Reflections on the role of consultant radiographers in the UK: what is a consultant radiographer?

Context: This paper is the second paper from a two year in depth case study, exploring the role of consultant radiographers in the UK. Methods: A longitudinal case study approach was used to determine the role of consultant radiographers. Interviews were used to explore experiences of being a consultant, which were analysed using thematic analysis. Eight consultant radiographers participated (Note, two of the consultants withdrew after the first interview due to workload). Therefore two consultants were interviewed only once. The remaining six consultants were interviewed twice over a 12 month period. Findings: The data presented in this paper explores the nature of the role, differences between roles, the four domains of practice, and how the role fits into local organisational structures. The study shows wide variation in the types of roles undertaken, reflecting that the creation of these roles were in response to local clinical need and often related to an individual practitioner's skills. The broad scope of the role was shown across all the consultants, with evidence of roles developing into new areas of service delivery. Conclusions: The paper offers insight into the role(s) of consultant radiographers in the UK. The range and scope of their practice is extensive, with much variation. It is evident that the clinical aspect of the role dominates, with research being the least supported domain of practice. There remains a lack of clarity around the role, with concerns about remuneration and other limitations that may restrict the role developing further

Leadership and the everyday practice of consultant radiographers in the UK: transformational ideals and the generation of self-efficacy

Introduction: This paper outlines findings from a broader, two-year project investigating the role of Consultant Radiographers (CRs) in the UK, focussing specifically on the leadership aspect of that role. Methods: Using a qualitative-thematic approach, the leadership-related experiences of a purposive sample of six participating CRs are explored, alongside the systems through which they evaluated how successful they had been as leaders. Results: It is evidenced that many of the ways in which participants describe their own leadership practice, particularly in the intra-team domain, is consistent with the precepts of the Transformational Leadership Model. For example, they highlight how they have asserted positive influence and encouraged collective action and decision-making. However, the experiential focus of the analysis reveals that in specific examples of practice, the transformational approach was not always seen as the most useful route to a productive outcome given constrictions on time and other resources within real professional environments. More ‘direct’ managerial approaches were sometimes deemed necessary, and at others leadership was reduced to simply ‘solving other people's problems'. It was also found that the manner in which participants evaluated their own success as leaders was a practical concern, based in part upon having satisfied ‘hard’ institutional goals, but also on the more personal business of having affirmatively ‘surprised’ oneself, or a general sense of feeling trusted by colleagues. Conclusion: These findings may help support CRs in the business of real leadership, not least through better understanding how even apparently mundane outcomes can have significant impacts on professional self-efficacy

Reflections on the role of consultant radiographers in the UK: the perceived impact on practice and factors that support and hinder the role

Study context: This paper is the third paper arising from a two year long, in-depth case study exploring various components of the role of consultant radiographers in the UK. This paper focuses particularly upon the perceived impact of the role and factors that support and hinder the role in practice. Methods: A longitudinal case study method was used to explore the role of consultant radiographers. Interviewing was informed and guided by a phenomenological approach to promote a deeper understanding of consultants' experiences in the role. Eight consultant radiographers participated, with six involved throughout the whole study. Over an 18 month period each of those six consultants was interviewed three times. Two consultants only participated in the first interview; these interviews are also reported here. A total of 20 interviews were conducted. Findings: Interviews explored the impact of the consultant role as perceived by consultants themselves, and encouraged individual reflection on factors which had both supported and hindered success therein. Analysis demonstrated that there was substantial variation in the experiences communicated yet, and without any exception, all consultants reported that the introduction of their role had been beneficial to service delivery and quality of patient care. A number of obstacles were outlined, as well as a range of support mechanisms. Recommendations are thus made as to how the consultant role might be more effectively supported in the future

Sonographers’ experiences of work-related musculoskeletal disorder: the everyday consequences of physiological stress and injury in contemporary ultrasound

