This document summarizes a presentation by Dr. Mark Bahnisch on the topic of "Medical Dominance" and the robustness of professional cultures in healthcare. It discusses how professional cultures, particularly within medicine, have proven resilient even in the face of changing educational, organizational, and policy agendas promoting interprofessional practice. This resilience may impact the success of initiatives aiming to shift governance models and drive organizational change. The presentation questions assumptions about erosion of medical dominance and explores how professional boundaries are reproduced culturally.
This document discusses healthcare occupations that operate outside of direct medical dominance, including allied health workers and complementary/alternative medicine (CAM) practitioners. It explains that allied health workers, though diverse, collectively support patient care but have faced constraints on their autonomy from the medically dominated healthcare system. CAM was historically the norm but faced challenges gaining legitimacy from biomedicine's rise in the late 19th century. Both allied health and CAM practitioners have struggled for professional recognition due to medical dominance maintaining control through subordination, limitation, exclusion and incorporation. Gender relations have also influenced their professionalization as roles dominated by women are more easily devalued. The document outlines some future directions including CAM potentially challenging medical dominance through growing public support, and allied health facing
This document discusses cultural and ethical issues in medical surgical nursing. It addresses key aspects of Indian culture including religion, language, social structure, family structure, health beliefs, diet and nutrition. It also discusses implications of cultural issues for healthcare, including family dynamics, diet, health remedies and cultural practices. The document then examines ethical issues nurses may face in clinical practice, with employers, colleagues, and in upholding personal excellence and the nursing profession. Specific bioethical issues are explored, such as end of life planning, euthanasia, organ transplantation, and frameworks for ethical decision making. Resources for addressing ethical dilemmas are also presented.
This document summarizes a seminar presentation on trends and issues in medical surgical nursing. It discusses major trends like reduced length of stay and increased technology. It also covers ethical and cultural issues in nursing care, including communication barriers and religious/family differences. Significant cultural aspects like health beliefs, language, and family structure are examined specifically for Indian culture. The conclusion emphasizes the importance of documentation to meet legal obligations and continue improving patient care.
2010 05 Hooker Cawley Leinweber PA Career Flexibilityrodhooker
1) Nearly half (49%) of physician assistants change specialties at some point in their careers, with 24% switching specialty classes.
2) Over four decades, physician assistants have demonstrated career flexibility in responding to changing healthcare needs by adapting their specialties.
3) This career flexibility could help address workforce shortages, such as in primary care, by incentivizing physician assistants to work in high-demand specialties.
The document discusses the evolving definitions of nursing from early conceptualizations to present-day characterizations. It traces how nursing has been defined by various nursing organizations and theorists over time. Early definitions described nursing as nourishing and protecting others, while more recent definitions emphasize health promotion, prevention, and optimization. The document also differentiates nursing's role in care from medicine's role in cure and examines how nursing meets the traditional criteria for a profession such as having its own body of knowledge and code of ethics.
The document discusses interdisciplinary training in healthcare. It defines interdisciplinary training as education that involves professionals from different disciplines learning together to improve patient outcomes. Current medical training programs are beginning to incorporate more interdisciplinary approaches. A proposed framework for interdisciplinary certification includes rotations of students from various fields like nursing, pharmacy, social work on collaborative healthcare teams. This would allow students to gain experience with an interdisciplinary approach while completing their primary training. The benefits of interdisciplinary training include improved understanding between professionals which can lead to more comprehensive patient care plans and better outcomes. Some challenges include the extra time and resources required for such an approach.
This document discusses trends and issues in medical-surgical nursing that nurses need to study. It identifies several key trends and issues, including a growing need for ethical decision making in health care, concerns over human rights, and a more educated and mobile health workforce. Nurses must understand these trends and issues to effectively adapt nursing education, research, management, and services to the changing health care environment.
This document discusses healthcare occupations that operate outside of direct medical dominance, including allied health workers and complementary/alternative medicine (CAM) practitioners. It explains that allied health workers, though diverse, collectively support patient care but have faced constraints on their autonomy from the medically dominated healthcare system. CAM was historically the norm but faced challenges gaining legitimacy from biomedicine's rise in the late 19th century. Both allied health and CAM practitioners have struggled for professional recognition due to medical dominance maintaining control through subordination, limitation, exclusion and incorporation. Gender relations have also influenced their professionalization as roles dominated by women are more easily devalued. The document outlines some future directions including CAM potentially challenging medical dominance through growing public support, and allied health facing
This document discusses cultural and ethical issues in medical surgical nursing. It addresses key aspects of Indian culture including religion, language, social structure, family structure, health beliefs, diet and nutrition. It also discusses implications of cultural issues for healthcare, including family dynamics, diet, health remedies and cultural practices. The document then examines ethical issues nurses may face in clinical practice, with employers, colleagues, and in upholding personal excellence and the nursing profession. Specific bioethical issues are explored, such as end of life planning, euthanasia, organ transplantation, and frameworks for ethical decision making. Resources for addressing ethical dilemmas are also presented.
This document summarizes a seminar presentation on trends and issues in medical surgical nursing. It discusses major trends like reduced length of stay and increased technology. It also covers ethical and cultural issues in nursing care, including communication barriers and religious/family differences. Significant cultural aspects like health beliefs, language, and family structure are examined specifically for Indian culture. The conclusion emphasizes the importance of documentation to meet legal obligations and continue improving patient care.
2010 05 Hooker Cawley Leinweber PA Career Flexibilityrodhooker
1) Nearly half (49%) of physician assistants change specialties at some point in their careers, with 24% switching specialty classes.
