Development and Validation of a Chinese Version of a Professional Identity Scale for Healthcare Students and Professionals

This study was intended to develop a comprehensive and psychometrically adequate professional identity scale for healthcare students and professionals based on Taiwanese cultural contexts. In order to elicit a more consistent result of the psychometric indices of the newly developed scale, the study adopted a combination of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine the consistency of the scale factors. In a pilot study of 562 randomly selected healthcare students and professionals, the EFA yielded a 33-item four-factor model with the terms "professional commitment & devotion" (16 items; 47.33% of variance), "emotional identification & belongingness" (7 items; 9.72% of variance), "professional goals & values" (5 items; 8.17% of variance), and "self-fulfillment & retention tendency" (5 items; 3.38% of variance). The CFA yielded an 18-item four-factor model with good or even excellent fit to the data, where the χ²/df ratio = 1.138, Tucker Lewis index (TLI) = 0.997, comparative fit index (CFI) = 0.997, and root mean square of approximation (RMSEA) = 0.016. The convergent validity and discriminant validities were also conducted to test the feasibility of the Professional Identity Scale for Healthcare Students and Professionals (PIS-HSP) scale. For the EFA model, the Cronbach's alphas for the four factors and the overall scale ranged from 0.84 to 0.96; for the CFA model, the Cronbach's alphas and composite reliabilities were, respectively, in the ranges of 0.78-0.93 and 0.78-0.97, demonstrating satisfactory reliabilities. The results proved that the developed PIS-HSP can be a reliable measurement tool to assess professional identity for healthcare students and professionals.

Transition to dental practice: Newly graduated dentists' views of being successful in dental practice

BACKGROUND

The transition of dental graduates to the workforce is of interest to dental educators. The ways dentists think about success and successful practice tend to be tied to business parameters, patient flow and job satisfaction. These measures are narrow, however, and there is scant literature exploring success in ways that connects with professional identity formation. This study aims to add to scholarly understanding about the experiences of newly graduated dentists by asking: What is the variation in the ways new graduate dentists experience success in practice?

METHODS

The qualitative methodology used in this study is phenomenography. Phenomenography studies the variation in the way a group of people experience a common phenomenon. In-depth, semi-structured interviews were conducted with 12 new dentists who had graduated from the University of Sydney.

RESULTS

Five increasingly sophisticated, qualitatively distinct categories of description were identified: the day runs smoothly, keeping busy, providing quality patient care, generating personal meaning and having a sense of connection and belonging.

CONCLUSIONS

This study gives insights into the complex ways newly graduated dentists think about successful dentistry. It broadens our view of successful practice beyond commercial aspects to include practitioner identity. Importantly, sense of responsibility, the practice environment and mentorship emerge as key players in this transitional career stage.

A qualitative study of perioperative nursing students' experiences of interprofessional simulation-based learning

AIM

To explore perioperative nursing students' experiences of interprofessional simulation-based learning to gain a deeper understanding of how this educational tool can be used to support students' learning and enable them to achieve the intended learning outcomes.

BACKGROUND

Despite extensive research, it remains unclear what and how participants learn from interprofessional simulation-based learning. There is a need to specify how interprofessional simulation-based learning should be organised to support and promote learning processes, especially for postgraduate learners. In particular, there seems to be little evidence in the existing literature in the field of educating perioperative nurses, where advanced technical skills and high-quality nursing care are required.

DESIGN

The study's qualitative and explorative design is reported in accordance with the COREQ guideline.

METHOD

Between May-October 2019, thirty-four perioperative nursing students from four educational institutions participated in six focus group interviews, with four to eight students in each. All participants had previous experience of interprofessional simulation-based learning in acute settings. Data were transcribed verbatim and were then subjected to phenomenological hermeneutical analysis involving three steps: naïve reading, structural analysis and comprehensive understanding.

RESULTS

Three themes were identified the following: customised interprofessional simulation-based learning; reality of the experience of interprofessional simulation-based learning; and preparedness for clinical practice.

CONCLUSION

Customised interprofessional simulation-based learning was found to be of value to the participants and reflected their feeling of mental preparedness entering interprofessional simulation-based learning. Furthermore, participants' experience of reality when using the tool was a key theme that also impacted how prepared participants felt for clinical practice.

RELEVANCE TO CLINICAL PRACTICE

The study findings contribute to the further expansion of interprofessional simulation-based learning in perioperative nursing education as a means of developing students' professional competence. This is essential knowledge, as professional practitioners must reflect on practice to further enhance that practice and patient safety.

Teamwork, Professional Identities, Conflict, and Industrial Action in Nigerian Healthcare

PURPOSE

Modern healthcare is delivered by teams of multidisciplinary professionals. Conflicts have been widely reported between these professionals in Nigeria. Furthermore, the health system is frequently crippled by industrial actions by trade unions representing these professionals. This study aimed to shed light on the complexities of factors perceived to cause workplace conflicts, including the extent to which these are thought to link to industrial action.

MATERIALS AND METHODS

Focus group discussions and in-depth interviews were conducted with nurses, doctors, and medical laboratory scientists who work in multiprofessional settings giving a total of 41 participants. Results were analyzed within the framework of the social identity theory.

RESULTS AND CONCLUSIONS

The dominant themes that emerged as barriers to teamwork include professional hierarchy, role ambiguity, and poor communication. At the same time, the health sector leadership and remuneration were the main themes concerning industrial actions. The salience of professional identities was also demonstrated, providing a link between interprofessional conflict in the workplace and competitive industrial actions by trade unions representing health professionals. The implications for educational and clinical practice and the need for interprofessional education are discussed.

[Training through the prism of the difficulties of internship students]

For 70 years, nurse training has been regularly reformed as knowledge and practices evolve. The 2009 reform is part of a professionalisation approach, with training supported by university. More than ten years after it came into force, the analysis of incidents encountered by students during clinical internships highlights two training points that need to be reinforced: acquisition of clinical reasoning and construction of a nursing identity.

Defining the Digital Self: A Qualitative Study to Explore the Digital Component of Professional Identity in the Health Professions

Background

Recent medical education literature pertaining to professional identity development fails to reflect the impact social media has on professional identity theory. Social media is transforming the field of medicine, as the web-based medium is now an avenue for professional development and socialization for medical students and residents. Research regarding identity development in social media has been primarily confined to electronic professionalism through best practice guidelines. However, this neglects other potential aspects pertinent to digital identity that have not yet been explored.

Objective

This study aims to define the properties and development of the digital self and its interactions with the current professional identity development theory.

Methods

A qualitative study was conducted using thematic analysis. A total of 17 participants who are social media education and knowledge translation experts were interviewed. The initial participants were from emergency medicine, and a snowball sampling method was used following their respective web-based semistructured interviews to enable global recruitment of other participants from interprofessional disciplines. The research team consisted of a diverse group of researchers including one current social media knowledge translation physician clinician educator, one postdoctoral researcher who is regularly engaged in social media knowledge translation, and 3 nonphysician research assistants who are not social media users. Half of the team conducted the initial coding and analysis, whereas the other 2 investigators audited the procedures followed.

