanding workloads, unpredictable patient situations, and emotional stressors while maintaining performance and well-being. Fostering resilience helps students develop the capacity to adapt to adversity, overcome setbacks, and remain committed to providing high-quality patient care. This qualitative study explores the challenges and supports influencing nursing students' resilience during clinical education. Interviews with 28 Thai nursing students revealed two key themes: the "experience of vulnerability" and the "experience of meaningfulness". The sub-themes of vulnerability included "navigating uncertainty", "transcending professional struggles", and "being exposed to diverse encounters". The sub-themes of meaningfulness focused on restoring strength through social interactions and engaging in positive transformation. This study highlights the need for comprehensive support systems that address personal and professional vulnerabilities. Integrating caring theory principles could further enhance resilience by emphasizing compassionate care and fostering student empathy. This suggests that instructors and stakeholders can significantly impact student well-being by creating supportive environments built on collaboration, empathy, and mentorship, all of which are aligned with caring theory.

Experiences of Pain Management Nurses during the COVID-19 Pandemic: A Qualitative Study

BackgroundThe knowledge and skills of pain management nurses positions them well to manage people's pain and provide critical services to patients with COVID-19. AimTo understand the personal and professional experiences and the support pain management nurses received during the COVID-19 pandemic. MethodsBetween July 2020 and 2021, data were collected through semi-structured telephone interviews from members of the American Society for Pain Management Nursing. Content analysis was used. ResultsEighteen pain management nurses who worked during the early stages of the pandemic were interviewed. Three main categories were identified: experiencing stress and burden, pain management strategies changed, learning to cope with support. Pain management nurses reported fear of exposure, difficulties with staff shortages, the complex social milieu, and how pain management took a backseat to other symptoms of COVID-19. They coped through support from their colleagues, organizational leaders, and community members. Pain management nurses provided recommendations for future care of patients’ pain during a pandemic. ConclusionsPain management nurses shared their professional and personal experiences and the support they received while managing patients’ pain during the COVID-19 pandemic. Their experiences provided findings on the importance of pain management and to support nurses during personal and professional vulnerabilities during crises. Key recommendations on the care of patients’ pain in future pandemics included developing expertise in pain management and health-related emergencies; engaging nurses in supportive mental health services, infectious disease testing, and vaccine efforts; and planning for surge capacity to reach out to underserved people living with pain.

Inclusion, Sustainability, and Equity at the Heart of a 5.0 Society.

Our everyday reality is perceived as more complex, unpredictable, and filled with barriers created by not-so-evident factors that can stifle thought, reflection, and the desire and energy to act. All of this intertwines with the reduction of physical and psychological well-being for many people, encouraging the presence and escalation of situations of vulnerability which are rapidly increasing nowadays. In addition to the more traditional and known ones, such as vulnerabilities connected to the presence of disabilities or diseases, today other forms of vulnerabilities are strongly emerging, such as environmental vulnerabilities or vulnerabilities connected to climate change, ecologic vulnerabilities, financial vulnerabilities, 'health-related' vulnerabilities, digital vulnerabilities, and professional vulnerabilities. Considering this standpoint, in this chapter we will focus to inclusivity, sustainability, social and environmental justice, human rights. Furthermore, we introduce the construct of Society 5.0 that aims to improve the living conditions of everyone and to relatively resolve problems at the micro-, meso-, and macro-social levels.

It’s good to talk: professional development through dialogic co-coaching in the primary school classroom in England

ABSTRACT The article reports a two-year qualitative investigation of peer co-coaching triads introduced into primary school classrooms In England to develop teachers’ skills in the pedagogies of dialogic teaching. Post-project interviews with teacher and senior leader Data analysis of post-project interviews with teachers and senior leaders revealed that teachers reported using dialogic teaching approaches more frequently and valued opportunities to systematically re-analyse received practices. However, participants felt that video co-coaching exposed professional vulnerabilities about customary interactional practices in classrooms and that senior leadership ‘drive’ for this intervention was key to its success. School leaders should seek ways of facilitating co-coaching in support of fostering cultures of confidence in experimenting with the craft skills of dialogic teaching.