Background: By 2013, the UK government’s Migration Advisory Committee had listed sonography as an official ‘shortage specialty’ (Migration Advisory Committee, 2013; Parker & Harrison, 2015). As a consequence of the working stresses allied to this shortage, British sonographers have increasingly been reducing hours or leaving clinical practice entirely (Society and College of Radiographers, 2014). Moreover, among those who remain, incidences of reported chronic pain and active injury are also on the increase within a profession that was already synonymous with high rates of work-related musculoskeletal disorder (WRSMD; Harrison & Harris, 2015). While contemporary research has described the rates of WRMSD among ultrasound practitioners (Bolton & Cox, 2015), none has to date extensively explored its personal and professional impacts. Methods: Using a model of Interpretative Phenomenological Analysis with proven facility in medical imaging research (Miller et al., 2017), extended semi-structured interviews with N=10 experienced sonographers were analysed. Results: Participants routinely reported a sensation of guilt and depleted self-efficacy that not only permeated any working absence resultant of their own WRMSD, but also to taking legitimate leave when colleagues were suffering from WRMSD. An upshot of this was to recurrently “take one for the team” and work through excessive pain, even when this would likely result in greater prospective physical damage. While the basic shortage of sonographers was the core attribution for such behaviours, participants also cited (1) increasingly obese patients, (2) increasingly unhelpful (i.e. profiteering) equipment manufacturers, and (3) their own paternalism regarding healthcare. Conclusions: The present situation in ultrasound mirrors a culture of potentially dangerous pain acceptance that been noted in the psychology of sport for some time (Weinberg et al., 2013) albeit for altruistic, rather than egotistic, reasons. There is a clear body of evidence to suggest that sonographers are in crisis point both in terms of staffing levels and in terms of inter-related issues of WRMSD. The issue of WRMSD remains complex and under-researched and few studies are able to establish a definitive cause of the condition, because the causes are multifactorial. However, the majority of the literature seems to agree that poor posture, repetitive movements and insufficient strength seem to be the main physical causes, but little has been explored in terms of how the philosophy of being a sonographer, their behaviours and cultures might also be contributing to this issue. This study contributes to a new body of knowledge, looking at the unique experiences of (n=9) individual sonographers and the ideological dilemmas they are facing. It is acknowledged that extensive deeper levels of analysis and interpretation need to take place around the data collected for this study in order to draw more comprehensive conclusions. References: Bolton, G.C. & Cox, D.L. (2015) 'Survey of UK sonographers on the prevention of work related muscular‐skeletal disorder (WRMSD)', Journal of Clinical Ultrasound, 43 (3), pp.145-152. Harrison, G. & Harris, A. (2015) 'Work-related musculoskeletal disorders in ultrasound: Can you reduce risk?', Ultrasound, 23 (4), pp.224-230. Loaring, J.M., Larkin, M., Shaw, R. and Flowers, P. (2015) 'Renegotiating Sexual Intimacy in the Context of Altered Embodiment: The Experiences of Women With Breast Cancer and Their Male Partners Following Mastectomy and Reconstruction', Health Psychology, 34(4), pp. 436. Migration Advisory Committee. (2013) Skilled Shortage Sensible: Full review of the recommended shortage occupation lists for the UK and Scotland, a sunset clause and the creative occupations. London: Migration Advisory Committee. Miller, P.K., Waring, L., Bolton, G.C. and Sloane, C. (2018) 'Personnel flux and workplace anxiety: Personal and interpersonal consequences of understaffing in UK ultrasound departments', Radiography; Radiography, . doi: 10.1016/j.radi.2018.07.005. Miller, P.K., Woods, A.L., Sloane, C. & Booth, L. (2017) 'Obesity, heuristic reasoning and the organisation of communicative embarrassment in diagnostic radiography', Radiography, 23 (2), pp.130-134. Parker, P.C. & Harrison, G. (2015) 'Educating the future sonographic workforce: membership survey report from the British Medical Ultrasound Society', Ultrasound, 23 (4), pp.231-241. Smith, J.A., Flowers, P. and Larkin, M. (2009) Interpretive Phenomenological Analysis; Theory, Method and Research. SAGE; London. Weinberg, R., Vernau, D. & Horn, T. (2013) 'Playing Through Pain and Injury: Psychosocial Considerations', Journal of Clinical Sport Psychology, 7 (1), pp.41-59