Results

A total of 4 themes were identified that pertain to digital identity. In the first theme, origins of initial digital identity formation were found to be derived from perceived needs in professional roles (eg, as a medical student or resident). The second theme consisted of the cultivation of digital identity, in which digital identity was developed parallel to professional identity. The third theme that emerged was the management between the professional and personal components of digital identity. Participants initially preferred keeping these components completely separate; however, attempts to do so were inadequate while the integration of both components provided benefits. The fourth theme was the management of real-life identity and digital identity. Participants preferred real-life identity to be wholly represented on the web. Instances of misalignment resulted in identity conflict, compromising one of the identities.

Conclusions

Social media introduces new features to professional identity in the digital world. The formation of digital identity, its development, and reconciliation with other identities were features captured in our analysis. The virtual component of professional identity must not be neglected but instead further explored, as educational institutions continue to give more importance to navigating professional identity development.

Professional identity of allied health staff associated with a major health network organizational restructuring

Maintenance of professional identity, particularly during periods of organizational restructuring, is critical within modern complex healthcare systems as professional identity contributes to the psychological well-being of staff and leaders. This study aimed to evaluate change in professional identity of allied health staff associated with a major health network organizational restructuring in Australia. Data were collected from allied health staff in 2017 and 2019, before (n = 226) and after (n = 197) the restructuring. An online questionnaire including the 10-question Brown's Group Identification Scale that considers the strength of professional identity of the individual with their own professional group was used. Professional identity of allied health staff was high before and after the organizational restructuring, although several individual statements, and overall professional identity, declined significantly post-restructuring. It was difficult to attribute these changes solely to the restructuring due to some differences in demographic characteristics between the two cohorts. Future studies should seek to understand the effect of other workplace factors on the professional identity of allied health staff. Further research could also investigate allied health professional identity to understand its importance within contemporary healthcare.

The role of workplace social capital on the relationship between perceived stress and professional identity among clinical nurses during the COVID-19 outbreak

AIM

Workplace social capital refers to relationship networks formed by individuals in an organization through long-term mutually beneficial interactions and cooperation with members. These relationship networks can create value and resources for organizations and individuals. This current study aimed to explore the potential impact of workplace social capital on the association between perceived stress and professional identity in clinical nurses during the COVID-19 outbreak.

METHODS

In this cross-sectional study, 308 Chinese clinical nurses filled out the Chinese Workplace Social Capital Scale, the Chinese Perceived Stress Scale, and the Chinese Nurse's Professional Identity Scale. Descriptive analysis, independent samples t test, analysis of variance, Pearson correlation analyses, and bootstrap method were performed to analyze the data.

RESULTS

Perceived stress was negatively correlated with professional identity (r = -0.455, p < .001). Workplace social capital was not found to moderate the relationship between perceived stress and professional identity (95% CI -0.03 to- 0.06, p = .47 > .05). Instead, it mediated that relationship (95% CI -0.61 to -0.19, p < .05), and its mediating effect was -0.37.

CONCLUSIONS

In the early stages of the COVID-19 outbreak, workplace social capital among the investigated clinical nurses failed to buffer the negative impact of perceived stress on professional identity, but it did play a part in mediating perceived stress and professional identity. A healthy workplace should be provided to clinical nurses to improve their professional identity, while lowering perceived stress.

A Historical Discourse Analysis of Pharmacist Identity in Pharmacy Education

Objective. To determine the discourses on professional identity in pharmacy education over the last century in North America and which one(s) currently dominate. Methods. A Foucauldian critical discourse analysis using archival resources from the American Journal of Pharmaceutical Education (AJPE) and commissioned education reports was used to expose the identity discourses in pharmacy education. Results. This study identified five prominent identity discourses in the pharmacy education literature: apothecary, dispenser, merchandiser, expert advisor, and health care provider. Each discourse constructs the pharmacist's professional identity in different ways and makes possible certain language, subjects, and objects. The health care provider discourse currently dominates the literature. However, an unexpected finding of this study was that the discourses identified did not shift clearly over time, but rather piled up, resulting in students being exposed to incompatible identities. Conclusion. This study illustrates that pharmacist identity constructs are not simple, self-evident, or progressive. In exposing students to incompatible identity discourses, pharmacy education may be unintentionally impacting the formation of a strong, unified healthcare provider identity, which may impact widespread practice change.

The influence of experiences of involvement in the COVID-19 rescue task on the professional identity among Chinese nurses: A qualitative study

Aims

To explore the influence of experiences of involvement in the COVID‐19 rescue task on professional identity among Chinese nurses from a qualitative method perspective.

Background

Professional identity of nurses is not static and easily affected by many factors. The COVID‐19 epidemic brings the tremendous physical and psychological challenges for rescue nurses. At present, there are limited data on the influence of rescue experiences on the nurses’ professional identity.

Methods

This study used a face‐to‐face interview with semi‐structured questions to learn about the influence of rescue experiences on the professional identity of nurses. Purposeful sampling was used to collect participants (n = 14), and interview data were analysed following the Colaizzi's phenomenological analysis.

Results

The ‘impression of exhaustion and fear’, ‘feeling the unfairness’, ‘perceiving incompetence in rescue task’ and ‘unexpected professional benefits’ were the main factors affecting the professional identity of rescue nurses.

Conclusion

The present study showed that special attention and targeted support measures should be provided to improve the professional identity of rescue nurses.

Implications for Nursing Management

Nurse managers should make a post‐epidemic recovery plan to help nurses to improve the professional identity. Designed education programmes and complete disaster response system should be developed to deal with infection disease in the future.

Professional Identity Formation in Pharmacy Students During an Early Preregistration Training Placement

Objective. To explore the lived experiences of pharmacy students undertaking an early preregistration training placement in the United Kingdom, particularly with respect to the development of different aspects of their professionalism. Methods. Fourteen students returning from an early preregistration placement (during the third year of their pharmacy degree) were interviewed, using a semi-structured approach. Grounded theory methods were used to analyze the transcripts and a theory was developed. Results. Developing a professional identity was the core process that occurred during the placement. This included four stages: reflection, selection of attributes, professional socialization, and perception of role. As a consequence of developing a professional identity, participants had a strong vision of the kind of pharmacist they wanted to be when qualified. They articulated an increased responsibility as students, and began to see themselves as a "trainee professional." Conclusion. The findings of this study strongly support having an early preregistration period for pharmacy students to develop a sense of professional identity and strengthen their motivation to learn.

Coping Dynamics of Consulting Psychology Doctoral Students Transitioning a Professional Role Identity: A Systems Psychodynamic Perspective

To remain relevant and valuable, the psychology profession in South Africa continues to transform and evolve in response to the changing needs of society. Some psychologists embark on development opportunities to advance their professional qualifications and skills. In doing so, they experience identity tensions inherent to professional identity development and transformation. Understanding how psychologists cope with professional identity transition will enable them to develop a self-efficacious service offering and broaden the reach of psychology in the South African context. The aim of this study was to explore the identity work of a group of eight consulting psychology doctoral students to develop a system psychodynamic understanding of their coping dynamics while transitioning to a professional role identity. Students’ self-reflective essays about becoming a consulting psychologist constituted the data protocols for the study and were analysed through hermeneutic phenomenological analysis. Findings describe how students cope with performance and survival anxieties through anti-task behaviour and immature as well as sophisticated psychodynamic defences. The study contributes to the exploration of the coping concept and its manifestation, by proposing defensive coping as a natural dynamic phenomenon in the process of adapting to a transforming professional identity.