2) Over four decades, physician assistants have demonstrated career flexibility in responding to changing healthcare needs by adapting their specialties.
3) This career flexibility could help address workforce shortages, such as in primary care, by incentivizing physician assistants to work in high-demand specialties.
The document discusses the evolving definitions of nursing from early conceptualizations to present-day characterizations. It traces how nursing has been defined by various nursing organizations and theorists over time. Early definitions described nursing as nourishing and protecting others, while more recent definitions emphasize health promotion, prevention, and optimization. The document also differentiates nursing's role in care from medicine's role in cure and examines how nursing meets the traditional criteria for a profession such as having its own body of knowledge and code of ethics.
The document discusses interdisciplinary training in healthcare. It defines interdisciplinary training as education that involves professionals from different disciplines learning together to improve patient outcomes. Current medical training programs are beginning to incorporate more interdisciplinary approaches. A proposed framework for interdisciplinary certification includes rotations of students from various fields like nursing, pharmacy, social work on collaborative healthcare teams. This would allow students to gain experience with an interdisciplinary approach while completing their primary training. The benefits of interdisciplinary training include improved understanding between professionals which can lead to more comprehensive patient care plans and better outcomes. Some challenges include the extra time and resources required for such an approach.
This document discusses trends and issues in medical-surgical nursing that nurses need to study. It identifies several key trends and issues, including a growing need for ethical decision making in health care, concerns over human rights, and a more educated and mobile health workforce. Nurses must understand these trends and issues to effectively adapt nursing education, research, management, and services to the changing health care environment.
Linking clinical workforce skill mix planning to health and health care dynamicsIme Asangansi, MD, PhD
Current health workforce planning methods are inadequate for the complexity of the task. Most approaches treat the workforce supply of individual health professions in isolation and avoid quantifying the impact of changes in skills mix, either planned or unplanned. The causes and consequences of task delegation and task substitution between or within health professions is particularly important in handling workforce shortages in developing countries and understanding and planning possible responses to both rapid catastrophic health demands and slower background trends in their social and political environment. As well as the contextual environment, interactions and delays in supplying and balancing health resources and configuring clinical services are required to address the geographic, profession-specific and quality imbalances. These supply side resources include knowledge and research, skills and attitudes of clinicians, buildings and equipment, medications and medical technologies, information and communications technologies and any other methods and models to improve the provision of clinical services. The interaction between demand
and supply could adjust for feedbacks of health services outcomes, policies and governance on population expectations, funding, political and social supports and explicitly link these to clinical workforce supply in a useful, rigorous and relevant tool. The challenge is capture the relevant essence of the dynamic complexity of health and healthcare for this purpose.
Nursing in Nepal has undergone significant changes in recent decades due to trends in society, technology, and politics. As Nepal opened to the outside world in the 1950s, there were no professional nurses. Now nursing education varies from certificate to bachelor's degree programs. However, many qualified nurses have left Nepal for better opportunities abroad due to low pay and job dissatisfaction at home. This nursing exodus has created staffing shortages and inexperienced nurses in Nepal's health system. Nursing must achieve greater autonomy, recognition, and control over its profession to improve conditions and retain staff.
This document discusses culture and leadership in healthcare between the Middle East and Western world. It notes key differences in Middle Eastern culture, such as a stronger emphasis on family and developing personal relationships. Middle Easterners also have different views of time, personal space, and personal privacy. Western medical professionals need to understand these cultural differences to effectively serve Middle Eastern patients and work with their families. The document concludes that culture and leadership are important to healthcare everywhere, and leaders must address cultural issues to provide quality care.
This document discusses trends in the US healthcare workforce, including slower growth, an increasing number of older workers, and continued growth in racial and ethnic diversity. It also examines factors like social, human capital, and organizational barriers that can lead to disparities in career advancement for women and minorities. The document recommends that healthcare organizations adopt a systems approach to managing a diverse workforce through actions like community responsiveness, culturally proficient care, and leadership diversity.
This document discusses the importance of compassion and self-renewal for nurses. It defines compassion as sorrow or pity for others' suffering. While nurses have high levels of compassion, caring for others without caring for oneself can lead to burnout, fatigue, and unhealthy behaviors. The document outlines negative effects of lack of self-care, including loss of self-esteem, irritability, and physical symptoms like fatigue. It encourages nurses to develop self-care plans involving relaxation, breaks away from work, and meditation to replenish inner energy and serve as role models for holistic health. Barriers to self-care include lack of time, knowledge, skills, and motivation.
2011 08 Hooker Everett Primary Care Pa Reviewrodhooker
Physician assistants can contribute significantly to primary care systems. Studies show that PAs can provide comprehensive care, maintain accessibility and accountability comparable to physicians. While PAs perform many of the key
The development of gerontological nursing began in the early 20th century with the first articles on elder care published in nursing journals. Gerontological nursing established itself as a specialty area through the mid-20th century with the publication of textbooks and the formation of professional organizations focused on elder care. Gerontological nursing roles include healer, caregiver, educator, advocate, innovator according to holistic principles addressing elders' biological, psychological, social and spiritual needs to promote health and independence.
This document discusses trends and issues in nursing. It covers how nursing has evolved over time and will continue to change with advancements in technology and healthcare. Some key trends that will impact nursing include a shift to preventative care in the home and community rather than hospitals. Nurses will take on more prominent roles as primary care providers. There will also be challenges relating to rising costs, ethics, and ensuring access to and quality of care. The document also outlines issues in nursing education, services, and the workplace.
