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Professionals and professions: a philosophical examination of an ideal.

Being regarded as a professional and having one's occupational group regarded as a profession are often deemed desirable. It is not immediately apparent why this is so. 'Professional' often contrasts simply with 'amateur', and as a label conveys not honor but the recognition that the one so labelled is paid for doing what others do for free. But there is a distinct, honorific sense in which the professional contrasts not with the amateur but with the person who simply has a job rather than a life-long calling. It is in this honorific sense that physicians, attorneys and members of the clergy serve as paradigm professionals. Aspiring professionals in disciplines other than the paradigm ones regard themselves as more nearly like these paradigms than is usually recognized, and this is their claim to recognition as professionals. The paper explores several possible points of similarity by developing an account of the ideal for professionals which has been held in Western society at least since the time of the Hippocratic Oath, which best captures its spirit. As the Oath makes clear, professionals have fiduciary relations with their patients or clients, and provide services of a personal nature. The paper explores the principal demands of this ideal, the principal steps which physicians have taken in pursuit of it, and some of the implications of this ideal for various groups of social scientists associated with medicine. Finally, it recognizes a professional spirit or attitude which transcends occupation.

Clinical Competence↗

Smoking and the female professions: pre-occupational influences on the behaviour of recruits to nursing and teaching.

A questionnaire and interview study of female recruits to nursing and teaching showed that occupational differences in the prevalence of smoking are already established at entry to training. The social characteristics of the smokers in the sample corresponded to those of women smokers generally. Differences in education and social origin contributed to occupational variations in behaviour. The influence of sibling behaviour and parental opinion operated differently within the two occupational groups. The psychological attributes of individuals attracted to a particular profession may also contribute to occupational patterns, specifically risk-taking and a concern for personal freedom.

Adolescent↗

The holistic heresy: strategies of ideological challenge in the medical profession.

Heresy is a neglected term in sociology. Yet insofar as science and the professions demand a conformity to basic concepts of ideology and practice, certain types of dissent may best be described as heresy. In this paper, heretical movements are discussed, and heresy is defined [8. Zito G. V. Social. Anal. 44, 123-130, 1983] as an attempt to challenge an orthodoxy for the right to control a discourse. The difficult position of the heretic as a challenger to an entrenched orthodoxy is described, particularly the attempt of heretics to assert their allegiance to the discourse itself while the orthodoxy attempts to portray them as traitors or apostates. It is argued that a four part strategy is necessary for a successful heretical challenge: the heretic must portray the discourse as in crisis, must provide an alternative ideology to rescue the discourse, must legitimize their ideology through appeal to a reframed historical myth, and must portray the orthodoxy as a betrayer of the discourse. The holistic movement in medicine is used as an exemplar to show how holistic physicians use this four part strategy.

Holistic Health↗

Outlook of British dentists towards their profession.

Dental practice in Britain has undergone significant changes in recent years. These changes have undoubtedly affected the outlook of dentists towards dentistry. This study was undertaken to examine the current outlook of general dental practitioners working in the General Dental Service. A representative sample of 1000 dentists was surveyed by mail. The response rate was 73.7 per cent. Most characteristic of the respondents' outlook on various aspects of their profession is the wide diversity of opinion. Neither respondent gender or practice location were associated with outlook. More preventively oriented dentists and those whose practices were most busy, however, were found to have a more positive outlook.

Attitude of Health Personnel↗

The drug-use patterns of helping-profession students in Brisbane, Australia.

A survey of 1691 first-and final-year students in the helping professions (medicine, law, nursing, pharmacy, police science, seminary, social work/ psychology, and teaching) as to their use of drugs was carried out during February to April, 1980, in Brisbane, Australia. The results indicated that about 86% drank coffee or tea, 85% drank alcohol, 85% used non-prescription analgesics, 31% used tobacco, 25% antihistamines, 9% marijuana, 9% sedatives, 6% tranquilizers, 2% hallucinogens, 2% stimulants, 1% cocaine and 1% used opiates at least once a year. Of these students, females used analgesics and antihistamines significantly more frequently than males and consumed more caffeine, tobacco and analgesics than males, while males drank significantly more alcohol than females. Final-year students used more alcohol, coffee or tea and tobacco, and used marijuana, coffee and tea and tobacco significantly more frequently than first-year students. Individuals who did not consider religion important used more alcohol and tobacco and used marijuana, tobacco and hallucinogens more frequently compared to individuals who considered religion to be important. There was also a significant difference in drug usage between the different courses of study for most of the substances, with law students using the majority of substances the most frequently and seminarians the least frequently.