Alignment of CanMEDS-based Undergraduate and Postgraduate Pharmacy Curricula in The Netherlands

In this article the design of three master programs (MSc in Pharmacy) and two postgraduate specialization programs for community or hospital pharmacist is described. After a preceding BSc in Pharmacy, these programs cover the full pharmacy education capacity for pharmacists in primary and secondary health care in the Netherlands. All programs use the CanMEDS framework, adapted to pharmacy education and specialization, which facilitates the horizontal integration of pharmacists’ professional development with other health care professions in the country. Moreover, it is illustrated that crossing the boundary from formal (university) education to experiential (workplace) education is eased by a gradual change in time spent in these two educational environments and by the use of comparable monitoring, feedback, and authentic assessment instruments. A reflection on the curricula, based on the principles of the Integrative Pedagogy Model and the Self-determination Theory, suggests that the alignment of these educational programs facilitates the development of professional expertise and professional identity of Dutch pharmacists.

The Importance of Professional Values From Radiologic Technologists' Perspective

PURPOSE

To determine radiologic technologists' perception of professional values.

METHODS

A sample of 3500 American Society of Radiologic Technologists members was emailed the Radiologic Technologists' Perceptions of Professional Values Scale survey-modified from the Professionalism in Physical Therapy: Core Values Self-Assessment tool-which captured participants' demographic information (eg, education level, age, job title) and their ratings of 7 specific professional values. The mean item score was computed for each of the 7 professional values as well as the mean item score for the 61 items. A 1-way analysis of variance (ANOVA) was used to compare the mean item score for several demographic characteristics.

RESULTS

Of those who were emailed the survey, 716 consented to begin the survey. The mean scores of all 7 professional values were above 3.0, indicating that radiologic technologists perceived each of the professional values listed as important. The between-group ANOVAs showed no significant difference in perceived importance of professional values based on demographic characteristics.

DISCUSSION

Professional values encourage consistent patterns of behaviors, which motivate professionals to behave ethically. Therefore, professional values should be identified, adopted, and articulated for radiologic technologists by the bodies that lead the profession: the American Registry of Radiologic Technologists, the American Society of Radiologic Technologists, and the Joint Review Committee on Education in Radiologic Technology.

CONCLUSION

Survey respondents perceived the listed professional values as important, which might be the first step to identifying a set of values to guide those in the radiologic sciences and set a benchmark of professionalism that will help radiologic technology gain acknowledgement as a profession rather than a trade or vocation.

Constructing nurses' professional identity through group performance

AIMS

The aim of this study was to examine professional identity through the group performances of nurses within a specific work environment.

BACKGROUND

Professional identity and social identity are closely linked. Nurses undertake clinical practice usually within a social group environment. The literature is limited on the development of professional identity within the context of nurses' daily work.

DESIGN

An integrated ethnographic case context design was adopted, consisting of two clinical wards in one acute health-care facility in Australia. The application of the social identity theory (SIT) was used to study two specific professional activities to describe the group performance of nurses within this organizational cultural context and how this influenced nurses' professional identity.

METHOD

The research was undertaken between 2012 and 2014. Data collection included observation, interviews and fieldnotes of a convenience sample of nurses and allied health-care professionals who undertook two professional activities in their normal work environment.

FINDINGS

The development of group efficacy contributed to the development of the professional identity in the homogenous handover activity. Self-efficacy was demonstrated in the heterogenous multidisciplinary activity.

CONCLUSION

The results indicated the importance of recognizing core identity-building activities and understanding the value of these activities to professional identity development.

In the Name of Family Medicine: A Nationwide Survey of Registered Names of Family Medicine Clinics in Taiwan

Family medicine is officially a specialty, but is often not regarded as a specialty by the general public. Past studies have usually investigated the opinions of medical students and resident physicians regarding family medicine, whereas few have focused on practicing family physicians themselves, especially in terms of analyzing how they represent themselves. This study aimed to investigate the patterns of clinic names to better apprehend whether general practitioners see themselves as being on an equal footing with other medical specialists. The registered names, medical specialties, and levels of urbanization of all clinics of Western medicine in Taiwan were collected. For clinics of each specialty, we examined whether their names contained the corresponding specialty designation. For example, a family medicine clinic was checked to determine whether its name contained the term “family medicine” or its abbreviation. The naming of family medicine clinics was then compared with that of clinics with other specialties. Of the 9867 Western medicine clinics included in this study, two-thirds (n = 6592) were single-specialty clinics. In contrast to the high percentages of single-specialty clinics of other specialties with specialty-containing names (97.5% for ophthalmology, 94.8% for dermatology, and 94.7% for otolaryngology), only 13.3% (132/989) of the family medicine clinics had such names. In addition, the urban family medicine clinics had a higher proportion (15.2%, 74/487) of specialty-containing names than the suburban (12.6%, 44/349) and rural family medicine clinics (9.2%, 14/153). Overall, a low percentage of family medicine clinics in Taiwan included “family medicine” in their names. This issue of professional identity deserves further qualitative investigation.

Should dentistry be a specialty of medicine? Two viewpoints

Dentistry and dental education are well-established domains with deep-rooted institutions, educational programs, organizational structures, and advanced specialty fields. Almost 100 years ago, Dr. William Gies, founder of the Columbia University College of Dental Medicine, stated that to best serve the oral health needs of the population, dentistry should be considered a specialty of medicine, and dental students should have the same solid foundation in the basic and clinical sciences as medical students. More recently, the report on "Advancing Dental Education in the 21st Century" recommends an increase in the integration of dental and medical education as a means to address 2 of its key challenges: "shrinking demand for dental services" and "shifting practice environment." However, it has also been argued that making dentistry and dental education a subspecialty of medicine and medical education will create logistical, structural, regulatory, and financial dilemmas. Instead of a drastic change to current dental educational, organizational, and institutional models, some argue a contemporary approach to dental education is required to ensure dentists are well prepared to address the healthcare needs of the population and future healthcare delivery systems and practice models. Recognizing the need for change in dental education to keep pace with changes in patient demographics and healthcare systems, the dental profession has the responsibility and opportunity to develop new models and paradigms that improve educational and clinical outcomes in our educational programs and future practice.

Physician Associate students and primary care paradigmatic trajectories: perceptions, positioning and the process of pursuit

As the role of the Physician Associate (PA) establishes within the UK, there is increasing interest in the recruitment of PAs to primary care. Yet, currently 72% of all UK PAs work in secondary care. Recruitment to primary care is wanting, for reasons that remain unclear. This work sought to investigate student PA experiences in primary care and their attitudes to primary care as a career choice. A multi-site, qualitative study involving one-to-one semi-structured interviews with 19 student PAs was conducted. Data were thematically analysed, in line with an interpretivist approach and informed by communities of practice and paradigmatic trajectory theory - 'visible career paths provided by a community'. Factors were identified enabling student PA engagement with primary care paradigmatic trajectories including engaging students with a degree of responsibility in service provision. Barriers to engagement included ignorance regarding the PA role, and reverence of medical students as a 'gold standard'. A conceptual model is proposed detailing the student process of engagement with primary care trajectories, encapsulating how this process influences emerging career identity. This model could be used to optimise student PA engagement in learning about, and coming to identify with, primary care careers.

Cancer Survivorship Care Roles for Primary Care Physicians

PURPOSE

Despite a burgeoning population of cancer survivors and pending shortages of oncology services, clear definitions and systematic approaches for engaging primary care in cancer survivorship are lacking. We sought to understand how primary care clinicians perceive their role in delivering care to cancer survivors.

