A Video Analysis of Intra- and Inter-professional Leadership Behaviours Within “The Burns Suite”: Identifying Key Leadership Models

Objective Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of “The Burns Suite” (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. Methods A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen’s κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos. Results All 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence “maintaining standards”), followed by making decisions. Although in terms of total frequency the senior surgeon engaged in more leadership behaviors compared with the entire team, statistically there was no significant difference between all 4 members within the 8 leadership categories. This analysis highlights that “distributed leadership” was predominant, whereby leadership was “distributed” or “shared” among team members. The leadership behaviors within TBS also seemed to fall in line with the “direction, alignment, and commitment” ontology. Conclusions Effective leadership is essential for successful functioning of work teams and accomplishment of task goals. As the resuscitation of a patient with major burns is a dynamic event, team leaders require flexibility in their leadership behaviors to effectively adapt to changing situations. Understanding leadership behaviors of different team members within an authentic simulation can identify important behaviors required to optimize nontechnical skills in a major resuscitation. Furthermore, attempting to map these behaviors on to leadership models can help further our understanding of leadership theory. Collectively this can aid the development of refined simulation scenarios for team members, and can be extrapolated into other areas of simulation-based team training and interprofessional education.

Myths and Realities of Inter-professional Working

Introduction: Childhood cancers are rare and community based health care professionals have limited experience in caring for these children and often even less experience in providing their palliative care. It is well recognised that the provision of palliative care falls beyond the remit of any one profession, thus inter professional working is the standard model. This qualitative study aims to examine the experiences of the range of health care professionals involved in providing palliative care at home for children with cancer, focusing on how knowledge is exchanged; the level of communication and support both interprofessionally and at the community/specialist interface. It also aims to examine interprofessional collaboration in palliative care; identifying healthcare professional's perceptions of problems involved, interprofessional boundaries, specific areas of the organisation or provision of care that could be enhanced through changes in practice, support issues and the educational needs of health professionals. Methods The study involves three types of data collection; in-depth interviews, facilitated case discussion (FCD) and field notes from up to 20 cases (a "case" refers to the provision of palliative care to one child). Cases are selected from children who were treated at one regional childhood caner centre. For each case the community based health care professionals (for example the GP, community nurse or health visitor) involved in the care of the child at home are invited to participate in a one-to-one tape recorded in-depth interview followed by a group discussion in the form of a FCD. Field notes are completed following each interview. Data analysis follows a grounded theory approach. The term "social worlds theory" (SWT) his used to define a type of social organisation with no fixed or formal boundaries (such as membership boundaries), for example the range of health professionals that work together to provide palliative care. The boundaries of SW's are determined by the interaction and communication between recognised organisations, such as community nursing teams and general practitioners. SWT examines encounters between different professional groups and can be used to extend knowledge in both the organisation (for example general practice) and the content of what is being provisioned (for example, palliative care). The use of SWT in the analysis of the data is through examining the ethos of the different professions and the associated individual approaches to palliative care, exploring how this determines their roles in the provision of palliative care. Results 10 cases have so far been completed: 47 1:1 interviews (with a range of between 2-7 health care professionals being involved in each case): ( 9 x GP, 19 x CCN, 4 x DN, 3 x HV, 1 x HV assistant 7 x paediatric palliative care nurses, 1 x home support worker, 1 x OT, 1 x physiotherapist, 1 x community paediatrician) and 5 x FCD. The range of participants in the FCDs reflected that of the individual interview sampler. Data obtained to date gives clear insight into the personal experience of the individual health care professional in providing palliative care. Two themes emerging from the data will be focused upon: the continuity of care provision throughout treatment and palliation and the emotional burden experiences by the health care professional. Conclusions SWT can provide a useful framework in examining the social worlds of a disparate group of health care professionals working together for the first and maybe, the only time. A wide variation in the continuity of care provision has been found not only between professions, but also within professions. The emotional burden is evident across the professions.

Caring for Children Dying from Cancer at Home: a Qualitative Study of the Experience of Primary Care Practitioners

Background. The rarity of childhood cancers makes providing palliative care in the community an unusual event for primary care practitioners. Providing this care requires effective interprofessional collaboration with the team that forms to provide the care often working together for the first and only time. Objective. To explore the experiences of primary care practitioners following their involvement in the palliative care of a child with cancer at home. Methods. The study design was a community-based qualitative study. The study location was the West Midlands region. Purposeful sample of GPs and community nurses involved in providing palliative care to 12 children. One-to-one in-depth interviews with 47 primary care professionals (10 GPs and 37 community nurses) and 5 facilitated case discussions were undertaken. Field notes were documented and grounded theory data analysis undertaken: chronological comparative data analysis identifying generated themes. Results. GPs had minimal input into the preceding care of children undergoing treatment for cancer but sought to re-establish their role at the child’s transition to palliative care. GPs felt they had a role to play and could add value to this phase of care, highlighted their continuing role with the child’s family and acknowledged that they had gained from the experience of contributing. However, lack of specialist knowledge and uncertainty about their role within the team made this more challenging. In contrast, community nurses were routinely involved in both active treatment and palliation care phases. There was little evidence of collaboration between the specialist and primary care professionals involved. There was considerable variation in out of hours provision across cases. Conclusions. Engaging primary care practitioners needs to be more actively anticipated and negotiated at the transition to palliation. Variation in out of hours care is another cause for concern. Enhancing inter-professional collaboration and planning during both active and palliative care phases may help. Keywords. Cancer, family medicine, palliative care, paediatric.