Analgesics↗

The evolution of a profession: where do boards of nursing fit in?

Differentiation between the structure and functions of Boards of Nursing and the professional association is important to understanding the evolution of nursing as a profession. This descriptive exploratory study revealed that Boards of Nursing usually have 5 members who are appointed by and can be removed by the governor of the state. All Boards are responsible for education and licensing at the professional entry-level but may not be responsible beyond that level. In contrast to the professional association, Boards report appreciable variability in structure and administration. Boards differ from the professional association in source of power and focus on the protection of the public rather than improvement of practice.

Data Collection↗

Vocational analysis of health care professions as a basis for innovative curricular planning. An analysis and prognosis of the development of the professional competencies of midwives--cornerstones of innovative curricula in tertiary education.

This article describes current and future tendencies in the development of curriculum planning for health care professions in Germany, using the example of midwifery education. In particular, it discusses 'output-based control' of curriculum planning giving consideration to issues related to German education, health policies and professional educational theories with a view to the general international development. The results of this analysis constitute the starting point for the conceptual planning of a dissertation at the medical faculty of the Berlin Charité with the goal of developing a competency model for the curriculum planning of midwifery education, thus creating a modern curriculum as a basis for a fundamental reform of German midwifery education.

Competency-Based Education↗

Clinicians and the governance of hospitals: a cross-cultural perspective on relations between profession and management.

This paper explores similarities and differences in the value stances of clinicians and hospital managers in Australia, England, New Zealand and China, and provides some new insights into how we theorise about the health profession and its relations with management. The paper draws on data derived from a closed-ended questionnaire administered to 2637 hospital-based medical, nursing and managerial staff. We examine variations between the countries in the value orientations of doctors, nurses and managers by considering their assessments of issues that are the focus of reform. In particular, we examine the ways in which the Chinese findings differ from those of the other countries. Whereas the results from the Commonwealth hospitals showed a marked division between clinicians and managers about issues that can affect clinical autonomy, this was not the case in the Chinese hospitals. The concluding discussion traces these differences to a number of cultural, organisational and policy-based factors. The implications of our findings on how we conceive the relationship between professionals and organisations are then discussed, as are further lines of research.

Analysis of Variance↗

Ethics in perioperative practice--advancing the profession.

Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and should be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this seventh of a nine-part series that is designed to help perioperative nurses relate the ANA code to their own area of practice, the author looks at the seventh statement, which emphasizes commitment to the profession.

American Nurses' Association↗

"Recovered-memory" therapy: profession at a turning point.

Six hundred Massachusetts-registered psychiatrists were surveyed for their opinions on items plausibly related to the production of false memories of childhood sexual abuse. One hundred fifty-four psychiatrists completed the written questionnaire. A majority of respondents (69%) endorsed the following statement: "The numbers of false accusations of childhood sexual abuse, appearing to emerge from the psychotherapy of adults, constitute a real problem needing public acknowledgment as such by the mental health professions." Nevertheless, a substantial minority endorsed the following practices: 37% endorsed searching for childhood roots of presenting complaints; 36% endorsed validation (expressed belief) of the patient's memories as an essential part of therapy; 36% believed in appropriateness of affect as an indicator of truth in memories; 36% believed in the therapeutic value of abreaction; 26% would refer presumed survivors of abuse to specialists in incest recovery; 18% believed in ritual abuse as an important cause of posttraumatic stress disorder (PTSD) and dissociative disorders; 18% trusted symptom checklists as indicators of sexual abuse histories; and 15% believed that memory is a complete record of the individual's history. Small minorities (6% to 8%) endorsed these practices: using hypnosis to gain access to repressed memories of childhood abuse; patient confrontation of alleged abusers; and recommending the severing of contacts with skeptical family members. A factor analysis was performed, and it was found that self-designated specialists were more likely than nonspecialists to score toward the riskier pole of the four factors extracted.

Humans↗

Impairment in the medical and legal professions.