METHODS

We conducted digitally recorded interviews with 38 clinicians in 14 primary care practices that had national reputations as workforce innovators. Interviews took place during intense case study data collection and explored clinicians' perspectives regarding their role in cancer survivorship care. We analyzed verbatim transcripts using an inductive and iterative immersion-crystallization process.

RESULTS

Divergent views exist regarding primary care's role in cancer survivor care with a lack of coherence about the concept of survivorship. A few clinicians believed any follow-up care after acute cancer treatment was oncology's responsibility; however, most felt cancer survivor care was within their purview. Some primary care clinicians considered cancer survivors as a distinct population; others felt cancer survivors were like any other patient with a chronic disease. In further interpretative analysis, we discovered a deeply ingrained philosophy of whole-person care that creates a professional identity dilemma for primary care clinicians when faced with rapidly changing specialized knowledge.

CONCLUSIONS

This study exposes an emerging identity crisis for primary care that goes beyond cancer survivorship care. Facilitated national conversations might help specialists and primary care develop knowledge translation platforms to support the prioritizing, integrating, and personalizing functions of primary care for patients with highly complicated issues requiring specialized knowledge.

How do veterinary students engage when reflecting on their development towards being veterinary surgeons?

BACKGROUND

Reflection has been widely acknowledged to contribute to professional development, the ability to manage tension and enhanced resilience. However, many practitioners struggle to reflect productively due to a lack of clarity of what constitutes effective reflection.

METHODS

To help develop reflective competence among future professionals, 30 veterinary students' reflective assignments were analysed by thematic text analysis. Theoretical frameworks were based on published criteria for critical and core reflection.

RESULTS

Reflection was described through resources (the tools used), practices (the ways of using these tools) and outcomes (what was achieved). This helped to distinguish simple skills based reflection from higher-level core reflection. Simple skills-based reflection was associated with an identity of expert learner: students perceive that their task is to identify a knowledge deficit that can be easily rectified through new learning. Core reflection was associated with students articulating an identity of adaptable professionals: rather than veterinary challenges being resolved simply through application of a body of knowledge, wider complexities of professional practice are recognised, including a need to resolve tension between their own and other stakeholders' priorities, values and beliefs.

CONCLUSION

Scaffolding an iterative, cyclical reflection process may support outcomes oriented towards resilience and the management of tension.

Professional identity: A concept analysis

The purpose of this study is to give clarity to the concept of professional identity, drawing from health-related fields to help provide a common language and understanding for research and practice. Professional identity, professionalism, professional socialization, and other related terms are often used without a clear definition or with conflicting definitions. This can lead to misunderstandings and assumptions that complicate research and confuse educators and professionals in guiding novice members. Concept analysis. Initially, 737 articles were identified by searching CINAHL, PubMed Central, Google Scholar, Academic Search Complete, PsyINFO, and SocINDEX for the period 2000 to 2019. Finally, 68 studies met the inclusion criteria, 60 of which are discussed in this concept analysis. This concept analysis uses the method described by Walker and Avant. This concept analysis clarifies the definition of professional identity, using literature from health and related professions, as containing the attributes: skills and functions; knowledge values and ethics; personal identity; group identity; and the influence of the context of care. A more clear definition of professional identity will help researchers to have more precision in their analyses and provide mentors and educators with a clear goal.

Embodying health behaviours in everyday life: the social and gendered practices of female senior managers

Objective: This article extends current theorising around health behaviours using insights from a study with women working in senior management positions in Switzerland. The study aimed to explore the meanings they attached to their everyday activities and examine implications for health and wellbeing by drawing on 1) social practices theory, 2) a socio-constructionist approach to gender, and 3) conceptualisations of embodiment.Design: Twenty female senior managers were interviewed at two time points six months apart: the first interview elicited highly-detailed, descriptive accounts of activities during the previous day, while in the second interview participants reflected on their previous accounts and discussed the meanings they ascribed to their activities. A thematic and narrative analysis of both sets of transcripts was conducted.Results: Three main themes captured the ways female senior managers talked about their everyday behaviours, all focused around their bodies: 'Functional bodies: Being on-the-go and meeting responsibilities'; 'Limiting bodies: Threats to everyday activities'; and 'Intentional bodies: Activities for wellbeing'.Conclusions: Results are considered in terms of contemporary postfeminist/neoliberal discourses in Western societies, how these are shaping and affecting everyday practices and subjectivities, and their consequences for women's health and wellbeing at work.

Academic Self-Efficacy, Social Support, and Professional Identity Among Preservice Special Education Teachers in China

The relationship among the social support, professional identity, and academic self-efficacy (ASE) of Chinese preservice special education teachers are explored by measuring the perceived social support, professional identity, and ASE of 302 undergraduate students. Results of the multiple regression are as follows. (1) A significant positive correlation exists among ASE, social support, and professional identity. When preservice special education teachers perceive high social support, they have a high sense of professional identity and high ASE. (2) Professional identity exerts a full mediation effect on the relationship between social support and ASE. In particular, social support positively influences ASE via professional identity. The results are discussed at the end of this paper and recommendations for improving the ASE of preservice special education teachers are presented.

Boundary-crossings among health students in interprofessional geropsychiatric outpatient practice: Collaboration with elderly people living at home

This qualitative research explores interprofessional learning among health students within a mental health outpatient setting. The focus is on how they manage to establish a boundary-crossing community of practice. Six final year students from medicine, occupational, and physical therapy, divided into two groups, visited elderly clients living at home on two occasions. Based on an assessment of the client, they had to consider suitable health and social initiatives to enhance quality of life, health outcomes, and wellbeing. The students then had to produce a jointly written health record documenting their professional and interprofessional evaluations. Two facilitators participated in the home visits and documented them through field notes. Focus group interviews conducted before and after the home visits and at the final seminar, together with health record documents, were audio-taped, coded, and thematically analyzed. Iterative reflexive analysis combined the findings with relevant research and theory from social and experiential learning. The findings show how boundary-crossing strengthened client-centeredness and students' knowledgeability, and how the intervention became more beneficial and qualitative. New insights were obtained from reflecting on and discussing professional stereotypes, identity, and roles. Writing the health record together enabled the students to reach a common ground.

Reflective Writing as a Window on Medical Students' Professional Identity Development in a Longitudinal Integrated Clerkship

Phenomenon: Integral to the formation of a professional identity is the concept of professional identity construction, an essential part of becoming a competent physician. In this framework, identity is dynamic and shaped by experiences and relationships. Minimal work has addressed the impact that clinical care settings and relationships with patients have in the construction of professional identity for medical students. This study explores how patient interactions and intentional curriculum design support professional identity construction in students participating in a longitudinal integrated clerkship focused on care for the underserved. Approach: This qualitative analysis investigated students' professional identity construction as detailed in 45 reflective essays from 15 students while enrolled in an 11-month longitudinal integrated clerkship (LIC) in a safety-net hospital system. Researchers used an inductive analytic approach. Findings: Students provided rich and complex descriptions of their experiences. Six themes emerged: care for the underserved; therapeutic alliance; humility and gratitude; altruism; resilience; and aspirations. Insights: Professional identity construction was observable through students' reflective essays. Student interactions with patients provided rich material for professional identity construction, and role models in patient care enhanced this process. This study suggests that clinical learning in a safety-net hospital system, coupled with an LIC curriculum that prioritizes continuity with vulnerable patients, faculty role models, and ongoing reflection, supported the professional identity construction of students as patient-centered caregivers providing equitable care and advocacy for the underserved, described here as an Equity Identity.

