Whose experts? How federalism shaped psychiatry in the late Habsburg monarchy

The late Habsburg period (1867-1918) created a constitutional dual monarchy of Austria-Hungary. This paper discusses the role of psychiatry in Cisleithania, both as a developing profession and as a distinct 'policy field'. Tension between psychiatry's academic professionalisation and the creation of public institutions as signature projects by individual crownlands created complex relationships between psychiatry and politics. In federalist Cisleithania, psychiatrists became very 'political': whether employed by the state or a crownland influenced their position on policy, despite claiming that their expert knowledge was 'scientific' and 'objective'. The conflicts between asylum-based and academic psychiatrists mirrored those between the central state and the crownlands. This led to intractable delays in mental health law reform, eventually resolved by Imperial decree in 1916.

The historical sociology of medicine in India: Introduction to the special section

This introduction to a special section brings together three papers first presented at a panel, 'Medical Professions in South Asia: Historical and Contemporary Analyses', at the 26th European Conference on South Asian Studies, held in Vienna, Austria and online, in July 2021. All three papers deal with aspects of the professionalisation of biomedical doctors in India since its independence in 1947. The authors bring together historical and sociological approaches to illuminate the growth of specialisms, patterns of practitioner-patient interactions and efforts to maintain occupational closure and maintain status in the face of growing challenges. The introduction concludes with a discussion of the relevance of these papers for the sociology of health and illness in India and beyond.

Impacts of ethical climate and ethical sensitivity on caring efficacy

BACKGROUND

Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses.

RESEARCH AIM

This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy.

RESEARCH DESIGN

This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively.

PARTICIPANTS AND RESEARCH CONTEXT

The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants.

RESULTS

Ethical climate was associated with caring efficacy (β = 0.340, p < .001) and ethical sensitivity (β = 0.197, p < .001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy (β = 0.860, p < .001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect.

CONCLUSIONS

The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses' caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation.

Bereavement care reimagined

Bereavement, a specific kind of grief in response to a death, has been embedded in human history, in cultural patterns, with ritual, ceremony, and community kindness being the mainstay of grief support. The advent of professionalised grief counselling has seen the increasing domination of professional support as the best way to support someone bereaved, with a consequent loss of the varied forms of community support. The availability of professional grief counselling is limited, with only a small percentage of bereaved people accessing it or needing to access it. In this article, we argue for a realignment of professional grief services, strengthening community actions, and reorientation of health care in keeping with the Ottawa Charter for Health Promotion. Community sources of grief support are being reinvented in multiple ways. Professional services can develop links and relationships with these communities of support. A population-based public health approach to bereavement care is needed. This can only be achieved through communities and professionals working together. This partnership working underlines three implications for practice. These are (I) love and friendship must be the bedrock of support for grief and loss and the strengthening of these supports should be the priority for all therapeutic and social actions, (II) the multiple and varied community and civic sector sources of grief support should be the mainstay of the bereaved, and (III) bereavement professionals should work in the context of community, linking their clients with sustainable community supports.

Key Maternity Care Stakeholders' Views on Midwives' Professional Autonomy

Advancement towards the professionalism of midwifery is closely linked to midwives' professional autonomy. Although the perspectives of Belgian midwives on their professional autonomy have been studied, the views of other maternity care stakeholders are a blind spot. The aim of this study, therefore, was to explore maternity care stakeholders' views on Belgian midwives' professional autonomy. A qualitative exploratory study was performed using focus group interviews. A heterogenous group of 27 maternity care stakeholders participated. The variation between midwives, with different levels of autonomy, was reported. The analysis of the data resulted in five themes: (1) The autonomous midwife is adequately educated and committed to continuous professional further education, (2) The autonomous midwife is competent, (3) The autonomous midwife is experienced, (4) The autonomous midwife assures safe and qualitative care, and (5) The autonomous midwife collaborates with all stakeholders in maternity care. A maternity collaborative framework, where all maternity care professionals respect each other's competences and autonomy, is crucial for providing safe and quality care. To achieve this, it is recommended to implement interprofessional education to establish strong foundations for interprofessional collaboration. Additionally, a regulatory body with supervisory powers can help ensure safe and quality care, while also supporting midwives' professional autonomy and professionalisation.