This document discusses trends and issues in nursing. It outlines how nursing will shift from hospitals to homes and communities, with a focus on prevention and patient outcomes. Nurses will be primary care providers for diverse services. There will also be challenges relating to ethics, costs, access, and quality of care. Globalization will bring opportunities and challenges as the work environment emphasizes cost-effectiveness and quality. The roles and responsibilities of nurses are changing as health care transitions to more community-based, evidence-based, and interdisciplinary models of care.
Perceptions of students with disabilities on support services provided in hig...Ambati Nageswara Rao
This document discusses a study on the perceptions of students with disabilities regarding support services at higher education institutions in Andhra Pradesh, India. It begins with an introduction describing the importance of education for persons with disabilities and the lack of access to higher education. It then describes the methodology which used a mixed methods approach, interviewing 100 students from 3 universities using purposive and snowball sampling. The findings section describes the demographic characteristics of respondents and their perceptions of support services. Overall, the study examines the experiences of students with disabilities and the need for universities to improve support services to promote inclusion.
Futuristic nursing and visibility of nursesVinodmohanan55
This document discusses future developments in nursing practice and strategies to increase the visibility of nursing. It outlines developments like expanding technology, genomic mapping, robotic nursing and space nursing. It also discusses factors affecting the visibility of nursing like handmaiden roles, hierarchical structures and nurses' views of themselves. Some strategies suggested to increase visibility include recruitment, enhancing public view, funding, relationships with administrators and governments, and role of media. The document emphasizes expanding professional knowledge and skills through higher education and research to advance the nursing profession.
This document discusses the importance of nurse-patient communication and therapeutic relationships in elderly care. It makes three key points:
1) Nurse-patient communication is crucial as it indicates the quality of the relationship and many elderly patients rely on nurses as their primary human contact.
2) Developing therapeutic relationships through communication is essential for effective nursing care, including understanding patients' needs and preferences.
3) Effective communication is needed to provide individualized care for elderly patients, who often have multiple medical issues or special communication needs.
The document provides a timeline and overview of the evolution of several advanced practice nursing roles from the 1800s to present day, including nurse anesthetists, nurse midwives, clinical nurse specialists, nurse practitioners, and physician assistants. It traces the development of these roles in response to societal needs and pressures from organized medicine. Key events included establishing educational standards, gaining prescriptive authority, and fighting for reimbursement and full recognition of their scope of practice. Resistance from physicians occurred when nursing roles competed for similar jobs or responsibilities.
TRANSCULTURAL NURSING AND FUTURISTIC NURSINGvishnu vm
The document discusses the history and principles of transcultural nursing. It describes transcultural nursing as interacting with different cultures in a nursing context, based on anthropology and supported by research. The goal of transcultural nursing is to provide culturally congruent care to people of all cultural backgrounds. It also discusses challenges of transcultural nursing and the need for cultural competence among nurses.
Interdisciplinary teamwork involves different healthcare professionals collaborating to provide patient care. An interdisciplinary team shares knowledge and skills to improve patient outcomes. It is a dynamic process requiring open communication and shared decision making between professionals with complementary backgrounds and skills working toward common health goals. The need for interdisciplinary teams is increasing due to factors such as an aging population with complex needs, more specialized knowledge required for patient care, and policies emphasizing multi-professional collaboration and continuity of care.
This document discusses transcultural nursing. It defines transcultural nursing as focusing on comparing and analyzing cultures with respect to nursing practices, beliefs, and values in order to provide culturally sensitive care. The document outlines outcomes of transcultural nursing including demonstrating understanding and respect for different cultures. It also discusses skills nurses need, such as cultural competence, and transcultural variations that should be considered like communication styles, concepts of space and time, biological factors, environmental control, and social institutions.
Physician shortages in Canada have been a topic of debate for decades. In the 1990s, there was a consensus that Canada had a physician surplus, but by the early 2000s policies shifted to increasing medical school enrolment and allowing more foreign graduates due to a perceived shortage. However, the causes of shortages are complex, with factors like physician migration to the US and preferences for specialty careers over family medicine contributing. While some argue for general increases in physician supply, others propose improving retention through addressing job satisfaction or focusing on primary care over specialties. There are differing views on how to best address physician resource issues in the Canadian healthcare system.
Building the frontline health workers: Strengthening the role and training o...Prashanth N S
Presentation made at the All India People's medical and health education conference organised in February 2015 by the All India People's Science Network by Tanya Seshadri & Prashanth N S
This document summarizes a certificate program on structural competence offered by the Center for Public Health Continuing Education. The program teaches practitioners to recognize how broader social, political, and economic factors impact patient vulnerability and health outcomes. It shifts the focus from individual beliefs and behaviors to the social contexts that influence health. The certificate includes webinars on various racial/ethnic groups that discuss histories of oppression, sociopolitical health barriers, and community engagement. The goal is to empower practitioners to address health inequities and stigma.
This document discusses the need to address biases that can negatively impact clinical care for patients with disabilities. It outlines three common biases: 1) ineffectual bias which perceives patients as less capable or competent based on narrow markers, 2) fragile friendliness bias which perceives patients as more fragile or saintly based on capacities for warmth, and 3) catastrophe bias which overestimates patient suffering and underestimates resilience. The document recommends educational and clinical interventions like raising awareness of biases, expanding clinical formulations, and increasing contact with people with disabilities to improve care and reduce inequities.
