Professional autonomy in 21st century healthcare: nurses’ accounts of clinical decision-making

Autonomy in decision-making has traditionally been described as a feature of professional work, however the work of healthcare professionals has been seen as steadily encroached upon by State and managerialist forces. Nursing has faced particular problems in establishing itself as a credible profession for reasons including history, gender and a traditional subservience to medicine. This paper reports on a focus group study of UK nurses participating in post-qualifying professional development in a London university in 2008. Three groups of nurses in different specialist areas comprised a total of 26 participants. The study uses accounts of decision-making to gain insight into contemporary professional nursing. The study also aims to explore the usefulness of a theory of professional work set out by Jamous and Peloille in 1970. The analysis draws on notions of interpretive repertoires and elements of narrative analysis. We identified two interpretive repertoires: ‘clinical judgement’ which was used to describe the different grounds for making judgements; and ‘decision-making’ which was used to describe organisational circumstances influencing decision-making. Jamous and Peloille’s theory proved useful for interpreting instances where the nurses collectively withdrew from the potential dangers of too extreme claims for technicality or indeterminacy in their work. However, their theory did not explain the full range of accounts of decision-making that were given. Taken at face value, the accounts from the participants depict nurses as sometimes practising in indirect ways in order to have influence in the clinical and bureaucratic setting. However, a focus on language use and in particular, interpretive repertoires, has enabled us to suggest that despite an overall picture of severely limited autonomy, nurses in the groups reproduced stories of the successful accomplishment of moral and influential action

Fully leakage-resilient signatures revisited: Graceful degradation, noisy leakage, and construction in the bounded-retrieval model

We construct new leakage-resilient signature schemes. Our schemes remain unforgeable against an adversary leaking arbitrary (yet bounded) information on the entire state of the signer (sometimes known as fully leakage resilience), including the random coin tosses of the signing algorithm. The main feature of our constructions is that they offer a graceful degradation of security in situations where standard existential unforgeability is impossible

Continuously non-malleable codes with split-state refresh

Non-malleable codes for the split-state model allow to encode a message into two parts, such that arbitrary independent tampering on each part, and subsequent decoding of the corresponding modified codeword, yields either the same as the original message, or a completely unrelated value. Continuously non-malleable codes further allow to tolerate an unbounded (polynomial) number of tampering attempts, until a decoding error happens. The drawback is that, after an error happens, the system must self-destruct and stop working, otherwise generic attacks become possible. In this paper we propose a solution to this limitation, by leveraging a split-state refreshing procedure. Namely, whenever a decoding error happens, the two parts of an encoding can be locally refreshed (i.e., without any interaction), which allows to avoid the self-destruct mechanism. An additional feature of our security model is that it captures directly security against continual leakage attacks. We give an abstract framework for building such codes in the common reference string model, and provide a concrete instantiation based on the external Diffie-Hellman assumption. Finally, we explore applications in which our notion turns out to be essential. The first application is a signature scheme tolerating an arbitrary polynomial number of split-state tampering attempts, without requiring a self-destruct capability, and in a model where refreshing of the memory happens only after an invalid output is produced. This circumvents an impossibility result from a recent work by Fuijisaki and Xagawa (Asiacrypt 2016). The second application is a compiler for tamper-resilient RAM programs. In comparison to other tamper-resilient compilers, ours has several advantages, among which the fact that, for the first time, it does not rely on the self-destruct feature

Professional identity in nursing: UK students' explanations for poor standards of care

Research concludes that professional socialisation in nursing is deeply problematic because new recruits start out identifying with the profession’s ideals but lose this idealism as they enter and continue to work in the profession. This study set out to examine the topic focussing on the development of professional identity. Six focus groups were held with a total of 49 2nd and 3rd year BSc nursing students studying at a university in London, UK and their transcripts were subject to discourse analysis. Participants’ talk was strongly dualistic and inflected with anxiety. Participants identified with caring as an innate characteristic. They described some qualified nurses as either not possessing this characteristic or as having lost it. They explained strategies for not becoming corrupted in professional practice. Their talk enacted distancing from ‘bad’ qualified nurses and solidarity with other students. Their talk also featured cynicism. Neophyte nurses’ talk of idealism and cynicism can be understood as identity work in the context of anxiety inherent in the work of nurses and in a relatively powerless position in the professional healthcare hierarchy

Resistance to group clinical supervision: a semistructured interview study of non-participating mental health nursing staff members

This paper is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has traditionally been theorised as a supervisee’s maladaptive coping with anxiety in the supervision process. The aim of the study was to examine resistance to group clinical supervision by interviewing nurses who did not participate in supervision. In 2015, we conducted semi-structured interviews with 24 Danish mental health nursing staff members who had been observed not to participate in supervision in two periods of 3 months. Interviews were audio recorded and subjected to discourse analysis. We constructed two discursive positions taken by the informants: Forced non-participation where an informant was in favour of supervision, but presented practical reasons for not participating and Deliberate rejection, where an informant intentionally chose to not to participate in supervision. Furthermore, we described two typical themes drawn upon by informants in their positioning: Difficulties related to participating in supervision and Limited need for and benefits from supervision. The findings indicated that group clinical supervision extended a space for group discussion that generated or accentuated anxiety because of already existing conflicts and a fundamental lack of trust between group members. Many informants perceived group clinical supervision as an unacceptable intrusion, which could indicate a need for developing more acceptable types of post-registration clinical education and reflective practice for this group