Between virtue and profession: Theorising the rise of professionalised public participation practitioners

Participatory planning practice is changing in response to the rise of specially trained public participation practitioners who intersect with but are also distinct from planners. These practitioners are increasingly being professionalised through new standards of competence defined by their industry bodies. The implications of this are not well accounted for in empirical studies of participatory planning, nor in the theoretical literature that seeks to understand both the potential and problems of more deliberative approaches to urban decision-making. In this paper, we revisit the sociological literature on the professions and use it to critically interrogate an observed tension between the 'virtues' of public participation (justice, equity and democracy) and efforts to consolidate public participation practice into a distinct profession that interacts with but also sits outside of professional planning.

Community Learning Centres (CLCs) for Adult Learning and Education (ALE): development in and by communities

Institutionalised forms of adult learning and education (ALE) such as community learning centres (CLCs) and related models are found in most parts of the world. These are spaces offering opportunities for literacy and skills training, health and citizenship, general, liberal and vocational education, in line with fuller recognition of the meaning of lifelong learning, and in the context of local communities. Often these institutions form the basis for even more informal and participatory learning, like study circles and community groups. They may share facilities like libraries and museums, clubs and sports centres, which are not within the remit of the Ministry of Education. This article reviews relevant literature and identifies recent studies and experiences with a particular focus on the Asia-Pacific and Africa regions, but also considers insights related to interventions at the global level. Findings point to low levels of participation of adults in general, and more specifically so for vulnerable and excluded groups which can hardly cross respective barriers. The authors' discussion is guided by the question What conditions are conducive to having more and better ALE for lifelong learning - and which roles can CLCs and other community-based ALE institutions play? This discussion is timely - the authors argue that CLCs need to be given more attention in international commitments such as those made in the context of the International Conferences of Adult Education (CONFINTEA) and the United Nations 17 Sustainable Development Goals (SDGs). CLCs, they urge, should be part of transformative discourse and recommendations at CONFINTEA VII in 2022.

Vision Testing in Late Nineteenth- and Early Twentieth-Century Britain: Opticians, Medical Practitioners and the Battle for Professional Authority

In the 1890s, opticians were reforming their practice against a body of medical practitioners who were increasingly attempting to specialise in, and monopolise, vision testing and spectacle dispensing. This article explores how and why vision testing became a subject of debate and how opticians were able to successfully set out their claims to professional authority in the face of medical competition. It argues that opticians created a scientific rhetoric distinctive from medical training by combining optics and anatomy. In response, medical practitioners attempted to consolidate the medicalisation of an area of the body through claiming completely new, and potentially unfounded, areas of expertise and medical jurisdiction. A study of the optician's role in the 1890s demonstrates the broader influence of fringe professions, commercial marketing and the public's receptiveness to the construction of expertise in enabling but ultimately inhibiting the medicalisation process, an outcome that medical practitioners had to grudgingly accept.

Professional development for spiritual care practitioners: a program review

Professional development is a crucial aspect for further successful progression of an individual's skills and effective function in their role. It is also a compulsory part of registration for most professionals in the health care sector. This article reports on the evaluation of a monthly professional development program, specifically for spiritual care practitioners, offered over the period 2017-2019 by Spiritual Health Association (Victoria, Australia) and its partners. Many common themes such as motivation, culture, purpose and areas for improvement have been identified and are further examined. Recommendations such as greater emphasis on the professionalism in the sector, broader inclusions of sessions across culture and ethnicity and the development of cross disciplinary communication skills are made for the future of this program.

[Temporality in nursing research: a metronome for the benefit of quality?]

Time is a key element of the nursing research process, notably because it is lacking in daily life and is subject to strict regulations. Engage in a nursing research project thereby forces the researcher to review the time available, to rethink nursing practice. It can therefore prove to be a useful tool in the organisation of are and the improvement of practices.