An Interprofessional Approach to Teaching Advocacy Skills: Lessons from an Academic Medical-Legal Partnership

Medical students and educators recognize that preparing the next generation of health leaders to address seemingly intractable problems like health disparities should include advocacy training. Opportunities to acquire the knowledge and skills needed to effectively advocate at the policy level to promote systems-, community-, and population-level solutions are a critical component of such training. But formal advocacy training programs that develop and measure such skills are scarce. Even less common are interprofessional advocacy training programs that include legal and policy experts to help medical students learn such skills. This 2016-2017 pilot study started with a legislative advocacy training program for preclinical medical students that was designed to prepare them to meet with Capitol Hill representatives about a health justice issue. The pilot assessed the impact of adding an interprofessional education (IPE) dimension to the program, which in this case involved engaging law faculty and students to help the medical students understand and navigate the federal legislative process and prepare for their meetings. Results from the pilot suggest that adding law and policy experts to advocacy-focused training programs can improve medical students' advocacy knowledge and skills and increase their professional identity as advocates.

What does it mean to be a physician? Exploring social imaginaries of first-year medical students

OBJECTIVES

To explore if community embedded discussions with local community members reshape the social imaginary of medicine among students and contribute positively to their professional identity.

METHODS

This explorative, qualitative study involved 35 first-year medical students who volunteered to attend a 2-hour forum at a local church to ask community members about their experiences with doctors and healthcare systems.  Student participants were asked to reflect on five structured questions. The written reflections were submitted for analysis, de-identified, and analyzed using Glaser's classic grounded theory, constant comparative analysis, and Taylor's model of modern social imaginaries as an analytical lens.

RESULTS

The results indicate that student participants identified seven main themes regarding what community members expect from their doctors, including active listening (n=22), physical touch (n=18), and compassion (n=16). Responses also indicated that only 5.6% of the students felt that the preclinical curriculum was adequately preparing them for what local community members identified as important to patient care. However, students recognized that two aspects of the curriculum, Physical Diagnosis (n=12) and volunteering/community engagement (n=9), were congruent with the expectations of future patients.

CONCLUSIONS

The results suggest that students identified educational experiences that were congruent with the social imaginary of patients. However, patient expectations were discordant to some aspects of the medical imaginary of medical students. The experience and subsequent reflections may be salient to contributing to each student's professional identity and provide a model for other medical schools to explore how the curriculum is fulfilling the community's perception of ideal patient care.

Advanced Nurse Practitioners' (Emergency) perceptions of their role, positionality and professional identity: A narrative inquiry

AIMS

To explore Advanced Nurse Practitioners' (ANP) (Emergency) perceptions of their role, positionality and professional identity.

BACKGROUND

Advanced nursing practice was formally established in the Republic of Ireland in 2001 with 336 ANPs currently registered, projection increasing to a critical mass of 750 by 2021. Advanced practitioners (Emergency) give full emergency care for a specific cohort of clients with unscheduled, undifferentiated and undiagnosed conditions.

DESIGN

Qualitative narrative inquiry using Bourdieu's concepts of habitus, field and capital as the theoretical framework was undertaken.

METHODS

Data were collected in 10 in-depth interviews and thematic analysis applied.

RESULTS

Five key themes emerged: participants' career pathways, personal and professional transitions, role dimensions and core concepts, and position in the organization and emergent professional identity. Role transitioning and a change in habitus, field and capital revealed the uniqueness of their nursing role. Minimizing waiting times, timely patient care and patient satisfaction were key performance indicators. A heightened awareness regarding higher-level decision-making, autonomy and accountability is integral to advanced practice.

CONCLUSION

This study presents unique insights into the ANP role covering recruitment, organizational culture changes required and support to ease transition emerged.

IMPACT

Better understanding the motivation to undertake the role, the transition experience and use of advanced practice skills sets will inform the targets for the future recruitment and retention of ANPs are met nationally and internationally. Dissatisfaction with previous management roles and wanting to be clinically close to patients were motivations to follow an advanced practice clinical career trajectory. Positionality and emergent professional identity are key enablers ensuring that advanced practitioners' roles demonstrate the attributes of advanced practice. Educators could use the findings to develop recruitment, retention and progression strategies. Disseminating the role and scopes of practice could positively influence collaborative models of service delivery and policy development.

From context to contexting: professional identity un/doing in a medical leadership development programme

Physicians are known for safeguarding their professional identities against organisational influences. However, this study shows how a medical leadership programme enables the reconstruction of professional identities that work with rather than against organisational and institutional contexts to improve quality and efficiency of care. Based on an ethnographic study, the results illustrate how physicians initially construct conflicting leadership narratives - heroic (pioneer), clinical (patient's guardian) and collaborative (linking pin) leader - in reaction to changing organisational and clinical demands. Each narrative contains a particular relational-agentic view of physicians regarding the contexts of hospitals: respectively as individually shapeable; disconnected or collectively adjustable. Interactions between teachers, participants, group discussions and in-hospital experiences led to the gradual deconstruction of the heroic -and clinical leader narrative. Collaborative leadership emerged as the desirable new professional identity. We contribute to the professional identity literature by illustrating how physicians make a gradual transition from viewing organisational and institutional contexts as pre-given to contexting, that is, continuously adjusting the context with others. When engaged in contexting, physicians increasingly consider managers and directors as necessary partners and colleague-physicians who do not wish to change as the new 'anti-identity'.

Exploring the Impact of Participating as Pharmacy Camp Counselors on Student Pharmacists' Professional Identity

Objective. To explore how participation as a pharmacy camp counselor impacted pharmacy students' professional identity and views on professionalism. Methods. A pharmacy camp was developed to introduce rising high school juniors and seniors to the pharmacy profession. First- and second-year student pharmacists were invited to serve as counselors and, afterward, to participate in a focus group to share their experiences. Researchers used the focus group data to explore the impact of the camp experience on the student pharmacists. A direct interpretation approach was used to examine data as it allowed the research team to assess this single instance and draw meaning from focus group findings. Categories/themes were constructed through the interpretations of patterns and relationships discovered within the deconstructed results. Results. Ten student pharmacists participated in the focus group. The students provided their perspectives on the camp experience, including their role as camp counselors, the campers attending the camp, and the differences observed between student pharmacists and non-pharmacy camp counselors. Student pharmacists' comments gravitated toward the topic of professionalism. Student pharmacist counselors recognized positive and negative models of professionalism and made personal judgments concerning these concepts. Conclusion. Inclusion of student pharmacists in leadership roles such as this proved to be an effective means for further developing professional attributes. The focus group feedback provided novel insights into the professional mindset of student pharmacists. After serving as camp counselors, student pharmacists described their new perspectives on the importance of professionalism in their individual journeys, among their peers, and as future student pharmacists.

"A Taste of Real Medicine": Third Year Medical Students' Report Experiences of Early Workplace Encounters

INTRODUCTION

Medical students extend their preparatory learning on entering the clinical work environment, by joining their clinical team as peripheral participants and start to care for "real" patients. This learning is situated, experiential, varied, mainly unstructured, highly dependent on clinical opportunities (affordances), and students' motivation to learn (learner agency). Students ideally contribute to workplace activities, which allow their practical skills, confidence and professional identity to evolve. This study sought to investigate senior students' perspectives in their early stages of workplace learning, by using social learning theory as a framework. The focus is on team integration, practical skills performance, professional development and their evolving professional identity.