This document discusses interprofessional collaboration from a social work perspective. It begins with a case study of a 31-year-old woman named Patricia Chalmers who is resistant to addressing her health issues. It then provides definitions of interprofessional practice that emphasize team-based care and goals that cannot be achieved alone. The document outlines why interprofessional collaboration is important to improve population health, enhance patient care, and control costs. It discusses social work values and ethics around interdisciplinary teams, including respecting colleagues and contributing to decisions that affect client well-being. The role of social workers on interprofessional teams is also examined.
Linking clinical workforce skill mix planning to health and health care dynamicsIme Asangansi, MD, PhD
Current health workforce planning methods are inadequate for the complexity of the task. Most approaches treat the workforce supply of individual health professions in isolation and avoid quantifying the impact of changes in skills mix, either planned or unplanned. The causes and consequences of task delegation and task substitution between or within health professions is particularly important in handling workforce shortages in developing countries and understanding and planning possible responses to both rapid catastrophic health demands and slower background trends in their social and political environment. As well as the contextual environment, interactions and delays in supplying and balancing health resources and configuring clinical services are required to address the geographic, profession-specific and quality imbalances. These supply side resources include knowledge and research, skills and attitudes of clinicians, buildings and equipment, medications and medical technologies, information and communications technologies and any other methods and models to improve the provision of clinical services. The interaction between demand
and supply could adjust for feedbacks of health services outcomes, policies and governance on population expectations, funding, political and social supports and explicitly link these to clinical workforce supply in a useful, rigorous and relevant tool. The challenge is capture the relevant essence of the dynamic complexity of health and healthcare for this purpose.
Nursing in Nepal has undergone significant changes in recent decades due to trends in society, technology, and politics. As Nepal opened to the outside world in the 1950s, there were no professional nurses. Now nursing education varies from certificate to bachelor's degree programs. However, many qualified nurses have left Nepal for better opportunities abroad due to low pay and job dissatisfaction at home. This nursing exodus has created staffing shortages and inexperienced nurses in Nepal's health system. Nursing must achieve greater autonomy, recognition, and control over its profession to improve conditions and retain staff.
This document discusses culture and leadership in healthcare between the Middle East and Western world. It notes key differences in Middle Eastern culture, such as a stronger emphasis on family and developing personal relationships. Middle Easterners also have different views of time, personal space, and personal privacy. Western medical professionals need to understand these cultural differences to effectively serve Middle Eastern patients and work with their families. The document concludes that culture and leadership are important to healthcare everywhere, and leaders must address cultural issues to provide quality care.
This document discusses trends in the US healthcare workforce, including slower growth, an increasing number of older workers, and continued growth in racial and ethnic diversity. It also examines factors like social, human capital, and organizational barriers that can lead to disparities in career advancement for women and minorities. The document recommends that healthcare organizations adopt a systems approach to managing a diverse workforce through actions like community responsiveness, culturally proficient care, and leadership diversity.
This document discusses the importance of compassion and self-renewal for nurses. It defines compassion as sorrow or pity for others' suffering. While nurses have high levels of compassion, caring for others without caring for oneself can lead to burnout, fatigue, and unhealthy behaviors. The document outlines negative effects of lack of self-care, including loss of self-esteem, irritability, and physical symptoms like fatigue. It encourages nurses to develop self-care plans involving relaxation, breaks away from work, and meditation to replenish inner energy and serve as role models for holistic health. Barriers to self-care include lack of time, knowledge, skills, and motivation.
2011 08 Hooker Everett Primary Care Pa Reviewrodhooker
Physician assistants can contribute significantly to primary care systems. Studies show that PAs can provide comprehensive care, maintain accessibility and accountability comparable to physicians. While PAs perform many of the key
The development of gerontological nursing began in the early 20th century with the first articles on elder care published in nursing journals. Gerontological nursing established itself as a specialty area through the mid-20th century with the publication of textbooks and the formation of professional organizations focused on elder care. Gerontological nursing roles include healer, caregiver, educator, advocate, innovator according to holistic principles addressing elders' biological, psychological, social and spiritual needs to promote health and independence.
This document discusses trends and issues in nursing. It covers how nursing has evolved over time and will continue to change with advancements in technology and healthcare. Some key trends that will impact nursing include a shift to preventative care in the home and community rather than hospitals. Nurses will take on more prominent roles as primary care providers. There will also be challenges relating to rising costs, ethics, and ensuring access to and quality of care. The document also outlines issues in nursing education, services, and the workplace.
This document discusses trends and issues in nursing. It outlines how nursing will shift from hospitals to homes and communities, with a focus on prevention and patient outcomes. Nurses will be primary care providers for diverse services. There will also be challenges relating to ethics, costs, access, and quality of care. Globalization will bring opportunities and challenges as the work environment emphasizes cost-effectiveness and quality. The roles and responsibilities of nurses are changing as health care transitions to more community-based, evidence-based, and interdisciplinary models of care.
Perceptions of students with disabilities on support services provided in hig...Ambati Nageswara Rao
This document discusses a study on the perceptions of students with disabilities regarding support services at higher education institutions in Andhra Pradesh, India. It begins with an introduction describing the importance of education for persons with disabilities and the lack of access to higher education. It then describes the methodology which used a mixed methods approach, interviewing 100 students from 3 universities using purposive and snowball sampling. The findings section describes the demographic characteristics of respondents and their perceptions of support services. Overall, the study examines the experiences of students with disabilities and the need for universities to improve support services to promote inclusion.