Professional boundary struggles in the context of healthcare change: the relational and symbolic constitution of nursing ethos in the space of possible professionalisation

The paper draws on Bourdieu's conceptualisation of the symbolic order and his little used concept of ethos in order to gain novel understandings of boundary struggles between nursing and medicine as well as internally in nursing. The constituents of boundary struggles are analysed in the context of healthcare transformation, focusing on organisational, institutional and political boundary undertakings. Changing conditions for boundary demarcations and professionalisation include a preference for evidence-based knowledge and practice, seen as a remedy against common problems in health care. The paper shows how nurses use the changes in 'the space of possible professionalisation' in their struggle for professionalisation when they expand their scope of practice and embark on what is conceptualised as a curing ethos, where nursing is understood as a discipline performing practices that lead to cure. However, this is repudiated by the medical profession at all levels. Moreover, curing stands opposed to the caring ethos in nursing and boundary struggles surface as 'ethos confrontation' between caring- and curing-oriented nurses in practice. The boundary struggles analysed in this paper raise important questions about healthcare manageability and the development of sustainable professional environments.

Can empathy be preserved in medical education?

OBJECTIVES

The aim of this study was to investigate changes in empathy during medical education, as well as to identify promoters and inhibitors of empathy and analyse their roles.

METHODS

We used qualitative content analysis to examine 69 critically reflective essays written by medical students as a part of their final examination at the end of the medical program. The essays were based on previous self-evaluations performed each term and represented retrospective reflections on their professional development.

RESULTS

A majority of the students felt that their empathy did not decrease during medical education. On the contrary, many felt that their empathy had increased, especially the cognitive part of empathy, without loss of affective empathy. Many of them described a professionalisation process resulting in an ability to meet patients with preserved empathy but without being overwhelmed by emotions. They identified several factors that promoted the development of empathy: a multiplicity of patients, positive role models, and educational activities focusing on reflection and self-awareness. They also identified inhibitors of empathy: lack of professional competence and a stressful and empathy-hostile medical culture.

CONCLUSIONS

Our analysis of these retrospective reflections by students suggests that empathy can be preserved during medical education, despite the presence of important inhibitors of empathy. This finding might be due to the presence of more potent promoters and/or to the fact that educational activities might result in a decreased susceptibility to empathy-decreasing circumstances.

[The impact of digital technology in healthcare]

The digitisation of health areas, care, training, research and innovation has an impact on the work, skills and knowledge of health professionals. This requires permanent professionalisation and a digital learning organisation.

[From new ICT to digital technology in healthcare]

In the field of healthcare, IT has been constantly evolving for decades. It has revolutionised and professionalised the practices of healthcare workers. It has helped to improve traceability, reliability, information exchange and continuity of care. New information and communication technologies have also contributed to the development of research.

[Producing, transferring and using scientific knowledge for the benefit of patients]

By combining clinical reasoning and evidence-based practice, nurses can create a virtuous circle which can in turn increase the probability of obtaining satisfactory clinical results for patients. Nursing research must thereby benefit practice by producing scientific knowledge which can be used in day-to-day care.

[Assessment of students' knowledge and pathological processes]

Nurses' initial training is undergoing academisation against a backdrop of the omnipresence of digital technologies in the teaching methods. Trainer managers who support the students in their learning process towards professionalisation are re-evaluating their teaching approaches and in particular the assessment of knowledge in order to fit the quality of training to the needs of the healthcare system. This article presents an example around the theme of pathological processes.

Developing Professional Identity in Undergraduate Pharmacy Students: A Role for Self-Determination Theory

Professional identity development, seen as essential in the transition from student to professional, needs to be owned by the universities in order to ensure a workforce appropriately prepared to provide global health care in the future. The development of professional identity involves a focus on who the student is becoming, as well as what they know or can do, and requires authentic learning experiences such as practice exposure and interaction with pharmacist role models. This article examines conceptual frameworks aligned with professional identity development and will explore the role for self-determination theory (SDT) in pharmacy professional education. SDT explains the concepts of competence, relatedness and autonomy and the part they play in producing highly motivated individuals, leading to the development of one’s sense of self. Providing support for students in these three critical areas may, in accordance with the tenets of SDT, have the potential to increase motivation levels and their sense of professional identity.