The personal impact of work-related musculoskeletal disorders (WRMSD) on sonographers

Background: Since 2005, the UK government’s Migration Advisory Committee has listed sonography as an official ‘shortage specialty’ (Migration Advisory Committee, 2019). Work-related musculoskeletal disorder (WRMSD), already widespread among sonographers, is increasing due to the additional physical stresses of working in understaffed environments (Harrison & Harris, 2015). While contemporary research has described the broad picture regarding WRMSD in ultrasound (Bolton & Cox, 2015), none has, to date, extensively explored its personal and professional impacts. Method: Extended semi-structured interviews with N=9 experienced sonographers working in the UK were conducted and analysed using Interpretative Phenomenological Analysis (Miller, et al, 2017). Core thematic areas that emphasised personal impacts of WRMSD were then further examined to highlight how participants specifically made sense of them. Results: The key ideological tensions evident in the findings pertained to those between individuality and collectivity, and freedom and necessity. Evidence indicated that the participants held a range of perspectives highlighted in the following themes: (1) acknowledgement, or denial, in terms of experiencing symptoms of WRMSD (2) recognition of own vulnerability, (3) ‘spinning plates’ against emotional investment, (4) metaphorically ‘jumping through hoops’ and (5) total denial of the phenomenon. Conclusions: Participants acknowledged their role as professionals, and also their own commitment to a broader altruistic model that reinforced their identities as good healthcare professionals. The ‘personal self’ provides a useful analytic framework for understanding some of the everyday feelings of sonographers towards the phenomenon of WRMSD. Further exploration of the conceptual facility thereof is recommended. References 1. Bolton, G.C. & Cox, D.L. (2015) 'Survey of UK sonographers on the prevention of work related muscular‐skeletal disorder (WRMSD)', Journal of Clinical Ultrasound, 43 (3), pp.145-152. 2. Migration Advisory Committee. (2019) Full review of the Shortage Occupation List Migration Advisory Committee. London: Migration Advisory Committee. 3. Miller, P.K., Woods, A.L., Sloane, C. & Booth, L. (2017) 'Obesity, heuristic reasoning and the organisation of communicative embarrassment in diagnostic radiography', Radiography, 23 (2), pp.130-134. 4. Parker, P.C. & Harrison, G. (2015) 'Educating the future sonographic workforce: membership survey report from the British Medical Ultrasound Society', Ultrasound, 23 (4), pp.231-241

Eliciting consent from patients with dementia in general X-ray departments: Law, ethics and interpretation of context

Background: While the numbers of individuals suffering from dementia syndromes in the UK steadily increase, many practitioners in the allied healthcare professions, and particularly junior staff, still feel ill-equipped for face-to-face communicative encounters with such individuals (Miller et al., 2019; Tullo et al., 2016). An elemental feature of effective communication in healthcare contexts is the seeking of proper consent to perform given procedures. The propositions above, however, raise questions regarding how ‘properly’ consent is being acquired when dementia is at stake. This paper, thus, reports findings from a qualitative study of general radiographers’ experiences of acquiring consent from patients with dementia, specifically exploring participants’ interpretations of correct legal and ethical practice therein. Methods: With institutional ethical approval, N=6 general radiographers with less than ten years of clinical experience were recruited to sit for extended interviews. Verbatim transcripts were analysed using the domain-established techniques of Interpretative Phenomenological Analysis (Miller et al., 2017). Results: Four key areas of extremely variable interpretation and practice were identified. (1) How to assess capacity for informed consent; (2) How to effectively modify communication when gaining consent; (3) Managing carer involvement during consent-acquisition and; (4) Constituting the ‘best interest’ of the patient. Conclusion: Participants’ own accounts often indicated that they were often not lawfully implementing the Mental Capacity Act (MCA) when acquiring consent. Moreover, as previously identified by Miller et al. (2019), the situational confusion did little for participants’ confidence, with prospectively damaging import for future encounters. Stronger training in practical application of the MCA is recommended