Immigrant teachers’ experience of professional vulnerability

ABSTRACT The mobility of teachers is a global phenomenon that has affected the education environment worldwide. This study examines the professional transition of immigrant teachers and finds that teacher professional vulnerability is a critical emotion in the complex process of professional transition. Using a qualitative inductive approach, this study reports on the professional transition experiences of ten teachers who migrated from Asia to Australia. Findings revealed that teachers’ perceived teaching competence and interactions with students and colleagues are significant elements contributing to immigrant teachers’ professional vulnerability during their professional transition. I conclude by discussing the resonance between our findings and previous studies, new emerging findings, implications, and recommendations.

The structural and micropolitical realities of physical literacy professional development in the United Kingdom: navigating professional vulnerability

ABSTRACT This research examines the implications of professional vulnerability (PV) during physical literacy (PL) teacher professional development, through the lens of structural and micropolitical theory in the United Kingdom (U.K.). The research was conducted over a twelve-week period with qualified teachers across primary and secondary school contexts, within the U.K. Semi-structured interviews were used to capture the professional development journey of each teacher. Thematic analysis and pen profiles were used to analyse and present the findings of the semi-structured interviews. The results explore expressions of teacher vulnerability through the structural and micropolitical realities experienced during PL professional development. Structural realities were categorised using the political (macro), organisational (meso) and structural (micro) levels with the micropolitical realities categorised using the power dynamics of power over, with and through. This paper calls for the contextual element of professional development to be given as much consideration as the content itself. Professional development can be more effective by connecting the ‘what’ and ‘how’ alongside an understanding of the ‘where’ and ‘who’. Structural and micropolitical theory and PV offer glimpses into this contextual world, revealing a different but equally important narrative around the wider context of successful and meaningful PL teacher professional development. Finally, the study identifies aspects of transferability into the wider domains of sport coaching and sport development where PL is becoming increasingly visible.

Contending with vulnerability and uncertainty: what coaches say about coaching

ABSTRACT In exploring how coaches contend with their professional vulnerability, the purpose of this paper is three-fold. Firstly, to describe the informal rules of coaching that demand the appearance and expression of a certain persona. Secondly, to examine how such rules are tied to a culture of ‘the individual”; and, thirdly, to demonstrate how coaches’ accounts of their work not only reflect, but also ensure such practices. The dataset emanated from 20 individual interviews with professional football coaches. Although taking full consideration of what the coaches actually said, the analysis sought to explore what the explanations were standing on behalf of; what Garfinkel described as an “official (professional) line”. The findings pointed to coaches’ necessity to ‘work hard’, to do things the ‘right way’, whilst limitedly acknowledging any vulnerability associated with the job. Positioned as a ‘greedy institution’, the narrative appeared as a means to contend with the difficulties coaches encountered.

People in Motion: Introduction to Transnational Movements and Transwar Connections in the Anthropological and Genetic Study of Human Populations

People in Motion: Introduction to Transnational Movements and Transwar Connections in the Anthropological and Genetic Study of Human Populations

Disparities in Teachers’ Access to Schools’ Collective Social Assets Based on Role, Race, and Poverty

A schools’ collective social assets (i.e., school culture, administrative support, and satisfied colleagues) are especially important for beginning teachers at higher risk of attrition, including special educators, teachers of color, teachers in high-poverty schools, and teachers in schools serving predominantly students of color. These teachers often report experiencing less social support than general educators, White teachers, teachers in low-poverty schools, and teachers serving predominantly White students, respectively; we labeled this inequitable access to schools’ collective social assets intersectional professional vulnerability. Using data from the Schools and Staffing Survey and structural equation modeling, we examined how beginning teachers’ race/ethnicity and their students’ race/ethnicity, socioeconomic status, and disability status related to perceptions of their U.S. schools’ collective social assets and how those perceptions shaped intent to continue teaching. We found significant differences in access to collective social assets based on their race/ethnicity, role as special versus general educators, and students served within their school.

Understanding professional vulnerability in an era of performativity: experiences of EFL academics in mainland China

ABSTRACT Drawing on data collected from multiple sources, this qualitative case study investigates how seven English-as-a-foreign-language (EFL) academics from a university in mainland China perceive and cope with their professional vulnerability within the system of performativity. Three themes were generated from the data: (1) professional vulnerability as a state of conformity and self-learning, (2) professional vulnerability as a state of constrained agency, and (3) professional vulnerability as a state of disengagement. The findings not only reflect the complex and dynamic nature of EFL academics’ professional vulnerability, but also unpack numerous contextual and personal factors mediating EFL academics’ experiences of professional vulnerability. The paper ends with some practical implications on how to mitigate the negative influences that vulnerability has on EFL academics’ professional practice within the system of performativity.