Male doctors and lawyers are among the job groups with high mortality from alcohol-related diseases, although the prevalence of substance misuse among these groups is not known. Both professions have occupational risk factors. This article describes aspects of the work environment which have facilitated substance misuse by doctors and lawyers, and describes the professional consequences of addiction. Data will be presented from two studies: a retrospective casenote survey of doctors treated for substance misuse; and a questionnaire survey of lawyers in recovery from alcohol problems. Mechanisms for assisting impaired professionals into treatment have been developed in the UK and the USA. The most successful models separate health procedures from disciplinary procedures as much as possible, and offer a confidential evaluation and treatment program. Self-help groups play a crucial role in these therapeutic processes.

Adult↗

Integral Nursing: an emerging framework for engaging the evolution of the profession.

These are turbulent times for health care as well as nursing. Nursing needs to consciously evolve to survive and thrive in the 21st century. The authors suggest that nursing has many of the theoretical and conceptual models needed to facilitate this evolution. However, the profession would benefit from the addition of a comprehensive framework that can integrate various aspects of nursing and serve as a device to effectively interface nursing with the rest of the health care system. We believe that the Integral Nursing approach described here is such a framework. In this article, we describe the model and explore benefits of its application for nursing within health care.

Empathy↗

Building community. Developing skills for interprofessional health professions education and relationship-centered care.

In 1995, the National League for Nursing commissioned a Panel on Interdisciplinary/Transdisciplinary Education. The focus of the Panel's work was to examine educational issues that transcend the health professions and to make recommendations for future implementation of an interdisciplinary approach to addressing them. This article is being simultaneously published by several professional journals. The goal is to seek as much feedback as possible.

Curriculum↗

Occupational stress within the paramedic profession: an initial report of stress levels compared to hospital employees.

We report a study of occupational stress in 374 paramedics. Results indicate that this profession experiences a high degree of job-related stress relative to other medical personnel. In a component analysis of this stress the results show that job stress manifests itself as job dissatisfaction, organizational stress, and negative patient attitudes, but not as frequently as somatic distress.

Adult↗

Vocationalism: a mirror on the profession.

The introduction of National Vocational Qualifications in Care (Care Sector Consortium 1993) has received considerable attention in the nursing press. This article seeks to explore vocationalism and its effects on nursing. It argues that the very nature of vocational competence acts as a mirror on the profession and should encourage reflection on the nature of nursing and its professional aspirations.

Clinical Competence↗

Checking the carotid pulse: diagnostic accuracy in students of the healthcare professions.

This study evaluated the competence of students of the healthcare professions to locate the carotid pulse using a computerised manikin, within 10 s. A sample of 105 students from physiotherapy, radiography, midwifery and nursing participated in measuring diagnostic accuracy in a single attempt at pulse check using a computerised manikin, timed to an accuracy of +/-1 s. All had received basic life support instruction, and one group had advanced life support skills. The mode and median diagnostic delays were calculated for each group. Comparisons of mean rank values for the groups were determined, and comparisons of previous training and accuracy in diagnosis were calculated. Forty (38%) students were able to give an accurate diagnosis within 10 s. The results identified significant differences between the performance of the groups (chi(2) 16.74, P<0.01), with the advanced life support course students demonstrating most competence. Previous training did not affect performance in the skill (chi(2) 0.29, P=0.58). Carotid pulse check skills should be emphasised and tested as part of cardiopulmonary resuscitation instruction.

Carotid Arteries↗

A survey of basic life support training in various undergraduate health care professions.

Basic life support (BLS) is a core skill in which all healthcare professionals should be proficient. It is logical to provide BLS training during undergraduate years ensuring basic competence in all graduating healthcare students. Previous surveys of medical and dental schools have highlighted deficiencies in BLS training. This survey sought to assess the level of BLS training provided for students across a broad range of disciplines in the North West region of the UK. This included courses leading to an entry qualification into medicine, dentistry, nursing, midwifery or a profession allied to medicine (PAM). Information was collected by self-administered postal questionnaire with a response rate of 87%. The survey highlighted major variations in BLS training provided at undergraduate level across disciplines.

Adult↗

The profession of cardiac sonography and the status of professionalization of cardiac sonographers.

The role of the cardiac sonographer has evolved in the profession of cardiac ultrasonography to a level requiring rigorous education, training, and high standards. Although we want to consider ourselves professionals, further efforts are necessary to meet the various criteria conferring such a status. It is essential cardiac sonographers realize these necessary steps to achieve recognition as professionals.

Allied Health Personnel↗