Student radiographers' attitudes towards the older patient: a longitudinal study

Purpose: To design, implement and evaluate the effect of an educational intervention on student radiographer attitudes across their educational tenure. Methods: In the first phase, an educational intervention that involved didactic lectures, reflective exercises and simulation suits, aimed at improving student radiographer attitudes towards the older person, was designed and implemented. Kogan’s attitudes towards older people (KoP) scale was administrated at five test points; pre-intervention; post-intervention; 6 months post intervention; 12 months post intervention and 24 months post intervention. At the final test point these quantitative data was supplemented with qualitative data for triangulation of the findings. Results: Students held positive attitudes towards older people pre intervention, these increased significantly post intervention (p=0.01). However, this increase in positive scores was not noted at 6 months and 12-months post intervention. At 24-months post intervention, although there was a slight increase in positive attitudes when compared to the 6 and 12 month scores, this increase was not found to be significant (p=.178) Conclusions: The results post-intervention suggested that an educational intervention can have a significant impact on student radiographer’s attitudes towards older people. However, the qualitative data suggests that experiences on initial clinical placement can be detrimental to attitudinal scores, particularly if the intervention does not include Dementia care strategies

Use Of Hand-Held Devices With First Year Associate Degree Nursing Students

The use of personal digital assistants (PDAs), hand-held devices and/or IPod Touches, is becoming widespread in the health care field. Many medical and nursing schools require their students to purchase a PDA prior to the beginning of their classes. PDA’s can carry information directly to the patient’s beside for instant retrieval of information. What does this mean to nursing students and clinical instructors? It means that up-to-date information is available to the student and clinical instructor in seconds, as opposed to searching for a reference book only to find it is outdated and 10 to 15 minutes of valuable time lost. This study identified associate degree nursing students’ use and application in the clinical using PDAs. Results of this study indicated that associate degree nursing students are very satisfied with the use of PDAs in the clinical setting. This study was funded by the Ohio University Regional Faculty Research Fund.

Towards a discursive psychology of expertise in radiography education: lecturers’ use of “authenticity through autobiography” in classroom sessions

Background: Often drawing upon K. Anders Ericsson’s approach (Ericsson, 2007), the contemporary corpus of research into radiography expertise tends to reflect a set of broadly social-cognitive concerns, whereby the knowledge and experience acquired by a professional are the focus (Donovan and Litchfield, 2013). The Discursive Psychological (DP) approach, however, provides an alternative model; herein, how expertise is performed becomes key (Wiggins, 2017) - DP describes how actors endeavour to make their own expertise persuasively and dynamically relevant in ways tailored to the intended audience. Methods: Using the standard methods of DP (Miller and Richardson, 2017), N=10 classroom sessions were analysed to highlight the nuanced interpersonal ways in which experienced radiography lecturers performed their own expertise. Results: Findings indicate the routine use of a socio-linguistic device termed “authenticity through autobiography” in the discursive sciences (Widdicombe and Wooffitt, 1995). The lecturers, in a variety of (usually) subtle ways, recurrently drew attention to: (1) The quantity and/or quality of their professional service in radiography; (2) the quantity and/or quality of their teaching experience; and (3) the quantity and/or quality of their research outputs and activities. All were raised only in moments whereby the specific topics of discussion - or the actions of the students - could in some way be inferred to contextually challenge the lecturers’ own status as experts. Moreover, the particular autobiographical details raised always directly addressed the specific nature and implications of any challenge. Conclusions: The work presented draws attention to the importance of interpersonal performance in communicating information in radiography, such that it might be recognised by students as expert knowledge

The Purdue Extension and Indiana CTSI's Community Health Partnerships collaboration: An innovative, generalizable, state-wide model to help communities build a culture of health

The Indiana Clinical and Translational Sciences Institute's Community Engagement Partners-Purdue Extension collaborative model demonstrates tremendous potential for creating state-wide programmatic efforts and improvements in both the health culture and status of Indiana residents across the state. It can serve as a prototype not only for others interested in pursuing wide geographic health improvements through Clinical and Translational Sciences Award-Cooperative Extension partnerships but also for broader collaborations among United States Department of Agriculture, National Institutes of Health, Centers for Disease Control and Prevention, state and local health departments, and health foundation efforts to improve population health