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

Autonomy, evidence and intuition: nurses and decision-making

Aim: This paper is a report of a study conducted to examine how nurses represent professional clinical decision-making processes, and to determine what light Jamous and Peloille’s ‘Indeterminacy/Technicality ratio’ concept can shed on these representations. Background: Classic definitions of professional work feature autonomy of decision-making and control over the field of work. Sociologists Jamous and Peloille have described professional work as being high in ‘indeterminacy’ (the use of tacit judgements) relative to technicality (activity able to be codified). The rise of the evidence-based practice movement has been seen as increasing the realm of technical decision-making in healthcare, and it is relevant to analyse nurses’ professional discourse and study how they respond to this increase. Method: Three focus groups with qualified nurses attending post-qualifying courses at a London university were held in 2008. Participants were asked to talk about influences on their decision-making. The discussions were tape-recorded, transcribed, and subjected to discourse analysis. Findings: Participants described their decision-making as influenced by both indeterminate and technical features. They acknowledged useful influences from both domains, but pointed to their personal ‘experience’ as the final arbiter of decision-making. Their accounts of decision-making created a sense of professional autonomy while at the same time protecting it against external critique. Conclusion: Pre- and post-registration nurse education could encourage robust discussion of the definition and roles of ‘irrational’ aspects of decision-making and how these might be understood as components of credible professional practice

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

The idealization of 'compassion' in trainee nurses' talk: a psychosocial focus group study

Why do nurses in training continue to draw on the ideal of compassion when responding to their experiences of nursing work in the UK National Health Service (NHS), despite the difficulties that they face in developing compassionate, long-term relationships with patients in practice? To answer this question, we draw from a psychosocial analysis of focus groups data from 49 trainee nurses in the NHS. First, we show how the manifestation of this ideal in trainee nurses’ discourse leads them to blame qualified nurses for failures in patient care. We suggest this is an unconscious defence against the anxiety evoked both by the vulnerability of their position as those who need to gain access to the profession, and of being unable to conduct compassionate nursing work. Second, we emphasise that less powerful occupational groups, such as trainee nurses, may adopt defences that underpin dominant organizational policy, such as idealization, despite further disadvantaging their group and benefitting those in power. We conclude by questioning the particular emphasis on compassion in nurses’ training, which can prevent occupational solidarity and the ability to reflect on the structural and organizational factors required to conduct patient-centred nursing work

Occupational closure in nursing work reconsidered: UK health care support workers and assistant practitioners: a focus group study

In healthcare, occupational groups have adopted tactics to maintain autonomy and control over their areas of work. Witz described a credentialist approach to occupational closure adopted by nursing in the United Kingdom during the 19th and early 20th centuries. However, the recent advancement of assistant, ‘non-qualified’ workers by governments and managers forms part of a reconfiguration of traditional professional work. This research used focus groups with three cohorts of healthcare support workers undertaking assistant practitioner training at a London university from 2011-13 (6 groups, n=59). The aim was to examine how these workers positioned themselves as professionals and accounted for professional boundaries. A thematic analysis revealed a complex situation in which participants were divided between articulating an acceptance of a subordinate role within traditional occupational boundaries and a usurpatory stance towards these boundaries. Participants had usually been handpicked by managers and some were ambitious and confident in their abilities. Many aspired to train to be nurses claiming that they will gain recognition that they do not currently get but which they deserve. Their scope of practice is based upon their managers’ or supervisors’ perception of their individual aptitude rather than on a credentialist claim. They ‘usurp’ nurses claim to be the healthcare worker with privileged access to patients, saying they have taken over what nursing has considered its core work, while nurses abandon it for largely administrative roles. We conclude that the participants are the not unwilling agents of a managerially led project to reshape the workforce that cuts across existing occupational boundaries

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

Mesenchymal stem cell response to topographically modified CoCrMo

Surface roughness on implant materials has been shown to be highly influential on the behavior of osteogenic cells. Four surface topographies were engineered on cobalt chromium molybdenum (CoCrMo) in order to examine this influence on human mesenchymal stem cells (MSC). These treatments were smooth polished (SMO), acid etched (AE) using HCl 7.4% and H2 SO4 76% followed by HNO3 30%, sand blasted, and acid etched using either 50 μm Al2 O3 (SLA50) or 250 μm Al2 O3 grit (SLA250). Characterization of the surfaces included energy dispersive X-ray analysis (EDX), contact angle, and surface roughness analysis. Human MSCs were cultured onto the four CoCrMo substrates and markers of cell attachment, retention, proliferation, cytotoxicity, and osteogenic differentiation were studied. Residual aluminum was observed on both SLA surfaces although this appeared to be more widely spread on SLA50, whilst SLA250 was shown to have the roughest topography with an Ra value greater than 1 μm. All substrates were shown to be largely non-cytotoxic although both SLA surfaces were shown to reduce cell attachment, whilst SLA50 also delayed cell proliferation. In contrast, SLA250 stimulated a good rate of proliferation resulting in the largest cell population by day 21. In addition, SLA250 stimulated enhanced cell retention, calcium deposition, and hydroxyapatite formation compared to SMO (p < 0.05). The enhanced response stimulated by SLA250 surface modification may prove advantageous for increasing the bioactivity of implants formed of CoCrMo. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2015

Positive allosteric modulators of the μ‐opioid receptor: a novel approach for future pain medications

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109803/1/bph12599.pd