METHODS

Between 2015 and 2018, we conducted five focus groups, with a total of 36 volunteers, out of a possible 200 (18% Stage 3 (Year 3)) medical students. Each focus group session was audio recorded and transcribed verbatim. Participants were de-identified, and framework analysis used the theoretical frameworks of communities of practice, and workplace affordances to gain insight into their work-place learning experience during the first two months of their clinical rotation.

RESULTS

Thirty-six students out of 200 (18%) attended focus groups over a four-year period. The results are presented using the theoretical frameworks of community of practice and workplace affordances and presented as themes of: meaning, "learning as experience", practice, "learning as doing" community, "learning as belonging", and identity, "learning as becoming".

DISCUSSION

Participants reported many positive examples of workplace learning while dealing directly with patients. Students were also exposed to ethical dilemmas and unexpected risks in the workplace. These included lack of site orientation, unsupportive teams, lack of supervision, and students' inability to initiate agency, all of which contributed to their workplace uncertainty. Performing manageable tasks for their team provided a role in their community of practice, strengthening their identity as evolving doctors. Exposure to both positive and negative role models allowed students to reflect on ethical issues, further extending their own professional identities.

SUMMARY

Participants were quick to observe and report workplace dynamics as they were exposed to the positive and negative aspects of the hidden curriculum. This allowed them to reflect on patient safety, and ethical concerns promoting the development of their professional identity.

Using Focus Groups to Explore Evolving Perceptions of Student Pharmacists' Curricular Experiences

Objective. To explore student pharmacists' shared experiences as they transitioned through the first three years of a Doctor of Pharmacy curriculum, from dependent learners to autonomous contributors. Methods. The researchers used interpretive phenomenology to examine the lived experiences of student pharmacists. Previously gathered focus group data for 309 student pharmacists from the 2015-2016 academic year were explored. A step-wise approach to data analysis was used to perpetuate the natural emergence of themes and alignment with theory. Utilizing Arthur Chickering's Seven Vectors of Identity Development as a lens, the researchers analyzed findings related to self-realization and identification of purpose. Results. The research team identified several themes associated with the teaching and learning process: professionalism, autonomy, and managing the expectations of the curriculum. A connection between the researchers' findings and Chickering's seven vectors was seen as students' comments demonstrated their progress along the vectors over three academic years. Conclusion. This exploration provided a glimpse into the lived experiences of student pharmacists at three different stages in their journey from dependent learners to autonomous contributors. By comparing students in one year with those in the next, the researchers were able to see the evolution that occurred over time as students became self-authored individuals, which is the ideal outcome for pharmacy graduates.

Pre-entry perceptions of students entering five health professions: implications for interprofessional education and collaboration

Dysfunctional interprofessional teams are a threat to health system performance and the delivery of quality patient outcomes. Implementing strategies that prepare future health professionals to be effective collaborators requires a comprehensive understanding of how early professional socialization and professional identity formation occur. We present findings from a qualitative study, grounded in narrative methodology, examining early professional socialization among students across five health professional programs (dentistry, medicine, nursing, pharmacy, physiotherapy) in the first year of health professional training. Between April and September 2015, students (n = 49) entering programs at an Atlantic Canadian University participated in one-on-one, audiotaped interviews starting before formal program orientation. Pre-entry interviews focused on factors influencing students' career choice and expectations of future profession and interprofessional collaboration (IPC). Findings revealed that many different experiences influenced participants' career choice and framed the social positioning of their future career (e.g., leadership, prestige, autonomy). Participant narratives revealed the existence of stereotypes pertaining to their chosen and other health professions. Study findings provided insights that may help strengthen initiatives to promote positive professional identity formation within the context of IPC. Implications of this research highlight the need for the early introduction of IPC including pre-entry recruitment messaging for prospective health professionals.

Interprofessional identity development within a brief shadowing experience: An exploratory case study

The Deans' Interprofessional Honors Colloquium (DIHC) is an honors-level interprofessional elective course that provides a seminar-based forum for students from eleven academic programs to explore the characteristics and implications of collaborative interprofessional practice around a contemporary health topic. This project-based course combines didactic presentations, interactive group learning, and an interprofessional shadowing experience with a corresponding written reflection paper. Ten semesters of Interprofessional Shadowing Reflections (n = 401) were studied via thematic and content analyses to examine the extent to which a brief interprofessional shadowing experience influenced interprofessional identity development. Interprofessional socialization framework was employed as a lens to refine themes and to track students' trajectory in developing a dual professional identity. This exploratory case study indicated that nearly all participants' reflections included content indicative of the second stage (interprofessional role learning) of the interprofessional socialization framework, and many progressed toward the third stage (dual identity development). Major themes included emergent role learning, increased differentiation among roles and care models, and increased appreciation for other professionals. The experience provided an opportunity for correction of misconceptions and improved understanding of the role and practice of other professions. Nearly all of the participating students (1) reflected on the benefits of interprofessional collaboration and (2) indicated a desire to work interprofessionally in the future, an early indication of dual identity formation. Findings indicated that the interprofessional shadowing experience and written reflection were highly valuable elements of the DIHC and provided a critical opportunity for interprofessional identity development.

Interprofessional education as a contributor to professional and interprofessional identities

According to the World Health Organization interprofessional education (IPE) is a necessary step in preparing a collaborative practice-ready health work force. However, the processes of developing professional identity within interprofessional education programs have not been fully explored and require a deeper understanding. Participation in interprofessional education groups may influence the development of professional identity including increased awareness of one's own profession-specific competence as well as socialization into a professional role. Interprofessional education is a dynamic social process related to students' memberships in IPE-groups. We conducted focus groups with representatives from students in seven different professional education programs involved in interprofessional education during all three years of their educational programs. We used the principles of systematic text condensation as an analytical frame. This article is a contribution toward grasping how IPE can contribute to both professional and interprofessional identity. Group collaboration in interprofessional education enabled students to identify with their profession as well as creating a safe place to gain insight into other professions' competencies. Moreover, students could obtain knowledge about being a professional participant and could enrich their professional identity, as they were involved with students from other professions. IPE-groups strengthened professional identity rather than threatened it.

Do emotional labour strategies influence emotional exhaustion and professional identity or vice versa? Evidence from new nurses

AIMS

The aim was to examine the reciprocal relationships of emotional labour strategies with emotional exhaustion and professional identity.

DESIGN

This study adopted a four-wave cross-lagged panel design.

METHODS

Survey data were collected in 2018 from a sample of 171 newly hired nurses from 58 hospitals in 11 provinces of China. Nurses' emotional labour (i.e., deep acting and surface acting), emotional exhaustion and professional identity were repeatedly measured. Cross-lagged panel analyses were conducted to examine the reciprocal relationships we hypothesized.

RESULTS

We found that emotional exhaustion was positively related to surface acting (but not vice versa); deep acting was negatively related to emotional exhaustion (but not vice versa); professional identity was positively related to deep acting (but not vice versa).

CONCLUSION

Our findings suggest that deep acting and professional identity may decrease the level of emotional exhaustion, whereas emotionally exhausted nurses are more likely to employ surface acting strategies.