Futuristic nursing and visibility of nursesVinodmohanan55
This document discusses future developments in nursing practice and strategies to increase the visibility of nursing. It outlines developments like expanding technology, genomic mapping, robotic nursing and space nursing. It also discusses factors affecting the visibility of nursing like handmaiden roles, hierarchical structures and nurses' views of themselves. Some strategies suggested to increase visibility include recruitment, enhancing public view, funding, relationships with administrators and governments, and role of media. The document emphasizes expanding professional knowledge and skills through higher education and research to advance the nursing profession.
This document discusses the importance of nurse-patient communication and therapeutic relationships in elderly care. It makes three key points:
1) Nurse-patient communication is crucial as it indicates the quality of the relationship and many elderly patients rely on nurses as their primary human contact.
2) Developing therapeutic relationships through communication is essential for effective nursing care, including understanding patients' needs and preferences.
3) Effective communication is needed to provide individualized care for elderly patients, who often have multiple medical issues or special communication needs.
The document provides a timeline and overview of the evolution of several advanced practice nursing roles from the 1800s to present day, including nurse anesthetists, nurse midwives, clinical nurse specialists, nurse practitioners, and physician assistants. It traces the development of these roles in response to societal needs and pressures from organized medicine. Key events included establishing educational standards, gaining prescriptive authority, and fighting for reimbursement and full recognition of their scope of practice. Resistance from physicians occurred when nursing roles competed for similar jobs or responsibilities.
TRANSCULTURAL NURSING AND FUTURISTIC NURSINGvishnu vm
The document discusses the history and principles of transcultural nursing. It describes transcultural nursing as interacting with different cultures in a nursing context, based on anthropology and supported by research. The goal of transcultural nursing is to provide culturally congruent care to people of all cultural backgrounds. It also discusses challenges of transcultural nursing and the need for cultural competence among nurses.
Interdisciplinary teamwork involves different healthcare professionals collaborating to provide patient care. An interdisciplinary team shares knowledge and skills to improve patient outcomes. It is a dynamic process requiring open communication and shared decision making between professionals with complementary backgrounds and skills working toward common health goals. The need for interdisciplinary teams is increasing due to factors such as an aging population with complex needs, more specialized knowledge required for patient care, and policies emphasizing multi-professional collaboration and continuity of care.
This document discusses transcultural nursing. It defines transcultural nursing as focusing on comparing and analyzing cultures with respect to nursing practices, beliefs, and values in order to provide culturally sensitive care. The document outlines outcomes of transcultural nursing including demonstrating understanding and respect for different cultures. It also discusses skills nurses need, such as cultural competence, and transcultural variations that should be considered like communication styles, concepts of space and time, biological factors, environmental control, and social institutions.
Physician shortages in Canada have been a topic of debate for decades. In the 1990s, there was a consensus that Canada had a physician surplus, but by the early 2000s policies shifted to increasing medical school enrolment and allowing more foreign graduates due to a perceived shortage. However, the causes of shortages are complex, with factors like physician migration to the US and preferences for specialty careers over family medicine contributing. While some argue for general increases in physician supply, others propose improving retention through addressing job satisfaction or focusing on primary care over specialties. There are differing views on how to best address physician resource issues in the Canadian healthcare system.
Building the frontline health workers: Strengthening the role and training o...Prashanth N S
Presentation made at the All India People's medical and health education conference organised in February 2015 by the All India People's Science Network by Tanya Seshadri & Prashanth N S
This document summarizes a certificate program on structural competence offered by the Center for Public Health Continuing Education. The program teaches practitioners to recognize how broader social, political, and economic factors impact patient vulnerability and health outcomes. It shifts the focus from individual beliefs and behaviors to the social contexts that influence health. The certificate includes webinars on various racial/ethnic groups that discuss histories of oppression, sociopolitical health barriers, and community engagement. The goal is to empower practitioners to address health inequities and stigma.
This document discusses the need to address biases that can negatively impact clinical care for patients with disabilities. It outlines three common biases: 1) ineffectual bias which perceives patients as less capable or competent based on narrow markers, 2) fragile friendliness bias which perceives patients as more fragile or saintly based on capacities for warmth, and 3) catastrophe bias which overestimates patient suffering and underestimates resilience. The document recommends educational and clinical interventions like raising awareness of biases, expanding clinical formulations, and increasing contact with people with disabilities to improve care and reduce inequities.
This document discusses interprofessional collaboration from a social work perspective. It begins with a case study of a 31-year-old woman named Patricia Chalmers who is resistant to addressing her health issues. It then provides definitions of interprofessional practice that emphasize team-based care and goals that cannot be achieved alone. The document outlines why interprofessional collaboration is important to improve population health, enhance patient care, and control costs. It discusses social work values and ethics around interdisciplinary teams, including respecting colleagues and contributing to decisions that affect client well-being. The role of social workers on interprofessional teams is also examined.
The document discusses the creation of a new elective course at Yale School of Medicine aimed at exposing health professional students to domestic health inequities in the United States. The course was founded by two second-year medical students who recognized a lack of instruction on social determinants of health and their impact on health outcomes and healthcare delivery. The 10-session course brings in faculty, administrators, community leaders and organizations to discuss topics like implicit bias, social determinants of health, food insecurity, and advocacy. The goal is to better equip future healthcare providers with an understanding of how social factors influence health and patient interactions. The course has received strong interest and support from the medical school and community.
Primary health care aims to address local health problems through community education and disease treatment and prevention, while promoting individual and public health participation. It involves services like nutrition promotion, sanitation, family planning, immunization, and disease control. Nurses play an important role in primary health care through community education, surveillance, screening, and notification of health issues.