A scoping review of interprofessional education within Canadian nursing literature

The purpose of this scoping review is to examine the nature of the interprofessional education (IPE) discussion that the Canadian nursing profession is having within the Canadian peer-reviewed nursing literature. An electronic database search of CINAHL was conducted using a modified Arksey & O'Malley scoping review framework. Peer-reviewed, English-language articles published in Canadian nursing journals from January 1981 to February 2016 were retrieved. Articles were included if they discussed IPE, or described an educational activity that met our conceptual definition of IPE. A total of 88 articles were screened, and 11 articles were eligible for analysis. Analysis revealed that this body of literature does not seem to be purposefully engaging Canadian nurses in a critical discourse about the role of IPE. The majority of articles located were reflective or commentaries. At the time of this review, there was a paucity of theoretically informed empirical research articles on IPE in the nursing literature. While IPE may be viewed by some critical scholars as a means of shifting the control of healthcare delivery traditionally held by medicine to other professions, our results suggest that this may not be the case in the Canadian nursing profession.

The professional humanitarian and the downsides of professionalisation

Criticisms lodged at humanitarian relief often include the belief that professionalisation is needed. The problems associated with humanitarianism would end, it is assumed, if the delivery of aid, and relief workers themselves, were more professional and 'business like'. To explore this further, the paper asks what comprises a profession, and offers four criteria: (1) specialisation of knowledge; (2) establishment of the profession as a livelihood; (3) organisation and institutionalisation; and (4) legitimacy and authority. A model for understanding professionalisation, as developed by the author, is then presented. The analysis compares six other professions against the same criteria to argue that the humanitarian community already constitutes a profession. Finally, three potential downsides of professionalisation are offered: the distance of the relief worker from the beneficiary, barriers to entry into the humanitarian sector, and adding to risk aversion and a decline in innovation. Based on these findings, professionalisation should be approached with some caution.

[Pediatric consultation receptionist, at the crossroads of two professions]

As part of the reorganisation of a paediatric consultations department, the observation of the reception staff and its analysis opened up a discussion around the hospital's usual approach of separating administrative and nursing activities. Focusing on theoretical concepts of clinical analysis of work, the fonction of the reception staff was analysed in detail, revealing at the same time its invisible, often indescribable character.

Reason, emotion, compassion: can altruism survive professionalisation in the humanitarian sector?

The humanitarian sector has grown enormously over the past two decades. Some fear that professionalisation comes at the expense of altruistic volunteering. This may be a valid concern if altruism is the product of organisational culture and individual experiences rather than an innate trait. This paper examines advances in evolutionary biology and neurology that provide evidence in support of both the nature and nurture arguments, echoing earlier insights from social sciences. It then questions to what extent humanitarian principles build on altruistic impulses or instead seek to constrain them, and reviews recruitment profiles of selected humanitarian organisations and applicants' letters accordingly. This initial investigation warrants further research to identify how altruism as a personal trait and an organisational principle has influenced diverse humanitarian actors and traditions. This paper outlines how training curricula and organisational reward systems can build on-rather than stifle-natural altruism to nurture critical, reflexive practitioners.

Nursing education reform in South Africa--lessons from a policy analysis study

BACKGROUND

Nursing education reform is identified as an important strategy for enhancing health workforce performance, and thereby improving the functioning of health systems. Globally, a predominant trend in such reform is towards greater professionalisation and university-based education. Related nursing education reform in South Africa culminated in a new Framework for Nursing Qualifications in 2013.

OBJECTIVE

We undertook a policy analysis study of the development of the new Nursing Qualifications Framework in South Africa.

DESIGN

We used a policy analysis framework derived from Walt and Gilson that interrogated the context, content, actors, and processes of policy development and implementation. Following informed consent, in-depth interviews were conducted with 28 key informants from national and provincial government; the South African Nursing Council; the national nursing association; nursing academics, managers, and educators; and other nursing organisations. The interviews were complemented with a review of relevant legislation and policy documents. Documents and interview transcripts were coded thematically using Atlas-ti software.