IMPACT

This research finding will have an impact on the nursing management. Healthcare managers may consider workshops or training and development programs that promote nurses' professional identify to promote nurses' use of deep acting and consequently reduce their level of emotional exhaustion, which has been associated with a variety of negative consequences, such as low quality of patient service, high medical accidents, and turnover rate.

The hidden curriculum: Undergraduate nursing students' perspectives of socialization and professionalism

BACKGROUND AND AIM

Nursing students form a professional identity from their core values, role models, and past experiences, and these factors contribute to the development of their professional identity. The hidden curriculum, a set of ethics and values learned within a clinical setting, may be part of developing a professional identity. Nursing students will develop a professional identity throughout school; however, their identity might be challenged as they attempt to balance their core values with behaviors learned through the hidden curriculum. The purpose of this project was to educate students on the hidden curriculum in the development of their professional identity.

MATERIALS AND METHODS

A sample of 112 senior nursing students was recruited from a northeastern university in the United States for this study. Pre-post survey design was used, and an educational session was administered prior to the post-survey. Descriptive statistics and a valid percentage were used to describe the data within the surveys.

ETHICAL CONSIDERATION

Study was approved by the author's University Institutional Review Board.

FINDINGS

A significant finding was for advocacy as students would speak up if witnessing inappropriate behavior toward patients or families with a mean score increase from 2.50 (pre-survey) to 1.45 (post-survey). Also, over 95% (n = 106) found the educational session beneficial as they learned they had the ability to advocate and speak up for their patients.

CONCLUSION

Students were able to use their core values and advocate for their patients and families which allows for safer patient care.

'I wish I was someone else': complexities in identity formation and professional wellbeing in veterinary surgeons

BACKGROUND

There is widespread concern surrounding veterinarians' mental health. Upon entering the profession, early career veterinary surgeons encounter colleagues with diverse and conflicting identities, manifesting in their differential prioritisation of definitive clinical treatment, interpersonal interactions or the commercial success of the practice. In other professions, poor wellbeing arises from confusion between these conflicting identity discourses, as new professionals attempt to identify role models aligned with their own identity beliefs. New veterinarians' wellbeing may thus depend on their negotiation of different identities, as they construct their own sets of professional values and determine the type of veterinarian they wish to become.

METHODS

Identity formation was explored narratively using veterinarians' social media stories.

RESULTS

Poor professional wellbeing appeared to arise from identity confusion: failure to consistently commit to either the dominant diagnosis-focused discourse valued by academic role models, or a relational discourse, emphasising working through contextual challenges such as varying client needs. Workplace stress appeared to magnify the dominance of academic priorities in self-identity understanding, worsening identity confusion. Also concerning was the positioning of the client 'as enemy', obstructive to veterinarians' identity goals. Social dialogue, intended to provide support during veterinarian-client conflict, potentially reinforced rejection of the client from the veterinary professional identity, strengthening a context-inappropriate, non-relational identity. This worsened identity confusion between the prized 'diagnostic identity' and the locally valued relational identity and was detrimental to wellbeing.

CONCLUSIONS

Interventions are required, within veterinary education and postgraduate continuing professional development, that encourage reflection on identity and reinforce the value of relational identity attributes.

Developing a comprehensive career development scale for public health nurses in Japan

OBJECTIVES

This study aims to develop a scale that can comprehensively measure public health nurses'(PHNs) career development and to verify the validity and reliability of that scale.

DESIGN AND SAMPLES

This study is a cross-sectional investigation. The participants were 1,009 PHNs working in a government facility in Japan. A total of 586 participants who had been working for more than 3 years as PHNs were analyzed.

MEASUREMENTS

Anonymous self-response questionnaires included items on professional awareness, practical competency, and job satisfaction. We conducted exploratory factor analysis and confirmatory factor analysis to clarify the construct validity of the scale. The reliability was examined by the Cronbach's α coefficient. The validity was examined by an external reference relevant validity and the known-group method.

RESULTS

The scale was structured with 32 items covering three factors: "community activities, policy, and management," "PHN identity," and "foundations as a PHN." The Cronbach's α coefficients were all greater than 0.9. In confirmatory factor analysis, the scale showed acceptable goodness of fit.

CONCLUSIONS

The comprehensive career development scale for PHNs proved its reliability and validity. This scale may be useful to promote PHN identity and competency comprehensively in basic education and in-charge education.

Nursing and medical students near-peer activity in the anatomy laboratory: format for success

BACKGROUND/AIMS

An anatomy interprofessional near-peer learning activity (AIP-NPLA) between nursing and medical students was piloted to assess its implementability. This study aimed to: (1) identify key factors of feasibility and (2) describe student-group perceptions of their experience of the interprofessional education (IPE) activity.

METHODS

A total of 59 medical and 179 nursing students participated in the AIP-NPLA whereby medical students were asked to facilitate and lead group discussions with their nursing students colleagues on an anatomical topic using a donor cadaver. Each AIP-NPLA session lasted a total of two hours. A mixed methods approach was employed using both quantitative and qualitative means of assessment. Variables such as Readiness for Interprofessional Learning, Professional Self-Identity, Clinical Teaching Preference, and Near-Peer Teaching and Learning Experience were assessed quantitatively using validated surveys. Qualitative measures included thematic content analysis of focus group interviews conducted following the AIP-NPLA to capture the perceptions of the student groups' experience in the IPE activity.

RESULTS

The results of this investigation demonstrated that there are key factors to consider when designing successful and sustainable IPE activities; the level of clinical exposure and therefore student-group pairing based on professional self-identify scores, optimal tutor-to-tutee group ratios and an activity format that maintained an informal, flexible and free forum for discussion on a topic of common knowledge. Focus group interviews also revealed reflections on professional stereotypes.

CONCLUSION

These findings suggest that early implementation of IPE activities outside of a clinical setting are beneficial and can foster both learning from one another and positive perceptions of interprofessional roles when carefully designed.

Organizational Culture and Job Demands and Resources: Their Impact on Employees' Wellbeing in a Multivariate Multilevel Model

(1) The present study aims to explore the impact of job demands and resources (JDR), personal resources, and the organizational culture on workers' wellbeing and health. (2) A cross-sectional survey of Spanish workers in small and medium-sized enterprises (SMEs) was conducted with a sample of 1599 workers from 154 SMEs. A multivariate multilevel analysis was performed to analyze the different relationships. (3) In light of the results obtained, we observed that job demands were negatively associated with workers' health, while job resources were positively correlated to workers' health and wellbeing. Secondly, the different types of identification at work are positively related to job satisfaction and organizational citizenship behaviors (OCBs), but the intensity of this association differs with the form of identification. Finally, at the organization level, the dimensions of organizational culture are related differently to employees' job satisfaction, OCBs, and health; (4) these results confirm the role of organizational culture and its association with desirable outcomes, allowing us to expand the JDR model.