Using Social Worlds Theory to Explore Influences on Community Nurses’ Experiences of Providing Out of Hours Paediatric Palliative Care

Abstract Background: Paediatric oncology palliative care in the community is rare and nationally there is a lack of standardisation of out of hours nursing service provision. Objectives: This paper seeks to explore influences on the experiences of paediatric nurses providing out of hours palliative care within the family home to children with cancer. The study used social worlds theory to aid identification and demonstration of the findings. Methods: Twelve community-based palliative cases were purposively selected from children with cancer treated at one regional centre. Tape-recorded interviews were undertaken with 54 health professionals (general practitioners, community nurses and allied health professionals) involved in providing their palliative care and five facilitated case discussions completed. Data analysis followed a grounded theory approach; chronological comparative data analysis identifying generated themes. Social worlds theory was used as a framework to examine the data. Results: Nurses’ experiences are shaped by their social world and those of the nursing team,child and family and the inter-professional team providing the care. The lack of a formalised service, sub-optimal inter-professional working and impact of social worlds influence the experience of the nurse. Conclusions: Social worlds theory provided a new perspective in understanding these experiences based within a paediatric palliative care setting, knowledge that can be used to inform service provision.

The Personal and Professional Selves of Teachers: Stable and Unstable Identities

In much educational literature it is recognised that the broader social conditions in which teachers live and work, and the personal and professional elements of teachers' lives, experiences, beliefs and practices are integral to one another, and that there are often tensions between these which impact to a greater or lesser extent upon teachers' sense of self or identity. If identity is a key influencing factor on teachers' sense of purpose, self‐efficacy, motivation, commitment, job satisfaction and effectiveness, then investigation of those factors which influence positively and negatively, the contexts in which these occur and the consequences for practice, is essential. Surprisingly, although notions of ‘self’ and personal identity are much used in educational research and theory, critical engagement with individual teachers' cognitive and emotional ‘selves’ has been relatively rare. Yet such engagement is important to all with an interest in raising and sustaining standards of teaching, particularly in centralist reform contexts which threaten to destabilise long‐held beliefs and practices. This article addresses the issue of teacher identities by drawing together research which examines the nature of the relationships between social structures and individual agency; between notions of a socially constructed, and therefore contingent and ever‐remade, ‘self’, and a ‘self’ with dispositions, attitudes and behavioural responses which are durable and relatively stable; and between cognitive and emotional identities. Drawing upon existing research literature and findings from a four‐year Department for Education and Skills funded project with 300 teachers in 100 schools which investigated variations in teachers' work and lives and their effects on pupils (VITAE), it finds that identities are neither intrinsically stable nor intrinsically fragmented, as earlier literature suggests. Rather, teacher identities may be more, or less, stable and more or less fragmented at different times and in different ways according to a number of life, career and situational factors.

A Multinational Health Professional Perspective of the Prevalence of Mood Disorders in Patients with Acute and Chronic Wounds.

Recent research has started to identify mood disorders and problems associated with acute and chronic wounds, which have been shown to contribute to delayed healing, poor patient well-being and a reduced quality of life. Furthermore, mood disorders have been shown to have a negative impact on financial costs for service providers and the wider society in terms of treatment and sickness absence. This study aimed to survey a multinational sample of health professionals to explore their perspective and awareness of mood disorders amongst acute and chronic wound patients. Responses were received from n = 908 health professionals working in Asia, Africa, Australia, Europe, North America and South America. A strong awareness of the prevalence of mood disorders appeared to be widespread among the health professionals across the world, in addition to a view on the potential factors contributing to these problems with mood. Despite this, it was thought that few patients were actually receiving treatment for their mood disorders. Implications for clinical practice include the need for health professionals to actively engage with their patients to enable them to learn from their experiences. Studies that explore the benefits of treatments and techniques appropriate for minimising mood disorders in patients with wounds would provide empirical evidence for health professionals to make recommendations for patients with acute and chronic wounds.