RESULTS

The revision of nursing qualifications was part of the post-apartheid transformation of nursing, but was also influenced by changes in the education sector. The policy process took more than 10 years to complete and the final Regulations were promulgated in 2013. The two most important changes are the requirement for a baccalaureate degree to qualify as a professional nurse and abolishing the enrolled nurse with 2 years training in favour of a staff nurse with a 3-year college diploma. Respondents criticised slow progress, weak governance by the Nursing Council and the Department of Health, limited planning for implementation, and the inappropriateness of the proposals for South Africa.

CONCLUSIONS

The study found significant weaknesses in the policy capacity of the main institutions responsible for the leadership and governance of nursing in South Africa, which will need to be addressed if important nursing education reforms are to be realised.

The development of the specialism of emergency medicine: media and cultural influences

In this article we analyse, via a critical review of the literature, the development of a relatively new medical specialism in the United Kingdom, that of emergency medicine. Despite the high media profile of emergency care, it is a low-status specialism within UK medicine. The creation of a specialist College in 2008 means that, symbolically, recognition as a full specialism has now been achieved. In this article, we will show, using a sociology of professions approach, how emergency medicine defined itself as a specialism, and sought to carve out a distinctive jurisdiction. While, in the context of the UK National Health Service, the state was clearly an important factor in the development of this profession, we wish to develop the analysis further than is usual in the sociology of professions. We will analyse the wider cultural context for the development of this specialism, which has benefited from its high profile in the media, through both fictional and documentary sources.

Failing to professionalise, struggling to specialise: the rise and fall of health promotion as a putative specialism in England, 1980-2000

Significant attention has been paid to the history of public health in England during the final part of the twentieth century. Within this, however, the field that came to be known as specialist health promotion (SHP) has been relatively neglected. Between 1980 and 2000 those working in this field, generally known as health promotion specialists (HPSs), enjoyed a relative rise in policy and practice prominence before SHP was effectively abandoned by government and others charged with developing and sustaining public-health structures. This paper seeks to explain why the fall of SHP is important; to move towards explaining its rise and decline; and to argue for greater historical attention to be paid to an important but neglected field within health and health care. Essentially, SHP emerged from a set of loose and contingent practices known as health education. A range of important social, economic, organisational and political influences contributed to the slow construction of a putative specialism in health promotion, accompanied by the desire on the part of some (but not all) HPSs to ‘professionalise’ their role. Finally the projects of both specialisation and professionalisation failed, again as a result of then prevailing organisational and political influences. The importance of such a failure in a so-called era of public health is discussed. In the light of this, the paper concludes by briefly setting out an agenda for further research related to the history of SHP.

How to be a good professional: existentialist continuing professional development (CPD)

This article reflects on the construct and practice of continuing professional development (CPD) and its significance for the professional careers workforce. The article presents the idea of the CPD triad and considers how professional bodies, employers and individuals can each benefit from a practitioner's ongoing commitment to continuing professional development. The tension between the practitioner's quest for lifelong learning is set against professional body demands, leading to the conclusion that these are not necessarily mutually exclusive. Consideration is given to propositional, practical and procedural knowledge, and to overall competence. The article explores an existentialist approach to professional learning, and concludes that, along with personal agency, this could usefully be adopted by career practitioners to weather turbulent times.

Evidence-based medicine? Patient case studies in English surgical treatises, 1660-1700

The implications of the presence of case information included in English surgical treatises published from 1660 to 1700 are discussed. While such casework has been frequently examined and cited, the phenomenon of including case information in treatises has yet to be studied in any depth. The context, presentation and origins of the case information are discussed, and the reasons behind the inclusion of casework are explored in terms of "blame-narratives", teaching models and evidence-based medicine. It was found that, while the reasons behind the inclusion of case information varied, English surgeons practised evidence-based medicine. This finding is significant, as it proposes that evidence-based medicine was practised a century earlier than-and across the Channel from-its supposed first emergence in modern medical practice.

Student Corner

The struggle that nursing has experienced to gain just status and financial reward can be explained, at least in part, by examining dominant ideologies in Australian society today. For example, such ideologies devalue caring in various ways, and since caring is a basic tenet of nursing, these ideologies ultimately devalue nursing itself. This paper explores the way in which the image and role of nursing has been socially constructed in light of such hegemonic assumptions.