The good doctor in medical education 1910-2010Stian Håklev
The document traces the shifting discourses around conceptions of the "good doctor" in medical education from 1910 to 2010. It identifies three unexpected discursive shifts: [1] From Flexner's focus on the doctor as "scientist" to science becoming curricular content, [2] From character being important to characteristics emerging in the late 1950s, and [3] From characteristics to the development of competency frameworks and physician roles in the 1990s. The construction of models for the good doctor is influenced by economic, social, and political factors shaping health systems.
This document summarizes a presentation given by Dr. Efrain Talamantes on culture and resilience in Latino health, past, present, and future. The presentation discusses how cultural strengths can be leveraged to improve health equity for Latinos. It outlines five strategies for making health equity a priority in healthcare organizations: making it a leader-driven priority, developing supportive structures and processes, taking actions to address social determinants of health, confronting institutional racism, and partnering with community organizations. The presentation then explores how personal experiences with language barriers, low income, and lack of resources can build qualities needed in healthcare providers today, like being bilingual and culturally competent.
Medical sociology and health service research - Journal of Health and social ...Jorge Pacheco
This document summarizes key findings from medical sociology research on health services and systems over the past 50 years. It discusses three main findings: 1) Health services in the US are unequally distributed based on gender, socioeconomic status, and race, contributing to health inequalities. 2) Social institutions reproduce these inequalities by enabling or constraining actions of providers and consumers. 3) The structure and dynamics of health care organizations shape quality, effectiveness and outcomes for different groups in communities. The authors conclude by discussing implications for future health policy and reform efforts.
Culture of health care lecture 2 slidesCMDLearning
- Effective health information technology requires understanding health care culture, including clinical settings, processes, and people involved.
- Cultures are always plural, partial, and relational depending on both observer and observed. Differences in language use, called "rich points," highlight cultural differences.
- Cultural competence is important for health informatics professionals to avoid stereotypes and "othering" groups. Insights into health care culture can inform design and evaluation of health IT.
- Ethnographic research methods are used to study health care culture and how it impacts clinical work practices and technology use.
This document summarizes a colloquium that discussed different perspectives on the concept of "quality" in healthcare. Four key themes emerged from the discussion: 1) High quality care requires balancing contradictory views of quality; 2) There should be more emphasis on describing care qualitatively rather than just quantitatively measuring it; 3) Practitioners need opportunities to discuss experiences with peers; and 4) Trusting relationships between practitioners and patients are central to quality but difficult to define and measure. The document argues that top-down quality initiatives often fail to capture the complex realities of care delivery and may have unintended negative consequences.
S28 September-October 2016HASTINGS CENTER REPORTUndispu.docxWilheminaRossi174
S28 September-October 2016/HASTINGS CENTER REPORT
Undisputedly, the United States’ health care sys-
tem is in the midst of unprecedented complexi-
ty and transformation. In 2014 alone there were
well over thirty-five million admissions to hospitals in
the nation,1 indicating that there was an extraordinary
number of very sick and frail people requiring highly
skilled clinicians to manage and coordinate their com-
plex care across multiple care settings. Medical advances
give us the ability to send patients home more efficiently
than ever before and simultaneously create ethical ques-
tions about the balance of benefits and burdens associ-
ated with these advances. New treatments for cancer or
complex heart disease may prolong life until the disease
becomes irreversible while causing significant morbidity
that undermines functional status, independence, and
quality of life in ways that patients find unacceptable.
Some patients and families voice concerns about access
to treatments and about the quality and safety of the care
they or their loved ones receive.
Every day on every shift, nurses at the bedside feel
these pressures and the intense array of ethical issues that
they raise. A staggering 17.5 percent of trained nurses are
leaving their roles or the profession after less than one
year of service,2 and increasing levels of moral distress
and burnout contribute to their decisions.3 Meanwhile,
research supports the common-sense understanding that
patients and health care organizations fare better when
nurses are not harried, are supported in their work en-
vironments, and are able to practice high-quality, ethical
care.
At the same time, administrators, policy-makers, and
regulators struggle to balance commitments to patients,
families, staff members, and governing boards. Health
care organizations are compelled by laws, regulations,
and accrediting bodies to pursue externally reported
measures of effectiveness that can put their mission and
values at risk. While health care systems declare their
commitment to core ethical values, many clinicians
struggle to understand institutional priorities, budgets,
policies, and decisions seemingly inconsistent with their
values as professionals.
Increasingly clinicians find their ability to provide
compassionate care at odds with the intensifying focus
on matters such as clinical pathways aimed at standard-
izing care, cost-cutting efficiencies, electronic medical
records, and hospital policies and procedures.4 Arguably,
each of these have merit in the current system, but what
is not accounted for are the unintended consequences
of diverting attention from the core ethical values of the
professions. For example, the advent of the EMR requires
clinicians to focus on documentation rather than being
fully present during patient encounters. An emphasis on
clinical pathways increases the risk of reducing patient
symptoms and diseases to what fits a rote app.
Madeleine Leininger developed the Culture Care Theory, which emphasizes that nursing care should be provided in a way that respects a patient's cultural values, beliefs, and practices. Her theory was groundbreaking as the first to incorporate culture and consider it essential to quality nursing care. The theory is depicted in her Sunrise Model and has guided 50 years of research on diverse cultural healthcare practices and their influence on health outcomes.
The document discusses the development of a teaching program to raise awareness of vulnerable populations in a workplace. It describes nursing theorists Leininger and Watson who emphasized holistic and culturally competent care. The author developed posters on ethical cultural competence that were displayed and will be used in a September presentation. The presentation aims to discuss how understanding different cultures can help provide equitable, patient-centered care and meet quality standards. Understanding cultural factors is important for implementing effective health interventions in a holistic manner.