Design and Evaluation of a Professional Identity Development Program for Pharmacy Students

Objective. To design and evaluate a professional identity program (PIP) based on self-determination theory (SDT) for entering Bachelor of Pharmacy (BPharm) students. Methods. The PIP, which featured autonomy-supportive teaching approaches, was delivered as 10 workshops that were integrated into existing pharmacy courses over the first four semesters (2 years) of the BPharm program. The program was evaluated using a student satisfaction survey and two previously validated tools for measuring professional identity (MCPIS-9) and motivation to study pharmacy (Pharm-S). Nonparametric statistical techniques were used to compare students' scores before and after introducing the PIP. Results. Students responded positively to the introduction of the PIP in the pharmacy program. Based on survey responses, the students valued opportunities to engage in activities and discussions related to professional development and identity formation. Student scores on the motivation-based tool (Pharm-S) increased by the end of the first year of participation in the PIP, indicating an increase in student autonomy levels. There was no change in students' scores on the professional identity measure (MCPIS-9) after the first year. Conclusion. The use of SDT-based instruction in professional identity education resulted in increased levels of autonomy in pharmacy students, indicating a transition to more intrinsic levels of motivation. This has the potential to positively impact student professional identity and future professional practice.

Exploring the development and identity of advanced practice nursing in the UK

The development of advanced nurse practice in the UK has been slow compared to some parts of the world. This article explores the history of advanced level nursing, the drivers for advanced nurse practice in the context of contemporary nursing and clinical leadership, the identity of advanced practice nursing roles, and the importance of advanced nurse practice in the UK.

The novel role of paramedics in collaborative emergency centres aligns with their professional identity: A qualitative analysis

OBJECTIVE

The Collaborative Emergency Centre (CEC) model of care was implemented in Nova Scotia without an identifiable, directly comparable precedent. It features interprofessional teams working towards the goal of providing improved access to primary health care, and appropriate access to 24/7 emergency care. One important component of CEC functioning is overnight staffing by a paramedic and registered nurse (RN) team consulting with an off-site physician. Our objective was to ascertain the attitudes, feelings and experiences of paramedics working within Nova Scotia’s CECs.

METHODS

We conducted a qualitative study informed by the principles of grounded theory. Semi-structured telephone interviews were conducted with paramedics with experience working in a CEC. Analysis involved an inductive grounded approach using constant comparative analysis. Data collection and analysis continued until thematic saturation was reached.

RESULTS

Fourteen paramedics participated in the study. The majority were male (n=10, 71%) with a mean age of 44 years and mean paramedic experience of 14 years. Four major themes were identified: 1) interprofessional relationships, 2) leadership support, 3) value to community and 4) paramedic identity.

CONCLUSIONS

Paramedics report largely positive interprofessional relationships in Nova Scotia’s CECs. They expressed enjoyment working in these centres and believe this work aligns with their professional identity. High levels of patient and community satisfaction were reported. Paramedics believe future expansion of the model would benefit from development of continuing education and improved communication between leadership and front-line workers.

Authenticity made visible in medical students' experiences of feeling like a doctor

OBJECTIVES

To interpret the phenomenon of authenticity made visible in medical students' experiences of feeling like a doctor, i.e., how authenticity took shape in narratives about feeling like a doctor in clinical situations where students were challenged to be independent and to a high degree make choices and clinical decisions.

METHODS

The conducted research was positioned within phenomenological hermeneutic research tradition, interpreting participants' experiences in a life-world perspective using narrative inquiry. Fifteen medical students in their fifth year were interviewed focusing on clinical situations. An abductive analysis approach was used to discover patterns and to interpret data following a phenomenological hermeneutic research method for textual interpretation.

RESULTS

The analysis resulted in a thematic structure of findings: Opportunity to experience authenticity through creating relationships; Opportunity to experience authenticity through responsibility; Opportunity to experience authenticity through independence, managing wholeness, and follow-up processes; Opportunity to experience authenticity through being able to reason and discern. Overarching the four themes was the perceived need for attachment, i.e. attachment to patients, to supervisors, to the workplace, to the situation and reasoning and knowledge.

CONCLUSIONS

Essential for the experience of feeling like a doctor was authentic situations that resulted in the experienced members of a community of practice and the perceived development of a professional identity. These findings can advance the understanding of how clinical education should be organized to facilitate professional identity development.

Affective and Cognitive Empathy in Pre-teachers With Strong or Weak Professional Identity: An ERP Study

Pain empathy is influenced by a number of factors. However, few studies have examined the effects of strength of professional identity on pain empathy in pre-service teachers. This study used the event-related potential (ERP) technique, which offers a high temporal resolution, to investigate the neurocognitive mechanisms of pain empathy in pre-teachers with strong or weak professional identity. The N110 and P300 components have been shown to reflect an individual's emotional sharing and cognitive evaluation in pain empathy, respectively. The results of the current study show that pre-teachers with strong professional identity showed a significant difference in N110 amplitudes evoked towards painful and non-painful stimuli; whereas pre-teachers with weak professional identity did not show a significant difference in the amplitudes evoked by the two stimulus types. For the P300 component, pre-teachers with weak professional identity showed a significant difference in the amplitudes evoked towards painful and non-painful stimuli; whereas pre-teachers with strong professional identity did not show a significant difference in the amplitudes evoked by the two stimulus types. Our results indicate that pre-teachers with strong professional identity show a higher level of pain empathy than those with weak professional identity.

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Practice placements are highlights of student nurses' professional training. They are an important opportunity for students to learn as an extension to the theoretical teachings. Coming at the end of the training, the eight-week practice placement allows students to really immerse themselves in the profession. A student shares her experience discovering palliative care.

Professional Role Identity: At the Heart of Medical Collaboration Across Organisational Boundaries

Purpose:

The purpose of this paper was to help answer two persistent calls in the literature: the first asks to strengthen the understanding of medical collaboration across levels of healthcare delivery; the second one requests paying more attention to the individual experience of different forms of professional work. Accordingly, the study was guided by the following research question: How do family physicians and specialists working at different levels of healthcare delivery enact their professional identity when interacting in their situated clinical contexts?

Methodology:

This was a multiple interpretive case study in which, based on Giddens’ ideas, professional identity was viewed as a dynamic structural element of social life recursively related to professionals’ collaborative actions through sensemaking processes. The study involved 57 participants. Face-to-face individual semi-structured interviews and organizational documents were the main sources of data. Deductive-inductive thematic analysis was adopted as strategy for data analysis.

Findings:

Three prevailing physicians’ identity roles were elicited: medical expert, care coordinator, and team member. These professional identities, not mutually exclusive, were instantiated in three specific modalities of collaboration: quasi-inexistent, restrained, and extended. The entanglement of a particular identity role and a specific collaborative practice became meaningful through a complex net of organizational and institutional features, and patients’ nosological profiles.

Implications of a wide-scale educational intervention to engage nurses in evidence-based practice: The Italian RN4CAST experience

BACKGROUND

In Italy, there are still many barriers to the development of a culture of evidence-based practice (EBP) and nurses' knowledge of EBP is lacking. Additionally, in Italy there are still very few advanced practice registered nurses to significantly contribute to the development of EBP.

AIM

This aims to identify the implications of a wide-scale nursing education intervention to engage clinical nurses in EBP through the Italian RN4CAST study.

METHODS

A qualitative study based on a thematic analysis. A total of 800 clinical nurses actively participated in nine training sessions across Italy. At the end of each training session written feedback data were collected and then underwent thematic analysis.

RESULTS

All participants were strongly motivated to engage in EBP thanks to their involvement in the RN4CAST project. With regard to the implications of EBP, the thematic analysis produced the following themes: Professional identity; Quality of care; Perceptions of patients and nurses; Research impact; and Organization.

CONCLUSIONS

The involvement of a large number of clinical nurses in a research project raised their awareness about the advantages of engaging in EBP, and how evidence can be used to raise motivation to change current practice policies.