A critical self-reflexive account of a privileged researcher in a complicated setting: Kakuma refugee camp

As a white, Western-educated man, undertaking research in Kakuma refugee camp, Kenya, I encountered ethical dilemmas related to my privileged racial and gender status. These include power imbalances between researchers and refugees and conducting research in the face of human suffering. Through critical self-reflexivity, I analyze my own experiences to reveal the personal and professional vulnerabilities that researchers from high-income countries (HICs) may encounter when working in contexts where oppression and forced displacement are prominent. I conclude that researchers who work in contexts of forced migration must extend beyond the boundaries of procedural research ethics and include components of relational ethics. This involves close collaboration with refugee participants to develop more culturally relevant research ethics guidelines for refugee-specific populations.

Knowing your audience: understanding urban superintendents' process of framing equitable change

PurposeThe purpose of this study is to understand how superintendents leading large, high-profile and politically complex urban districts make sense of their district–community context and advocate for issues of equity.Design/methodology/approachThis qualitative multi-case study took place over the 2017–18 school year and involved superintendents leading large urban districts in the United States, with data derived from semi-structured interviews, observations of school board and other public meetings and document collection.FindingsThis article describes how superintendents' sensemaking around equity was situated within the context of interactions with district board members and other stakeholder groups within their communities and influenced by their sense of professional vulnerability of public advocacy. Leaders often felt the need to attenuate their personal sense of equity and act strategically when framing related policies or practices. This study highlights examples by which superintendents were forced to confront instances when community support and prioritization of equity issues did not match their own and subsequently struggled to make sense of how to frame issues that were not in alignment.Originality/valueDespite their positional authority, relatively little attention has been paid to the experience of school district superintendents in fostering equity. This study provides practical examples of superintendents making sense of complex leadership scenarios and taking strategic action to promote equity in authentic circumstances and has important implications for research and practice.

Community pharmacy and public health: preserving professionalism by extending the pharmacy gaze?

Community pharmacy faces ongoing challenges to its economic and social standing. A concern to legitimate professional status explains the attraction of public health. Interventions currently advocated by UK State-sponsored health care seek to reconcile the autonomous 'entrepreneurial' patient with market-driven solutions. Engaging critically with recent Foucauldian sociological work on pharmacy as a conduit for disciplinary power, we explore how professional ambiguity is exploited to 'manage' the subjectivities of community pharmacists. Locating our discussion in the observed empirical realities of pharmacy practice (the inclusion of alcohol and other 'healthy living' advice in the Medicines Use Review), we connect unresolved historical debates in community pharmacy with current ongoing (neoliberal) changes in policy and pharmacy business practices, drawing attention to the poor evidence base underpinning healthy living activities in community pharmacy. Our findings show how community pharmacists struggle to provide meaningful advice, valued by patients. Instead of enhancing professional status, 'add-on' public health roles created the risk of offering little more than an essentialised enactment of consumerist health care. Understanding how patients conceptualise drinking and 'healthy living' in relation to their long-term health, using more open discussions, including the negotiation (rather than provision) of information, could help community pharmacists challenge the current professional vulnerabilities they face.

A critical reconceptualization of faculty readiness for online teaching

ABSTRACT Online courses are mainstream throughout higher education. This pattern has been accelerated, temporarily or permanently, due to the coronavirus pandemic (Allen & Seaman, 2016; Arum & Stevens, 2020; Garrison, 2011). Tenure-track and contingent faculty’s willingness to teach online serves students, but little research critiques the forces that produce and constrain faculty’s efforts. Even the most current discussions of faculty readiness lack a strong grounding in criticality. Without such a critical orientation, the power and equity issues involved in the higher education marketplace of online teaching cannot be adequately examined. This critical integrated literature review of 44 studies documents themes of the affective dimensions and identity disruption surrounding faculty’s readiness to teach online and explores their professional vulnerability. Structural and cultural forces that produce and constrain faculty’s experiences transitioning to online teaching emerged from the analysis. This conceptualization of faculty readiness provides a foundation upon which to theorize faculty’s equitable experiences of online teaching.