Best Practice for Providing Social Care and Support to People Living with Concurrent Sight Loss and Dementia: Professional Perspectives

Purpose-Approximately 100,000 people in the UK aged 75 and over have concurrent dementia and sight loss, but current understanding of their experiences, needs and preferences is limited. The purpose of this paper is to report on a research project that explored the provision of social care and support for older people with both conditions. Design/methodology/approach-The project was a collaboration between the universities of York, Worcester, Bournemouth and Cambridge, supported by the Thomas Pocklington Trust and the Housing and Dementia Research Consortium. Data for this paper were drawn from focus groups held in 2013 involving 47 professionals across the dementia, sight loss and housing sectors. Findings-Thematic analysis identified five main barriers to providing high-quality, cost-effective social care and support: time constraints; financial limitations; insufficient professional knowledge; a lack of joint working; and inconsistency of services. The requirements of dementia and sight loss often conflict, which can limit the usefulness of equipment, aids and adaptations. Support and information needs to address individual needs and preferences. Research limitations/implications-Unless professionals consider dementia and sight loss together, they are unlikely to think about the impact of both conditions and the potential of their own services to provide effective support for individuals and their informal carers. Failing to consider both conditions together can also limit the availability and accessibility of social care and support services. This paper is based on input from a small sample of self-selecting professionals across three geographical regions of England. More research is needed in this area. Practical implications-There are growing numbers of people living with concurrent dementia and sight loss, many of whom wish to remain living in their own homes. There is limited awareness of the experiences and needs of this group and limited provision of appropriate services aids/adaptations. A range of measures should be implemented in order to support independence and well-being for people living with both conditions and their family carers. These include increased awareness, improved assessment, more training and greater joint working. Social implications-People living with dementia or sight loss are at high risk of social isolation, increasingly so for those with both conditions. Services that take an inclusive approach to both conditions can provide crucial opportunities for social interaction. Extra care housing has the potential to provide a supportive, community-based environment that can help residents to maintain social contact. Originality/value-This paper adds much-needed evidence to the limited existing literature, and reflects the views of diverse professionals across housing, health and social care

Legal, Ethical and Professional Issues

The chapter addresses the professional, legal and ethical issues associated with medicines management and the role of the nurse. To ensure safe practice it is imperative safeguards are recognised and applied; therefore pertinent legislative frameworks, policy and professional regulation are discussed. Safeguarding patients when administering prescribed medicines means the nurse must have up-to-date knowledge and skill and a key aspect of this is to ensure consent to treatment from the service user is secured; for this reason drawing on relevant legislation, the consensual process is reviewed. Not infrequently medicine management provokes ethical and legal challenges for the health care professional; these demand reflection and careful consideration; consequently in this chapter legal and ethical parameters and professional boundaries are appraised.

Changing Professional Identity in the Transition from Practitioner to Lecturer in Higher Education: an Interpretive Phenomenological Analysis

This research explores the experiences of five professional practitioners from disciplines including teaching, youth work, sport and health who had become lecturers in Higher Education. Their experiences are considered using Interpretative Phenomenological Analysis and tentative conclusions are reached on the meaning of such experiences for the individuals. The work extends previous studies (Shreeve 2010, 2011; Gourlay 2011a, 2011b; Boyd & Harris 2010) to consider the relationship between knowledge and influence and how institutional preference for knowledge gained from research impacts on the validity of knowledge derived from professional experience. The research finds shared feelings associated with inauthenticity and loss arising from concerns that the contribution of the professional in Higher Education is undervalued. The research challenges the assumption that professional practitioners adopt the professional identity of a lecturer in Higher Education instead finding that they create their own professional identities in the liminal space between the professional and academic domains, but points to difficulties associated with constructed nature of such professional identities within the institutional structure of a Higher Education institution.

Unpacking the Link Between Entrepreneurialism and Employability: an Assessment of the Relationship Between Entrepreneurial Attitudes and Likelihood of Graduate Employment in a Professional Field

Purpose This research investigates the relationship between students’ entrepreneurial attitudes and traits and their classification of employment six months after university graduation. It aims to identify what specific attitudes and traits of entrepreneurial graduates are linked to employability in a professional or managerial field. Design/Methodology The research adopts a quantitative approach to measure the entrepreneurial drive of final-year undergraduate business school students and regresses this measurement against the employment level of the same students six months after their graduation. The employment classification of each respondent was classified as ‘professional/managerial’ or ‘non-professional/non-managerial’, in line with the Standard Occupational Classification (SOC) 2010. Findings The research found that both proactive disposition and achievement motivation were statistically linked to the likelihood of graduates being employed in a professional or managerial position six months after graduation. Originality/Value This research goes beyond existing literature linking entrepreneurship to employability to quantitatively examine what specific attitudes and traits can be linked to employability in recent graduates. By identifying the aspects of entrepreneurialism that have a relationship with employability, more information is available for educators who are designing entrepreneurial education programs and allows for greater focus on aspects that may be of greatest benefit to all students.