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Medical dominance and professional cultures in health care bahnisch uq school of social science 100812
1. 'Medical Dominance' and the continuing robustness
of professional cultures in healthcare: Implications
for modes of governance and temporalities of
organisational change.
Dr Mark Bahnisch
School of Medicine, The University of Queensland
10 August 2012
School of Social Science Seminar
2. Contexts
FRENK, J., CHEN, L., BHUTTA, Z., COHEN, J., CRISP, N., EVANS, T.,
FINEBERG, H., GARCIA, P., KE, Y., KELLEY, P., KISTNASAMY, B., MELEIS,
A., NAYLOR, D., PABLOS-MENDEZ, A., REDDY, S., SCRIMSHAW, S.,
SEPULVEDA, J., SERWADDA, D. & ZURAYK, H. 2010. Health
professionals for a new century: transforming education to strengthen
health systems in an interdependent world. The Lancet, 376, 1923-58.
“100 years ago, a series of studies about the education
of health professionals, led by the 1910 Flexner report,
sparked groundbreaking reforms. Through integration
of modern science into the curricula at university-based
schools, the reforms equipped health professionals
with the knowledge that contributed to the doubling of
life span during the 20th century.
3. “By the beginning of the 21st century, however, all
is not well. Glaring gaps and inequities in health
persist both within and between countries,
underscoring our collective failure to share the
dramatic health advances equitably. At the same
time, fresh health challenges loom. New infectious,
environmental, and behavioural risks, at a time of
rapid demographic and epidemiological transitions,
threaten health security of all. Health systems
worldwide are struggling to keep up, as they
become more complex and costly, placing
additional demands on health workers.”
4. “Professional education has not kept pace with these challenges,
largely because of fragmented, outdated, and static curricula that
produce ill-equipped graduates. The problems are systemic: mismatch
of competencies to patient and population needs; poor teamwork;
persistent gender stratification of professional status; narrow technical
focus without broader contextual understanding; episodic encounters
rather than continuous care; predominant hospital orientation at the
expense of primary care; quantitative and qualitative imbalances in the
professional labour market; and weak leadership to improve health-
system performance. Laudable efforts to address these deficiencies
have mostly floundered, partly because of the so-called tribalism of
the professions—ie, the tendency of the various professions to act in
isolation from or even in competition with each other.”
[Emphasis mine]
5. Caveats and comments
• Research I am doing, and am hoping to do rather
than research I have done
• But note potential to re-analyse data from
completed study
• Literature has been approached systematically
but not yet comprehensively
• Ability to realise research design would be
dependent on funding, opportunity – choices
framed to take this into account
• I am presenting to discuss ideas, research design,
methods, get feedback
6. Medicine and the sociology of
professions and of medical education
• An ideal-typical case
• Structural-functionalism and Parsonian sociology – searching for
what typifies a profession, expert knowledge and the professional
hierarchy and division of labour (Emile Durkheim, Max Weber)
• Normative assumptions
• Eliot Friedson (1970) Profession of Medicine – closure theory
– But did Friedson really say what he has been said to say?
• Studies of ‘negotiated order’ (notable is STRAUSS, A., SCHATZMAN,
L., BUCHER, R., EHRLICH, D. & SABSHIN, M. 1963. The hospital and
its negotiated order. FRIEDSON, E. (ed.) The Hospital in Modern
Society. New York: Free Press.
• Studies of the formation and reproduction of student professional
cultures (Merton et al 1957 The Student-Physician from a Parsonian
perspective, Becker et al 1961 Boys in White: Student Culture in
Medical School from a symbolic-interactionist perspective)
7. ‘Medical Dominance’
• Evan Willis – 1983, 1989; Revisited in 2006 special issue of the Health
Sociology Review (cf particularly COBURN, D. Medical dominance then and
now: critical reflections. Health Sociology Review, 15, 432-433.)
• Willis (1989:2-3) posited three axes of ‘medical dominance’
– Autonomy (“over its own work”)
– Authority (“over other health professions”)
– Sovereignty (“dominant in relations between the health sector and the wider
society”)
• Willis’ method – historical case studies (midwifery, optometry, chiropractic
– subordination, limitation, exclusion)
• Implicit but not really theorised here was a dynamic and more complex
historical and social interaction than the simple exercise of power or
authority (different concepts)
• Too much structure, too little agency?
• Problems of typification?
8. Have we moved beyond ‘medical dominance’ to
‘plasticity’ in health professions?
• Institutional and cultural resilience and
embeddedness may not have been given
adequate weight in shifting educational,
organisational and policy agendas towards
‘interprofessional practice’.
9. Why is this important?
• There often seems to be an assumption that
‘medical dominance’ is a ‘bad thing’
• Some sociological insights about the individual
focus or orientation of medical work as compared
to ‘shaping’ institutions may have a lot to tell us
about the circumstances under which IPP is or is
not desirable and is or is not realisable
• Do we really know that much about ‘the hidden
curriculum’? And/or how professional cultures
are reproduced?
10. Research questions
• How are the dynamic boundaries of medical
authority reproduced in educational, institutional
and organisational cultures?
• What implications are there of the cultural
reproduction of medical authority for education
and public policy?
• What implications are there of the cultural
reproduction of medical authority for modes of
governance and temporalities of organisational
change?