EXPLORATION OF COMPUTER NETWORK BY VULNERABILITY SCANNER NESSUS

For today, computer networks are an integral part of our daily lives. As the analysis shows, the network is ex-tremely vulnerable, it can serve as a place of information leakage, changes of configuration of settings and modification of data by the attackers. There are many more threats, and the security of the network requires a great deal of attention to ensure the security of the network in order to maintain the confidentiality and integrity of the data. Organizations must regularly assess the vulnerability of the entire network to test the security level and strengthen the network. We use vulnerability scanners to find weaknesses, which are useful for detecting security vulnerabilities on a case-by-case basis and across the network as a whole. The purpose of the work is to explore the computer network for vulnerabilities using the Nessus Professional scanner. Research Methods – network scanning by Nessus Professional vulnerability scanner. The Nessus Professional vulnerability scanner from Tenable Network Security, which is freely available, was used for the research. The Nessus Professional scanner has been found to have better functionality and performance than other available scanners. The only downside to the scanner is its cost per year, as well as scanning a large number of hosts on the network at a time (over 100 hosts). After the scanner was successfully installed, carried out it was in-spected from the moment it was launched to the generation of host test reports. For the work, the Lviv State University of Life Safety network was tested. In the post-scan report, which is displayed in HTML format, you can see scan details for each host; the number and nature of vulnerabilities; the error correction dashboard. According to the results of testing, vulnerabilities of low, medium and high levels of hazards were identified, totaling 376. Vulnerabilities were ana-lyzed based on the obtained results, namely: a brief description and a way to solve the problem.

Secondary Traumatic Stress in Foster Carers: Risk Factors and Implications for Intervention

ObjectivesFostering, a professional or semi-professional role that is in increasing demand, involves potential exposure to material related to children’s trauma in a domestic setting. Yet, professional vulnerability to secondary traumatic stress (STS) is under-researched in foster carers, as is the suitability of associated intervention techniques. We therefore investigated incidence of STS and psychological predictors relevant to secondary and primary stress appraisal in UK foster carers.MethodsBritish foster carers (n = 187; 81% female; aged 23–72 years; mean length of experience 9 years) were approached through a range of organizations managing paid foster caring in the UK for a survey study. Self-report measures were obtained on STS, burnout and compassion satisfaction from the Professional Quality of Life (ProQOL) scale, as well as on primary trauma and variables previously recommended for inclusion in training targeting secondary trauma: empathy, resilience and self-care.ResultsHigh levels of STS and burnout were found among foster carers. In multivariate model testing, STS was directly and positively predicted by burnout, compassion satisfaction and primary trauma (R2 = 0.54, p < 0.001). Resilience, empathy and self-care did not show direct associations with STS, but self-care had a significant indirect effect on STS.ConclusionsFindings support the view that STS is a substantial risk factor in foster caring. While self-care is confirmed as a promising factor in intervention, the roles of empathy and resilience are more ambiguous.

Professional vulnerability in mental healthcare contexts: A focus group study of milieu-therapists' experiences.

Aims and objectivesTo gain insight into how the workplace influences milieu‐therapists’ vulnerability in the mental healthcare context.BackgroundMental health services have experienced substantial changes. Reduced institutional treatment capacity is replacing the development of locally based treatment. Changes in external conditions in mental health services have influenced the working conditions of nurses and milieu‐therapists.DesignQualitative design. The study complied with the COREQ checklist.MethodsFocus group interviews.Results“Vulnerability due to unpredictable and threatening working context” was the common key theme that emerged in both contexts. Two key themes were different and opposite. In municipal mental health care, “Alone and unprotected” and in institutional care, “Together and protected.”ConclusionThe participants from both specialized and community mental health care, experienced vulnerability at different levels interpreted as a contradictory relationship between the healthcare system and their own ideals of what professional practice ought to be.Relevance to clinical practiceThis study contributes to extended knowledge and understanding about the experienced influence of the working environment on professional vulnerability of nurses and milieu‐therapists` in mental health services. The impact of contextual conditions on health professionals’ working conditions has multi‐professional relevance for milieu‐therapists and managers of mental health services, and it is an important topic in health and social higher education.

Journalism under fire

An analysis of the duress that was brought to bear on the press in northeastern Mexico during the so-called “War on Drugs,” based on the experience of ten journalists displaced between 2010 and 2015. The text reveals warring armed groups’ fight to control media editorial lines, in addition to messengers’ vulnerable position in the line of fire due to a lack of security protocols their employers might develop, as well as existing connections between public officials and organized crime. In a context where journalists’ murders and disappearances are left unpunished, organizational initiatives designed to compensate for this high professional vulnerability are emerging.