A Global Portrait of Counselling Psychologists’ Characteristics, Perspectives, and Professional Behaviors

Counselling psychologists in eight countries (Australia, Canada, New Zealand, South Africa, South Korea, Taiwan, the United Kingdom, and the United States) responded to survey questions that focused on their demographics as well as their professional identities, roles, settings and activities. As well, they were asked about satisfaction with the specialty and the extent to which they endorsed 10 core counselling psychology values. This article reports those results, focusing both on areas in which there were between-country similarities as well as on those for which there were differences. These data provide is a snapshot of counselling psychology globally and establish a foundation for the other articles in this special issue of the journal.

Conceptualizing and Researching the Professionalization of Religious Education Teachers: Historical and International Perspectives

Current discussions on Religious Education (RE), both in Germany and England, focus on the quality of teaching and the professionality of teachers, but neglect the historical and institutional process of professionalization upon which conceptions of teaching quality and teacher professionality hinge. This article seeks to provide definitional clarity by differentiating between individual and collective professionalization; exploring teacher professionalization in general and in the special case of RE; and operationalizing the concept of RE teacher professionalization for the purposes of planned historical and international comparative research. A three-fold conceptualization of professionalization is proposed, consisting of the following inter-related levels: (1) initial and continuing professional development; (2) professional self-organization and professional politics; and (3) professional knowledge. The breadth, complexity and significance of the historical and institutional processes associated with the professionalization of RE teachers at each of these levels is described and discussed. It is argued that further historical and international comparative research on these lines would contribute a broader and deeper understanding of the presuppositions of RE teacher professionality beyond current debates.

The Professionalisation of Non-Denominational Religious Education in England: Politics, Organisation and Knowledge

In response to contemporary concerns, and using neglected primary sources, this article explores the professionalisation of teachers of Religious Education (RI/RE) in non-denominational, state-maintained schools in England. It does so from the launch of Religion in Education (1934) and the Institute for Christian Education at Home and Abroad (1935) to the founding of the Religious Education Council of England and Wales (1973) and the British Journal of Religious Education (1978). Professionalisation is defined as a collective historical process in terms of three inter-related concepts: (1) professional self-organisation and professional politics, (2) professional knowledge, and (3) initial and continuing professional development. The article sketches the history of non-denominational religious education prior to the focus period, to contextualise the emergence of the professionalising processes under scrutiny. Professional self-organisation and professional politics are explored by reconstructing the origins and history of the Institute of Christian Education at Home and Abroad, which became the principal body offering professional development provision for RI/RE teachers for some fifty years. Professional knowledge is discussed in relation to the content of Religion in Education which was oriented around Christian Idealism and interdenominational networking. Changes in journal name in the 1960s and 1970s reflected uncertainties about the orientation of the subject and shifts in understanding over the nature and character of professional knowledge. The article also explores a particular case of resistance, in the late 1960s, to the prevailing consensus surrounding the nature and purpose of RI/RE, and the representativeness and authority of the pre-eminent professional body of the time. In conclusion, the article examines some implications which may be drawn from this history for the prospects and problems of the professionalisation of RE today.

Supporting Completion of an Online Continuing Professional Development Programme For Newly Qualified Practitioners: a Qualitative Evaluation

Background: Development programmes to support newly qualified practitioners gain confidence in their first professional role often show varied levels of engagement, due to competing priorities and demands. In Scotland, the Flying Start NHS® programme uses a structured programme of online and work-based learning with associated mentoring, to support individuals through an often difficult transition to become capable, confident practitioners. . Whilst the programme was generally well received, the factors leading to widely varying completion rates between professions and organisations were not well understood. Aim: to identify the factors leading to successful completion of Flying Start, a transition programme for newly qualified practitioners. Method: A qualitative approach was adopted to gather data from two groups of participants. Semi-structured telephone interviews were conducted with strategic and management level participants (n=23), from five health boards in Scotland. Semi-structured interviews (n=22) and focus groups (n=11) were conducted with practitioners within 6 months either side of completing the programme. The interviews were transcribed and analysed using framework analysis. Results: Four key themes related to successful completion emerged from the analysis: organisational support; the format of the programme; understanding completion; motivation and incentives to complete. Factors leading to successful completion were identified at programme, organisational and individual level. These included clear communication and signposting, up-to-date and relevant content, links with continuing professional development frameworks, effective leadership, mentor and peer support, setting clear standards for assessment, and facilitating appropriate IT access. Conclusions: A strong strategic commitment to embedding a development programme for newly qualified practitioners can ensure the necessary support is available to encourage timely completion. The mentor’s role - to provide face-to-face support - is identified as a key factor in completion and is achieved through setting attainable targets, monitoring progress, and providing motivation. However organisational structures that facilitate the mentoring relationship are also necessary.