RN16_01b: Health Professions
The Challenge Of Interprofessional Care For Health Professions. Obstacles And Resistance In The Italian Case.
1Unitelma Sapienza University of Rome, Italy; 2Sapienza University of Rome
In the field of health services, the issue of interprofessional care is becoming increasingly important as one of the most innovative solution to care problems of patients with complex diseases (WHO, 2010).These care problems require different specialized health professionals, able to treat in a comprehensive and personalized way therapeutic paths not always having clinically predictable developments.
However, an interprofessional approach is not simple to be implemented. It implies the reorganization of health services, usually based on traditional approaches to treatment, in a new way and the reconciliation of professional differences, often characterized by mono-disciplinary practices and conflicting visions. International research on interprofessional care also highlights the importance of specific training, both in the academic courses and in the implementation of interprofessional collaboration practices (WHO, 2013), in order to change the acquired routines by traditional intradisciplinary socialization processes (D'Amour et al., 2005).
Starting from this premise, the paper presents the results of a research on interprofessional knowledge and attitudes of students, health professions, doctors and practitioners in the Italian healthcare context. The collection and the analysis of information was conducted within a multi-method approach through: 1) a survey on a sample of students and teachers of academic courses in health care; 2) a delphi analysis on different panels of healthcare experts 3) case studies of health services based on interprofessional organizations.
The research is among the first in Italy on this issue. It aims to analyse the obstacles and resistances in academic, organizational, regulatory and professional fields, which slow down the development of interprofessional practices.
Cooperation in Multiprofessional Child Protection Groups
Universität Kassel, Germany
The field of child protection is often described as a medicalized field. Many publications such as, for example, Fangerau et al. (2015) claim, that the push towards medicalization was enabled through the introduction of improved diagnostic methods to detect abuse and maltreatment. The consequence was an extending of medical definition in the field of child protection. But despite the improvement of medical diagnostics and further medical research the concrete practices of identifying abuse and maltreatment are bound to a high level of uncertainty. One progressively established way to deal with this uncertainty in hospital settings is the formation of multiprofessional child protection groups, where medical professionals work alongside the non medical professions like social work, psychology and nursing. In this paper, I will present findings from participant observation in a German child protection group and show how certainty is achieved within the multiprofessional setting. I will answer the question how the cooperation does function in practice and which roles the different professional perspectives play when dealing with the suspicion of abuse or maltreatment? How much power of definition has the medical perspective in this process?
Fangerau, Heiner; Görgen, Arno; Griemmert, Maria (2015): Child Welfare and Child Protection: Medicalization and Scandalization as the New Norms in Dealing with Violence Against Children. In: Bagattini, Alexander; Macleod, Colin (ed.): The Nature of Children's Well-Being: Theory and Practice. Heildelberg, New York, London: Springer.
Decision-making During Childbirth: The Challenges of ‘Choice’ for Midwives and Obstetricians
1University of York, United Kingdom; 2Sheffield Teaching Hospitals NHS Foundation Trust; 3Calderdale and Huddersfield NHS Foundation Trust
Health policy guidelines in the English NHS place considerable emphasis on patient choice and patient involvement in decision-making about their care. Nowhere is this more evident than in maternity care. In this paper we focus on the quandaries that healthcare professionals (HCPs) face in providing choice to women in two English NHS midwife-led Units.The analysis is based on in-depth semi-structured interviews with 20 HCPs (midwives and obstetricians) which is part of a larger study of decision-making in childbirth funded by the National Institute of Health Research (NIHR). We show how decision-making and choice are rendered contingent and complex by the contexts in which labour and birth take place. We explore the situations where HCPs feel promoting choice is more straightforward and those where is it more difficult. We focus particularly on the challenges of determining women’s capacity to make informed choices (such as when in pain) and HCPs’ preferred approach for women and their birth partners to take during labour and birth. Such challenges show that this often calls for women to flex between passivity and assertion and to embrace an open attitude to the changing and unpredictable clinical circumstances of labour and of birth. The consequences for women’s engagement in decision-making about their care are explored.
Caring Profession and Emotional Regime of the Institution: Doulas’ Institutional Work in Russian Maternity Care
European University at St.Petersburg, Russian Federation
Until recent, the role of emotions in maintaining and changing health-care institution has been largely neglected in social sciences. The ‘agentic turn’ in neo-institutional theory has lead to reassessing the institutional dynamic as conditioned by behavior of situated actors who not only rationally navigate organizational rules, but also have feelings according and about these rules. This paper contributes to advancement of the outlined approach by considering how emotions come into play in the process of institutional transformations of Russian maternity care.
The research is focused on institutional work of doulas, the representatives of a caring profession whose quest for professionalization is intertwined with creating new institutional meanings and new emotional regime in Russian hospitals. The paper relies on the data from 25 semi-structured qualitative interviews with doulas from different Russian cities. Interviews have been conducted by the author in May – December 2018.
The research aims to enrich our understanding of post-Socialist healthcare transformations. Changes in this field are typically considered in relation to the shifts in state policy, introductions of evidence-based medicine, and emergence of neoliberal patient-consumer. By employing the lenses of the sociology of emotions and neo-institutional theory I intend to conceptualize these changes also as changes in feeling rules of the institution that are induced by actors’ efforts on the work-place level.