11. The erosion of medical dominance?
• General erosion of professional autonomy vis
a vis control or monopoly over knowledge
• ‘Neo-liberal’ governance
– CURRIE, G., FINN, R., MARTIN, G. 2009. Professional competition and
modernizing the clinical workforce in the NHS. Work, Employment &
Society, 23, 267-284.
• Agendas such as ‘patient centred care’,
‘interprofessional practice’
12. But…
• Erosion of professional autonomy over
knowledge
– The other side of micro-studies about ‘dominance’
in consultations.
– Macro-social theorising – meta-observation or the
received wisdom of liberal academic elites?
– ‘Dynamic professional boundaries in the healthcare workforce’
NANCARROW, S. A. & BORTHWICK, A. M. 2005. Dynamic
professional boundaries in the healthcare workforce. Sociology
of Health & Illness, 27, 897-919.
– Negotiated orders as such are not new.
13. • ‘Neo-liberal’ governance
– How strong is the state and how to what degree is state power if not authority
contested through inertia, folkways, ‘how things are done here’ ie –
professional and institutional cultures?
– Following on from this, how about the power of interest groups and the field
of policy interaction? We could look for instance at the journey of the National
Health and Hospital Reform Plan through inception to ‘local hospital boards’
under the LNP government in Queensland.
– NATIONAL HEALTH AND HOSPITALS REFORM COMMISSION 2009. A healthier
future for all Australians: Final report of the national health and hospitals
reform commission. Canberra, ACT: National Health and Hospitals Reform
Commission.
– Additionally, can the evidence that ‘managerialism’ and ‘teamwork’ are
subverted in some contexts by professionally-bound cultural strategies be
generalised?
– FINN, R., LEARMONTH, M. & REEDY, P. 2010. Some unintended effects of
teamwork in healthcare. Social Science & Medicine, 78, 1148-1154.
14. • Patient-centred care/IPP
– The continued resilience of professional cultures, and
particularly how these are reproduced and lived
institutionally.
– HALL, P. 2005. Interprofessional teamwork: Professional cultures
as barriers. Journal of Interprofessional Care, May 2005, 188-
196.
– The sustainability of IPP initiatives and their
sustainability in the absence of a ‘good’ doctor
– WHITEHEAD, C. 2007. The doctor dilemma in interprofessional
education and care: how and why will physicians collaborate? Medical
Education, 41, 1010-1016.
15. Then or now?
• STRAUSS, A. 1971 ‘Psychiatrists in a Private
Hospital’ and ‘The Nurses at PPI’ in
Professions, Work and Careers. San Francisco:
The Sociology Press.
• FINN, R. 2008. The language of teamwork:
Reproducing professional divisions in the
operating theatre. Human Relations, 61, 103-
130.
16. Hypothesis
• The relative failure of many IPP initiatives is
caused in part by the resilience of professional
medical culture in institutions, particularly in
its reproduction in the ‘hidden curriculum’ in
medical education.
– BOURGEAULT, I. & MULVALE, G. 2006. Collaborative health care teams
in Canada and the USA: Confronting the structural embeddedness of
medical dominance. Health Sociology Review, 15, 481-495.
17. How do we measure?
• RIPLS
– MCFADYEN, A., WEBSTER, V. & MACLAREN, W. 2006. The test-retest
reliability of a revised version of the Readiness for Interprofessional
Learning Scale (RILPS). Journal of Interprofessional Care, 20, 633-639.
– Critique in THANNHAUSER, J., RUSSELL-MAYHEW, S. & SCOTT, C. 2010.
Measures of interprofessional education and collaboration. Journal of
Interprofessional Care, 24, 336-349.
• What is the independent variable?
• What is the dependent variable?
18. Another way of
measuring/conceptualising
• Not what has happened but what has not happened
– GREENFIELD, D., NUGUS, P., TRAVAGLIA, J. & BRAITHWAITE, J. 2011.
Factors that shape the development of interprofessional improvement
initiatives in health organizations. BMJ Quality and Safety, 20:332-337.
– NUGUS, P., GREENFIELD, D., TRAVAGLIA, J., WESTBROOK, J. &
BRAITHWAITE, J. 2010. How and where clinicians exercise power:
interprofessional relations in health care. Social Science & Medicine,
71, 898-909.
• Continuities rather than fractures
• Ie – findings from
– ACT IPE/IPL Study
– NUGUS, P., GREENFIELD, D., TRAVAGLIA, J. & BRAITHWAITE, J. 2011.
Action research for interprofessional learning and interprofessional
practice in ACT Health. Paper presented to the University of
Queensland Centre for Clinical Research.
– Wide Bay IPE/IPP Study
19. Replication and a longitudinal or cross-
sectional study…
• The American and UK literature contains rich
studies of the reproduction of professional
cultures in medical education
• Recency?
• Cross-national replication and/or longitudinal
or cross-sectional study
• Mixed methods
21. Implications for medical sociology &
sociology of the professions
• Back to the foundations – grounding macro-
theory in micro-sociology
• Questioning some of the normative or ideological
assumptions underpinning sociological theory
which may themselves be reflections in part of
contests over/within social fields
• What are the temporalities of organisational and
institutional change and how susceptible are
organisational and professional cultures to modes
of governance?
22. Implications for medical education and
public policy
• ‘Barriers’ to IPP/Patient-centred care may be
much more rigid than thought – the lack of
malleability might lie in culture/s
• A better evidence base for ‘the informal
curriculum’
• An ability to assess ‘what works’ – under what
conditions is ‘medical dominance’ a good or a
bad thing? Or is this a poorly framed question?
(Ie professional expertise/specialisation and
clinical reasoning within particular contexts of
care) – links into the competency agenda